Sick Transit

Now this is what college is all about.

I am in the middle of reading Healing the Soul in the Age of the Brain, a fascinating book by neo-Freudian Elio Frattaroli arguing for psychotherapy as the dominant approach to mental health treatment.

I’m only a quarter of the way through, but I wanted to write about a few things that have struck me so far. They are: 1) Frattaroli’s rejection of scientific materialism; 2) the economic costs of the psychotherapeutic approach; and 3) the ideological safety of what Frattaroli calls “the Medical model.”

Continue Reading “Viennese If You Please”

I am in the middle of reading Healing the Soul in the Age of the Brain, a fascinating book by neo-Freudian Elio Frattaroli arguing for psychotherapy as the dominant approach to mental health treatment.

I’m only a quarter of the way through, but I wanted to write about a few things that have struck me so far. They are: 1) Frattaroli’s rejection of scientific materialism; 2) the economic costs of the psychotherapeutic approach; and 3) the ideological safety of what Frattaroli calls “the Medical model.”

First off, a brief summary of Frattaroli’s thesis. He describes the current mindset of psychiatry as a “Medical Model” focused on prescribing drugs to treat an illness. While he does believe that there is a place for psychotropic medications, he states:

Unsurprisingly, he calls this the “Psychotherapeutic Model.” While I am inclined in large part to agree with him, I think that there is one glaring flaw in his argument, and a couple of other issues that need addressing.

1. Scientific Materialism

Frattaroli explicitly rejects “scientific materialism” in those very words. He believes that “there are very real differences between brain, mind, and spirit”, and that the idea that our psyches are exclusively the result of brain function is based on “a general misunderstanding of the nature of science.” (6,8)

His defense of this position–including charges of “articles of quasi-religious faith cloaked in the language of science”–is eerily similar to Intelligent Design argumentation. (8) The psyche is too complex and mysterious to be just neurons, he feels; and since science can’t actually prove that there’s no soul, “we cannot do better than to have faith in our own authority, and base our beliefs on what makes the most sense, and feels most deeply right, to us.” (14)

Just like the IDers, Frattaroli forgets that the burden of proof is on him to prove the existence of the soul, not the other way around. He does not give a single example of a psychological process that could not be the result of brain function. We know from chaos theory that a set of simple algorithms connected in feedback loops (which is what a brain is) can produce incredibly complex results. And so, despite what Frattaroli says, we don’t need to prove that the soul doesn’t exist. Since neurons provide adequate explanatory cover, Occam’s Razor tells us that adding a soul into the mix is a bad hypothesis.

Interestingly, this soul proposition is actually completely unnecessary to Frattaroli’s argument. Given that the brain is a chaotic system, it’s quite reasonable to argue that psychotherapy–i.e. language, a complex and dynamic brain process–is a much more powerful healing method than the one-trick pony of medication. Instead, by arguing on the basis of a nebulous soul, Frattaroli makes it easy for the Medical Model crowd to dismiss him as an unscientific crank.

2. Economics

It’s no coincidence that the increased accessibility of mental health care has paralleled the rise of the Medical Model. Frattaroli savages managed care for limiting hospitalization and promoting medication over psychotherapy, but he also recognizes that a stay in a mental hospital costs $40,000 a month. (97) If mental health care were routinely conducted the way that Frattaroli wants, most insurance simply wouldn’t cover it. That shouldn’t stop him from arguing for what he believes to be the best treatment, of course; but it might at least temper his rants against a profession that has chosen the attainable over the utopian.

A related issue is time. Frattaroli says that “two months is about the average time it takes for a hospitalized patient to become meaningfully engaged in treatment.” (33) If the alternative is home disability, then this may not matter much. On the other hand, if medication can return a patient to the workforce or other productive activity, then the multi-month hospitalization that Frattaroli suggests incurs not just a direct cost but also a significant opportunity cost.

3. Religion and Society

Freud was no fan of religion, and for most of the 20th century, traditional religion responded in kind. While this antagonism is regrettable, it also seems understandable in light of Frattaroli’s description of psychotherapy as an instance of “a universal process of spiritual quest, the need for which seems to be part of the human condition.” (76) Religion has traditionally regarded such quests as its own domain, and will naturally take poorly to psychiatry’s transgression on its territory, especially since psychotherapy involves a process of deconstruction that is often anathema to religious faith.

This tension seems to have abated since the rise of the Medical Model, which imposes less of a requirement on the patient to question their beliefs. Overall social acceptance of psychiatric illness has increased as well, now that treatment is no longer such an emotional threat.

Frattaroli would probably say that this is just an expression of the universal fear of–and hence resistance to–consciousness, and he would undoubtedly be right. However, this is still an obstacle that psychiatry will have to face if it is to change as Frattaroli suggests.

Despite the above criticisms, I want to re-emphasize that I agree with Frattaroli’s fundamental idea, and–based on my reading so far–would highly recommend the book.

Sometimes you wonder where journalists find their “experts”. It’s even worse if the howler is in a speciality journal. E.g. this article from the National Law Journal:

But of course, direct religious contributions are already tax-deductible. The reason that tuition for religious education is not deductible is because it’s payment for a service, not because it’s religious.

I guess there are two possible morals of this story:

1. People will say any half-assed thing just to get quoted by a journalist.

2. Don’t retain the services of Elizabeth Pierson, attorney-at-law.

Never undestimate the power of a bored engineer. Specifically, Kevin Kelm of triggur.org, inventor of the RoboDump.

What is RoboDump? It is a small collection of electronics playing a sound file in constant loop, attached to a pair of pants and shoes. And placed in a bathroom stall, thus:

The sound file, of course, includes grunts, horrific farts, etc. Soon, the whole office was wondering who this perpetual pooper could be. No word on the consequences of Kelm’s website confession.

Abu Aardvark reports:

So, pick your spin:

1. The Bush Administration is not really serious about promoting democracy in the Middle East, since they allow this to happen with no objection.

2. Look at how the Arab nations treat the Palestinians in their borders! They’re hypocrites for condemning Israel.

My vote? I’m saying both are true.

The NYT prints a ham-handed op-ed by Texas DA Ronnie Earle (of DeLay fame) just for the pleasure of rubbing DeLay’s face in his failure to uphold the Republicans’ vaunted “moral values.” At one point, the op-ed uses the term “moral values” five times in five consecutive sentences.

Childish as it may be, you can’t say it’s undeserved.

I fully accept the scientific consensus that humans are the product of natural selection. But, as I’ve written before, it bugs me when people assume that anyone who doesn’t believe in evolution must be ignorant and/or stupid. And now I have solid evidence to back up my point.

According to Paul Waldman at Gadflyer, a Gallup poll found that only 65% of individuals surveyed who had a postgraduate education believed that “evolution is a scientific theory that has been well-supported by evidence.”

While I think this indicates a sad ignorance of biology, I am not willing to state that 35% of individuals with a postgraduate education are dumb merely because they don’t believe in evolution.

Another interesting finding of the survey is that while 44% of 50-to-64-year-olds believe that evolution is well-supported, only 41% of 18-to-29-year-olds do, and only 34% of 30-to-49-year-olds do. My best guess would be that this is attributable to the 50-to-64 group having lived through the strong modernization/secularization period of the 50’s and 60’s.

(link via Yglesias)

Tyler Cown hits on a heartbreaking truth:

Makes you want to break down and cry. Or, if you’re more optimistic, be amazed that we’ve gotten as far as we have.

With apologes to Brad DeLong for ripping off his trademark phrase, I simply see no explanation for this WaPo scoop about Bush’s tax plan, if it is true:

Scrapping the business tax deduction for employer-provided health insurance? What possible justification could there be for this? Aside from being horrible policy at a time when we have a healthcare crisis, it simply makes no sense, given that employee compensation is normally deductible.

It almost sounds as if this was deliberately inserted to give the plan a Scroogeian aspect. Either there’s some profoundly devious leak afoot, or the WaPo got the wrong end of the stick. Or maybe I’m missing something; anyone care to enlighten me?

(link via Sullivan)

There’s been a lot of talk in terrorism policy discussions about how we can reach out to “the Arab street”; but it might help Democrats if we could reach our own “street” first. TNR has an excellent analysis by a liberal volunteer who spent weeks canvassing undecided voters in suburban Wisconsin. He encountered exactly the same things that I’ve run across in trying to discuss politics with people who aren’t politically active.

There are three key points. First, don’t expect people to be genuinely interested in politics:

Second, the less informed people are, the more inclined they are to think that there’s no real difference between candidates:

And finally, undecided voters aren’t just uncertain of the answer, they often don’t even know what the debate is about:

It’s ultimately a vicious cycle: people think that politics doesn’t affect their lives, and so they’re not interested. Because they’re not interested, they’re uninformed. And because they’re uninformed, they think that politics doesn’t affect their lives.

The result is that the field is wide open for facile ad hominems, like ’strong leader’, ‘common man’, and ‘out-of-touch liberal’. And we’re not going to get anywhere against these arguments if we don’t understand why there’s such a large audience for them.

My first reaction to the Republican rule change that will allow Tom DeLay to retain his House leadership post even if he is indicted was fairly predictable: outrage and anger.

But I’m a lot more hopeful after reading this quote from a Democratic Representative on Talking Points Memo:

Gingrich and his cohorts in ‘94 weren’t naive idealists by any means; but they did have genuine revolutionary zeal. The Republican backbenchers were even willing to stand up to their leadership on occasion.

But if something like this can pass, and with hardly even any dissent, then the movement is spent. I know this seems like an odd time for liberal triumphalism, but the Republicans are arcing downwards.

Newsday isn’t exactly the most trustworthy rag around, but if there’s any truth to this story, it’s pretty darn funny:

Right. Everyone knows about those damn bleeding-heart liberals at the CIA.

(link via Intel Dump)

Via Publius, I just found this post by an ex-Southern Baptist written the day after the election.

It’s a very powerful explanation, and while I was a Jehovah’s Witness–a non-political religion–the mindset she describes rings true to my experience as well:

It’s long post, but well worth reading in its entirety.

As much as it sucks to have a deceitful, Machiavellian, power-hungry war criminal in the Oval Office, it’s a lot better than having a religious nut. Via Sullivan, comes this gem from the Christian right:

I never thought I’d say this, but way to go Dubya.

Dan Savage crunches the numbers and points out that the real divide in the United States isn’t red state vs blue state. It’s the much more classic urban vs rural. Only partly tongue in cheek, he rails:

He also proves that trying to appeal to the reds while taking the blue base for granted is not a winning strategy:

Fair warning: the article includes Rush-Limbaugh-caliber ranting: hilarious if you’re a frustrated urban liberal, deeply offensive if you’re anybody else. But there is a serious core to the article, and it’s the freshest answer I’ve read yet to the “Whither the Democrats now?” question.

Updated 11/20: The URL has changed.

James Buchanan, Nobel laureate in Economics and Advisory Director of an eponymous center at GMU (I didn’t think universities did that while the honorees were still alive!) lectured in Boise tonight to a packed hall. His thesis, premised on the fact that the rise of the welfare state and the ideal of socialism coincided with the decline of religion, was that the state has replaced God as the ultimate parent, providing the sense of psychic security that used to come from religion and community. The growth of the state, therefore, will continue as other sources of psychic security erode.

Aside from placing the idea in its intellectual context, Buchanan didn’t really develop or support the thesis very much; but it was still an interesting lecture and worth attending. He lamented that the public often did not understand free-market ideas, and he suggested the metaphor of the frontier–where there’s always room to move out–as the best way of ’selling’ captialism.

The Professor spoke somewhat contemptuously of the masses who were not strong enough to accept “the personal responsibility of liberty”, and who felt the psychological need for a parent figure; it struck me how much libertarianism is a matter of values as much as of intellect. I believe that people’s desire for freedom from responsibility is just as valid a goal as their desire for freedom of choice. The person who wants to be able to work and not worry about their pension has just as legitimate a preference as the person who wants to be able to control every penny of their investments. The latter (on average) maximizes value; the former minimizes stress. Both are paths to the ultimate goal of societal organization, which is maximizing happiness.

In the Q&A, I challenged Buchanan’s statement early on in his lecture that corruption grows with the size of government. I pointed out that political corruption on the scale of Tammany Hall or the Chicago machine is unheard of in the contemporary United States, even though government has grown significantly since then. He responded that the rent-seeking and similar private giveaways and transfers are corruption on a much larger scale, which provoked a large round of applause, especially from the VIP section at the front of the room (ironically populated with politicians and businesspeople).

There was no provision for follow-up questions, and at the time I couldn’t think of one anyway. In retrospect, one could definitely challenge the use of the word ‘corruption’ to describe rent-seeking; but ultimately, it’s a matter of semantics, since rent-seeking obviously does impose a major efficiency cost on collective government (and few people are better qualified to prove that than James Buchanan).

So at least now I can cross off “being smacked down by a Nobel laureate in front of 1,000 people” from my list of things to experience in life.

I don’t generally find myself agreeing with arch-originalist David Bernstein, but I think his latest post is spot on:

As Bernstein points out, Rehnquist could easily have resigned last year, allowing Bush to ensure that his replacement was another paleocon. Assuming Kerry wins tomorrow, we can count ourselves lucky that Rehnquist stayed on. But why should Supreme Court Justices have that degree of control over their successors?

Kevin Drum takes a fairly naive view of Campaign Finance Reform by claiming that McCain-Feingold has failed because more money was spent on the campaign this time around than last time.

IMHO, Kevin is missing the point. It’s not money itself that’s bad, except perhaps relative to some goo-goo fantasy of a world where the 30-second spot is replaced by long blocks of free airtime on public television. Americans are consumers, and trying to get us to not spend money on something as important as an election is just ridiculous.

The real issue is cutting the direct nexus between officeholders and big money–the fat-cat connection, if you’ll pardon the term. The personal contribution limit has been doubled to $2,000, but in terms of influence peddling, that’s still peanuts. The real problem all along (think Lincoln Bedroom, Buddhist Monks, and all the Republican equivalents) has been soft money; and instead of being channeled directly to politicians, that is now going through 527s, which are legally prohibited from directly coordinating with the candidates. It’s not quite a brick wall between contributors and candidates, but it’s at least a bit of foam padding.

Also, as praktike points out, the parties didn’t really do very well at appealing to individual voters. A lot of the 527 cash, however, is coming from individuals, probably because the 527s are free to brand themselves and practice market segmentation, whereas the parties have to present a more homogenous image.

Counter-arguments could certainly be made (e.g. that 527s have contributed to polarization, and have made dirty tricks easier; and of course there are constitutional issues with McCain-Feingold). But pace Kevin, I think we’re much better off than we were in 1996 or 2000.