A Perfect Example of Misunderstood Existentialism

I came across an article this morning that was written back in March, which turned out to be a perfect example of what causes the perpetual misunderstanding of existentialism. The author, Lynsey Hanley, of course starts off with one of the most overused and misunderstood quotes from Sartre: "Hell is other people."

Let me first start off by saying that Sartre did not mean that other people create a hellish world for me, or that I should go through life only caring about myself. On the contrary, Sartre explains that our awareness of ourselves is contingent on other people. Whenever I reflect on who I am, that reflection is not without my awareness of what others think me to be. Essentially, "hell is other people" means that no matter how much I want to be something, I can never fully be considered as such if another has an opposing view. In that type of situation, I am constantly struggling to find a medium between what I want to be and how I am perceived to be. With Sartre, one has to remember not to get caught up in his dramatic terminology, and instead pay close attention to what that terminology means, rather than what it implies.

Hanley continues by stating: "Being an existentialist requires being satisfied with the absurd and random nature of events, freeing you to create your own life in circumstances that aren't of your own making." Not so much. Being an existentialist does not require a satisfaction of the absurd, and I hesitate to even say that it requires an acknowledgment of the absurd. In Sartre, the absurdity of the world is used to portray the individual's ability to create meaning for oneself, since there is not essential meaning to begin with. In Camus, the absurd lies not in the individual or the world, but rather the individual seeking clarity in an irrational world. To Camus, the world is not necessarily without meaning, but he claims that if the world does have meaning, it transcends the individual's intelligence. One thing that people who are not familiar with the actual philosophy of Sartre, for instance, is that they do not realize that his philosophy is based on ontology, which is the study of being. It does not necessarily say that "one must do this in order to do that," rather it merely describes what is. To the existentialists, the absurd is, and there is no imperative that follows (i.e., be satisfied with). More importantly, the root of Sartre's philosophy is that you always have the freedom "to create your own life in circumstances that aren't of your own making," and being satisfied with the absurd is not a prerequisite.

"I'd like to be an existentialist in the sense of wanting to approach life as though I were a mind-body battering ram, but tend instead to hover at obstacles wondering what the best course of action would be from every possible angle, knowing really that there is no best or worst, simply what is, and must be, dealt with."

Hanley, I hate to tell you, but what you "prefer" is what existentialism actually is. In order to be able to "wonder what the best course of action would be from every possible angle, knowing really that there is not best or worst, simply what is," you must first realize that there are possibilities available to you, and that there is no choice that is better than another; either way, it is your choice.

Another confusion that Hanley states is: "At the centre of this philosophy is the insistence that, while you must think, there's a time when you have to act on what you've been thinking about," which is again, not the case. One point that is stressed by existentialists is that not choosing is still a choice. You can think all you want, but not acting is still a choice.

Her statement, "wanting cheap goods while blaming migrants for low wages, in spouting populist opinions and then berating politicians for the consequences of populist policies, in blaming cakes for obesity and guns for murder," is partly false. Bad faith is one's rejection of one's available choices and the freedom and responsibility of one to choose from amongst those choices. Hypocrisy is not bad faith, as long as one does not reject the choice of being a hypocrite being one's own, but blaming one's obesity on cakes and guns on murder is a semi-appropriate example, since it was up to one to eat the cake or pull the trigger on the gun.

"But here again my inner softy counsels caution. We can't reject the loop-like nature of how individual actions contribute to social effects, which in turn influence individual actions. You can't eat a hamburger by osmosis, but it would be stubborn to deny that capitalism has an interest in getting you to eat more of them than is healthy."

This, though, is bad faith. Our social circumstances do limit the choices available to us, but we still have the ability to choose. Eat your hamburger, Hanley, but don't blame it on anyone else.

Hanley then throws a curve ball into the mix, and I am not sure whether she is now a proponent of what she thinks is existentialism, or is against it: "There are some unfortunate proponents of the law of individual responsibility, who corrupt the essentially optimistic nature of existentialism."

Either way, her concluding paragraph just goes to show her naïveté as she oversimplifies Nietzsche and improperly attributes it to existentialism: "It's not so much that existentialist thinking can't be applied to life's moral greyscale. It's more that the problem with maintaining, or at least refusing to challenge, a popular political culture based on denial and hysteria is that it requires regarding people who are not like you as simultaneously less than human and superhuman. Only the deserving get to be simply human."

Nietzsche is considered an existentialist due to some of the views that he shares with the other existentialists, but his theory on the Übermensch is not one of them.

Thank you, Lynsey Hanley, for adding to the confusion and misunderstanding that plagues existentialism today.

Excessive Grooming in Mice = Mental Illness

It's safe to say that my face almost hit the keyboard as I was reading the article Bone marrow transplants cure mental illness – in mice in The Guardian today. Apparently, Nobel prize for medicine winner, Mario Capecchi, conducted a study which consisted breeding "mice that carried a mutation in a gene called Hoxb8 that causes faulty immune cells to grow in the bone marrow. Mice that carry the defective gene groom themselves too often and for too long, leaving them with bare patches and skin wounds." Because this excessive grooming is similar to trichotillomania, a disorder in which people pull out their hair, it somehow means that OCD, depression, autism, and schizophrenia may be caused by immune deficiencies.

Wait...what?

"Writing in the US journal Cell, the team describe how transplanting healthy bone marrow into the mice cured them of the grooming disorder. In later operations, the scientists induced the disorder in healthy mice by giving them bone marrow from affected mice."

By now, I really hope you see problems with this. For one, the scientists bred mice with a mutated gene which could have had numerous different effects, and because the resulting effect was excessive grooming, they linked it to a sort of spectrum disorder, without acknowledging the possibility that the mutated gene may have made the mice excessively, well, itchy.

Second, the team takes this behavior and somehow links it to other disorders such as depression, autism, and schizophrenia. Tell me, did the mice hum as a result of the mutated gene as well?

However, these issues do not stop Capecchi from concluding: "We're showing there is a direct relationship between a psychiatric disorder and the immune system, specifically cells named microglia that are derived from bone marrow."

Of course, right in the middle of the article, Capecchi comes out with it: "The recognition that many neuropsychiatric diseases have a direct connection to the immune system emphasises that we should be taking immune deficiencies associated with neuropsychiatric disease much more seriously. We know a lot more about the immune system and how to treat immune deficiencies than we know about how our brain works and what the drugs used to treat neuropsychiatric disorders are doing."

As with a previous blog post, the Mind Over Meds Reaction, it would appear that the goal of psychiatry is ultimately how to figure out what type of medication to assign to the individual based on assumed biological predisposition.

The article did assuage my immediate, overwhelming concern by adding as a final comment: "Other researchers were more cautious about the work. Paul Salkovskis, clinical director of the Maudsley Hospital Centre for Anxiety Disorders and Trauma in London, said it was impossible to draw strong conclusions about the role of the immune system in human mental illnesses from the study. 'Excessive grooming in mice is not a good model for obsessive-compulsive disorder in humans, a condition that can be treated effectively with cognitive behavioural therapy,' he said."

Reaction to "Mind Over Meds"

On April 19, 2010, the New York Times published an article by a psychiatrist named Daniel Carlat called Mind Over Meds. The article featured Carlat arriving at the possibility that "It may be time to consider whether the term 'psychopharmacologist' is actually doing damage to the field of psychiatry." (In this case, jumping on board later is better than never, I suppose.) While I fully appreciate his general attempt to portray contemporary psychiatry as incomplete in terms of reaching a limit with medications, the article is a perfect illustration of the philosophical naïveté of psychiatrists today.

The meat of the article begins with Carlat giving his question a foundation, by producing evidence to suggest that psychotherapy is decreasing in the perceived effectiveness at aiding the individual's so-called "recovery," and that the perceived efficiency of taking a pill is preferred over the trials and tribulations of the psychotherapeutic process:

"...the percentage of visits to psychiatrists that included psychotherapy dropped to 29 percent in 2004-5 from 44 percent in 1996-97. And the percentage of psychiatrists who provided psychotherapy at every patient visit decreased to 11 percent from 19 percent."

Carlat blames the psychiatrist's "not having enough time" as the reason why psychiatrists are increasingly untrained in psychotherapy, and states that once the psychiatrist reflects on the situation of the patient and not only concentrates on the assumed "biological deficiencies" the patient may have, they reach a tantalizing limit. He claims that once he began probing his patients, he realized he did not know them at all.

In addition, Carlat implicitly explains that the pharmaceutical companies have more interest in the individual's cost-efficacy, rather than their recovery:

"Oddly, managed-care companies discourage us from doing psychotherapy, arguing that it is cheaper to have psychiatrists do 20-minute medication visits every three months and to hire a lower paid non-M.D. for more frequent therapy visits."

"...the overall amount of money paid out by insurance companies is actually less than when the treatment is split between psychiatrists and psychotherapists. When patients see only one provider, they require fewer visits overall. "

Finally, Carlat states that these quick-fixes that the pharmaceutical companies are oppressing humanity with (my words, not his) are not the only effective means to treating patients, but psychotherapy and cognitive behavior therapy are sometimes needed to escape the limits of psychiatry. (Which also leaves the possibility of other therapies being equally - if not more - effective.) In addition, Carlat also states that three quarters of placebo trials prove to be just as effective as the medications they are a placebo for. This leads to Carlat giving an example of a patient that was in need of more than just a pill, and concluding that "She needed someone who could expertly probe her thought process, in order to understand the fateful logic that led her to conclude that the only solution was to end her own life. She needed treatment that was intensive and exquisitely coordinated."

If that "someone" that his patient needed doesn't sound like a philosopher, I don't know what would. Which leads me to my main criticism of the article:

Carlat also states that "Clearly, mental illness is a brain disease, though we are still far from working out the details. But just as clearly, these problems in neurobiology can respond to what have traditionally been considered 'nonbiological' treatments, like psychotherapy. The split between mind and body may be a fallacy, but the split between those who practice psychopharmacology and those specializing in therapy remains all too real." Fundamentally, he realizes the philosophical issue that he is dealing with. At the level of analysis, however, he still remains trapped by his reductionist account of "mental illness," without truly understanding the complexity of such a position. (He also refers to psychologists and social-workers as professional "lowers" in the "mental-health hierarchy.")

So, we have two issues with psychiatry today, as outlined by a professional psychiatrist:

1) The pharmaceutical and insurance companies have too much leeway when it comes to treating patients. A 20-minute medication-related visit is more cost-effective, and skills that may help in the progression of the patient are discouraged.

2) Due to the psychiatrist's knowledge being limited to a set of structured categories, and pills to attribute to each one of those categories, the patient becomes dehumanized and is treated in generally the same way a malfunctioning machine may be treated, despite possible unique properties and features that may be contributing to their "illness." This also leads to subsequent limits in the psychiatrist's ability to treat their patients.

All of the philosophical problems with all of the implications that can be drawn from this article (and psychiatry in general) would take too long to look at in a single blog post, and will be saved for a future date. However, as you are reading the article, I urge you to think of some of those problems and possible solutions. And of course, spread the word.