A new age of spite and entitlement is dawning in the West, as the haves, confronted by a yawning abyss of their own manufacture, struggle to find a way to so demonize their opposite numbers at the bottom that they need no justification to remain at the top.

It is observed, including by my own perennial favorite Adam Cadre, that a powerful motivator for this sort of behavior is simple spite – that after a certain amount of privilege accrues, one of the main ways of enjoying it is finding ways to wave it under the noses of those without it. We observe this on a daily basis with money – the whole category of Veblen goods could not exist otherwise.

A trans-Atlantic culture of fat snobbery has emerged on similar terms, with people – blessed by the mix of economic and physical privilege such that they do not, by their normal day-to-day- routine, gain or retain large amounts of weight – basically heaping abuse on the disgusting, morally incontinent fat-asses who inexplicably now form a majority in the US and a plurality in the UK. While the temptation, as always within the framework of choice-based liberalism, is to view obesity as a simple consequence of personal choice, a more coherent view emerges if you construct it in the same manner at least some liberals are willing to qualifiedly accept class or wealth.

(Certainly much more coherent than Jamie Oliver flogging up-market delicacies as a substitute for prolefeed with similar caloric content, and treating the choice as one not just of diet but of morality – as though money were no object.)

But these are not subjects I am touching on in detail today. With the 2011 autumn of rage still sputtering along and still making the odd headline,  I would only be adding to a vast stream of noise about money to discuss it; and I have already done too much futile speaking for too long on my left approach to obesity, and a man gets discouraged after a while.

What I am interested in now is a new push against the discipline of mental health.

Finally, The Eggheads Are No Longer In Lockstep

Here is a representative article. I summarize: “Hey, turns out some of these eggheads don’t want to medicate your kid for being just the most special boy in the whole world! Good for humanity.” To hear all of these articles – largely by laymen, and by an exciting mix of woo-pedlars and the luddite fringe of the big-s Skeptics – you’d think that there was some kind of massive rebellion against the iron dogmas of psychiatry from within. A veritable Macintosh commercial!

It goes without saying that these petitions draw almost exclusively from professionals at ideological loggerheads with psychiatry. This element of the narrative is never discussed, as though psychologists, psychiatrists, counselors, therapists, and yogis were all equal partners in the Teen Medicalization Crisis (now entering its 25th year, and stronger than ever). These are people who, as the neurochemical model of the brain has gained more and more empirical traction, have lost  authority and professional cachet in the category of mental wellness.

Their critiques never really hit at one of the substantial points of actual grievance with the expansion of recognized neurological conditions – to wit, that they treat those problems with a mix of therapies with a mix of medical bases. Especially affected are professionals in areas like talk therapy who are basically camp-followers to the medical profession, hanging on to obsolete ideas of the mind and often actively agitating against newer, more effective modes of therapy.

Your Hour Is Up. Medication? Whatever For?
The question “cui bono?” is asked with encouraging frequency  when it comes to pharmaceuticals, but rarely answered well – and when it comes to critics of medicalization, never at all. I have never once seen it mentioned, in the full year or so that controversy has been swirling over the incipient DSM-V, that most of the people up in arms about it lose authority and business from referrability to psychiatrists. They object to medicalization of life experiences, but are perfectly willing to bill patients by the hour for them. No one has been honest about this; they prefer, dishonestly, to fit their complaint within the public narrative.

They will take your money to talk to you about your hurt fee-fees – and, indeed, will take parents’ money to talk to children about their hurt fee-fees, and needless to say schools’ money as well. But the moment pills get involved, it’s medicine gone mad.

“Seasonal Affective Disorder?” Ha Ha Ha Winter Sucks Bro
Of course, the telling thing is that they don’t generally stick to diagnoses which are new within the DSM-V. The article makes a laundry list of disorders in the usual snide fashion without getting into how any of them work or what they constitute. (Several are catastrophic threats to anything resembling a livable life, let alone a social or successful one.) It challenges the DSM-IV-TR’s criteria for attention deficit disorder, following the usual infantile pseudo-critique of Big Pharma in considering medically resolvable ADD a phantasm.

Not content to agitate against novelties which have potential conflicts of interest and which may in fact merit reinspection before they are canonized, they go on to muddy the waters on genuine, observable neurological disorders that ruin the lives of real people and are trivially resolvable with medication. The pop culture view they are pandering to, and which they are willing to accept the grim consequences of to restore their status in the power structure of mental health, is that we are masters of all of our own neurochemistry and that the whole business of psychiatry is a figleaf over moral incontinence. Never mind all the suicides and lost livelihoods attributable from observed, consistent diseases within the reach of psychiatry’s tools – surely we would be better off if parents and talking cure experts linked hands and scared those nasty fidgeters straight.

It is a popular view because it appeals to the idea of the fit that their fitness is a matter of moral choice. They never chose to blame their problems on some illness, they think – not realizing that they have no frame of reference on how badly mental illness can hold someone back. They live the same bitter, miserable, hungry lives the rest of us do and on some level they resent the capacity of some people to just take pills and get over it, and they want those people to suffer – suffer more than they do, even – so that they can feel better about their own lives.

What’s the point of being well if you can’t see people wither away of illness? If we were all well, surely no one would be? Who’s the government to tell me I can’t drink my own piss???

Evidence? Two Million! Five Million! Children Are Our Future!

Astute readers will notice that I have no evidence. Of course I don’t; I’m not writing a fucking peer-reviewed essay. I don’t have numbers in my head and I wouldn’t intrinsically trust any numbers I could dig up, because I am not funded by some kind of lab and I do not have a strong grounding in the interpretation of data. I’m not going to throw around numbers to try and give myself the false color of authority. Like thousands of talk-curists and therapists and anti-medical popularists every day for the last year, all of this is the product of my own deranged, limited little brain.

Unlike them, I am willing to admit this. Really, I’m mainly saying this because I’m sick to death of being quoted scare numbers – some million of children on Prozac, and what I’m supposed to care about is not that Pfizer has billions of dollars in guaranteed business because of government-supplied research and contracts, but that maybe we’ll find out this medicine is Thalidomide all over again. And Heaven forbid you point out how rare that is – how staggeringly unlikely it is that a medication millions have used, which has been tested for decades, will turn a corner and become dangerous because it is used in a new way you don’t like. Because you will never extricate yourself from the blabbering about Vioxx etc.

Mostly, I wish that more people were just honest and forthright and said that they felt it was morally wrong to give teenagers medication instead of letting them take their knocks and suck it up because life isn’t fair, etc. I’m tired of being told horror stories with no punchline that I’m supposed to infer that from, and I’m sure I’m not alone.

Austerity of the Brain

In short, I feel that these people – who are largely in solid mental health and who benefit concretely from a customer base who are encouraged to see their mental problems as a matter of personal choice and initiative rather than neurology – form a group mirroring the exploitative fiscal elite now dominating American and British culture. Their solutions are all the same – we must pull our brains up by our bootstraps and balance our chemical accounts honestly, and take responsibility for our lack of initiative and inability to live a normal life. They can do it, after all, and all they have on us is the ability to wake up rested, work happily in an office, get along with a wide circle of supportive friends, and go to bed rested. Nothing at all, really. And we’ve done well enough for ourselves to have color TVs and to have gone eighteen years without jumping off a bridge, so how dare we complain.

The slicker of them will always pretend to care about the ability of psychiatrists – pushy, exploitative psychs, driven somehow by the meager swag they receive from drug companies to dole out medication, we are assured, like candy, and basically for nothing – to exploit patients by medicalizing them. It’s labelling, we are told, and enables bullying. Pay no attention to the workplace discrimination rules dictating a diagnosis before remedy, nor any attention to the high likelihood of existing stigmas in teens succeptible to diagnosis for illness. We’ll be better off without that pesky label, after all – and every good liberal knows labels are the enemy.

But they can’t escape their emotional drive to stigmatize their targets. We are weak, and we disgust them. The best thing we can do for everyone is to be separated from medication that helps us function – we are being preyed on and don’t even realize it. Just like those unemployment layabouts, we just have no idea what we could achieve if only anyone had the love and concern to refuse us our dignity. Why, what incentive do we have to even try not to fall into catatonic panic attacks? Parasites all!


Special Mention: Ben Goldacre

A beautifully illustrative moment commends itself to me from a recent episode of QI: “Illness”. Goldacre, the golden boy of a skeptics’ movement much more pissy and driven by resentment of medicine than America’s own, has a lot to say about medicalization of mental illness – because, as a doctor, he believes his own understanding of it is plenary and any mechanism he doesn’t immediately understand is buncombe. He is the epitome of the worst sort of ‘skeptic’ – the one who learned all he intends to know some time ago and uses his prestige as a thinker to bully anyone with new ideas.

On QI itself he pooh-poohed the prevalence of ADD, and the belief that female arousal could be distinguished by clitoral blood flow. (I love an actual Goddamn doctor being apparently ignorant of the erectile function of the clitoris.)  Elsewhere, he went as far as to dismiss social anxiety disorder as “medicalizing shyness”!

That’s the first part of my point – that these people don’t have any defined end point. There’s no reason for Goldacre to believe in any particular psychiatric remedy, because on a fundamental level he holds the neurochemical model of the brain in contempt. There’s no reason for someone who earns his crust to accept that medication is useful for a dissociative or a depressive or a delusional paranoid – all of them quite serious suicide risks at one end of the spectrum and lucrative customers of exploitative antimedical therapists on the other. Goldacre isn’t judging on the density of studies, or the results of studies. He might hold up the instruments of science and gesture at them, and might swaddle himself in the culture of scientolatry. But he only does so to sweeten a farrago of cultural obsessions already friendly to the comfortable and suspicious among his fellow ‘skeptics’.

And the second point is this. Stephen Fry, the beloved moderator of that program, mentioned that two things were true of him – that he could have been diagnosed with ADD if he were born later but he was genuinely a prat and needed that beaten out of him as well.

What he didn’t mention, while the BBC was hosting its special Goldacre dog and pony show edition of one of the country’s most popular shows, is that he didn’t reach 40 without making an attempt on his own life.

Funny how no one ever seems to.