Sunday, February 21, 2010

Every week CUIP’s president Jacqueline Salit and strategist/philosopher Fred Newman watch the political talk shows and discuss them. Here are excerpts from their dialogues compiled on Sunday, February 21, 2010 after watching selections from “PBS NewsHour,” CNN’s “Campbell Brown,” “Hardball with Chris Matthews,” “Morning Joe and ABC’s “This Week.”

Salit: There was something strangely similar for me about the political discussions that we watched on Hardball, Morning Joe and CNN’s Campbell Brown and the PBS NewsHour discussion about mental illness and the DSM-V. DSM stands for the Diagnostic Statistical Manual, the diagnostic guide of the American Psychiatric Association. DSM-V is the proposed update of DSM-IV. I’m trying to think how to characterize the similarity. One word comes to mind…

Newman: Try “mythology.”

Salit: Mythology. OK. I was going to say “closed system.” A closed system which fosters mythology or something along those lines.

Newman: I’m inclined more towards the words “open system.”

Salit: Open system, oh. How do you see that?

Newman: Anything goes. There’s no standard. There are no empirics. There’s no science. There’s no careful reasoning. These days in both politics and in psychiatry/psychology, you can make up whatever you like and self-fulfill it.

Salit: Self-fulfill it.

Newman: Because the “real story” in mental illness is whatever the DSM-IV or V says it is. When you actually look at the book, either IV or, I presume, V – I haven’t seen it yet – it’s just the preferred ordinary language of these particular people – who happen to be psychiatrists – in talking about mental states, emotional attitudes, postures, and feelings. I suggest that’s not much better, or more valid, than what anybody else is talking about. That might be a little extreme, so let me put it differently. The psychiatrists have only a slightly more technical definition of the blues than does Louis Armstrong.

Salit: That’s so interesting because at the beginning of the discussion Judy Woodruff reasonably asks, ‘Why do we have a DSM anything? What’s the premise, medically and scientifically, for having classifications of mental disorders?’

Newman: She might just as well have asked why do we have psychology or psychiatry?

Salit: Well, yes.

Newman: A classificatory component is a part of virtually any true science. Judy Woodruff is correctly asking why we have this. She might well have asked – it would have been more direct – Why would you consider these things to be true science?

Salit: These particular classifications?

Newman: No, this particular approach to human emotion.

Salit: But she didn’t ask that.

Newman: No, but I’m saying she asked something that was effectively equivalent.

Salit: Then Dr. Alan Schatzberg, the head of the American Psychiatric Association, said – he doesn’t quite use these words, but his tone is What I’m about to say goes without saying – he said that having classifications of mental disorders and distress allows the profession to treat them more effectively.

Newman: Right, which is true. What he didn’t say, interestingly enough, was the reason we have a classificatory system is that it’s an attempt to make psychology a science. A necessary component of any true science is to have a classificatory system associated with it.

Salit: Correct.

Newman: But, he didn’t say that. Even Dr. Schatzberg feels squeamish about declaring that.

Salit: Squeamish because?

Newman: Because it isn’t a science. If you’re perpetrating a fraud, even if you don’t quite think of it that way…if you’re sitting on the Stanford campus and that university pays you hundreds of thousands of dollars a year, you feel some restrictions on undercutting the presumed value of your so-called science.

Salit: The purpose of the DSM-V is to make the arena of emotionality less emotional and more scientific.

Newman: If you study true sciences, the ones that most people would agree are sciences – like physics, like chemistry – they’re based on creating a new discovery. Chemistry is not just another way of talking about chemicals. There were some discoveries made, actual discoveries in the real world with real instruments, that produces a science. And out of that came theories. That’s not the historical process by which mental health has tried to turn itself into a “science.”

Salit: OK.

Newman: I’m not the only one who’s saying this. The whole construct is suspect. After all, even Dr. Allen Frances, the psychiatrist who put together the last DSM is now somewhat suspicious of it.

Salit: Of the whole classificatory system.

Newman: From DSM to DSM.

Salit: Exactly. That’s what I was going to ask you next. Dr. Frances is a psychiatrist. He’s the former chief of psychiatry at Duke and he headed up the DSM-IV process, the one that concluded the last guide. In the interview with Judy Woodruff, he shared a set of unintended consequences that occurred as a result of his work on refining and updating the classificatory system. He said that the changes triggered “false epidemics.” Then he named three areas where false epidemics were triggered, including Attention Deficit Disorder (ADD), autistic disorder and the childhood diagnosis of bipolar disorder. On his account, what happened was that they created these new classifications and – I almost hate to go political on this because I feel like it’s getting away from…

Newman: Feel free.

Salit: …the scientific point that you’re making.

Newman: No, I’m making a political scientific point.

Salit: Going political, he essentially says we created these new categories and some combination of the drug companies and the psychiatric profession rushed in and, suddenly could diagnose and treat people in these categories and, that it’s become hugely profitable.

Newman: Yes.

Salit: So, at a very minimum, while he might not be questioning the methodology of scientific classifications…

Newman: Well, I hope he is now, when he’s off camera.

Salit: But even on camera, he is saying that here’s something extremely negative that happened as a result of doing this activity called classification.

Newman: Right.

Salit: At one point, he referenced the situation with ADD. He calls it a huge over-diagnosis. It became a growth industry.

Newman: And remains one.

Salit: And it remains one, exactly. I know we’re discussing an issue that you’ve spent a lifetime working on here.

Newman: Or at least an hour and a half yesterday.

Salit: OK. Can you talk a little bit about what is being discussed in the field now, about the negative impact of diagnosis?

Newman: I’m not so much a part of the field that I can really speak all that intelligently to that. I speak to a small circle of radical anti-psychology people who are themselves training others. In the spirit of answering the question, I think people in the field are conflicted. Ordinary social workers who do therapy or counseling, not only feel a personal need for some classificatory system, but it’s economically useful to them, because it’s the standard used for insurance reimbursement. So it’s not going to be given up. On the other hand, I think there is a skeptical and wary tone in the air and there’s been enough talk about that, enough movement within the field of psychology, which includes the supposition that there’s something fundamentally wrong with this DSM thing. I wouldn’t be shocked if many practitioners use the official classificatory system, whether it’s V or IV, but simultaneously in their first session they say to their patients, You’ve probably read about DSM-V in the newspapers. All of this diagnosis is imprecise and clearly not helpful. We have to do this for the purpose of satisfying the bureaucratic needs of the insurance companies. Now let’s keep it at the size that we want. We’re not going to use it practically. I think that’s a posture for some in the field right now.

Salit: Then to thread the needle back to the political conversations and your comment that you can make anything up and call it science…

Newman: I don’t think you can make anything up. But you can come up with something and then paint it in such a way as to give it a resemblance to science. Then that turns out to be of economic benefit, because the money goes to science. I’m not at all questioning that it should. But it should go to real science.

Salit: On the political side, there continues to be, for obvious reasons, a discussion about the movement for social conservatism and whether it can power the Republican Party to victory. Leaving aside the issue of whether it can, it’s certainly trying. I don’t even know whether it makes sense to talk about whether it can.

Newman: That’s a trick, of course. What you’re describing is a trick very much in the way that DSM-IV and DSM-V are tricks.

Salit: How is that?

Newman: It’s a way of covering over that the Republicans lost.

Salit: Yes.

Newman: They would like to keep talking about whether the conservatives can drive the GOP to a win until Election Day. And the Democrats are in something of a bind. It’s a good chess play.

Salit: The Democrats are in a bind because?

Newman: Because if they respond directly, if they say, You know, we won by a huge margin, then the Republican response to that chess play is I don’t know why you’re saying that so loud. If you actually won, why do you have to say anything?

Salit: Yes. Just execute off of that.

Newman: Exactly. But they can’t.

Salit: They can’t, OK. This conflict was the subject of the discussion we watched between Chris Matthews, Al Sharpton, and NAACP President Ben Jealous. The jumping off point was that Jealous, Sharpton and Marc Morial of the Urban League met with President Obama. It was billed as a meeting of the major leaders of the national civil rights movement with the president. So, Sharpton talks to Chris Matthews about how the Republicans are being obstructionist. They’re obstructing everything. He makes the point that this isn’t just equivalent to what happened with the Dixiecrats when they obstructed civil rights legislation designed to enfranchise African Americans. What the Republicans are now obstructing is jobs programs and health care programs that would help all Americans, including their own constituents. They’re so intent upon their political play, says Sharpton, that they’re willing to hurt the people that they’re supposed to represent, for political gain. Then Chris Matthews says, ‘Here’s something I don’t understand. Why aren’t they, meaning the Republicans, afraid of blowback from moderate Republicans and independents?’

Newman: They are.

Salit: OK, you say they are. Sharpton says they’re fearless. And, the reason that they’re fearless is that there hasn’t been pushback from the civil rights and labor movements. To me there was an interesting disconnect between the question and the answer, because Sharpton didn’t address independents. In essence, Matthews says, ‘Well, the independents are out there. They’re out there and the Republicans could lose them if they play too far to the right. Why aren’t they afraid of that?’ Then Sharpton says, ‘Well, they’re not afraid because the civil rights movement and the labor movement aren’t fighting back strongly enough. That’s what our meeting with Obama was about. And now we’re doing that.’ But, you said the Republicans are afraid of blowback from the moderates and independents, yet they’re pursuing this obstructionist strategy. I guess Matthews’ question and my question is: How do those two things fit together?

Newman: Timing. They’re not going to prematurely respond to blowback until blowback occurs. And the moderates and independents will blow back as it gets closer to election time because that’s when you determine the net gains and net losses in Washington.

Salit: So then Sharpton says, ‘Why are we running from the people who lost the election?’ This goes to your point about the chess game. Sharpton says, ‘We won the election. We are the majority. We elected the president. We control Congress. Why are we so worried about these people? We should stop being so worried about them and go about our business of taking care of creating jobs and all these things we need to do. What’s the problem?’ And Matthews says, ‘That’s a good question. What is the problem?’

Newman: The answer is blowing in the wind. The Democrats are not doing that because the Republicans have used their minority position – as minorities are often capable of doing in certain circumstances – to paint a bleak picture of the president and to use whatever techniques are available under the law, in the Senate or in the House, to defeat enough legislation to make him seem, justifiably so, less than effective. That’s why.

Salit: Sharpton seems to be saying that we shouldn’t worry about all of that. But he’s not an elected official and he’s also not the president.

Newman: Yes. Though, at some level, he’s also an unelected representative of the poor. That’s where he’s come from. That’s who he is. That’s what he remains. And he’s a good one. I’m very proud of him.

Salit: Then we watched a discussion on CNN about the Conservative Political Action Committee meetings. They’re doing their thing. There’s a parade of presidential wannabes and leading lights, including Dick Cheney. John Avlon, CNN commentator and author who is an independent, said that the conservatives and the Republican Party need to be careful here. They can build a bridge to independents on fiscal conservatism and, insofar as that’s their rhetoric, they will connect with independents. But if they go beyond that, in his words, ‘If they go to making this a battle with socialism, independents won’t buy that.’ That will be a bridge too far in terms of trying to coalesce with independents.

Newman: I was telling you about Pat Choate’s new book “Saving Capitalism”* where he says that insofar as the central ideological battle between conservatives and liberals is framed as a battle between capitalism and socialism, the fight is badly framed. Because it’s not really a fight between capitalism and socialism. It’s a fight, as he says – and I think he’s fundamentally correct about this – between state capitalism and free market capitalism. But I don’t think it’s seen that way, by and large.

Salit: What do you think about the argument from some Republicans who are disputing all of this talk about the system being broken? They say the system is not broken. The system’s working fine. The stimulus bill was passed. The bailout bill was passed. Periodically, you hit bumps in the road. They’re laying the blame for any dysfunction on the doorstep of the Democrats because they’re not compromising enough.

Newman: And we all know that. It’s just a case of these particular Republicans intentionally refusing to understand a mixed metaphor. The system’s not broken, in a literal sense. It’s not broken the way when the sink is broken, you call a plumber.

Salit: As in, when the water is stopped up.

Newman: People know what “It’s broken” means. It means that some things look like they might not be fully fixable. That’s what it means. But it’s more rhetorically effective to say “This system is broken!”

Salit: Thanks, Fred.

Newman: You are welcome.

* Pat Choate was Ross Perot’s running mate in 1996 and a major figure in the Reform Party from 1996 to 2000.