Quondam colleague John Timmer at Ars Technica writes up a recent study on how people cling to cherished beliefs in the face of countervailing scientific evidence. The conclusion—they fall back on the idea that the question is somehow outside the domain of science—seems plausible enough, and it’s certainly not hard to think of bogus moves along those lines made in various debates. But one specific question they chose seems like an awfully poor one, because the idea that there’s ultimately a non-scientific component to the answer is, in the instance, pretty reasonable:
To get at this issue, Munro polled a set of college students about their feelings about homosexuality, and then exposed them to a series of generic scientific abstracts that presented evidence that it was or wasn’t a mental illness (a control group read the same abstracts with nonsense terms in place of sexual identities). By chance, these either challenged or confirmed the students’ preconceptions. The subjects were then given the chance to state whether they accepted the information in the abstracts and, if not, why not.
Now, for one, this is a bad question because I’d expect many college students to come in knowing that the consensus since the early ’70s has been that it is, of course, not a mental illness. But there’s a deeper problem that emerges if you look at the history of how homosexuality was classified as a mental illness, and how that classification came to be overturned—which, if you’re not familiar with it, is the subject of a really wonderful This American Life episode. There are, of course, real empirical questions for science here. As the narrative explains, research on homosexual psychology had long been conducted on people who were already in therapy for one reason or another—and therefore missed the rather significant empirical fact that there were plenty of gay men who were perfectly happy with who they were and otherwise psychologically indistinguishable from straights. But the question of whether some particular psychological variation is in itself an “illness” or merely an atypical bit of weft in the human cloth does not, ultimately, strike me as a genuinely scientific question so much as a normative one. When do we call something a mental illness? One criterion is that it’s a subjective source of distress, but that’s of limited help, since we’re often inclined to say that it’s society’s failure to accommodate the variation that should be blamed for that distress. And, on the other hand, we’d probably continue speaking of even the happiest sociopaths in the clinical terms of disease because of the distress they tend to cause the rest of us. (Would it be different if we had a general mechanism for identifying sociopaths early and channeling them into socially sanctioned roles? Other than campaign consulting, I mean.)
Science can inform our thinking about these questions, but the core of the question is often beyond the strict scope of science. An “illness” is a kind of mismatch between an individual psychological disposition and a social norm where we are prepared to reflectively validate the norm. (It’s important to bear this in mind, because the norm itself can get an illegitimate, tautological boost from the sense that science has independently and authoritatively condemned some behavior or disposition as disordered and diseased.) A complete inventory of the scientific facts of the matter might yield agreement—as when, for instance, the mismatch is the result of other widely-held false factual beliefs. But it might not.
I’m glad, of course, that we’ve dispensed with a lot of bogus science that served to rationalize homophobia—that’s a pure scientific victory. And I’m glad that we no longer classify homosexuality as a disorder—but that’s a choice and, above all, a moral victory. It ultimately stems from the more general recognition that we shouldn’t stigmatize dispositions and behaviors that are neither intrinsically distressing to the subject nor harmful, in the Millian sense, to the rest of us. And that comes across clear as day in the This American Life account: The change in the psychiatric establishment’s bible, the DSM, was partly a function of new scientific information, but it was equally a moral and a political choice. The test, if we’re trying to keep ourselves honest, is not whether we place some questions beyond the scope of science, but whether we do so in an opportunistic, ad hoc way, depending on whether the science seems to cut for or against our preferred beliefs.
24 responses so far ↓
1 lemmy caution // Jun 7, 2010 at 6:12 pm
That was an excellent “This American Life” episode. I agree that it was moral rather than scientific progress that was happening in the APA change on the status of homosexuality.
2 Eli // Jun 8, 2010 at 12:15 pm
I think this is true. It also explains the persistence of irrational bigotry, as we are seeing coloring (no pun intended) the debate around immigration, social programs, not to mention our black president. People no longer have any scientific, rational justification for their biases, yet they persist. This is best evinced by the person who has no religious or moral problem with gays – but just thinks they’re “gross”.
I think the discussion on racism, sexism, etc. would benefit greatly from a transition from the dogmatic – you “are” or “are not” a bigot – to the nuanced – are your feelings/opinions being informed by social patterns of bias? I think in the past, when bigotry was largely acceptable, the unconscious biases were still there, and just because we decided as a society to make them taboo – the underlying drivers of bias didn’t simply vanish into thin air. The problem now is in identifying ways in which we are still being driven by them.
This is always incredibly dicey. People worked up over illegal immigration always hate any suggestion that racism/ethnocentrism/nativism/etc. might be playing a role in the anger they feel over the issue. This is justified in the sense that no one’s political beliefs should be declared illegitimate from the start, especially if they aren’t explicitly bigoted. But at the same time, there is a historical pattern of bias, built on cultural structures, against poor immigrants. So it is an important conversation to have.
Wikipedia has an excellent list of cognitive biases that provide a nice framework for understanding how this pattern might have historically developed. http://en.wikipedia.org/wiki/Cognitive_biases. It’s actually a pretty frightening as a look into the frailty of the human psyche. But it’s also disarming in that by explaining why we err, we offer our ego forgiveness.
Of course, the next step is to remain vigilant. And that is a lifelong process that will never achieve perfection. As humans, we are all prone to be led by our fears, angers and prejudices. I think larger social diseases such as bigotry can be thought of as on the same spectrum of behavior as, say, being rude to a store clerk, or acting selfishly towards a roommate or spouse. We are flawed and we are all (hopefully) engaged in an endless struggle to “be better”. The way we do this is always the same: we reflect, we untangle the root of the problem, and then we try to develop the cognitive tools so that should the behavior arise in the future, we have the ability to keep it in check.
3 Barry // Jun 8, 2010 at 3:13 pm
I’d add that of course homosexuals would have had a lot of problems back in the day, because part of their core identity was hammered on by society. It’d be like some Star Trek episode (never made) where heterosexuality was scorned and persecuted; straights would tend to be rather unhappy, self-loathing and stressed
4 Julian Sanchez // Jun 8, 2010 at 3:26 pm
Right, hence: “One criterion is that it’s a subjective source of distress, but that’s of limited help, since we’re often inclined to say that it’s society’s failure to accommodate the variation that should be blamed for that distress.”
5 William // Jun 8, 2010 at 8:58 pm
I’m not so sure that it’s ONLY a moral victory that homosexuality is no longer considered a mental illness. Back when it was considered an illness by the scientific community, it was because of BAD SCIENCE in addition to a different moral climate. Once the bad science got corrected, it helped change the moral climate. Remember, psychologists officially stopped classifying gay people as sick in 1973. I doubt that there was a moral consensus among the general public that the scientists were correct back then.
6 Julian Sanchez // Jun 8, 2010 at 10:08 pm
Right, as I say, partly it was a question of correcting bad science. But… well, listen to the This American Life episode about how the change actually happened.
7 Mark F. // Jun 8, 2010 at 11:40 pm
This should make you question the whole notion of “mental illness.” How many physical illnesses are no longer thought of as illnesses? One can hardly imagine cancer being declassified as an illness.
8 Gus // Jun 9, 2010 at 3:57 am
In response to William (#5), does it seem plausible that the science was able to be revised precisely because of changing social attitudes? I’d expect that attitudes are also influenced by scientific development, but it seems to me more likely that science and attitudes change together, and changes in one facilitate changes in the other. Is this a common way of looking at things?
9 William // Jun 9, 2010 at 1:52 pm
GUS: My point about correcting the bad science back in 1973 was that it occurred quite some time BEFORE the general public BEGAN accepting that gay does not mean mentally ill. As far as I’m concerned, the scientists, as late as they were in realizing that gay is normal, were ahead of the general population.
JULIAN: To an extent I can see where the (then slowly) changing moral climate HELPED the psychologists address their previous biases. As I recall, the This American Life broadcast discussed the episode where a high level Am Psychological Assn member was suddenly confronted by a large number of respected colleagues who were both gay AND successful and well adjusted. Now this may have affected his moral view of gays, but I’d argue that it also affected his SCIENTIFIC view. In other words, he was confronted with strong evidence that showed the old view of gays as mentally ill losers was simply incorrect. The discovery of these healthy, well adjusted people was empirical, scientific evidence. Now if the APA opinion makers also discovered that these gay psychologists were nice, friendly, moral and principled people, I suppose it also affected their moral view of homosexuality.
10 Pithlord // Jun 9, 2010 at 5:06 pm
William,
Scientists may make moral progress faster than the rest of the population. That doesn’t mean their moral progress is scientific in an epistemological as opposed to sociological sense.
It just is not a scientific question whether a particular condition is an illness or a disorder.
11 Pithlord // Jun 9, 2010 at 5:06 pm
IOW, judging people to be “healthy” and “well-adjusted” is no more scientific than judging them to be nice or friendly.
12 William // Jun 9, 2010 at 7:33 pm
Pithlord: Well how about the mental condition called depression? Are you saying that it is a moral rather than scientific question whether depression is an illness/disorder? I’m talking about can’t get out of bed, too weak to commit suicide depression here, not a bout of the blues. How about Post Traumatic Stress Disorder? You’re saying that diagnosis is a moral rather than medical (scientific) question? Granted, it may be a ‘judgment call’ as to how seriously someone is depressed or traumatized, but I don’t view it as a moral question. Of course there are those out there of the ‘churchy’ persuasion who believe all this (and nearly everything) is a moral issue. But we’re talking about professional psychologists here, not bible thumpers (who still believe gay = immoral).
13 William // Jun 9, 2010 at 7:40 pm
PS: And if the pre-1973 “diagnosis” of homosexuality was simply to be viewed as a ‘moral’ rather than scientific question, then the APA never should have included it in their diagnostic manual in the first place. Obviously THOSE particular scientists thought it was a scientific question rather than a moral one at the time. They were WRONG in their conclusion based on the bad science used (only reviewing cases of gay people who sought therapy). However they were still scientists who viewed themselves as looking at a scientific, not moral, question.
14 Prajwal // Jun 10, 2010 at 12:11 am
Julian: great post! You have a great example of what nuclear physicist Alvin Weinberg called “trans-science.” For some issues, norms and science can’t really be separated. I wish I had your post when I was teaching. If you’re interested, I’ve expanded my thoughts here:
http://prajwalk.wordpress.com/2010/06/09/science-and-trans-science/
William: you’re missing the point. No one is saying that all of mental health diagnosis is subjective and based on values. I’m not an expert, but I’m pretty sure that PTSD and depression are largely objective. But some diagnoses do involve moral values. Homosexuality as a disorder is one of them. Go to my link above if you want to read more.
15 Gus // Jun 10, 2010 at 4:18 am
William (#12), interesting that you should use PTSD as an example of scientific objectivity. While that may be the case these days, I’m pretty sure I recall that during WW1 the same disease was referred to as “lack of moral fibre” or something similar. I think that implies a moral judgement!
Similarly, Trofim Lysenko rejected Mendellian genetics because it didn’t fit with Soviet philosophy. Sure, you can say “well, he wasn’t a true scientist”, but that sounds a bit like the “no true Scotsman” saying to me…
Maybe we should view science as an ideal to which we, as individuals, can only aspire. Having said that, I’m happy to accept that when individuals attempt to follow the scientific method, in the long run we as a species do actually achieve it. Does that sound reasonable?
16 William // Jun 10, 2010 at 11:00 am
Prajwal: “No one is saying that all of mental health diagnosis is subjective and based on values. ”
Actually somebody DID say something very much like that. Go back read Pithlord’s final sentence in Post # 11 . That was what I was responding to.
And GUS: Yes, I AM looking at ‘science’ as an ideal. To me, science uses the “scientific method”. It must be done with objectivity and it must be replicable. Crazy Soviet “geneticists” were no more “scientific” than are the “Birthers” who claim Obama was born in Kenya (or Mars, or wherever). I agree that moral judgments can distort “science’s” conclusions, but that would be BAD SCIENCE. That’s what I’ve been trying to say. BTW, when the psychologists interviewed only gays who were in therapy, pre-1973, it was not so much because of moral judgments, but simple BAD SCIENCE which did not properly employ the scientific method. Once the methodology was corrected, they got the science right and did away with listing homosexuality in their diagnostic manual. It may have taken some theatrics (as shown by the This Amer. Life program) to convince people who held biases based on BAD SCIENCE, but eventually real science won out over bad data and bad methodology. I really think much of this discussion is caused because we have different beliefs on what science actually is. To my mind, when someone brings moral biases and bad data together to reach a preconceived conclusion, it ain’t science. It may (temporarily) affect the rest of the scientific establishment, but in the end good science should carry the day, if good methods are employed and biases are not allowed to cloud the issue.
17 Pithlord // Jun 10, 2010 at 12:42 pm
I don’t believe that the world is divided into the subjective and the scientific. Nor do I dispute that there is some scientific content to contemporary psychology. But deciding whether a condition is a disorder is a normative decision, and normative decisions aren’t scientific. In some cases, they may be uncontroversial: we all agree cancer is bad. But a doctor has no particular *scientific* insight into what is wrong with cancer, as opposed to its causes and possible cures.
To give an example where there is real controversy: is deafness a disorder? Deaf activists say it is no more of a disorder than sexual orientation. No amount of knowledge about its causes is going to prove them wrong. That’s just a political opinion.
The same is certainly true with a lot of what is in the DSM. Moreover, even though psychology has some scientific content, it also has a lot of scientistic pretension — even when it comes to causes and cures.
I will concede that sometimes apparently normative disagreements turn out to have factual elements. Maybe people oppose or support abortion rights based on misunderstandings that science could in principle correct. But two world-leading experts on human gestation can disagree about the morality of abortion, and there is no set of experiments that can resolve that disagreement.
18 Julian Sanchez // Jun 10, 2010 at 1:13 pm
So, the underlying physiological mechanisms underlying depression or PTSD are what they are, objectively, whatever terms we want to apply to them. But we have a substantial amount of choice about how the words “disease” and “illness” are going to be used in our language game.
There are, of course, some paradigm cases that count as a “disease” if anything is—if people disagree about these core cases (flu, measles, cancer) then it’s a pretty good sign they’re not even dealing with the same concept. And the demands of coherence impose some constraints: It would be an oddly shaped concept of “disease” that included measles and flu but arbitrarily excluded chicken pox, or that included (say) literacy. When people argue over whether addiction or depression or counterrevolutionary tendencies or whatever else should be considered a “disease” or “disorder,” they’re essentially arguing that the relevant similarities between these and the paradigm cases are more important than the differences for a certain set of purposes, making it useful to group them together. Partly this is an empirical argument about the nature of the thing—about the underlying mechanisms that give rise to it, the extent of its disruptive effect on the lives of people who have it, the most effective approach to mitigating or eliminating it, whatever. But it’s also sometimes an argument about what we want the word to mean and what purposes we want it to serve.
Recall Borges’ famous fictional encyclopedia that classified animals by a bizarre taxonomy including “those that belong to the Emperor”, “mermaids”, “those that are trained” and “others”. When we use words to carve the world into manageable chunks, we are not just cutting along the outlines built into the world; we’re deciding which of many possible ways of cutting are useful to us.
19 William // Jun 10, 2010 at 1:46 pm
I’m not arguing that there are NO psychological questions that are subjective. I’m just arguing that the question of whether or not homosexuals are mentally ill is not such a question. In 1950 there was not enough good data to answer that question, today there is. In 1500, in some places, Protestantism and left-handedness were considered mental illnesses by the establishment. Today, not so much. Of course deafness is not a mental illness. Whether it is/is not a disorder of what the human auditory system evolved to do is not in question.
Now depending upon how you define your terms, homosexuality may not be ‘normative’, but that does not relate to whether or not it is a mental illness. In the same way that a left handed person, or one who does not masturbate may not be normative, it has no bearing on the question of them being mentally ill.
20 Julian Sanchez // Jun 10, 2010 at 2:12 pm
Well, put it this way: If you have a definition of “mental illness” stipulated in sufficient detail, it might well be a strictly empirical question whether depression or protestantism or homosexuality meet that definition. But the concept itself is inherently contestable. Wikipedia gives us this definition:
“A mental disorder or mental illness is a psychological or behavioral pattern associated with distress or disability that occurs in an individual and is not a part of normal development or culture.”
Which patterns are, in practice, disabling in a given society? Which do we regard as “part of normal development or culture”? Which cultural groups are the benchmark for “normal”? Whose distress counts? Some community of practitioners COULD answer those questions such that the best empirical assessment would place homosexuality—or Protestantism—in that category. The question of how to construct the category is not itself a scientific question.
21 William // Jun 10, 2010 at 3:28 pm
Too often we who make comments on internet blogs get bogged down in questions of definition. Ultimately it gets to be like arguing about EXACTLY how many angels can dance on the head of a pin. But since there is sunshine and a cool breeze where I am, being a mentally healthy gay dude, I’m gonna go out and live my life now. I’m now ready to fully agree you: in a world where the entire population of Protestants, southpaws and bloggers MAY (by definition) be judged to be mentally ill, then in that world, perhaps Republicans, straight people, Unitarians (and yes, even gay people) are all also mentally ill. We’re now in full agreement, but I’m not sure our agreement signifies much… Have a good day, and get outside if possible, it does wonders for one’s mental health.
22 Pithlord // Jun 10, 2010 at 3:30 pm
What Julian said.
I curse the academic training that got me to use the word “normative” since it suffers from an ambiguity between “statistically usual” and “evaluative”. When you claim a condition is an illness, you are making a normative claim in the evaluative sense that you are claiming the condition is bad (it might not be unusual).
Of course, there is a consensus that cancer is bad and chicken pox is also bad, although usually not nearly as bad. But that consensus does not derive from any fancy scientific data, and scientists have no particularly privileged position.
Among deaf people, anyway, it is highly controversial that deafness is bad. Everyone agrees it is a physical condition and that it is abnormal in a statistical sense. So is having red hair. Red hair clearly has genetic causes. There are also well-known remedies in the form of hair dye, and I suppose someday there might be medical interventions. Science could tell us more about what causes red hair or deafness, but it just isn’t going to tell us which is a disorder or illness. That’s politics.
The point is that the same politics goes into whether some DSM diagnosis is a disorder. I don’t necessarily disagree that schizophrenia is a disorder/illness, or that depression sometimes is, but I do disagree that scientific data is going to resolve the issue.
This is important conceptually, and it is important so that we don’t delegate our political issues to scientists.
23 Pithlord // Jun 10, 2010 at 9:11 pm
There are at least 2 normative implications when you call a condition an “illness”:
1. It would be better if the condition did not exist.
2. Behaviour associated with the condition is not the “fault” of the person with the condition.
Neither are genuinely scientific questions. The left usually objects to implication 1, while the right objects to implication 2.
24 Adrian Ratnapala // Jun 12, 2010 at 9:43 am
JS says: “Would it be different if we had a general mechanism for identifying sociopaths early and channeling them into socially sanctioned roles? Other than campaign consulting, I mean.”
at http://www.gnxp.com/wp/uncategorized/bad-to-the-bone-the-genes-and-brains-of-psychopaths-2
They say that psychopathy has an observable genetic cause and also that: “The majority of psychopaths are not violent and many do very well in jobs where their personality traits are advantageous and their social tendencies tolerated.”