John McIntyre, whom James Wolcott calls "the Dave Brubeck of the art and craft of copy editing," writes on language, editing, journalism, and other manifestations of human frailty. Comments welcome. Identifying his errors relieves him of the burden of omniscience. Write to jemcintyre@gmail.com, befriend at Facebook, or follow at Twitter: @johnemcintyre. Back 2009-2012 at the original site, http://weblogs.baltimoresun.com/news/mcintyre/blog/ and now at www.baltimoresun.com/news/language-blog/.

Friday, August 21, 2009

How to question authority

For my generation, now so slow to lumber off the stage, a rallying cry was “Question authority.”* It is still a sound principle, and I continue to advocate skepticism; but our current culture of credulity intermingled with skepticism has turned “question authority” into “there is no authority” or an equivalent, “every man his own authority.”

This troubling tangle was on my mind as I read this week Paul McHugh’s Try to Remember: Psychiatry’s Clash Over Meaning, Memory, and Mind (Dana Press, 276 pages, $25). Dr. McHugh, the formidable former head of psychiatry at Johns Hopkins, recounts the ugly “recovered memory” scandal of the 1980s and 1990s** and in the process explores some of the sources of authority in medicine, from which I would like draw some useful principles.

Doctors in particular are figures of authority, and we put our health and our lives in their hands.*** But some practitioners are less skillful, less well-trained, less competent. And there are quacks abroad. Dr. McHugh suggests that a prudent patient would be wise to ask appropriately skeptical questions in seeking a therapist:

What are the credentials? What training has the practitioner had?

Does the practitioner ask you questions and investigate your particular circumstances, or does he or she spring a ready-made theory on you?

What scientific research supports the practitioner’s approach?

What success has the practitioner had? (One of the most alarming elements of the “recovered memory” craze was that the longer patients were in treatment, the worse they got.)

It seems to me that these principles can be extrapolated beyond psychotherapy to larger realms of authority in politics and elsewhere. You should give no one unquestioning allegiance, but you should not disbelieve everything lest you fall into hysteria.**** So ask yourself when people make assertions about health care or other political issues:

What are the credentials? How is this person qualified to make these statements?

Do this person’s explanations fit the circumstances, or have the circumstances been made to fit a predetermined theory?

What evidence is there? What verifiable information is there to support this person’s assertions?

Has this person been right in the past on other issues? What credibility does he or she bring to the issue?

The grimmest and most pessimistic satire of the 18th century suggested that everyone is either a knave or a fool — either a con artist or someone ready to be gulled. If we are to avoid either trap, we have to learn how to sort out which sources of authority are more reliable than others. I apologize for imposing this rambling reflection on you as I try to think through these issues for myself. They are too important to ignore.



*There was once a sign at The Sun’s copy desk, adapted from a bumper sticker, that read, “Question authority. Ask us anything.”


**Some background here to keep from cluttering the main line of argument.

Memory is malleable. The brain is not a simple recording device; our memories are stories we tell ourselves, and the way we tell the stories shapes the memories. They become what we believe to be true. You probably know this from your own experience, say of a childhood memory that you have been harboring for years that turns out to be at variance with what other family members recall.

Some therapists in the 1980s and 1990s, following in the Freudian tradition that current mental difficulties rise from long-buried conflicts of early childhood, used hypnosis, sedation, and persuasion to probe for suppressed memories of trauma. In the course of treatment, they helped patients construct memories of childhood sexual abuse, sometimes including satanic rituals. The practice became a craze, not unlike the hysteria of the Salem witch trials; families were disrupted, and some people went to jail for crimes that were entirely imaginary.

Dr. McHugh was part of a campaign to debunk “recovered memory” therapy, and ultimately court testimony helped to bring it down — including demonstrations that a therapist could implant an entirely false memory in a susceptible patient, who would then be thoroughly convinced that the event had occurred.

His book is not only illuminating about the original scandal, but also refreshingly clear and forthright about the practice of psychiatry in particular and psychotherapy in general. Anyone whose life is troubled and who is seeking help would do well to consult this book.


***My daughter has a relatively mild form of cerebral palsy from a case of bacterial meningitis in the neonatal ward when she was two weeks old. She was two years old when we moved to Baltimore and my wife and I took her to see a specialist at Johns Hopkins. After a forty-five-minute examination, the specialist pronounced that she was intellectually disabled as well as physically disabled, and recommended treatment accordingly. Fortunately, her pediatrician subsequently cautioned us not to credit that diagnosis but to trust more in our own judgment.

Alice graduated from Swarthmore in 2006 with an honors degree in Latin and Greek.


****Hysteria in medical terms, Dr. McHugh explains, is “a mimicry of disability resting on self-deception and responsive to persuasion.” That is, patients with hysteria display symptoms for which there is no physical cause and believe fixedly that their maladies are real. They are persuaded, sometimes by association with people who are genuinely ill, that they are diseased. There is also a social form of hysteria, exemplified by the Salem witch hunts, in which the public was persuaded by the assent of authority — the clergy — that the spiritual and physical threats from harmless old women were real. It is not difficult these days to find figures of some authority who will give their assent to paranoid suspicion.



6 comments:

  1. One of my favorite one-liners:

    "Do you have to actually belong to the Question Authority to be allowed to wear one of those buttons?"

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  2. Just a minor note: Your third footnote appears to be orphaned.

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  3. I would love to ask my doctor those questions but I am rarely given enough time to get my primary reason for coming in diagnosed and maybe answered. My barber is the only licensed professional who has her or his credentials on display. Doctors keep theirs on display in their offices, which mere patients never get to see. I can do some checking on the internet but I already know how much I can believe on the internet - A Medial Diploma with the Johns Hopkins (or other school) seal on it I will believe, any other listing is suspect.

    Retired in Elkridge

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  4. Diagnosis relies on knowledge, observation, and intuition. Doctors have to memorize a lot of information, which favors people people who can store and spew back a lot of information -- better doctors analyze and process that information when they use, and they also add to it continuously so they aren't making decisions based on obsolete information.

    Barbara Phillips Long

    Doctors who can't observe symptoms through examination, conversation and questioning are hampered by incomplete information when deciding on a diagnosis.

    Intuition pulls it all together, and I think the best diagnosticians are those who are always looking for a new angle -- questioning authority, if you will.

    During the evening news tonight, there was a feature on seeing eye dogs. A handler was saying seeing eye dogs aren't trained, because then whenever they were in a particular situation, the dog would always react the same way. Seeing eye dogs have to learn to do what their owner or handler wants them to do, except when the dog shouldn't because the owner would be endangered.

    Right now public schools are training students because we want to be certian they all have the reading and math skills they will need. I've come to believe that some level of testing is needed to make sure their teachers make sure they attain these skills. We need to figure out how to teach observation and problem-solving to help round out skills so people can evaluate political claims, work as physicians, or pursue other careers.

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  5. Patricia the TerseAugust 22, 2009 at 1:16 AM

    The 1970s psychiatrist Dr Frederick Perls (he of the Esalen Institutes in nutty,fruity California) once quoted a German analyst whose name escapes me, but I like the story: Memory and pride were arguing one day. Memory said,"It was like this." Pride said,"It couldn't have been." Pride won. Perls was more than slightly and fashionably wacko, but occasionally he hit "the old crumpet right on the head." (To quote Lord Peter Wimsey.)

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  6. Comedians are the new authority figures. Audiences laugh at their routines as surely and subservantly as office suckups laugh at their bosses' every joke. The material doesn't have to be funny to draw laughs. It doesn't have to be relevant to anything. It certainly doesn't have to follow a train of thought. Next thing you know, a comedian will become a U.S. senator, a late-night TV host will move to prime time. To defy authority today, you have to not laugh. Of course if you don't laugh you might cry.

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