December 15, 2011
Two weeks ago, the CFI On Campus Course of Reason blog posted a piece that I wrote in response to JT Eberhard’s Skepticon 4 talk titled “Why the Skeptic Community Must Concern Itself with Mental Illness.” My post caused quite a reaction for some people in the skeptic/atheist community; most of the reactions were not positive.
I have spent the better portion of the following week trying to decide the direction I wanted to take my second blog post. Did I want to address criticisms made in posts written by Sarah Moglia and Kay Abshire? Did I just want to reiterate and restate my original reasons for writing my first blog post? Or did I even want to write a second blog post? Would it really do anyone any good to read? Would it change the mind of anyone who read my first post and reacted negatively? Ultimately I decided that not writing a followup post would only serve to promulgate the idea that the skeptic community should take on the subject of mental disorders. I am writing this post with the sincere hope that at least some readers will put politics aside and focus on what is really at stake if the skeptic community decides to take on the subject of mental illness.
I am coming from the perspective of someone who has not only experienced depression and an eating disorder but who also has recovered from these disorders. That’s not to say that I don’t still struggle with mood and food issues; I mean to say that these things are no longer life-threatening or as much of a major concern for me as they used to be. I have spent literally several hundred hours with other people (mainly women) who are going through or have gone through the struggles of an eating disorder along with a mood disorder of some sort. I did not write my previous post with a lack of sympathy or a sense of flippancy. I was writing as someone who knows what it’s like to live with a mental disorder coming both from my perspective and the perspective of other women who struggle with these issues on a daily basis. To those people who said to just ignore my previous post, I ask: Would you say the same thing to someone who is struggling? Would you say the same thing to someone who is trying to give you information from the perspective of someone in recovery? I guess I am confused as to who the audience of JT’s talk is. Is his audience people who have been diagnosed with a mental illness? Is it people who are misinformed about mental disorders? Is it people who have loved ones struggling with mental illness? I suppose I am just not sure where I fit, if at all, into his audience. It makes no sense to me why a blog reader would dismiss offhand the perspective of someone who has lived with the diagnosis of a mental disorder for 15 years and has come out on the other side for the better.
In order to better explain what I wanted to communicate in my last post, I would like to address some of the arguments that have been brought up in other people’s blog posts regarding my original post. Specifically, I will be addressing two of the formal blog post responses to my own: Kay Abshire’s, and Sarah Moglia’s. While I will try to confine my remarks to the substance of the disagreements, it should be noted that both Abshire’s and Moglia’s replies seem to me to be insolent and condescending, implying that they either believe a sincere dissenter is not owed basic civility, or that I am not sincere. Either approach can only hurt discourse on the topic. I am aware that Ed Brayton has also written a response to my original blog post; however, I feel that he echoed the sentiments of Moglia and Abshire, so quoting from his post would be redundant.
A Priori Priorities
I previously summarized JT’s speech by writing that the overall theme “was that the atheist/skeptic community needs to move on from disproving religious claims and instead needs to help teach to the world that mental illness is not something to dismiss or take lightly.”
Kay Abshire responds to my statement with the following: “Nowhere did he ever say or imply that the skeptical/atheist movements should abandon arguing against supernatural claims. I have no idea where she pulled this assertion from, but it certainly wasn’t from JT’s Skepticon IV talk.” Moglia meanwhile said, “So at what point does he say we no longer need to work on disproving religious claims? To me, it seems like he’s saying we could work on more than one thing at a time? Woah, dude. Crazy concept.”
So, where did I get the notion that JT thinks the skeptic community needs to move on from disproving religious claims? JT said in his talk: “Our movement is evolving. The way we approach things is changing. And to come in here and do a talk about how to beat a bunch of religious arguments isn’t something we really need anymore.” It may be that JT’s fans or people who have been to many conferences understood JT’s remarks in the way that Abshire and Moglia did. What about those who aren’t in that group? They were told that “[discussion of religious arguments] isn’t something we really need anymore.” Note the lack of context in that statement. He didn’t say that this “isn’t something we should exclusively focus on,” nor did he say it “isn’t something I need to always harp on;” he just said that such a discussion isn’t needed. I merely want it to be considered that JT might be focusing on his own personal interests too much with regards to what issues the skeptic community should or should not address.
Both Abshire and Moglia take exception to my observation that JT’s talk implied that SSRI drugs are always paramount in treating disorders. Abshire does so rather colorfully: “In making her next point, [Gina] seems to have blacked out during the talk at some point…Eberhard mentioned his therapist and seeking therapy multiple times.” Moglia echoes this sentiment by saying, “he also talk [sic] about his therapy and going to a therapist.” You might expect two people intent on correcting someone’s misapprehension to fact-check the source, but it seems neither did so. Here are all of the references JT makes to either SSRIs/drugs or to therapy/therapists (emphasis mine):
- “Amber put the pill in my hand told me to take it…I was a little fuzzy taking SSRIs...I stopped taking them.”
- “Everyday there was one [pill] right by my computer, and things got better.”
- “Serotonin deficiency in your brain is like an insulin deficiency in your body, and when I stopped taking my pills, I was failing to manage it.”
- “When I was at the bottom and I couldn’t leave my room, I didn’t want to work on anything…My SSRIs fixed that, and it’s the first thing that gets fixed. All of a sudden, you get your motivation back.”
- “The threat to kill yourself is always there, and it gets better after the first few weeks [of medication] when the depression gets fixed.”
- “I want to talk about one particular myth of treatment before I get off the stage, and that myth in particular is that taking these medications for depression…what have you, will make you kill yourself.”
- “SSRIs fix different aspects of your personality in time.”
- “Why do these meds work? The drugs I’m on, why do they work?”
- “I could hear my therapist’s voice in the back of my head say ‘stop’.”
That is the only time that he used the word therapy or therapist in his talk. He said nothing about the importance of therapy in a presentation about mental illness. Issues like these are generally not easily fixed with medication alone. It can take the combination of drugs and therapy in order to even begin to combat this stuff. Even if it was JT’s experience that drugs were incredibly helpful for him, it is irresponsible for him to imply that this is a general truth about treatment. His statement that “it gets better after the first few weeks when the depression gets fixed” is fallacious. It is hardly critical thinking which would lead us to tell people, mentally ill or otherwise, that pills “fix” depression, let alone imply that the length of treatment is merely a few weeks. JT may not have meant to include this bias, but that does not change the fact of it.
Questions of Authority
In my previous post, I objected to JT’s disregard for accepted standards of subject matter authority, stating, “I don’t think it’s okay just to pick a topic simply because you believe it should be focused on.” We should expect that our skeptical presenters have standing in a subject matter when making unreferenced statements that could be taken as authoritative or prescriptive. Here, too, we see Abshire’s disagreement: “Really? Are you fucking serious? So why not jump on Hemant for talking about math education, since he’s a math teacher? Or Jamila Bey for addressing the hurtles [sic] faced specifically by black communities? Or PZ for tackling creationism?” Moglia, again, reacts similarly: “Well, shame on him for speaking from experience! In that case, PZ shouldn’t have talked about science education…Why does he get to decide what topic to give?! I mean, it’s just his speech!”
Because we have standards of standing. Jen McCreight can talk authoritatively about genetics because she studies genetics. Hemant has a degree in math education; he has been trained to teach math. Jamila Bey does not pretend to be a sociologist when she speaks. She talks about her experiences and draws conclusions which follow from them. PZ Myers has a degree in biology; he has been trained to teach biology and has the credibility and knowledge needed in order to debate creationists from a position of standing. JT doesn’t have a degree in psychology. He isn’t trained as a clinical psychologist. If he wants to give a talk on what it’s like living with a mental illness, I don’t have a problem with that. But his talk specifically addressed the fact that the skeptic community must take on the issue of mental illness, and he didn’t mention any names regarding who is or should be leading this discussion. So in my mind, that leaves one person leading this discussion: JT. Why? Because he didn’t mention anything about this issue that’s already being discussed in the skeptic community, and he didn’t mention anyone else he had in mind regarding who could lead the discussion regarding mental illness.
Are we the 25%?
Both Moglia and Abshire reference the National Institute of Mental Health (NIMH) regarding the validity of JT’s statement about the prevalence of mental illnesses. Here is what JT said towards the beginning of his talk: “The most recent statistics tell us that either 22 or 23% of Americans have a mental disorder of some kind.” JT didn’t cite the source of this statistic, so I pointed out that JT was his own source. This is peculiar in a talk from a non-expert calling for skepticism. Did JT get his data from the NIMH? Perhaps. Does that change the fact that a non-authority tossing out un-cited health statistics while some of his friends produce post-hoc justifications later isn’t a sterling example of skepticism? No. Furthermore, such a statistic labeled as “Americans with a mental disorder” is an extremely broad group covering everything from an anxiety disorder to schizophrenia to alcoholism. These have widely divergent causes, levels of severity, treatments, etc., many which have little or nothing to do with SSRIs or the struggles JT described. Following such broad declarations with what could easily be understood as prescriptive or suggestive statements is also not responsible or well-conceived.
I wrote that JT is hypocritical to respond to believers as if their beliefs arise in some sort of vacuum while asking for compassion for those with other kinds of harmful beliefs on the basis that they don’t.
Abshire responds to my statement by saying: “Not quite. Religious belief is voluntary, based on the acceptance of supernatural claims made by others. Mental disorders are not rooted in irrational beliefs; irrational beliefs are often the sign of a mental disorder. They are a symptom, not the cause.”
Moglia echoes: “It’s not a choice to have a mental disorder. It is a choice to believe in religious dogma. The fact that you even compared those two things is appalling to me…Mental disorders are not founded on un-provable beliefs and thoughts. They’re founded on biological, environmental, and psychological factors. As someone who is a psychology student, the author of this blog should have known better than to make such a poor argument.”
A plethora of research has been done regarding the psychological component of depression, “un-provable beliefs and thoughts” notwithstanding. One of the psychological components of depression is the high occurrence of negative thoughts (Borton & Casey, 2006). Negative thoughts occur frequently in an individual diagnosed with depression (Peden, Hall, Rayens,& Beebe, 2000). Negative thoughts are easier to access than positive thoughts because negative thoughts have more associations in the brain of people diagnosed with depression (Beevers, Wenzlaff, Hayes, & Scott, 1999). (I provide the full references at the end of this post for those interested.)
The ready accessibility to negative thoughts contributes a great deal to depression. Moglia said herself that “mental disorders are founded on…psychological factors.” One of those psychological factors is the presence of negative thoughts. To discredit them is to remove a large piece of the puzzle regarding depression. The biological causes of depression do not explain depression in full.
Religious belief also does not spontaneously materialize in brains. It usually results in part from powerful experiences beyond an individual’s control such as instruction from a loved and trusted parent. It’s impacted by the socio-emotional landscape a person lives in. It may be fed by a very human need to feel loved, to feel special, and to have a meaningful existence. Deficiencies of ego, depression, substance abuse, negative life events, and other psychologically important elements can all influence a person’s acceptance of religious beliefs. Why is it that when psychological, physiological, and social factors lead to irrational feelings of depression we should employ empathy, but when they lead to irrational feelings of spiritual connection or knowledge we should employ aggression? Is this the compassion JT, Moglia, or Abshire are recommending? Is this the fruit of their “skeptical” approach?
The reason I believe that the skeptic community should not take on the issue of mental illness is that the subject matter is not one to be taken lightly—it can include life-threatening conditions. Misinformation or basing opinions only on one person’s experience could result in giving potentially fatal advice to someone, and it is easy to think that we are stating facts when we recite something that we have heard as a truth but do not have the medical knowledge to evaluate. In his talk, JT stated that depression is (at least partly) the result of a serotonin deficiency in the brain (see SSRI section of this post for the full statement). Unfortunately, this statement is incorrect. Dr. Steven Novella (co-host of “The Skeptic’s Guide to the Universe” podcast) gave a talk at TAM 9 about depression and the low serotonin myth. Unfortunately, I could not locate a link to his talk online, but I will provide the reader with some studies that researchers have done on the subject. A 2008 meta-analysis of 35 studies determined SSRIs (drugs which increase serotonin availability in the brain) were no better than placebo in all but the most extreme cases of depression (Kirsch et al., 2008). More recently, a meta-analysis by Fournier et al. (2010) reaffirmed this finding by concluding that SSRIs have little to no benefit when compared to placebo for people diagnosed with mild to moderate depression. The scope of the subject is beyond the purpose of this post, but a good place to begin to learn more about this is to Google the search term “serotonin myth.”
If JT wants to create a support community for people who struggle with mental illness, that would be great. If he wants to use skepticism to disprove specific myths about mental illness, then I think he should narrow his focus, cite and use only reputable sources, and avoid making broad statements about medicine. Calling a whole movement of people to address complex and widely varied diagnoses and medical topics may cause more harm than good.
Beevers, C. G., Wenzlaff, R. M., Hayes, A. M., & Scott, W. D. (1999). Depression and the ironic effects of thought suppression: Therapeutic strategies for improving mental control. Clinical Psychology: Science and Practice, 6, 133-148.
Borton, J. L. S., & Casey, E. C. (2006). Suppression of negative self-referent thoughts: A field study. Self and Identity, 5, 230-246.
Fournier, J. C., DeRubeis, R. J., Hollon, S. D., Dimidjian, S., Amsterdam, J. D., Shelton, R. C., et al. (2010). Antidepressant drug effects and depression severity: A patient-level meta-analysis. JAMA - Journal of the American Medical Association, 303, 47-53.
Kirsch, I., Deacon, B. J., Huedo-Medina, T. B., Scoboria, A., Moore, T. J., & Johnson, B. T. (2008). Initial severity and antidepressant benefits: A meta-analysis of data submitted to the food and drug administration. PLoS Medicine, 5, 0260-0268.
Peden, A. R., Hall, L. A., Rayens, M. K., & Beebe, L. L. (2000). Reducing negative thinking and depressive symptoms in college women. Journal of Nursing Scholarship, 32, 145-151.
About the Author: Gina Colaianni
Gina Colaianni is a senior psychology undergraduate student at Kennesaw State University in Kennesaw, Georgia. When she isn't pondering the existential crises taking place in the world today, she can be found reading, attending secular and skeptic meetups, or working towards her goal of attending graduate school through the process of blogging about her personal failures, successes, and shortcomings.
#1 mike (Guest) on Saturday December 24, 2011 at 7:27pm
As a fan of JT's and someone in general agreement with the sentiment he was expresses, I thought this response was fantastic. Excellently stated. Thanks for writing it.
I like to think JT would actually agree with you on several of the points. He was clearly speaking from a very personal perspective and I never got the impression he was claiming professional authority on the topic (though I can see how others might see his presentation differently,) so I took it mostly as an opinion piece. I think you got him (and Abshire and Moglia) pretty good on the question of choosing one's belief. He'd have to come down on one side or the other of that, rather than splitting the difference.
I'm curious as to what, if anything, he would actually disagree with you on, though. Presumably the whole "serotonin myth" question. I've heard both sides of that discussion and haven't come to a conclusion myself.