May 2001 -- [BOOK REVIEW]: PC, M.D.: How Political Correctness is Corrupting Medicine. By Sally Satel (New York: Basic Books, 2000. 256 pp. $27.00).
Postmodernism is the most recent incarnation and the now-reigning cult of the "anti-Enlightenment," having arisen largely from the ravings of Jacques Derrida and Michel Foucault. In Foucault's view, especially, the world is a victim-ridden place where the powerful impose their cultural values and even their thought patterns on the "disenfranchised." It is a world of the reptilian brain, where jockeying for power, status, and "domination" serve as the premier social activities. The postmoderns view all human problems through the prism of this struggle for domination and its resulting imbalances in power. And their remedy for those problems is a radical rejection of objectivity, the embrace of subjectivism, and, what is most important to them (andnever omitted), a redistribution of power—which in practice means giving political power to the self-anointed advocates of the disenfranchised.
In PC, M.D., Sally Satel (a psychiatrist practicing in Washington, D.C., and a fellow at the American Enterprise Institute) has written an incisive exposé of the dangers threatening clinical medicine from intellectual infection by postmodernist dogma. Taken on the "Horror File" level, Satel's book is a good read, but one quickly senses the emptiness and monotonous predictability of the medical postmoderns. Fortunately, Satel goes beyond the manifest silliness to show us the real dangers that medical ideologues pose to patients when their prescriptions are taken seriously in such diverse fields as public health, psychiatry, and nursing practice.
The schools of public health are the institutions tied most closely to the postmodern university, and community health was the first target of these ideas. In the postmodern conception, community health is like a pie—if some have more, then the rest of the community must have less. Some people are sick, because others are healthy. In this way, treating disease is transformed into a social imperative: redistribute health by redistributing wealth. No wonder a former dean of the Harvard School of Public Health described his institution as a "school of justice."
Postmodern public health theory supports this looniness with an idea known as the "social production" of disease. "Society," it seems, is the real source of disease, not the natural causes we have foolishly sought since the days of Hippocrates. So: redistribute power to "victim groups," and disease as we know it will disappear. After all, differences in disease incidence among social or ethnic groups are due not to factors amenable to scientific investigation, such as genetic predisposition or diet, but to ideological causes, such as the "stress of oppression," material disadvantage, and "lack of access" to health care.
"Oppression," of course, is one of those elastic, demagogic words that can be drafted into service for any power-lusting cause. In this case, P.C. propaganda takes the higher incidence of hypertension among blacks than among whites—a well-known phenomenon—and twists it into a tale of racial oppression and domination. The claim is that the higher incidence of hypertension is due to the "stress" of racial oppression. There is no evidence for that whatsoever. Ever since Hans Selye wrote his famous book on the physiology of stress in the mid-1950s, determining the role that stress plays in disease has been an elusive goal, and even after forty years no definitive answer has been found. Moreover, even if there were some stress unique to "oppression," the social-productionists have certainly not found it by engaging in those dominating, patriarchal, penetrative activities such as defining or studying it.
Satel also makes short work of the "material disadvantage" and "lack of access" arguments. She cites the "Mexican-American baby paradox," which raises serious questions about this whole line of argument. In brief, Mexican-American women often lack health insurance, live in impoverished circumstances, and have minimal-to-no prenatal care, yet they still have robust babies with an infant mortality rate the same as whites: six deaths per thousand births (versus nine per thousand for American Indians and fourteen per thousand for blacks). Intact family-structures, personal responsibility, and avoidance of drugs during pregnancy may help explain this, but postmodernist assertions of power imbalance clarify nothing.
The best chapter in the book, "Inmates Take Over the Asylum," concerns Satel's field of psychiatry. Here, she enters the Marat/Sade world of advocates for "abused survivors of psychiatry." Cloaked in the banal rhetoric of "caring," activists (usually former psychiatric patients) argue that patients who have undergone psychiatric treatment, especially institutional treatment, are victims of "abuse" and "labeling" by white, male, dominating psychiatrists, They further maintain that only former "victims of psychiatry" can treat other victims. A real psychiatrist is too much part of the power structure to be trusted. Former patients thus lead their "survivor groups" in endless talkfests about victimhood and psychiatric abuse. The formerly "abused" leaders of such activities are not schizophrenics who hear voices, but high-functioning individuals who (perhaps after a brief period of psychotherapy) have latched onto this victimhood ideology. These people have it together enough to proselytize, lobby politicians, hassle hospitals, and raise money, though they are too ill to hold a job. Others in these "therapy" groups, however, are indeed ill and need professional care. Yet they are kept from competent care by fanatic ideologues who exercise control over them by threat of expulsion from the group that frequently has become these sad souls' only home. (And this, naturally, is not considered "domination.")
These true believers work to "liberate" psychiatric patients both from treatment (frequently by legal means), and from the identity of their disorders. They get court orders to remove patients from psychiatric care, even patients desperately needing care, for example totally deranged schizophrenics who have little comprehension of what is going on around them. In the view of the true believers, such people are not ill; they have just been "labeled" as such by the psychiatric power establishment. To them, even the fact that a man murders on instructions from his dog is no evidence that psychiatry is not just a labeling game conducted on patients that are "imprisoned" victims.
Frequently, P.C. advocates deny the identity of these disorders by seizing upon the phrase "the myth of mental illness," which was the title of a famous book by Thomas Szasz. For the record, Szasz's book was a thoughtful if iconoclastic argument probing the mind-brain issue and criticizing the use of the so-called "medical model" in psychiatric disorders. Today, victim advocates use Szasz's phrase about mental-illness-as-myth to deny the existence of any mental pathology whatsoever, which was not Szasz's view. Szasz himself left that door open through problems in his account of clinical entities such as schizophrenia, which is clearly more than just a "labeling" issue. To be sure, Szasz was a great crusader against abuses by his own profession, such as the often-questionable use of compulsory hospitalization, which is also a target of the postmoderns And because Satel does not give a guiding principle to clarify the proper use of involuntary treatment, she fails to answer Szasz's legitimate concerns here. For this reason her arguments against the postmoderns lack bite on precisely this point.
We should note, too, that (unlike Szasz) the P.C. crowd is only too happy to use labeling when it suits their ideology, as in the case of pitcher John Rocker, whose ill-advised remarks were considered prima facie evidence of his need for psychological counseling, echoing Harvard psychiatrist Alvin Poussaint's claim that racism is a form of mental illness.
Satel's little shop of horrors offers more of the same when she turns to the postmodernists' invasion of the nursing profession. Journal articles with titles like "Nursing the Postmodern Body" and "Global Migration and Health—Ecofeminist Perspectives" exemplify the bona fides of this movement. Satel's account of "treatments" like "therapeutic touch," pushed by some nursing groups in opposition to the medical "patriarchy," shows the completely bogus quality of "postmodern nursing." In this technique, the practitioner waves his hands over a patient to re-align the "distorted energy" fields, which are purportedly the cause of the patient's illness. Of course, no evidence at all is advanced for this. Theatrical self-indulgence masquerading as therapy is quackery, pure and simple.
The "breast cancer awareness" project was a laudable undertaking to make women more aware of this illness and to take actions, like breast self-examination, that could help in early detection. Predictably, radical feminists who claimed that women are short-changed in both medical research and treatment by a male-dominated medical establishment hijacked it for a "women-as-victims" dog-and-pony show. Satel shows that their exaggerated claims are essentially groundless and that women are in fact the subjects of both research and drug trials at a slightly higher rate than men.
Satel's weakest chapter concerns the controversy surrounding a South Carolina law that imposed charges of child-abuse, and potentially jail time, on women who used illegal drugs during the last trimester of pregnancy. In the cities, these were predominantly black women using crack cocaine. The postmoderns fought this law with the usual rhetoric of racism (though the law was also enforced on rural white women using marijuana), addicts-as-victims, and so forth. But the postmoderns played only a bit part The big player here was the conservative (!) nanny-state. Holding that a viable fetus had the same rights as a live child, South Carolina officials, in their search for drug and (now) alcohol "abusers," proceeded to initiate a "protocol" increasing state power to regulate every imaginable clinical setting involving pregnant women. At that time, the major news outlets were awash in ominous stories of "crack babies" and the health crisis they portended, giving some plausibility to the law. Though these children are not problem-free, follow-up studies revealed that they were no more developmentally impaired than babies whose pregnant mothers drank or smoked tobacco or even smoked marijuana, for that matter, though Satel does not allude to this last awkward possibility.
Satel acknowledges these studies but then segues from a moral argument against (presumably) actual, in-womb child abuse to a utilitarian case for preventing child abuse, as ordinarily understood. Using the obvious fact that drug-abusing women often do not make good mothers, Satel attempts to argue that drug abuse virtually guarantees child abuse (presumably even the "abuse" of Mom being too stoned to put the TV dinners in the microwave) in order to justify keeping a government hand in child rearing— along with the control over others' behavior this would entail. Clearly the problem here is not postmodernism but rather the William Bennett-type conservatives' addiction to minding other people's business. Despite all the evidence that it is futile to attempt to legislate responsible personal conduct, these conservatives appear oblivious to (or are unconcerned by) the collateral loss of individual liberty and increase in government power that is the curse of their failing "war against drugs."
The postmoderns predictably climb on board when the racial-grievance establishment alleges racial bias in the health-care system, repeating the usual cant of pervasive racism conspiring at all levels to deny, or give substandard, care to blacks. In the postmod-ern view, whenever self-proclaimed leaders of blacks or any other politically favored group contrive a grievance in line with the P.C. ideology, that group then deserves special treatment and attention to its unique experience of victimhood. The solutions for this are "multicultural counseling" and "psychotherapy for victims," both of which are as bad as they sound. They consist of denying individuality in the name of race or sex or ethnicity or "name a group." In the view of groups pushing this foolishness, only a black or female or once-abused "therapist" can adequately nurture other members of the tribe. This reveals the profound anti-individualism of the postmoderns. They assume that all members of any of the congeries of "victim groups" have had the same experiences, the same reactions to those experiences, and the politically correct responses of rage and sense of entitlement. Dissenters are excoriated for not being "authentically" black or female or whatever. (Look at the scorn poured onto non-conformists like Thomas Sowell or Clarence Thomas.) These postmoderns reduce the variety of human experience to a few, grindingly dull options—or to none at all. This embrace of the collective brain assures that group membership determines both thought patterns and behavior. In terms of stereotyping, no neo-Nazi or Klan member could put this vile case any better.
This book shows several things about the P.C. practitioners: 1. Their knowledge of medicine is far below their pretensions. 2. Facts are irrelevant to them. 3. Concern for the results of their ideology on patients is nil. And 4. Politics is their real driving motive. Satel provides a telling example of this last item. At a conference on AIDS, Satel wrote down the comments of one Sally Zierler of the Brown University Department of Community Health, who advocated the following steps (believe it or not) to curb the AIDS epidemic: "limit the power of corporations, cap salaries of CEOs, eliminate corporate subsidies, prohibit corporate contributions to politicians, and strengthen labor unions." Whatever else they say or however else they justify themselves, the postmoderns always wind up prostrate before the altar of their fallen Moloch—socialism. The motive for this is certainly psychological. It gives them a sense of what Thomas Sowell called "differential moral rectitude"'—a posture that, in their own eyes, exalts them above the "less caring" and puts them in the community of the left-wing "anointed."
The notion that such a pose might give someone "moral rectitude" could be justified only by altruism. As Ayn Rand wrote: "Altruism declares that any action taken for the benefit of others is good, and any action taken for one's own benefit is evil. Thus the beneficiary of an action is the only criterion of moral value—and so long as that beneficiary is anybody other than oneself, anything goes." With this "beneficiary" standard of morality, there must be a permanent class of suffering victims held hostage to the need of the postmoderns to win their certification of "differential moral rectitude." Once they get this stamp, as Rand says, "anything goes"—as we have seen.
The most appealing aspect of Satel's book is her emphasis on individual responsibility and autonomy, the touchstones of a good psychiatrist. She shows both the anti-individualism of the postmoderns and (though she does not identify it as such) the key moral argument to be made against them. That argument is (again quoting Rand): "One of the worst indictments of altruism [is that it] permits no concept of a self- respecting, self-supporting man." Human beings are individuals and deserve to be treated as such, especially by those who undertake to help them. They are not to be dumped into some trendy ideological category where individuality is lost in a mass of helpless, indistinguishable "victims." The focus on victimhood becomes a black hole of anger and grievance from which no autonomous individual can ever emerge.
PC, M.D. is a useful work for anyone likely to encounter the movement it describes. Intellectually, that movement is lightweight, despite its philosophic hubris. Being lightweight, however, is no guarantee of failure, especially if there is no answer at hand. Satel provides the answer. What clearly emerges from her account is that the most effective way to counter these advocates' claims is to press them for proof, for the empirical studies that justify their claims. There will be none. All one will get will be anecdotal, non-peer-reviewed propaganda statements or irate refusals to bow to the dominant racist, etc., etc., establishment. It is more important, though, to puncture their moral pretensions. One must identify the fact that postmodern medicine is producing, not autonomous human beings, but chronically disturbed and dependent people, many on a path of self- destruction, whose only role in life is to be puppets in some psychodrama of moral self-exaltation by postmodern practitioners.
The good news about this whole trend is that reality will have the last word, as it usually does. In the field of health, Americans apparently still hold to the nineteenth-century idea of progress. Since the early 1950s, there has been continuous and dramatic progress against all forms of disease, and Americans expect this to continue. If, and to the extent that, any of these P.C. prescriptions are adopted in earnest, the appalling results will be so close to the perceptual level that everyone will be able to see them. The foolishness will be exposed for what it is and collapse. P.C. medicine will then retire to the shadows, along with voodoo, phrenology, and bleeding, where it belongs. All we need to do is keep our intellectual powder dry and wait. For those who have to go head to head with these people, keep Satel's book in hand.
James Lee Brooks is a retired anesthesiologist living in Orlando, Florida.May 2001 -- [BOOK REVIEW]:PC, M.D.: How Political Correctness is Corrupting Medicine. By Sally Satel (New York: Basic Books, 2000. 256 pp. $27.00).
This article was originally published in the May 2001 issue of Navigator magazine, The Atlas Society precursor to The New Individualist.