Obsessively Yours

Exploring the social and cultural roots of personality and its disorders.

Obsession: A History

Can non-scientists comment on obsessive compulsive disorder?

I've been generally happy with the reviews of my new book Obsession: A History but a recent one requires a response. Dag Agins in The Huffington Post writes that when someone tries to cross the line between science and the humanities, that person ends up pleasing neither side of the divide. He particularly criticized my effort to show a continuity between obsession in the culture at large and obsession in a person. Agins tells us that we must never blur the clinical with the cultural and he ratifies the idea that diagnoses have to be somewhat rigid to clearly demarcate the pathology from the sociology. Yet, he ends up making contradictory remarks about diagnoses, saying that they are just labels and strategies, but then asserts that they are necessary.

I want to respond to his objections. There has for too long been the feeling that only people "in" the sciences can critique the sciences. This is a strange point to make since science prides itself on being an unbiased search for truth with all parties allowed to make inquiries and subject results to strict oversight. The objection that only scientists are allowed to criticize scientists is therefore a violation of the claim to objective truth. In fact, the role of the humanities is not simply to provide novels and poetry for doctors to read, but to teach and explore the use of language, the logic of an argument, and necessary grounds for rhetorical persuasion. No one disputes that the data are the data, but interpretation always intervenes between data collection and scientific conclusions.

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So we need to look at Agins's language and reasoning itself: "...psychiatric categories are merely labels for clusters of symptoms, but it's also true that psychiatric categories of some kind are absolutely necessary in the clinic as a guide for what sort of behavior to expect from a patient. A psychiatric label is simply a practical device to assist in treatment." The summarization of his own data here isn't even logical. If diagnoses are "merely labels for clusters of symptoms," or "practical devices", then how can they be "necessary" in any scientific or rigorous way? If we said that "electrons" or "super novas" are only labels or devices, we would no longer be in the realm of science. If we are to examine such a cluster of symptoms as if it were a real thing, as we might in analyzing the neurochemistry or brain structure of people with OCD, then shouldn't we have a stronger sense that a diagnosis described a real thing rather than a cluster of symptoms?

Agins goes on to explain that although there isn't very good science now to explain what OCD is or how it works, nevertheless "people who are distressed by psychiatric symptoms do want and need treatment" and therefore "diagnostics and treatment must be constrained by pragmatism, by what seems to work." So in the end, Agins is saying in effect, "OK, we don't know what causes OCD or how the brain works in this disorder, but we have to do something since people come to us for help, and so we are forced to invent diagnoses that aren't proven by any rigorous system so that we can try treatments that ‘seem' to work." But the reality in OCD is that not only is there no diagnostic rigor but there are poor outcomes for patients who face a lifelong battle with the disorder. The best controlled statistics show that a third of patients get better, a third get worse, and a third remain the same. Anecdotal evidence is much more enthusiastic on the part of practitioners, as one would assume it would be with many websites for clinics claiming, without any controlled evidence, that their success rates are close to 70 per cent. Is that science?

Just because clincians are in the trenches doesn't mean they have the clearest view of what they do. Sometimes an educated observer from outside the specific profession can fly over the battlefield and get a better sense of the lay of the land. In fact, scientists are very good at one thing, detailing the increasingly narrow and specific mechanisms they study. What science isn't very good at, and where it needs people from the humanities-historians and sociologists of science, is in articulating the big picture and making logical claims about the implications of their particular discoveries.

Don't be fooled when a scientist tells you to keep out of his backyard. It's not done in the interest of science. It's done to protect the backyard.

Lennard J. Davis is professor of disability studies, medical education, and English literature at the University of Illinois at Chicago, and the author of Obsession: A History.

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