Is it all relative?

The dangers of relativism in psychiatry

Posted Oct 02, 2008

This CrossTalk debate began with differing responses to the involvement of some psychiatrists with the pharmaceutical industry, some of whom are now under congressional investigation. Larry Diller saw those persons, and their ideas, as mere shills for the pharmaceutical industry. I argued that this approach is one-sided and simplistic. I disagree with some (but not all) of their ideas, on the grounds of their ideas, not because they are corrupt people (which may or may not be the case). I argued that this approach - that money and power is all there is to it - is conceptually unsound and practically dangerous.

After two rounds of posts, Larry and I seem to be moving closer to each other, though not without some continuing differences. After this third round, we might stop, or perhaps there should be a final coda.

To provide the conclusion before the premises, my view is this:  Let's criticize the pharmaceutical industry, let's clean up and reform medicine - yes - but let's examine our own philosophical assumptions, and realize that relativism is a dangerous and slippery slope. We can reject dogmatism, and recognize the historical and social embeddedness of ideas (which Marx showed so well so long ago), while also remaining respectful of ideas on their own merits.

Back to the rationale for this conclusion:

In my last post, I explained some of the philosophical background for my critique, providing sources, including George Orwell, who saw relativist thinking as being at the root of totalitarianism. Larry takes me to task for using the "third rail" of fascism in debate. He is right that many people do so; Orwell often and repeated highlighted this problem. But I was not making the connection between relativism and Nazism: Orwell did. (And so did others: see Walter Lippman's 1945 book The Public Philosophy, another connection of the rejection of Enlightenment commitments to the rise of fascism). It is legitimate and justifiable to make this connection when citing primary sources contemporary to that era (Orwell risked his life taking up arms in Spain in his fight against the fascism he denounced), as opposed to making retrospective rhetorical use of that horrible era for contemporary unrelated matters. Larry implies I did the latter, which is not the case.

Making much of this issue is itself one of  the stigmata of the disease of postmodern relativism: content is interpreted as rhetoric, and instead of engaging with the content of ideas, their murky (usually monetary) intentions are divined.

Engaging with the content of his post, I would agree that one can claim relativist beliefs and not be a nihilist, but only despite one's relativism. Without the Enlightenment commitment to truth, postmodern relativism logically leads to nihilism, as Nietzsche showed. If Larry or anyone else claims to be relativist, but still claims to believe in something, then they need to explain the basis for their beliefs. If it is simply power or money or convenience, those beliefs are not likely to be intellectually convincing to anyone else.

In a way postmodernist relativism founders on itself: Larry argues that the pharmaceutical industry makes more money than Marcia Angell will make with her book, implying the former is corrupt while the latter is not. If the proto-Marxist "follow the money" attitude is correct, then a best-selling book is more corrupt than a poor-selling book, and we would have no reason to listen to a single sentence by Marcia Angell unless she gives every cent of her book income to charities. This is obviously absurd, but it is the logical consequence of postmodernism.

Larry is worried that those who believe in "Truth" cause more harm than relativists. He is partially correct, in that those believers in the truth of religious fanaticism have caused the world much pain in the annals of history. But other believers in truth have done much good.

It may be worth noting that someone we all admire, Martin Luther King Jr, railed against the perils of relativism, and based his movement squarely on the morality of a strong belief in certain non-relative truths.

Relativism has never ameliorated a social condition, it has never cured a single disease, I dare say it has never saved a single life; while, in some forms, it has cost many.

Here is where Larry and I agree, once some of this conceptual underbrush is cleared away: We both agree that social and economic factors are relevant to science; science is not a pure process that occurs in a vacuum. But - this is what postmodernists do not see and what some of their fellow-travelers fail to make explicit - this fact does not invalidate the truths of science. Cultural reductionism - everything being about power and money - is no advance over scientific reductionism.

Larry ended by bringing up a personal experience with Antonin Scalia, but we are not discussing the law or the US Constitution so "strict constructionism" seems irrelevant. What comes across though is that Larry seems to the think that there are only two intellectual options: Being a dogmatic believer in some truth (like Scalia), or being a relativist (like Larry). As if the only political options in the world were tyranny or anarchy. I have called these two approaches in psychiatry dogmatism and eclecticism. I reject Scalia, and I think Larry's eclectic relativism is only a small advance. Rather, one can be a non-eclectic non-dogmatic thinker, what I call pluralism, believing that truths exist, but not that that a single truth explains everything, nor that there are no truths.

If I were to be compared to a Supreme court justice, I would have preferred Oliver Wendell Holmes Jr, who introduced the pragmatism philosophy to law. Overall, my philosophy is much closer to pragmatism (which is not well understood by many), the notion that there are truths but they involve human effort in finding and understanding them, rather than the pure relativism of postmodernism.

People want to reject the pharmaceutical industry; they want to fight back against biological extremism in psychiatry. Fine. But let's do so with clear ideas and rational explanations, not with fire and brimstone, not with personal accusation, not with the denigration of biology, and not with the assumption that dollars are the sole guarantor of truth - because once we start burning things up, the whole city may go down in flames.