The Big Con

What follows is a short article I submitted to a popular web-zine. I don't think the editors will be interested in publishing it, so I thought I would download it onto my blog. It may possibly be a little rough but all my posts are.

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When a person visits the dentist, one is told repeatedly of the importance of flossing. Flossing, it is stressed, is vital to a healthy daily regimen, helping to prevent cavities and gum disease. The necessity of daily flossing has been considered so much conventional wisdom for decades, backed up as it is by experts such as dentists and oral hygienists, that few people think to question it. Yet in 2015, the Associated Press looked at research into the effectiveness of flossing and found that evidence for its efficacy was "weak, very unreliable", "of "very low" quality and has a "moderate to large potential for bias". Early this year, when the US Federal government published its most recent dietary guidelines, the advice to floss daily was quietly dropped. There is simply no real evidence that daily flossing works. On the Late Show, Stephen Colbert joked about the recent findings: "Based on this news, I am going to stop flossing – thirty-eight years ago!"

This story goes to show that expert opinion can be wrong or at least unfounded, but the purpose of this piece is not to talk about dentistry. Instead, I want to talk about something arguably far more serious - the conventional wisdom that there is such a thing as mental "illness" and that the best way to alleviate it is through medication. This idea is the big con, the big lie, of the late twentieth and early twenty-first century.

I wish to argue that psychotropic medication is at least ineffective, if not positively deleterious. I should say that I am not basing this claim on independent research. There is a serious methodological problem in attempting to research into mental illness anyhow (I shall come back to this later). Rather my argument is based on my own life as someone who has been a patient of the Mental Health System for the last ten years – on reflection upon my own experience and on my observations of others. It sometimes seems that everyone I have ever known has been diagnosed with depression or psychosis at some point of time. Ironically, I suspect that the decreased stigma surrounding mental illness has resulted in an increased rate of diagnosis - and certainly an increase in the number of people prepared to talk about it. But what is clear to me from looking at my friends is that often they are better off the drugs than on them.

The form of mental "illness" that I am particularly interested in is psychosis and the type of medication anti-psychotics. In recent decades, one particularly widely embraced theory of psychosis attributes the cause of psychosis to an overproduction of the neurotransmitter 'dopamine'. In fact, when I first came to the attention of the Mental Health System in 2007 having suffered an apocalyptically severe psychotic episode, my first psychiatrist told me that I had suffered "a dopamine explosion". Many antipsychotics work by reducing neurons' sensitivity to dopamine. It might seem, then, that we have a workable hypothesis concerning psychosis - that it is caused by a dopamine imbalance - and that psychiatrists invented antipsychotic medication subsequently but, in fact, the medication came first. It was discovered that conventional antipsychotics bind to dopamine receptors, that antipsychotics seem to work ('seem' being the operative word) and so the dopamine hypothesis was proposed, as it were, retroactively.

It would be convenient to believe that psychosis is caused by an excess in dopamine in the same way that depression is popularly imagined to result from a serotonin deficiency, and can be cured by an appropriate dopamine antagonist, but there is a problem with this easy answer. In her 2008 book The Myth of the Antipsychotic, British psychiatrist Joanna Moncrieff points out that early antipsychotics such as Clozapine were originally classed as 'major tranquilizers' and that antipsychotics do nothing to really remedy psychotic symptoms - all they do is sedate. Psychosis itself waxes and wanes quite independently of the particular drug one is taking – the term 'antipsychotic' is itself actually a misnomer. In my observations of other patients, I have never met anyone, taking medication voluntarily or compulsorily, who was entirely free from symptoms. In fact, to speak from my own experience, my worst period of psychosis occurred in 2009 while taking the antipsychotic Rispirdal. Last year, when at the clinic to receive my State-mandated Olanzapine injection, I met a trainee doctor and told him this. (I didn't tell him that I thought I had become psychotic because of the Rispirdal.) He expressed considerable astonishment. "You were psychotic when taking antipsychotics?" It seemed I told him that I believed that anyone could suffer a psychotic episode if exposed to enough stress. He said, "So you think everyone carries the schizophrenia gene?" – an absurd thing to say because, of course, if everyone carries the schizophrenia gene, the notion of a schizophrenia gene loses all explanatory power. It really makes you wonder what trainee doctors are being taught in Med School.

How then has the idea that antipsychotics work taken hold? The short answer is confirmation-bias. Psychiatrists and other health professionals often like to compare schizophrenia to diabetes but, while glucose levels in the blood can be objectively measured, there is no way to objectively measure how psychotic a person is. Any attempt is bogus. At the beginning of last year, when a reduction in my dosage had been mooted, the psychiatrist I was then seeing gave me a questionnaire asking me, among other things, to rate how paranoid I was on a scale of one to five - again absurd because, if I believed I was in the grip of a massive conspiracy, how could I answer honestly? I was also asked to rate my level of abstract thinking - supposedly because schizophrenics have difficulty thinking abstractly. I was asked what an apple and a banana have in common. I said that they were both fruit and told him that I had done harder tests.

If there is no way to objectively measures psychosis, psychiatrists can only be basing their diagnoses on intuition – and intuition, as many psychological studies have in recent years shown, is highly unreliable. For instance, it has been said about me at independent reviews that I was ill in 2008, well in 2009 and ill again in 2010, although the reverse was true. I am hesitant to talk about these reviews, except to say that my record was full of 'inaccuracies' - a person can be fined up to $10,000 for disclosing what happens in such hearings. I wonder if this law is more about protecting the doctors than the patients.

If antipsychotics are effective at all, it is as placebos. This might be halfway tolerable if there was not evidence that antipsychotics can be positively harmful. Sometime I believe in the 'nineties post mortem dissections of people who had been diagnosed schizophrenic revealed significant brain shrinkage; consequently psychiatrists revived a notion not current since the beginning of the twentieth century, that schizophrenia is a neuro-degenerative disorder. Because psychosis was now regarded as a brain-damaging illness, antipsychotics therefore were heralded as a way of preventing irreversible tissue loss. My first psychiatrist, the same one who told me that I had suffered "a dopamine explosion" also told me in 2007 that the Rispirdal I was prescribed for me was "fertilizer for the brain". There is a problem with this idea though, that psychosis itself causes brain shrinkage. All the schizophrenics in the study had been on antipsychotics for most of their lives and so it was actually impossible to determine if the 'illness' or the pills had caused the shrinkage. Around 2005, I believe, a study was performed on Macaque monkeys, none of whom, obviously, were schizophrenic, that showed fairly conclusively that it was the antipsychotics, in this study namely Haldol and Olanzapine, that caused the reduction in brain volume. It is the drugs rather than the psychosis that damage the brain. Naturally, most psychiatrists are very unwilling to accept the idea that the drugs they encourage or coerce people to take cause brain shrinkage but it seems incontrovertible.

This piece may seem overly negative. Even supposing antipsychotics (and other psychotropic medications) don't work, do we have an alternative? The best solution it seems to me is for Mental Health Professionals to try to find out what in the person's situation caused the illness in the first place and help the sufferer deal with this situation – I believe that psychosis is the result of a problem in the person's life, a problem that the person often has difficulty identifying and often little idea how to fix. For me, the solution was at once very simple and very hard to achieve. But you could argue that, today, the Mental Health System is still more part of the problem rather than part of the solution. Supposedly we live in a more compassionate era than the past but the same people who once would have overseen such barbaric practices as insulin shock therapy, lobotomies and permanent institutionalization still run the show. It is difficult enough for someone to suffer a bout of ill mental health without then becoming subject to a system based on bullshit and idiocy. Things need to change and one thing that definitely needs to change is the idea that mental 'illness' is literally an illness rather than a reaction to life events.

The Person and Her Situation

Philosophy concerns itself with the deepest questions, such as what it means to be human and how best to live one's life. Philosophers, it seems, commit themselves to the investigation of reality, to the disclosure of eternal truths. But despite millennia of discussion and debate, we seem no closer than the Greeks to a conclusive consensus regarding such issues such as the origin and foundation of morality. Perhaps the best strategy, the truest truth, is to say no truth exists, that all philosophical arguments are sophistry or casuistry, that we should choose which perspective to adopt for ethical or political or pragmatic reasons rather than because there is some way objectively to verify it. And that this is how it should be.

In today's post I want to talk about identity and ethics. What I am trying to express hopefully shall become clear as I go along.

What does it mean to describe a person? Say I choose, at random, a girl called Alice. I can describe her physical attributes – her hair color, her height, her dress size. I could describe her with respect to her occupations, saying for instance that she works as a telemarketer but has worked in hospitality in the past. I could define her in terms of her family, saying for instance that she is the youngest of four siblings, two of whom are successful journalists; I could specify in which suburb she grew up or which secondary school she attended. I could name her personality traits, saying that she is "generous" or "miserly", "extroverted" or "shy", "open-minded" or "intolerant". If I was a doctor, I could tell her that she has diabetes, perhaps, or that she has a genetic susceptibility to breast cancer or Parkinson's. If I was a psychiatrist I could diagnose her with Avoidant Personality Disorder, or Autistic Spectrum Disorder. All of these are means of delineating, characterizing, a person.

We live in a very essentialist age. Although we no longer believe, as the nineteenth century phrenologists did, that we can identify criminal tendencies by mapping bumps in the human skull, people often tend to believe that a person's behavior and lifestyle emerges from his or her essential  nature. Thus we have the hypothesis that Maori and African-Americans are more likely than Europeans to have  "a warrior gene" that makes it more probable that they will be violent, or the hypothesis advanced by the book The Bell Curve that different races have different levels of intelligence. The faith the public puts in DNA and biology generally as an explanation for everything arises from three key ideas: first, a strong belief in science, that every event has a cause, second, materialism, the idea that a person is identical with his or her own body, and, third, individualism, the idea that every person is a separate complete entity independent of his or her environment. These three creeds together make up modern essentialism which can express itself in its worst form in racism and other forms of bigotry or, not much more benignly, in the belief that a person's life can be radically improved through psychotropic medication or just multivitamins.

Arguably the rise in use of antidepressants, antipsychotics and anti-anxiety medication, together with the apparent increased prevalence of 'mental illness' arises from this essentialism and can be tied to neoliberal shift of the 'eighties in the Western World (neoliberalism being all about individualism after all.)

Are there alternative ways than Essentialism to understand a person? Yes, of course. One is Existentialism. Satre argued that our actions do not originate in a fundamental essential nature but in the exercise of free will. Famously, in L'Etranger by Albert Camus, Meursault shoots and kills an Arab for no reason at all. Existentialists, like Camus and Satre did not just argue that we freely choose our actions, they also said that we freely choose our identities. ("Existence precedes Essence.") Essentialism, for Satre and other Existentialists, is a form of 'bad faith' - the example often given being the waiter who believes so entirely that he is essentially a waiter that he never considers he could be anything else. Satre argues however that the meaning we assign to ourselves and others is always freely chosen. The wonder is that at least some people can face this fact, that the world is 'essentially' meaningless, absurd, ruled by chance and chance decisions, without being overwhelmed by terrible feelings of angst and dread.

Existentialism breaks with traditional science and materialism because it proposes that events can occur without causes (in this way resembling quantum physics), that actions do not arise from some 'deep self', and because it proposes a radical distinction between the ego that chooses and the physical body through which the ego operates. In these ways it rejects essentialism, while remaining deeply committed to individualism.

Although Existentialism seems preferable to Essentialism, there is a problem with it. Satre asserts that we freely choose who we are and so consequently must bear full responsibility for the lives we elect. As much as this may seem an attractive idea, it is morally untenable. Consider the girl who robs a grocery store when a teenager. An essentialist would simply label her a criminal for life; an Existentialist would ask her to assume responsibility for her action which amounts to same thing. A better approach, it seems to me, would be to enquire into the situation the girl found herself in when she committed the robbery. What influenced her decision to carry out the crime, what world encompassed her? To understand the girl, we must take into account such possible environmental factors as familial dysfunction, poverty, peer pressure. alcohol abuse, etc. It is wrong to define a person for life because of an action carried out once and, by paying attention to the girl's circumstances, we can more likely achieve this, be more likely to forgive.

What I would like to propose is a theory of ethics and identity we can call 'situationalism'. (It resembles in some ways the situational ethics proposed by Joseph Fletcher among others but I think is in some ways quite different.) I would like to argue that when we describe or try to understand another, what we are compelled to do is comprehend not that person's essential nature or the mystery of her free will but the situation in which she finds himself or herself. Consider Alice again. Perhaps Alice works as a tele-marketer but really considers herself a poet, or perhaps Alice comes from an affluent family who all vote National but identifies with the poor and votes Labour herself. In either scenario, Alice's situation is distinct from who she is. Alice's occupation and family politics do not really reflect her 'essential' identity; she is distinct, apart from her situation.

Sometimes we can identify a person with her situation. Sometimes a person is locked in an unceasing war against the situation in which she finds herself – in which case it is impossible or at least immoral for us to identify her with her situation.

To return to the various descriptions of Alice given above…Most of these descriptions apply not so much to Alice as her situation. Perhaps Alice works as a telemarketer because it is the only job she could find. Her circumstances are the result of luck, sometimes good, sometimes bad. Alice is lucky to have a job at all, even if it is not her desired job. That she should belong to the family she has is also the result of accidental and contingent circumstances, is not necessary. Luck, whether good and bad, has determined her situation. It is neither chosen nor natural.

When we start to look at the world this way, to see people in terms of their situations rather than their essential characters, it enables us to better empathize with others. We start to appreciate that a person's situation is neither natural nor chosen; more often it is contingent or accidental. Alice, to reiterate, may be working as a telemarketer solely because it is the only job she could find.  Consider a person who is diagnosed schizophrenic: that diagnosis is part of the situation in which she finds herself, a situation that is neither deliberate nor natural. If we recognize this, that the diagnosis is part of the person's situation rather than her essential identity, it makes it easier to empathize with her. It helps us view the sufferer as a kindred human being. Perhaps, for instance, the schizophrenic hates the label which has been attached to her; perhaps the diagnosis is incorrect. Perhaps the schizophrenic wants to be a dog groomer or adores Beethoven. By viewing the diagnosis as part of her situation rather than as a character-defining feature, we are better placed to understand her. Schizophrenia, I believe, is neither natural nor willed. Moreover. I believe that if we can understand the circumstances of a person's first psychotic episode, really understand them, we may be far less inclined to blame the victim. Psychosis in my observation is often the result simply of bad luck. Consider another example: suppose walking the streets you see a 'rough sleeper'. If you are an Essentialist, you may simply label him 'homeless' and walk on. If you are Existentialist, you may hold him himself responsible for his vagrancy. If you are a Situationalist however, you may be inclined to wonder about the situation he was in that first drove him to the streets and the situation that keeps him there. If you truly understand others, which is only possible if you understand their situations, you are less inclined to play judge. A focus on the situation rather than the essence of a person helps us to identify with  him or her – it enables a person to love his neighbor as he loves himself. If you appreciate that a person's situation is often accidental, contingent,  it makes it more difficult to blame the person for his troubles. "There", you might say, as the true Christians say, "but for the grace of God go I".

This perspective on the world, in which we assess a person by looking to the person's situation rather than essential character, runs completely counter to the ways in which psychiatrists assess their patients. There is a tendency in society today to put people into boxes. A discourse which treats a patient as an isolated object to be observed and described actually reduces the likelihood of empathy. But if one treats a person as someone much like oneself who just happens to be in different circumstances, the possibility of empathy is far greater. It may seem strange to you, my reader, that I am saying it is possible for a sane person to empathize with and identify with a crazy person but I believe that it is not only possible but necessary.

How can we train ourselves to be more empathetic? To empathize, we need to imagine ourselves in someone else's position and this is no easy task.  The best way to become more empathetic is to read a lot of literature and watch a lot of TV. A novel, to pick a random example, like The Power and the Glory, asks the reader, obliges the reader, to put himself or herself in the position of a Catholic priest in Mexico. Quality literature and to a lesser extent film and television continually ask the reader or viewer to identify with some other person, with someone of a different ethnicity, religion, political allegiance. Perhaps this is the preeminent purpose of literature. It teaches us how to view the world through others' eyes. And true empathy is as important to society as science. Perhaps more important.

Intuition and Language

In the previous post I proposed intuition as being a good term for non-verbal knowledge about the world, that is, as being both a category for beliefs about the world that we do not express linguistically and as a mechanism by which 'facts' communicated about the world can be received. Intuition, I argued, lies outside language and perhaps precedes it. 'Truths'  made manifest via intuition are not linguistic propositions. Although intuitive knowledge can usually be expressed in language (some intuitions taking longer to express than others, sometimes whole books), intuition, I argued, actually precedes language. In today's post I thought I would elaborate on this idea of intuition as a source of knowledge outside language.

The Aristotelian definition of a human is "rational animal". Another definition that emerged later was "language-using animal". Now, there is some evidence that many animals possess communicative behaviors that resemble, in a limited way, language, but it surely true that language is far more conspicuous among humans than among other species. It is not just that humans communicate with friends, family and acquaintances using words, we think in words. If not otherwise occupied by a film or physical activity that requires mental concentration, if, say, just walking the streets, a human maintains a continuous internal monologue and the material of that monologue is words. Leopold Bloom's stream-of-consciousness in Ulysses is a good example of how we think. When reading a book, the author's narrative, the author's language, replaces the internally generated monologue that characterizes human consciousness when not engaged in some task or focussed on some text – but the constituents of thought remain the same. Words. Furthermore our experience of the world is structured, saturated, by language. Sitting here writing I can look at the objects in my apartment and name each one - "book", "table", "oven", "chair". The appropriate words for describing my world are almost always immediately available to me. Language is always at hand. It can seem from this that experience is always capable of being expressed in language, even if some experiences take longer to describe than others.

Because language is so central to the human experience of the world, it may seem that all knowledge is linguistic. In analytic philosophy, I think, true justified beliefs are always presented in the form of propositions, statements. Yet if we consider types of animal other than humans, we are forced to recognize that non-human animals also possess knowledge even when they don't possess language. I remember once coming home to find my pet dog had locked herself in the study and the doorknob full of dents. Presumably the clever animal had tried to escape the room by attempting to turn the handle with her teeth. This idea that she had had, that turning doorknobs opens doors, was not an instinct – dogs evolved in a time before doors or door handles. Rather it was something she had learned from years of watching her human owners open doors. Dogs and cats and other animals can be very clever; I often suspect they know much more than we realize. Yet this knowledge is not verbal. It is intuitive. 

If animals possess extra-linguistic knowledge and humans are also animals, it seems logical that humans should also possess extra-linguistic knowledge.

Intuition is not only a non-verbal form of knowledge, it is also a non-verbal way of acquiring knowledge. The other night on the music channel on TV I was watching, a flamboyantly gay man appeared to report on celebrity gossip (Hollywood gossip having been for a long time the province of gay men). I knew immediately that he was gay even though he never announced the fact. How then could I know that he was gay? I recognized or intuited his homosexuality from a quality of his body language and of vocal intonation. The nearest words that I can find for the mannerisms he exhibited is 'camp' or 'swish' but neither word seems adequate. (Check out the wikipedia entries on these terms to see how they are usually defined.) Sometimes people describe the signals gay men display as 'effeminate' but this word also fails to encompass the phenomenon. Few women I know are limp-wristed. It seems there is no word for the quality of demeanor these men exhibit, a quality that enables others to know that they are gay or not; we have arrived at the limit of language. And yet we easily 'intuit' gay-ness from a person's demeanor.

It would be interesting to know if homosexuality comes before camp-ness or whether camp-ness precedes homosexuality. But I digress.

In this post and in the previous one, it may seem that I am prioritizing intuition over verbal knowledge, suggesting that the former is superior than the later because it precedes it. In fact the opposite is true. Intuition, as I argued in the earlier post, is often fallible. I have often falsely intuited things about others and others have often falsely intuited things about me. The notion that we should trust our 'instincts' is obviously quite wrong. Humans possess language for a reason. It is through language that we most truly manifest ourselves and come to understand others. When intuition fails, language can provide the remedy. And nothing should be off limits.

On Intuition

Science, in general, comprises two central processes, description and explanation. In today's post I am going to set aside the issue of explanation, although I am interested in it, to concentrate on the activities of description and definition. Definition, as readers of my blog may already know, interests me greatly. In today's post I hope to show the role intuition plays in both processes, in how we make sense of the world. I also intend also to talk a little about the way intuition can fail us.

The easiest way to illustrate how definition and description tend to operate is through a hypothetical example. Suppose you are a zoologist visiting Africa to study elephants. Your role is not so much to explain the characteristic features of these animals as simply to describe them - you take notes, for instance, on their physiology, their grazing patterns, their mating rituals, the social structures of herds. You do so for a reason. Before we can begin to explain a phenomenon, we must first describe it. However, a problem arises when we consider that before you can even begin to describe an elephant, you must first have some idea what an elephant is, must be able to distinguish it from a hippopotamus or a rhinoceros. You must, in short, already possess a definition of 'elephant' in mind before you can begin to describe it.

The Google definition of 'elephant' is "a very large plant-eating mammal with a prehensile trunk, long curved ivory tusks, and large ears, native to Africa and southern Asia. It is the largest living land animal." Now, what is important to note about this definition is that it is a kind of description. In order to define the word 'elephant' we must describe the common qualities of all those things called elephants. We need a description first, before we can propose a definition. But it seems definition must precede description – what then is the basis of this definition? It seems that in order to define something, we must already be able to describe it. But in order to describe something we first need to be able to define it, distinguish it from all other objects. The process is circular. It can only be that description and definition form a feedback circuit - description influences definition and vice versa. Better descriptions inform improved definitions and improved definitions enable better descriptions. We have a "What came first - the chicken or the egg?" type situation. On what foundation does knowledge rest if neither description nor definition come first, if neither have priority? The poultry problem can be dissolved by tracking the evolution of chickens back to a time when the chicken-egg distinction was non-existent, when chickens and eggs were undifferentiated, before in fact either 'chicken' or 'egg' as we know them now existed. Likewise, perhaps we can try to dissolve the definition-description paradox by tracing the evolution of concepts back to a time when there was no clear distinction between definitions and descriptions.

An alternative strategy than such a dissolution exists. We can appeal to an authority outside language, outside rationality and knowledge. We can appeal to intuition. Intuition, we can argue, is the fundamental origin of all knowledge. We intuit before we either define or describe. Consider - when the first European zoologist visited African, unacquainted with prior definitions or descriptions of the animals he would encounter, a kind of tabula rasa, he would, I believe, have intuited that elephants were of a kind that was different from hippos or rhinos. We are able to divide the world into different natural kinds because we intuit that different things are of different kinds.

This notion of intuition I am advancing is reminiscent of Immanuel Kant's theory of categories. In contrast to the hardline Empiricism of David Hume (and later, without attribution, Ayn Rand), Kant argued that people possessed innate ideas, that humans are born with mental faculties that enable them to structure and interpret their experience of the world. I would argue that the intuition that some things belong to one natural kind and other things to another is possibly an innate idea –although I am also open to the idea that intuition might be learned. It is not the purpose of this essay to discuss Kant or his theory of categories. I am not interested in this aspect of intuition. Rather, I am interested in situations in which intuition fails.

Consider another hypothetical example. Some people are Presbyterians and other are not – but when we encounter a stranger on the street it is impossible to know immediately if he or she is a Presbyterian. We cannot intuit this; in this situation intuition fails. What then makes a Presbyterian if it is not some perceptible essence? Is a Presbyterian someone who attends Church services every Sunday? Is it someone baptized into the Presbyterian faith? Or is it merely someone who tells people he or she is Presbyterian? Without intuition, without essences, we must fall back on definitions that are sometimes arbitrary. And sometimes definitions are defective or absent altogether.

We often think of definition as the act of revealing some kind of essence, of picking out the necessary and sufficient properties of a natural kind. In fact definitions are frequently made for ethical or pragmatic reasons rather than descriptive reasons. Lawmakers, and judges when they interpret the law, are continually defining and redefining the world in the interests of general and individual wellbeing. People need definitions and one role of the government and judiciary is to provide such definitions. For example, up until 2013 in New Zealand, marriage was legally defined as a union between a man and a woman; in 2013, this was changed to a union between two people, "regardless of their sex, sexual orientation, or gender identity". Had the essential nature of the marital institution changed thus requiring a new legal description? No. Rather the new legal definition changed the nature of marriage. Language does not just represent the world; it can reshape it. This legal amendment is an example of what John Searle calls 'a speech act', a verbal utterance that refashions social reality. (For more discussion of speech acts, I point the reader to the post "Literature as Speech-Act" and the tongue-in-cheek short story "Pastoral".)

A field in which intuition plays a key role is in psychiatry. Psychiatrists are concerned with distinguishing the 'mentally ill' from the 'well', the insane from the sane. What most people don't appreciate, however, is that psychiatry is a terribly inexact science and that psychiatric diagnoses are often made on the basis of intuition rather than evidence; in the absence of reported symptoms, a psychiatrist may assume that the patient is lying or hiding something and may make a diagnosis of psychosis based on body language and general demeanor. Sometimes, I sincerely believe, a psychiatrist will diagnose 'schizophrenia' simply because he or she dislikes the patient. They have that power. If a psychiatrist suspects that a patient is suffering a psychotic episode but has no hard evidence, and is asked to justify his or her professional opinion, he or she may extemporize one, such as 'weight loss'. (This happened to me.)  This is permitted to occur because 'Schizophrenic', for instance, is considered, by the psychiatric profession and by the general public, a natural kind rather than a social category. Definitions exist yet most are unhelpful. Arguably there is no way to define this term, yet the belief that it is a natural kind persists; psychiatry deems itself a science and the role of science is to delineate and describe nature. Basing a diagnosis on intuition might be all right if intuition is reliable, if psychiatrists possessed excellent social skills. But many psychiatrists are really only half-way competent, are lacking in human understanding, are, in fact, in this respect, little more intelligent than the laity. A medical training can give a person a good understanding of which antibiotic to prescribe for a boil but does little to encourage genuine empathy for actual people. The general public often attributes God-like powers of perception to psychiatrists, and some psychiatrists may come to believe this of themselves, but this attribution is not true.

An example illustrates this idea of psychiatric fallibility. One of the current theories about schizophrenia is that it often caused by cannabis use - the idea is that getting stoned once in one's life alters a person's neurology and sets them up for a psychotic episode sometime later. Many psychiatrists find this theory plausible, I think, because they have led such sheltered lives, have never spent time with stoners. What such psychiatrists fail to factor into the equation is the vast majority of people who have used drugs who never become 'unwell' – and, of course, when this is taken into account, the theory that pot smoking causes psychosis loses its explanatory power. Accurate intuition in this case it seems must depend on lived experience and can easily fail when a person's experience is limited.

To give a more concrete example... At a medical review last year it was asserted that I was psychotic in 2008 and well for most of 2009. In fact the reverse was true. I was almost well in 2008 and psychotic for most of 2009. This was either a complete failure of intuition or something else.

If intuition is at all reliable, it depends on the belief that people belong to 'natural kinds'. Another interesting example of supposed intuition, one well worth discussing a little,  is 'gaydar'. In the same way that psychiatrists are thought to have uncanny powers of perception, gay men are supposed to have an infallible ability to identify other gay men. It is some weird psychic gift these magical fairy people with ESP are accorded by the general public. In reality though, gay men are no better than straight men at identifying other gay men and look for the same clues when seeking to identify one – clues such as  a speech impediment or physical undernourishment. "Gaydar" does not exist. I am unsure if it possible to identify a gay man from a first impression but  I think it unlikely.

The debate about the efficacy of intuition is very evident today. On the one hand we have a book like Blink by Malcolm Gladwell which argues that many people can make extraordinarily accurate predictions based on momentary impressions; on the other we have extensive current research and literature, such as The Seven Laws of Magical Thinking by Matthew Hutson, arguing that irrational beliefs and biases are universal  (an example of an irrational cognitive habit, very common among psychiatrists, being confirmation bias). I admit that I am unsure about the power of intuition. I feel I am blessed, or cursed, with strong intuition, a capacity for empathy based not on psychiatric and psychological textbooks but on a lifetime of reading quality literature and watching sitcoms. I knew, from a glance, that my first psychiatrist was an asshole and knew almost immediately that I had been misdiagnosed. How could I be so right about my situation and he so wrong about me? I can only assume he misdiagnosed me deliberately.

But I digress.

To sum up… We cannot make sense of knowledge unless we suppose it is based on intuition. Intuition allows us to differentiate between different natural kinds. But intuition is fallible - it is especially fallible when it come to people, to human kinds. The terms "schizophrenic" or "homosexual", for example, do not denote natural kinds, rather they denote socially constructed categories. Rather than base our judgements on snap impressions (which are often inaccurate), we should try to reserve judgment – at least until the facts are in.

For other posts on this topic, I recommend the reader have a look at "The Therapeutic Relationship" and "Rationality vs. Mysticism".