Oh no Sarah’s talking about therapy again! There’s plenty of information on the methodology and effectiveness of certain therapies Sarah, have you looked at research papers on treatments for various problems such as depression, ptsd, ocd, health anxiety? They lay out the mechanisms of treatment very clearly. You need to do more reading as you just sound like you’re not informed and are operating from a gut feeling. As for whether therapy works, those of us working in the NHS have to demonstrate or success so we use questionnaires to measure symptoms (depression, anxiety, ptsd etc.) and there’s about a 50% recovery rate. Clearly this statistic means therapy doesn’t work for everyone but it helps a hell of a lot of people.
The podcast is not the place to go into it deeply in depth (so perhaps it is my mistake to bring it up at all!), but suffice to say I disagree entirely. Yes, my critique is broad, but that does not make it uninformed.
I do not think much of the supposed research measures what you think it measures, nor are questionnaires on mental states reliable, and a cross-cultural view of "mental health" would shake your faith in our approach to mental health entirely.
How do you know that what therapy treats is inherent to the human condition, and not a culturally-induced illness, specific to our time and place? If it is more of the latter than the former, as I contend, then therapy (as broadly understood and practiced) is not a harmless intervention, but part and parcel of the creation and sustenance of the symptom pool.
To be honest Sarah I’m not sure I even understand your comment, culturally-induced? Of course things are partly and maybe completely culturally induced, we are all a product of our culture, but how does that help someone who’s having PTSD nightmares and flashbacks about a trauma like being raped? Or someone who’s cleaning their house for five hours a day because they have OCD? They need to get help and there are clear tested and researched protocols for treating which have been successful. As for your point about questionnaires not being reliable, what’s your evidence for this? Are you using some research to tell you that because as a therapist we get the qualitative data from the patient also, we are seeing them in the room and can see their improvement that corresponds to what is on the questionnaires. But hey go, who cares because you think it might be harmful. Again, what data do you have on that?
I do not appreciate the tone there, nevertheless, I shall persist.
If a thing is more culturally-induced than (for lack of a better word) organically-induced, then that calls for an entirely different approach to treatment.
Anorexia is a good example (or gender confusion). Both are "diseases" that exist only in some places and times--some parts of the world don't have anything like anorexia and never have, or even anxiety or PTSD. How can you explain this?
Yes, the above are deeply felt, and can cause major life disruption to the afflicted--they can even cause physical pain/harm--I do not deny that. But the fact of the matter is that therapists broadly simply *do not consider* cultural origination of many mental health issues, nor do they analyze their part in legitimizing such illnesses (this exchange being an example). There is no excuse for the myopia, and yet!
What if the "cure" for the person with OCD was to tell her that there is no such thing as OCD? What if the specific shape and form of this person's illness is due in large part to their belief that it is a real, culturally-legitimate distress signal? What if in putting a name to something and cataloging it in some official-sounding book, you are in effect helping to create the thing itself?
How would you prove me wrong, if I thought that the above was all true?
There’s culturally induced and then there’s culturally constructed.
It may be that many of these specific mental illnesses are culturally induced but not culturally constructed. For example, diabetes is a very real illness, but is quite uncommon in some cultures and wildly common in the U.S. It’s also arbitrarily defined; there is no physical law that says that someone with an A1c of 6.6 is diabetic and someone with a 6.4 is not. There’s also considerable debate about whether it’s best described as a single disease entity or as part of the Metabolic Syndrome. The solution is not to tell someone with diabetes that their illness is not real. The non-enyzmatic glycosylation of microvasculature is definitely real, as are the debilitating consequences.
Similarly, even in times or places where “PTSD” was not a diagnosis, it may be that there is always a certain cohort of people who develop recurrent nightmares and have elevated cortisol levels after a traumatic event. The resilience of people to trauma, the availability and effectiveness of social support may differ. It may be that American society is just as anxiogenic as it is obesigenic. But would it really be helpful to tell someone with PTSD that their illness is not real because it is defined in culturally specific terms, or because it is more common in some cultures than others?
One thing you might want to consider is the flip-side: That some cultures simply encourage the covering-up of some mental illnesses. It seems unlikely that PTSD is any form of cultural neurosis, but a physiological/neurological response to extreme survival experiences (in those susceptible to it, which not necessarily all human beings are). Perhaps in societies in which there's "no PTSD" (and I mean *real* PTSD, of course, not the nouveau "I was denied the expression of my truth!" variety), people who suffer are meant to remain quiet about it, hide the effects at all costs, or possibly even drink them away. Culture can be a double-edged sword.
But consistently enough across those cultures that we still recognize it as the same phenomenon.
For example, there are a range of cross-cultural (and historical accounts) of people engaging in what sounds a lot like a persistent and exaggerated startle response after experiencing threat to life or bodily integrity. In contrast, post-traumatic elation is pretty uncommon.
The fact that there are symptoms that generally co-occur with one another, and generally don't co-occur with others - and that this generally remains true across time and culture - seems like at least a preliminary foundation for a science of psychopathology.
"Anorexia is a good example (or gender confusion). Both are "diseases" that exist only in some places and times--some parts of the world don't have anything like anorexia and never have, or even anxiety or PTSD. How can you explain this? "
I think you can see that these things are all kinds of dysmorphia. They have to do with the way people are viewing their bodies. In medicine people often confuse the outward symptom and underlying problem.
I can see this exchange is going no where as we appear to be talking at cross purposes, you’re talking about the origins of mental health distress and whether it is somehow created by the culture, something which you can have opinions about but whatever answer you come to it won’t move us on from the real distress people are experiencing in this culture, unless you seriously think that telling people something isn’t real is going to reduce their distress.
Look, its not an opinion, it is a reality. There are lots of things I can reference here, but you can start with the book "mad like us" if you want an introduction to the kind of critique I am making.
The origin of the illness is not some extraneous point to consider, it is *the* point to consider. If this was a true branch of medicine, you wouldn't dare dismiss it, given that origins are vital to understanding the nature of the disease (and thus, treating it).
It’s non-obvious to me that the origin of the disease is *necessarily* vital to treating it, even if it often works out that way in practice. For example, if a wound was caused by a gunshot, the type of gun might give the doctors useful information about how to treat it, but it also might not. Arguably, the motive for the shooting is also part of the “origin” of the wound, but doctors don’t need to consider that at all. The origin of the health issue (mental or otherwise) often furnishes medically useful information, but that doesn’t mean any information about the origin is automatically medically relevant. This extends to nature versus nurture questions. Whether someone has a genetic predisposition to lung cancer or got the cancer from smoking presumably doesn’t matter for the type of chemo they receive. Doctors are concerned with the medical facts of the case in the present moment. I’m no expert but that’s how I see it. Maybe John Bingham can weigh in here?
I am very familiar with the kind of critique you are referencing, we learn about them in training and what i don’t think you get about my perspective is that it doesn’t matter to me. What if you were right? What then? Is society and culture going to change in the way you want it to? Do we dismantle the whole system that helps people recover from crippling mental health problems in the hope society and culture will change? Do you really think our society is going to change in the way you’re suggesting so that mental health conditions aren’t a reality? Physical health is also hugely affected by our culture, everything is affected by culture. Mental health conditions are just a list of symptoms that cause people distress and whatever created them, my job is to help reduce them so when I hear you trashing therapy I don’t hear you putting forward any real, workable alternatives to helping people and that’s what really gets under my skin.
I just want to add that the majority of patients I see for PTSD treatment are asylum seekers whose trauma was in countries such as Egypt, Afghanistan and other war torn countries and I can tell you that their distress didn’t start when they stepped on British soil.
So to draw an admittedly crude analogy, it would be like somebody believing they’re possessed. Sure, they likely have genuine mental distress, and possibly even a genuine disorder in their brain. But it’s because they were raised in a culture that taught them demons can inhabit people’s bodies that they believe the reason for their distress is that demons are inhabiting their body. In which case, I’m sure you’d agree that the practice of exorcism should be treated with scrutiny, and is perhaps itself responsible for people believing they’re possessed.
There are so many examples throughout history of people making up bogus mental conditions (“drapetomania” anyone?). How can you be so sure that our current explanations for why people feel bad are so perfect, anyway?
What I’m saying is that the evidence based field of psychological therapy doesn’t look at explanations for mental health conditions as much as it looks at what treatment is effective, maybe one day we will find more effective treatments and I hope we do but effective treatment is what I’m interested in, not explanations for distress - unless of course they come paired with a treatment for alleviating the distress which in my experience they do not.
Sometimes placebos can be more effective than no intervention. Does that make them “treatment”?
Bogus treatments for psychosomatic illnesses throughout medical history have often been “effective”—bedridden women supposedly paralyzed from the waist down would get better by nonsense bathhouse visits.
I’m sure you know from the gender debate there’s a lot of bad studies or studies of specific treatments that aren’t effective which is why NICE (which regularly produces reviews of the evidence for paychological presentations, you can look up the one on PTSD or OCD) looks across the evidence and makes a judgement. As for citing bad treatments in the past, you can’t compare a treatment given years ago before there was any research with treatments today which are much more throughly researched with numerous (usually) three sample groups.
I’m inclined to agree that self-report questionnaires are subject to a variety of biases that the mental health basically sweeps under the rug by pretending that since we all are subject to these biases and can’t defeat them, they’re not worth worrying about.
But I’ve been to several neuroethics conferences in my time and I am optimistic about biomarkers potentially giving us a better handle on the science here. Just because we don’t have much quality scientific research in this area doesn’t mean we never will.
And I don’t even have a strong opinion on how different therapeutic approaches might perform if we had objective measures.
I agree mostly with you that therapy is not as scientific as people think it is.
It is a lot like 'nutrition science'.
It is all based on self reports.
More importantly, there is very little effort to figure out whether therapists are doing a good job.
I also question how much a single person can know about your personality and problems in the world just having heart *your* side of the story. What does your friend/spouse/colleague say about you? The psychologist/psychiatrist/therapist (very differently types of training, I know) only rely on *your* telling of the world. They can only know how you feel at the time that you are in their office. Maybe they ask you to keep a diary and read how you feel at times you can be bothered to write it down.
But people are not reliable narrators even of their own feelings.
The psychiatrist is the only professional who can look into conditions that can affect your mood with medical tests (eg a brain tumour or vitamin deficiency). Everyone else is just a good listener, maybe.
I have seen many friends almost brag about their new diagnoses... Even if your self-reported well-being has increased it still does not mean the therapy helped you.
Increasingly, I have the impression that people feel just better as a victim with a certificate. In the long run this will not improve your well being (but might make you more annoying and then less popular with people who don't centre their life around mental illness).
So, my in-laws are both PHDs in this field. One is a psychiatrist-works in a mental health facility in the modern version of what would have been called an insane asylum. The other is a psychologist and is a marriage and family therapist. Works from home doing therapy sessions.
They both would and have admitted to me that sometimes, depending on the client, therapy comes down to somewhat loose interpretations based on the only thing they really have to go off of-which is what the client physically says to the therapist. It’s imperfect, like a lot of health care is in reality. In this case, if you never hear both sides of a story, it can be very hard to try and accurately interpret the situation/problem.
This is why often the “story” changes when both parties are invited to therapy rather than just one aggrieved party.
I think the field is very well intentioned. I also think the amount of harm done to society that is referenced in Shrier’s book is evidence, as Shrier states, that it does have some healing ability or at least an ability to affect change in people’s lives.
It’s not as cut and dry as Sarah makes it seem here, not in my opinion.
I surely understand her position though and her position is easy to back logically because it’s very hard in these cases to provide hard objective measures or proofs. Everything is subjective, and worse it is often based on the subjective view of the patient(someone who is in therapy presumably because there is some mental issue at hand).
The most devastating critique of therapy is one that shier hardly touches: that "mental health" looks entirely different in different cultures. While some illnesses retain their basic shape (schizophrenia) others are basically non-existent (anxiety, ptsd), resisting the exhaustive efforts of "well-intentioned" American therapists to find them.
The obvious conclusion is that much of what we treat with therapy is culturally-induced, with therapists as active participants in the creation of the disease.
Having read the book, I disagree. One could argue that is one of the main points. Even if not explicitly defined. When she talks about societal influences like phones and therapeutic language she is implicitly acknowledging this point.
I have heard her, in interviews, talk about this explicitly. Listen for the word iatrogenic, that’s usually the start of her touching on the subject.
That’s fair. She fighting an uphill battle with the book premise to begin with.
Haha. I don’t think a full scale takedown of the profession would have been a good idea in the same book. Megan’s pushback in the podcast is a solid proxy for how that would have worked against her here.
It would be too easy for the idiot public to call her an anti-therapy nutjob. In her interviews she hedges so hard against that idea it makes me think she avoided explicitly saying it in the book on purpose.
I wouldn't be surprised if you are right, and in any case I'm glad people like her are around to open the door a bit so that the discussion can at least be aired.
The marital counseling field is an interesting example in that its subject of treatment doesn't indeed seem to exist in many cultures. But is this because the problems being targeted don't exist, or because in those cultures (including western ones until recent decades) the "solution" was for men to cheat, beat and/or emotionally abuse their wives, the wives to self-medicate with alcohol, and all with the cultural expectation that such is a man's prerogative and the wife's is to take it? It seems in this case the emergence of therapy would represent a movement towards a better way of problem solving (even if the conclusion is to end the relationship, rather than to continue the suffering)?
Do you distinguish clinical psychology from therapy, or do you consider them to be one and the same? Clinical psychology is based in science. It may be more social science than natural science, but it's still science nonetheless.
Thanks for that "lived experience" of therapists post.
There are severe cases where people are suicidal or delusional or too anxious to leave their house where objective measures of improvement can be applied. In this cases the quality of a treatment could be evaluated.
But for everyone who is a bit depressed or thinks they don't have enough friends because they are "on the spectrum" therapy can be just too much navel gazing.
Just... If nothing is really helpful... what do I do with a friend who has been depressed for years about a failed relationship (his fault)?
To your question at the end. Consistently answering their complaints/concerns with some form of “what are you going to do about that?” Is a great place to start. These people have to accept that there is one person who has the single greatest control over their lives and it’s them.
I have seen people lose friendships over this approach and it’s really unfortunate. I have also seen people make dramatically good progress after accepting responsibility for their lives.
If Sarah wants to make a substantive case against the effectiveness of therapy she should write it up. A podcast discussion isn’t the best medium for engaging with academic literature, which is what the case would need to do.
While I do think Sarah should write about this with more depth and citations, I don't want to miss her uncompromising takes on mental health on the podcast either. ; )
Totally, I just meant it as a friendly suggestion - I think the podcast format is too limiting for the scale and depth of argument she wants to make, which is part of what’s causing Georgie B’s frustration
I would like to salute Meghan's sense of journalistic duty. That she'd seek to sleep with a denizen of a cruise ship purely to surprise her readers with that information signals a profound willingness to go above and beyond. Bravo!
I love that they discussed the Shteyngardt Cruise ship piece.
I read it and found the first paragraph funny and captivating but then it became incredibly whiny.
I enjoy the slightly mocking/eloquent/witty view of an outsider. But he was very critical of all these fellow guests, yet, really craved their attention and admiration - and failed to get it. A grown middle-aged man crying (!) because he has to spend 5 days away from his wife on a luxury cruise ship. After 2h parading on deck in a silly T-shirt while looking (presumably) miserable and yet no one has approached him to be become his friend. I wonder why!? How pathetic!
This person probably hasn't left his little bubble in NYC (where he is a 'famous author') in a long while and displays shocking lack of self awareness while judging other people for liking mainstream things.
As an elitist snob myself, I am shocked at this overt display of elitist snobbery.
It read to me as tongue in cheek. He acknowledged poking fun at cruisers came off as snobby because it is, even if he is pointing to a real lack of depth in some people.
He lost me at this sentence: "It turns out that the aft is the stern of the ship, or, for those of us who don’t know what a stern or an aft are, its ass." Seriously? I thought snobs were known for their erudition. Also, you know "stern" but you're going to devote words to not knowing "aft"? Makes no sense. Maybe this is the point? Contradict oneself in erudite ways and see if anyone notices?
Wait - those of _us_ who don't know what a stern or an aft are? Maybe he's doing a parody of an elite trying not to sound elite? Maybe I'm wrong and this is very meta.
I think the conversation about data was interesting but not very helpful. What data show is usually how capable the data wrangler is and less about tapping into essential pieces of life like chemistry. For that very smart data wrangler, it still comes down to art, intuition, and their human flaws. The notion of getting data first is just a concept for humans who want to keep the status quo. Being wise and cautious has nothing to do with having data. Many companies spend ridiculous amounts of money to collect data about things which they have complete control over already, for executives whose interest in data is mainly to cover their asses.
When you break down some of the mathematical formulas upon which data analysis is based, to say that you are finding “truths” is hilarious. In every case you are learning something very limited which mainly leaves you with more questions. Data gathering is an art, and intuition is still a huge part of it. Data is great for immovable and unchanging things. If you see human beings as immovable and unchanging… go collect a data set. There is no objective place from which to view things outside of human experience.
In a democracy when people vote for things like trump, to me I’m less interested in who is chosen rather than will they buy out the bullshit that comes from their choices. Those people are the collateral of their choices. If you are going to be a radical leftist and start trans-ing people what I want to know is where is the collateral. Who will pay if things go badly. That’s my price for change, and I only listen to people who I have a good faith belief that they really mean what they say and will be the collateral if they find themselves at a dead end. The reason trans is an abuse is because there is no collateral, no surety. The gate keepers didn’t fail because they were open to new ideas, they failed because they played loosely with society as collateral. We should hate them for this. We should hate them because they said they knew better, and they fucked up.
If you are conservative, you can insist on data but that’s mainly a statement about how comfortable you feel with the status quo. If forced to re-examine that status quo you would hardly have any data to prove the merits of what you’re doing other than saying it seems to be working pretty well so far and you’re afraid of change. No human being is born ready for the amount of disruption that is available in facing facts like evolution, the malleability of the human mind. There’s little space to feel empowered and certain. And yet, the basics of everyday doing good, the small things we know do in fact work, the first principles of human life are right in front of us all the time. We need to eat, we need to make our way through a bevy of developments. These things aren’t a mystery. We’ve taken modernity too seriously.
People want the freedom to re-examine society and relationships and that’s great. The main problem as I see it is the narcissism to make others pick up the pieces for your experimentation. I think an interesting part of the conversation is how much experimentation do we allow, what collateral do we expect, and how much does society get to push back. We know some people are comfortable and never want to change and that can be burdensome, wrong, abusive. We know that some people have virtually no remorse if all if society is blown apart in the name of experimentation.
How much experimentation and disruption should a human society permit knowing that there is no such thing as a “safe” status quo?
The point I took from Shrier was that she didn’t have a problem with adults going to therapy. I thought she was mostly concerned about parents sending their children to therapy instead of having confidence in their ability to parent.
Children are much more susceptible to suggestions in a way adults are not. So for instance, in the traditional way therapy is done (in general) which explores feelings, if you constantly probe a child by asking them how something makes them feel, the therapist may actually be creating a problem in the child’s mind which isn’t really there but because the child wants to please the therapist or say the right thing, the child says what they think the therapist wants to hear.
We actually have examples of people being accused and convicted of child sexual abuse at a daycare because of bad therapy.
It is pretty terrifying to think of the damage a large number of well meaning individuals, with degrees in professions that depend on children as their patients, to earn a living.
I’m with Sarah on the necessity of enforcing “I am going to go to your house and murder you threats”. These people need to stop getting away with this bullshit.
The legal standard in California is “does the threat place the victim in reasonably sustained fear for their safety”. I don’t think Patel’s threats meet that standard. Would a reasonable person believe there’s any chance Riddhi Patel would show up at their door with an SJW posse?
She was directly threatening the city council. I disagree. These people are serving in their communities as members of their city councils, listening to violent threats to be guillotined and murdered in their homes is beyond the call of duty for an elected official. It’s bullshit and there should be consequences to this kind of behavior.
I don’t like her behavior either, but free speech means people have wide latitude to say horrible things to people who don’t deserve it. It’s possible the council members could bring a civil suit against her and win damages. But I don’t think the criminal charges will stick.
Agreed. They probably won’t stick, but even getting charged for this I think is a step in the right direction. If elected officials are subject to constant harassment, no one will do these thankless jobs.
Yes, I would. For speech to be “incitement to violence”, there has to be a possibility of it actually causing imminent violence. If there had been an angry mob behind Patel ready to charge at her words, it would be a different situation. Right wingers can (and do) advocate for the violent overthrow of the government without facing criminal prosecution.
There is a bit of nuance here. Riddhi Patel is an unintimidating person. It’s easy not to take her threats too seriously. If an ex-military Oathkeeper with a criminal past said something similar, it would be a lot more scary for the city council members, and the threat would arguably be more credible. That’s less about ideology than it is about whether the speaker seems like someone who might actually hurt you, but it does seem like a situation where the law might not apply to everyone equally.
Sure. Why wouldn't they? Is someone supposed to know there's no actual "we" of violent Antifa-types in her circle to whom she was referring? I'd be worried and I'm in Texas, where - if they showed up with any real conviction - I'd even be within my rights to light them up. Californians have no means of defense.
I’m no lawyer, but Riddhi Patel’s threats sounded hypothetical to me. She was saying she would murder them in the context of a violent revolution, which isn’t about to happen. Obviously a horrible thing to say, but treating it as a credible death threat is a little silly.
It’s incredible, really, how we’re supposed to never take these people at face value. “We’ll see you at your house.” This is why they’ve been able to get such a bully pulpit, nice liberals insisting we just ignore all their actual words and actions
We've created a culture of incredible indulgence amongst America's youth. There are many to fault for this, but it's come about largely because many of these people have never suffered consequences for their bad behavior. This has fostered a wide-spread and growing culture of mutual incivility in the US. The way to start setting things right is for those who've failed to learn what it means to be civil to suffer the natural consequences of their actions. If a man in a MAGA hat had said the same thing to a city council, I do not think there would be many currently pleading lenience for Patel pleading lenience for him. That double-standard in itself contributes to the air of incivility, particularly on the left - that the application of standards is a one-way street, and they are immune. It all needs to stop. It doesn't matter if you're right or left, male or female, or whatever means of discrimination one wants to draw. If you commit the crime you need to face the consequences.
She sounded rrage-filled and borderline demented. I could certainly see her getting swept up by some violent mob heading towards the mayor’s house ….
And the only reason to get that bent out shape about the metal detectors targeting her side is the hope that someone might bring a gun in there and kill them.
It sould have consequences, but maybe more in the community-service-type league of punishment.
Someone like her is harmless until the conditions are right.
But if you found yourself in a revolution (unlikely scenario) or a mob (possible scenario) someone like her may indeed be an agitator that helps whip the crowd into a frenzy that leads to people being hurt.
Yes, it’s contextual. If there was a violent leftist movement in the USA targeting public officials, her threats would be credible and she should go to prison. However, there isn’t such a movement, so her threat isn’t credible. The standard isn’t “would this threat be credible if the conditions were right”. The standard is “was this threat credible under the conditions in which it actually occurred”.
I think throwing the book at her is the right call here. A couple years in prison will make others consider the absurdity of the language/threats they choose to use in their activism. Activism is fine, threats based on misguided emotion are not.
I don’t know that throwing the book is actually the right strategy. Of course, prosecutors routinely overcharge and plead down, but it seems to me that the length of jail time being proposed is absurd relative to the actual offense (which I agree is an actual offense).
I’m thinking she should get a year or two. Threatening murder, no matter how absurdly, from a microphone in a city hall meeting gets you time. I’m ok with that being a hard and fast rule.
I think a year in jail is wildly excessive. In California, if she actually had a weapon and showed up at someone’s house, I doubt she’d get that. I’m not a lawyer obviously.
I think this is the sort of situation that demands a mental health court or other diversion program which gives this person a light slap on the wrist for now, but also requires her to do some community service and/or civics training and has conditions attached that she’ll get the hammer if she doesn’t get it together.
There’s always a balance in different considerations in criminal justice; this individual seems more like a crazy person, but rhetoric like this lead to entire sections of cities were taken over by people who sound an awful lot like her, so I think it’s important to send a message that just because you have dark-ish skin and use some pseudoleftist rhetoric doesn’t make you immune from the same fate that would befall anyone else who behaved in this manner.
California’s law enforcement is a joke right now. I’m leaving that out of my assessment even though you have a point.
I had this discussion further up in the thread, but when you make that threat, in that situation, everyone loses. Either this city council members look petty or the people lose respect for the law. You can’t do that and expect nothing to happen.
Prosecuting people for the absurdity of their language is illiberal. Patel was calling for the violent overthrow of the government more than threatening the specific council members as individuals. The first amendment protects the right to call for the violent overthrow of the government.
I agree, except she said we will murder you. That very different language to what you and I both think she meant.
I should be more clear. I’m not advocating sending her to prison for life or anything of the sort. I do think that a year or two would be helpful to the tomato soup throwing variety of activist in taking more care to say what you mean, rather than using this sort of very legally actionable language.
I am pretty much a free speech absolutist. That doesn’t remove the real world consequences of a persons speech. Murder threats are not well received anywhere haha.
The key word is “we”. The “we” refers to a non-existent cadre of violent revolutionaries, which is what makes it a hypothetical threat. Not to sound macho, but if I were on the Bakersfield city council, I would not be scared of Riddhi Patel. If she’d said “I will come to your house and murder you” instead of “we” the charge would be more credible.
If I say “in the event of a nuclear apocalypse that gives us the world of Fallout 4, I will murder you”, that’s not a death threat, because we don’t live in the world of Fallout 4. Similarly, Patel saying “when the Revolution comes, I will murder you” isn’t a real death threat, because the revolution ain’t coming.
It’s illiberal to punish a harmless threat to deter more serious threats in the future. Legal cases should be judged on their own terms, not seized as an opportunity to send a message to political forces you’re opposed to.
The reasonable person standard is awfully fuzzy, but if I was sitting on that council and I heard that person in that context saying those words in that manner, I would feel unsafe in my own house that night.
Can we have Sarah do economics next and how that is not a real science either. Does that have no place in the public sphere also?
When comparing therapy to medicine, I do want to point out blood pressure medication. In the 80s there are two different blood pressure medications, they worked for some people but not for others. This didn't make them any less scientific, it is just that everyone didn't react to them the same way. By the mid-90s there were a dozen different blood pressure medications and you didn't know which one would work for you until you tried them. I have to use six before I found one that was effective. It was just the matter of trial and error. Oh, and this is chemistry.
There is a lot of ideology in therapy and people are constantly trying new things. And bad science like the Power Pose and Grit keep on getting in the way.
I am not sure how old Sarah's kids are. I don't know how much experience with schools she as especially public schools. As a father with a child with ADHD I understand why it is nice to have counselors in school. Without counselors special ed would grind to a halt. there would be no IEPs, no 504, no mainstreaming of kids that should be able to learn in a regular classroom with a little help.
I was in school in the 80s with a undiagnosed reading disorder. I was told I was lazy when I was having a problem processing the words I was reading. I would have done better in school with a little more accommodating teaching and counseling. I want that for my son.
I will be listening to the bad therapy book soon. As a parent with a child who has had therapy, I think some of it is needed. I think it has helped us.
I thought I heard Sarah say that Therapy has no place in public health. That is a whole subject that need more attention.
On the discussion of school therapists or councillors:
Many (if not most) countries do not have them.
I am not aware of such a role at German schools. And as Sarah suggests: when the teacher is very concerned about the student and reaching out to the parents or other community members is not successful they would talk to social services.
I saw school counselors through the American school system in early adolescence (my teachers thought I was too argumentative). I don’t think it changed my personality, but it didn’t do me any harm, either. Mostly they would talk to me about my day, listen to whatever I had to say, and play the occasional board game. It was nice and I would look forward to it. You can argue it wasn’t the best use of the school’s resources, but based on my experience I’d say fears of school counselors corrupting children are overblown.
Middle Schoolers are all pretty impressionable. At 30, I don’t think I’m very impressionable, but I also recognize that most people like to think of themselves as independent-minded and I’m no exception, so I might not be the best judge of my own impressionability.
I can't imagine that school councillors have particular insights that teachers don't have. The councillor cannot know the student unless the student (or teacher maybe) approaches them.
A teacher will know their students to some degree because they see them every day/week in class. But there is one councillor for a whole school. I think they can be good as a "person to talk to" who is not also perceived as a person who controls your life (as a teacher or parent might be).
I assume they can be a good influence as long as their are not the kind who affirms people/children in their pathologies and suffering (which seems to increasingly be the trend n mental health).
I saw the councillors on a weekly basis so I imagine they did get to know me reasonably well. Most students wouldn’t see them so it’s not like they had to get to know every student in the school. They probably didn’t interact with more students than the average teacher did. I was there because I liked to argue and debate and give my teachers and classmates a hard time. My impression was they understood that their primary role was to be a sympathetic ear and escalate if I said anything too alarming. As you say, there are things kids tell councillors that they might not tell parents or teachers. In my case, not much came up. It’s hard for me to see anything sinister in the experience.
My wife was anti-cruise for a long time. She viewed a cruise ship as a petri dish. Then the switch flipped for her for some reason, and now it's her preferred vacation. Megan is exactly right that the appeal is the ease of planning, especially if you live within driving distance of the port.
Also, the Royal Caribbean/Carnival party ship type of cruise only represents a small portion of all the cruises out there. Even if going to the Caribbean, a Disney cruise has a totally different vibe than Carnival or Royal Caribbean. I've been on a Mediterranean cruise where the "entertainment" was lectures on the Ottoman Empire by a Yale professor. Some cruises can be pretty uppity if that's what you're looking for.
I went on one and didn't love the crowds, especially to get offshore, but as a way to travel with extended family with different special needs and activities for different age groups and interests, I recognize the upsides. I didn't read the article but I'm friends with a couple, as snooty as they come, who secretly loves cruises because they can just check out during them. I would have much preferred to read an article about cruising from someone like one of them.
I am generally a fan of easy conversations but I do think that if you make a point as broad as you have, repeatedly, you owe listeners a true follow up.
What can be asserted without evidence can be dismissed without evidence, and I don’t think you have presented much evidence here or elsewhere, to back up your claim other than assuring us that despite its broadness your critique isn’t uninformed. That assertion isn’t enough when compared not to questionnaires of self reported mental health but many rct studies of especially cbt.
So I suggest you properly make your case or rest assured that most people will do well dismissing your claim as baseless (not because it has to be wrong, but because you refuse to make your case).
I loved the DFW cruise ship piece. It was fun how committed he was to renaming the ship from “The Zenith” to “The Nadir” - the passengers became “Nadirites”, the onboard newspaper became “Nadir Daily”, etc.
Acupuncture is just the placebo effect?! Sarah needs to stop Asian hate!!!! 😂
(Sarah probably already knows this, but fwiw acupuncture has been increasingly, if tentatively, accepted by Western doctors for decades at this point. Still, it sounds like she's either dismissing wholesale or not fully aware of the idea that, like ayurveda, traditional Chinese medicine is a different medical system whose adherents would say is actually supported by thousands of years' worth of empirical foundation. It's just that our system has been slow to recognize that foundation because it takes stepping out of one paradigm and into another to be able to synthesize both approaches. But lots of doctors trained in Western medicine have done just that. Today, you could practically throw a rock in the air and hit a doctor who's at least somewhat open to acupuncture.)
Oh no Sarah’s talking about therapy again! There’s plenty of information on the methodology and effectiveness of certain therapies Sarah, have you looked at research papers on treatments for various problems such as depression, ptsd, ocd, health anxiety? They lay out the mechanisms of treatment very clearly. You need to do more reading as you just sound like you’re not informed and are operating from a gut feeling. As for whether therapy works, those of us working in the NHS have to demonstrate or success so we use questionnaires to measure symptoms (depression, anxiety, ptsd etc.) and there’s about a 50% recovery rate. Clearly this statistic means therapy doesn’t work for everyone but it helps a hell of a lot of people.
The podcast is not the place to go into it deeply in depth (so perhaps it is my mistake to bring it up at all!), but suffice to say I disagree entirely. Yes, my critique is broad, but that does not make it uninformed.
I do not think much of the supposed research measures what you think it measures, nor are questionnaires on mental states reliable, and a cross-cultural view of "mental health" would shake your faith in our approach to mental health entirely.
How do you know that what therapy treats is inherent to the human condition, and not a culturally-induced illness, specific to our time and place? If it is more of the latter than the former, as I contend, then therapy (as broadly understood and practiced) is not a harmless intervention, but part and parcel of the creation and sustenance of the symptom pool.
To be honest Sarah I’m not sure I even understand your comment, culturally-induced? Of course things are partly and maybe completely culturally induced, we are all a product of our culture, but how does that help someone who’s having PTSD nightmares and flashbacks about a trauma like being raped? Or someone who’s cleaning their house for five hours a day because they have OCD? They need to get help and there are clear tested and researched protocols for treating which have been successful. As for your point about questionnaires not being reliable, what’s your evidence for this? Are you using some research to tell you that because as a therapist we get the qualitative data from the patient also, we are seeing them in the room and can see their improvement that corresponds to what is on the questionnaires. But hey go, who cares because you think it might be harmful. Again, what data do you have on that?
I do not appreciate the tone there, nevertheless, I shall persist.
If a thing is more culturally-induced than (for lack of a better word) organically-induced, then that calls for an entirely different approach to treatment.
Anorexia is a good example (or gender confusion). Both are "diseases" that exist only in some places and times--some parts of the world don't have anything like anorexia and never have, or even anxiety or PTSD. How can you explain this?
Yes, the above are deeply felt, and can cause major life disruption to the afflicted--they can even cause physical pain/harm--I do not deny that. But the fact of the matter is that therapists broadly simply *do not consider* cultural origination of many mental health issues, nor do they analyze their part in legitimizing such illnesses (this exchange being an example). There is no excuse for the myopia, and yet!
What if the "cure" for the person with OCD was to tell her that there is no such thing as OCD? What if the specific shape and form of this person's illness is due in large part to their belief that it is a real, culturally-legitimate distress signal? What if in putting a name to something and cataloging it in some official-sounding book, you are in effect helping to create the thing itself?
How would you prove me wrong, if I thought that the above was all true?
There’s culturally induced and then there’s culturally constructed.
It may be that many of these specific mental illnesses are culturally induced but not culturally constructed. For example, diabetes is a very real illness, but is quite uncommon in some cultures and wildly common in the U.S. It’s also arbitrarily defined; there is no physical law that says that someone with an A1c of 6.6 is diabetic and someone with a 6.4 is not. There’s also considerable debate about whether it’s best described as a single disease entity or as part of the Metabolic Syndrome. The solution is not to tell someone with diabetes that their illness is not real. The non-enyzmatic glycosylation of microvasculature is definitely real, as are the debilitating consequences.
Similarly, even in times or places where “PTSD” was not a diagnosis, it may be that there is always a certain cohort of people who develop recurrent nightmares and have elevated cortisol levels after a traumatic event. The resilience of people to trauma, the availability and effectiveness of social support may differ. It may be that American society is just as anxiogenic as it is obesigenic. But would it really be helpful to tell someone with PTSD that their illness is not real because it is defined in culturally specific terms, or because it is more common in some cultures than others?
Maybe.
One thing you might want to consider is the flip-side: That some cultures simply encourage the covering-up of some mental illnesses. It seems unlikely that PTSD is any form of cultural neurosis, but a physiological/neurological response to extreme survival experiences (in those susceptible to it, which not necessarily all human beings are). Perhaps in societies in which there's "no PTSD" (and I mean *real* PTSD, of course, not the nouveau "I was denied the expression of my truth!" variety), people who suffer are meant to remain quiet about it, hide the effects at all costs, or possibly even drink them away. Culture can be a double-edged sword.
PTSD predates contemporary therapeutic approaches. During World War I, they called it “shell shock”.
And in each culture, in different times it has exhibited itself in completely different ways.
But consistently enough across those cultures that we still recognize it as the same phenomenon.
For example, there are a range of cross-cultural (and historical accounts) of people engaging in what sounds a lot like a persistent and exaggerated startle response after experiencing threat to life or bodily integrity. In contrast, post-traumatic elation is pretty uncommon.
The fact that there are symptoms that generally co-occur with one another, and generally don't co-occur with others - and that this generally remains true across time and culture - seems like at least a preliminary foundation for a science of psychopathology.
"Anorexia is a good example (or gender confusion). Both are "diseases" that exist only in some places and times--some parts of the world don't have anything like anorexia and never have, or even anxiety or PTSD. How can you explain this? "
I think you can see that these things are all kinds of dysmorphia. They have to do with the way people are viewing their bodies. In medicine people often confuse the outward symptom and underlying problem.
I can see this exchange is going no where as we appear to be talking at cross purposes, you’re talking about the origins of mental health distress and whether it is somehow created by the culture, something which you can have opinions about but whatever answer you come to it won’t move us on from the real distress people are experiencing in this culture, unless you seriously think that telling people something isn’t real is going to reduce their distress.
Look, its not an opinion, it is a reality. There are lots of things I can reference here, but you can start with the book "mad like us" if you want an introduction to the kind of critique I am making.
The origin of the illness is not some extraneous point to consider, it is *the* point to consider. If this was a true branch of medicine, you wouldn't dare dismiss it, given that origins are vital to understanding the nature of the disease (and thus, treating it).
"Crazy Like Us", I mean.
It’s non-obvious to me that the origin of the disease is *necessarily* vital to treating it, even if it often works out that way in practice. For example, if a wound was caused by a gunshot, the type of gun might give the doctors useful information about how to treat it, but it also might not. Arguably, the motive for the shooting is also part of the “origin” of the wound, but doctors don’t need to consider that at all. The origin of the health issue (mental or otherwise) often furnishes medically useful information, but that doesn’t mean any information about the origin is automatically medically relevant. This extends to nature versus nurture questions. Whether someone has a genetic predisposition to lung cancer or got the cancer from smoking presumably doesn’t matter for the type of chemo they receive. Doctors are concerned with the medical facts of the case in the present moment. I’m no expert but that’s how I see it. Maybe John Bingham can weigh in here?
I am very familiar with the kind of critique you are referencing, we learn about them in training and what i don’t think you get about my perspective is that it doesn’t matter to me. What if you were right? What then? Is society and culture going to change in the way you want it to? Do we dismantle the whole system that helps people recover from crippling mental health problems in the hope society and culture will change? Do you really think our society is going to change in the way you’re suggesting so that mental health conditions aren’t a reality? Physical health is also hugely affected by our culture, everything is affected by culture. Mental health conditions are just a list of symptoms that cause people distress and whatever created them, my job is to help reduce them so when I hear you trashing therapy I don’t hear you putting forward any real, workable alternatives to helping people and that’s what really gets under my skin.
I just want to add that the majority of patients I see for PTSD treatment are asylum seekers whose trauma was in countries such as Egypt, Afghanistan and other war torn countries and I can tell you that their distress didn’t start when they stepped on British soil.
So to draw an admittedly crude analogy, it would be like somebody believing they’re possessed. Sure, they likely have genuine mental distress, and possibly even a genuine disorder in their brain. But it’s because they were raised in a culture that taught them demons can inhabit people’s bodies that they believe the reason for their distress is that demons are inhabiting their body. In which case, I’m sure you’d agree that the practice of exorcism should be treated with scrutiny, and is perhaps itself responsible for people believing they’re possessed.
There are so many examples throughout history of people making up bogus mental conditions (“drapetomania” anyone?). How can you be so sure that our current explanations for why people feel bad are so perfect, anyway?
What I’m saying is that the evidence based field of psychological therapy doesn’t look at explanations for mental health conditions as much as it looks at what treatment is effective, maybe one day we will find more effective treatments and I hope we do but effective treatment is what I’m interested in, not explanations for distress - unless of course they come paired with a treatment for alleviating the distress which in my experience they do not.
Sometimes placebos can be more effective than no intervention. Does that make them “treatment”?
Bogus treatments for psychosomatic illnesses throughout medical history have often been “effective”—bedridden women supposedly paralyzed from the waist down would get better by nonsense bathhouse visits.
I’m sure you know from the gender debate there’s a lot of bad studies or studies of specific treatments that aren’t effective which is why NICE (which regularly produces reviews of the evidence for paychological presentations, you can look up the one on PTSD or OCD) looks across the evidence and makes a judgement. As for citing bad treatments in the past, you can’t compare a treatment given years ago before there was any research with treatments today which are much more throughly researched with numerous (usually) three sample groups.
I’m inclined to agree that self-report questionnaires are subject to a variety of biases that the mental health basically sweeps under the rug by pretending that since we all are subject to these biases and can’t defeat them, they’re not worth worrying about.
But I’ve been to several neuroethics conferences in my time and I am optimistic about biomarkers potentially giving us a better handle on the science here. Just because we don’t have much quality scientific research in this area doesn’t mean we never will.
And I don’t even have a strong opinion on how different therapeutic approaches might perform if we had objective measures.
I agree mostly with you that therapy is not as scientific as people think it is.
It is a lot like 'nutrition science'.
It is all based on self reports.
More importantly, there is very little effort to figure out whether therapists are doing a good job.
I also question how much a single person can know about your personality and problems in the world just having heart *your* side of the story. What does your friend/spouse/colleague say about you? The psychologist/psychiatrist/therapist (very differently types of training, I know) only rely on *your* telling of the world. They can only know how you feel at the time that you are in their office. Maybe they ask you to keep a diary and read how you feel at times you can be bothered to write it down.
But people are not reliable narrators even of their own feelings.
The psychiatrist is the only professional who can look into conditions that can affect your mood with medical tests (eg a brain tumour or vitamin deficiency). Everyone else is just a good listener, maybe.
I have seen many friends almost brag about their new diagnoses... Even if your self-reported well-being has increased it still does not mean the therapy helped you.
Increasingly, I have the impression that people feel just better as a victim with a certificate. In the long run this will not improve your well being (but might make you more annoying and then less popular with people who don't centre their life around mental illness).
So, my in-laws are both PHDs in this field. One is a psychiatrist-works in a mental health facility in the modern version of what would have been called an insane asylum. The other is a psychologist and is a marriage and family therapist. Works from home doing therapy sessions.
They both would and have admitted to me that sometimes, depending on the client, therapy comes down to somewhat loose interpretations based on the only thing they really have to go off of-which is what the client physically says to the therapist. It’s imperfect, like a lot of health care is in reality. In this case, if you never hear both sides of a story, it can be very hard to try and accurately interpret the situation/problem.
This is why often the “story” changes when both parties are invited to therapy rather than just one aggrieved party.
I think the field is very well intentioned. I also think the amount of harm done to society that is referenced in Shrier’s book is evidence, as Shrier states, that it does have some healing ability or at least an ability to affect change in people’s lives.
It’s not as cut and dry as Sarah makes it seem here, not in my opinion.
I surely understand her position though and her position is easy to back logically because it’s very hard in these cases to provide hard objective measures or proofs. Everything is subjective, and worse it is often based on the subjective view of the patient(someone who is in therapy presumably because there is some mental issue at hand).
The most devastating critique of therapy is one that shier hardly touches: that "mental health" looks entirely different in different cultures. While some illnesses retain their basic shape (schizophrenia) others are basically non-existent (anxiety, ptsd), resisting the exhaustive efforts of "well-intentioned" American therapists to find them.
The obvious conclusion is that much of what we treat with therapy is culturally-induced, with therapists as active participants in the creation of the disease.
Having read the book, I disagree. One could argue that is one of the main points. Even if not explicitly defined. When she talks about societal influences like phones and therapeutic language she is implicitly acknowledging this point.
I have heard her, in interviews, talk about this explicitly. Listen for the word iatrogenic, that’s usually the start of her touching on the subject.
I read the book too, I'm just saying she actually doesn't lean into it enough. I haven't listened to the interviews though, so you may be right.
That’s fair. She fighting an uphill battle with the book premise to begin with.
Haha. I don’t think a full scale takedown of the profession would have been a good idea in the same book. Megan’s pushback in the podcast is a solid proxy for how that would have worked against her here.
It would be too easy for the idiot public to call her an anti-therapy nutjob. In her interviews she hedges so hard against that idea it makes me think she avoided explicitly saying it in the book on purpose.
I wouldn't be surprised if you are right, and in any case I'm glad people like her are around to open the door a bit so that the discussion can at least be aired.
The marital counseling field is an interesting example in that its subject of treatment doesn't indeed seem to exist in many cultures. But is this because the problems being targeted don't exist, or because in those cultures (including western ones until recent decades) the "solution" was for men to cheat, beat and/or emotionally abuse their wives, the wives to self-medicate with alcohol, and all with the cultural expectation that such is a man's prerogative and the wife's is to take it? It seems in this case the emergence of therapy would represent a movement towards a better way of problem solving (even if the conclusion is to end the relationship, rather than to continue the suffering)?
Do you distinguish clinical psychology from therapy, or do you consider them to be one and the same? Clinical psychology is based in science. It may be more social science than natural science, but it's still science nonetheless.
Thanks for that "lived experience" of therapists post.
There are severe cases where people are suicidal or delusional or too anxious to leave their house where objective measures of improvement can be applied. In this cases the quality of a treatment could be evaluated.
But for everyone who is a bit depressed or thinks they don't have enough friends because they are "on the spectrum" therapy can be just too much navel gazing.
Just... If nothing is really helpful... what do I do with a friend who has been depressed for years about a failed relationship (his fault)?
To your question at the end. Consistently answering their complaints/concerns with some form of “what are you going to do about that?” Is a great place to start. These people have to accept that there is one person who has the single greatest control over their lives and it’s them.
I have seen people lose friendships over this approach and it’s really unfortunate. I have also seen people make dramatically good progress after accepting responsibility for their lives.
If Sarah wants to make a substantive case against the effectiveness of therapy she should write it up. A podcast discussion isn’t the best medium for engaging with academic literature, which is what the case would need to do.
You are right, I should.
I personally really enjoy listening to smart people kick ideas around. I don’t need a full fledged dissertation.
While I do think Sarah should write about this with more depth and citations, I don't want to miss her uncompromising takes on mental health on the podcast either. ; )
Totally, I just meant it as a friendly suggestion - I think the podcast format is too limiting for the scale and depth of argument she wants to make, which is part of what’s causing Georgie B’s frustration
I would like to salute Meghan's sense of journalistic duty. That she'd seek to sleep with a denizen of a cruise ship purely to surprise her readers with that information signals a profound willingness to go above and beyond. Bravo!
I was thinking a crew member (some kind of Captain Stubbing/Gopher hybrid) but in any case I appreciate your salute. Journalism is a calling.
I love that they discussed the Shteyngardt Cruise ship piece.
I read it and found the first paragraph funny and captivating but then it became incredibly whiny.
I enjoy the slightly mocking/eloquent/witty view of an outsider. But he was very critical of all these fellow guests, yet, really craved their attention and admiration - and failed to get it. A grown middle-aged man crying (!) because he has to spend 5 days away from his wife on a luxury cruise ship. After 2h parading on deck in a silly T-shirt while looking (presumably) miserable and yet no one has approached him to be become his friend. I wonder why!? How pathetic!
This person probably hasn't left his little bubble in NYC (where he is a 'famous author') in a long while and displays shocking lack of self awareness while judging other people for liking mainstream things.
As an elitist snob myself, I am shocked at this overt display of elitist snobbery.
It read to me as tongue in cheek. He acknowledged poking fun at cruisers came off as snobby because it is, even if he is pointing to a real lack of depth in some people.
He lost me at this sentence: "It turns out that the aft is the stern of the ship, or, for those of us who don’t know what a stern or an aft are, its ass." Seriously? I thought snobs were known for their erudition. Also, you know "stern" but you're going to devote words to not knowing "aft"? Makes no sense. Maybe this is the point? Contradict oneself in erudite ways and see if anyone notices?
Wait - those of _us_ who don't know what a stern or an aft are? Maybe he's doing a parody of an elite trying not to sound elite? Maybe I'm wrong and this is very meta.
I think the conversation about data was interesting but not very helpful. What data show is usually how capable the data wrangler is and less about tapping into essential pieces of life like chemistry. For that very smart data wrangler, it still comes down to art, intuition, and their human flaws. The notion of getting data first is just a concept for humans who want to keep the status quo. Being wise and cautious has nothing to do with having data. Many companies spend ridiculous amounts of money to collect data about things which they have complete control over already, for executives whose interest in data is mainly to cover their asses.
When you break down some of the mathematical formulas upon which data analysis is based, to say that you are finding “truths” is hilarious. In every case you are learning something very limited which mainly leaves you with more questions. Data gathering is an art, and intuition is still a huge part of it. Data is great for immovable and unchanging things. If you see human beings as immovable and unchanging… go collect a data set. There is no objective place from which to view things outside of human experience.
In a democracy when people vote for things like trump, to me I’m less interested in who is chosen rather than will they buy out the bullshit that comes from their choices. Those people are the collateral of their choices. If you are going to be a radical leftist and start trans-ing people what I want to know is where is the collateral. Who will pay if things go badly. That’s my price for change, and I only listen to people who I have a good faith belief that they really mean what they say and will be the collateral if they find themselves at a dead end. The reason trans is an abuse is because there is no collateral, no surety. The gate keepers didn’t fail because they were open to new ideas, they failed because they played loosely with society as collateral. We should hate them for this. We should hate them because they said they knew better, and they fucked up.
If you are conservative, you can insist on data but that’s mainly a statement about how comfortable you feel with the status quo. If forced to re-examine that status quo you would hardly have any data to prove the merits of what you’re doing other than saying it seems to be working pretty well so far and you’re afraid of change. No human being is born ready for the amount of disruption that is available in facing facts like evolution, the malleability of the human mind. There’s little space to feel empowered and certain. And yet, the basics of everyday doing good, the small things we know do in fact work, the first principles of human life are right in front of us all the time. We need to eat, we need to make our way through a bevy of developments. These things aren’t a mystery. We’ve taken modernity too seriously.
People want the freedom to re-examine society and relationships and that’s great. The main problem as I see it is the narcissism to make others pick up the pieces for your experimentation. I think an interesting part of the conversation is how much experimentation do we allow, what collateral do we expect, and how much does society get to push back. We know some people are comfortable and never want to change and that can be burdensome, wrong, abusive. We know that some people have virtually no remorse if all if society is blown apart in the name of experimentation.
How much experimentation and disruption should a human society permit knowing that there is no such thing as a “safe” status quo?
//The gate keepers didn’t fail because they were open to new ideas, they failed because they played loosely with society as collateral.//
Nicely put, and also true for schools.
First!
man, i am losing my first mojo
The point I took from Shrier was that she didn’t have a problem with adults going to therapy. I thought she was mostly concerned about parents sending their children to therapy instead of having confidence in their ability to parent.
Children are much more susceptible to suggestions in a way adults are not. So for instance, in the traditional way therapy is done (in general) which explores feelings, if you constantly probe a child by asking them how something makes them feel, the therapist may actually be creating a problem in the child’s mind which isn’t really there but because the child wants to please the therapist or say the right thing, the child says what they think the therapist wants to hear.
We actually have examples of people being accused and convicted of child sexual abuse at a daycare because of bad therapy.
It is pretty terrifying to think of the damage a large number of well meaning individuals, with degrees in professions that depend on children as their patients, to earn a living.
I’m with Sarah on the necessity of enforcing “I am going to go to your house and murder you threats”. These people need to stop getting away with this bullshit.
The legal standard in California is “does the threat place the victim in reasonably sustained fear for their safety”. I don’t think Patel’s threats meet that standard. Would a reasonable person believe there’s any chance Riddhi Patel would show up at their door with an SJW posse?
She was directly threatening the city council. I disagree. These people are serving in their communities as members of their city councils, listening to violent threats to be guillotined and murdered in their homes is beyond the call of duty for an elected official. It’s bullshit and there should be consequences to this kind of behavior.
I don’t like her behavior either, but free speech means people have wide latitude to say horrible things to people who don’t deserve it. It’s possible the council members could bring a civil suit against her and win damages. But I don’t think the criminal charges will stick.
Agreed. They probably won’t stick, but even getting charged for this I think is a step in the right direction. If elected officials are subject to constant harassment, no one will do these thankless jobs.
It is incitement to violence, not covered by free speech. If she was a right winger would you say the same things?
Yes, I would. For speech to be “incitement to violence”, there has to be a possibility of it actually causing imminent violence. If there had been an angry mob behind Patel ready to charge at her words, it would be a different situation. Right wingers can (and do) advocate for the violent overthrow of the government without facing criminal prosecution.
There is a bit of nuance here. Riddhi Patel is an unintimidating person. It’s easy not to take her threats too seriously. If an ex-military Oathkeeper with a criminal past said something similar, it would be a lot more scary for the city council members, and the threat would arguably be more credible. That’s less about ideology than it is about whether the speaker seems like someone who might actually hurt you, but it does seem like a situation where the law might not apply to everyone equally.
Sure. Why wouldn't they? Is someone supposed to know there's no actual "we" of violent Antifa-types in her circle to whom she was referring? I'd be worried and I'm in Texas, where - if they showed up with any real conviction - I'd even be within my rights to light them up. Californians have no means of defense.
I’m no lawyer, but Riddhi Patel’s threats sounded hypothetical to me. She was saying she would murder them in the context of a violent revolution, which isn’t about to happen. Obviously a horrible thing to say, but treating it as a credible death threat is a little silly.
"Believe all women!"
Thread winner!
It’s incredible, really, how we’re supposed to never take these people at face value. “We’ll see you at your house.” This is why they’ve been able to get such a bully pulpit, nice liberals insisting we just ignore all their actual words and actions
We've created a culture of incredible indulgence amongst America's youth. There are many to fault for this, but it's come about largely because many of these people have never suffered consequences for their bad behavior. This has fostered a wide-spread and growing culture of mutual incivility in the US. The way to start setting things right is for those who've failed to learn what it means to be civil to suffer the natural consequences of their actions. If a man in a MAGA hat had said the same thing to a city council, I do not think there would be many currently pleading lenience for Patel pleading lenience for him. That double-standard in itself contributes to the air of incivility, particularly on the left - that the application of standards is a one-way street, and they are immune. It all needs to stop. It doesn't matter if you're right or left, male or female, or whatever means of discrimination one wants to draw. If you commit the crime you need to face the consequences.
She sounded rrage-filled and borderline demented. I could certainly see her getting swept up by some violent mob heading towards the mayor’s house ….
And the only reason to get that bent out shape about the metal detectors targeting her side is the hope that someone might bring a gun in there and kill them.
It was a real threat. Directed at real people.
It sould have consequences, but maybe more in the community-service-type league of punishment.
Someone like her is harmless until the conditions are right.
But if you found yourself in a revolution (unlikely scenario) or a mob (possible scenario) someone like her may indeed be an agitator that helps whip the crowd into a frenzy that leads to people being hurt.
Yes, it’s contextual. If there was a violent leftist movement in the USA targeting public officials, her threats would be credible and she should go to prison. However, there isn’t such a movement, so her threat isn’t credible. The standard isn’t “would this threat be credible if the conditions were right”. The standard is “was this threat credible under the conditions in which it actually occurred”.
You could say the same thing about obsessed stalkers. Harmless until
The conditions are right.
I think throwing the book at her is the right call here. A couple years in prison will make others consider the absurdity of the language/threats they choose to use in their activism. Activism is fine, threats based on misguided emotion are not.
I don’t know that throwing the book is actually the right strategy. Of course, prosecutors routinely overcharge and plead down, but it seems to me that the length of jail time being proposed is absurd relative to the actual offense (which I agree is an actual offense).
I’m thinking she should get a year or two. Threatening murder, no matter how absurdly, from a microphone in a city hall meeting gets you time. I’m ok with that being a hard and fast rule.
I think a year in jail is wildly excessive. In California, if she actually had a weapon and showed up at someone’s house, I doubt she’d get that. I’m not a lawyer obviously.
I think this is the sort of situation that demands a mental health court or other diversion program which gives this person a light slap on the wrist for now, but also requires her to do some community service and/or civics training and has conditions attached that she’ll get the hammer if she doesn’t get it together.
There’s always a balance in different considerations in criminal justice; this individual seems more like a crazy person, but rhetoric like this lead to entire sections of cities were taken over by people who sound an awful lot like her, so I think it’s important to send a message that just because you have dark-ish skin and use some pseudoleftist rhetoric doesn’t make you immune from the same fate that would befall anyone else who behaved in this manner.
California’s law enforcement is a joke right now. I’m leaving that out of my assessment even though you have a point.
I had this discussion further up in the thread, but when you make that threat, in that situation, everyone loses. Either this city council members look petty or the people lose respect for the law. You can’t do that and expect nothing to happen.
Prosecuting people for the absurdity of their language is illiberal. Patel was calling for the violent overthrow of the government more than threatening the specific council members as individuals. The first amendment protects the right to call for the violent overthrow of the government.
I agree, except she said we will murder you. That very different language to what you and I both think she meant.
I should be more clear. I’m not advocating sending her to prison for life or anything of the sort. I do think that a year or two would be helpful to the tomato soup throwing variety of activist in taking more care to say what you mean, rather than using this sort of very legally actionable language.
I am pretty much a free speech absolutist. That doesn’t remove the real world consequences of a persons speech. Murder threats are not well received anywhere haha.
The key word is “we”. The “we” refers to a non-existent cadre of violent revolutionaries, which is what makes it a hypothetical threat. Not to sound macho, but if I were on the Bakersfield city council, I would not be scared of Riddhi Patel. If she’d said “I will come to your house and murder you” instead of “we” the charge would be more credible.
If I say “in the event of a nuclear apocalypse that gives us the world of Fallout 4, I will murder you”, that’s not a death threat, because we don’t live in the world of Fallout 4. Similarly, Patel saying “when the Revolution comes, I will murder you” isn’t a real death threat, because the revolution ain’t coming.
We’re splitting hairs here. I agree that the threat was in all actuality likely harmless.
She was still enormously stupid to say it.
You could just as easily argue that “we” means “me and my friends”.
That’s not my point. This is an easy opportunity to, with the right punishment, deter threats of violence in the future.
Overkill in the punishment will do nothing, but in this case I don’t think it’s ok to let that language go Scott free.
It’s illiberal to punish a harmless threat to deter more serious threats in the future. Legal cases should be judged on their own terms, not seized as an opportunity to send a message to political forces you’re opposed to.
Threats are hypothetical by definition.
The reasonable person standard is awfully fuzzy, but if I was sitting on that council and I heard that person in that context saying those words in that manner, I would feel unsafe in my own house that night.
Can we have Sarah do economics next and how that is not a real science either. Does that have no place in the public sphere also?
When comparing therapy to medicine, I do want to point out blood pressure medication. In the 80s there are two different blood pressure medications, they worked for some people but not for others. This didn't make them any less scientific, it is just that everyone didn't react to them the same way. By the mid-90s there were a dozen different blood pressure medications and you didn't know which one would work for you until you tried them. I have to use six before I found one that was effective. It was just the matter of trial and error. Oh, and this is chemistry.
There is a lot of ideology in therapy and people are constantly trying new things. And bad science like the Power Pose and Grit keep on getting in the way.
I am not sure how old Sarah's kids are. I don't know how much experience with schools she as especially public schools. As a father with a child with ADHD I understand why it is nice to have counselors in school. Without counselors special ed would grind to a halt. there would be no IEPs, no 504, no mainstreaming of kids that should be able to learn in a regular classroom with a little help.
I was in school in the 80s with a undiagnosed reading disorder. I was told I was lazy when I was having a problem processing the words I was reading. I would have done better in school with a little more accommodating teaching and counseling. I want that for my son.
I will be listening to the bad therapy book soon. As a parent with a child who has had therapy, I think some of it is needed. I think it has helped us.
I thought I heard Sarah say that Therapy has no place in public health. That is a whole subject that need more attention.
On the discussion of school therapists or councillors:
Many (if not most) countries do not have them.
I am not aware of such a role at German schools. And as Sarah suggests: when the teacher is very concerned about the student and reaching out to the parents or other community members is not successful they would talk to social services.
I saw school counselors through the American school system in early adolescence (my teachers thought I was too argumentative). I don’t think it changed my personality, but it didn’t do me any harm, either. Mostly they would talk to me about my day, listen to whatever I had to say, and play the occasional board game. It was nice and I would look forward to it. You can argue it wasn’t the best use of the school’s resources, but based on my experience I’d say fears of school counselors corrupting children are overblown.
Would you consider yourself an impressionable person?
Middle Schoolers are all pretty impressionable. At 30, I don’t think I’m very impressionable, but I also recognize that most people like to think of themselves as independent-minded and I’m no exception, so I might not be the best judge of my own impressionability.
annoyingly reasonable response!
Over the years I’ve learned to moderate my argumentativeness with reasonableness :)
I can't imagine that school councillors have particular insights that teachers don't have. The councillor cannot know the student unless the student (or teacher maybe) approaches them.
A teacher will know their students to some degree because they see them every day/week in class. But there is one councillor for a whole school. I think they can be good as a "person to talk to" who is not also perceived as a person who controls your life (as a teacher or parent might be).
I assume they can be a good influence as long as their are not the kind who affirms people/children in their pathologies and suffering (which seems to increasingly be the trend n mental health).
I saw the councillors on a weekly basis so I imagine they did get to know me reasonably well. Most students wouldn’t see them so it’s not like they had to get to know every student in the school. They probably didn’t interact with more students than the average teacher did. I was there because I liked to argue and debate and give my teachers and classmates a hard time. My impression was they understood that their primary role was to be a sympathetic ear and escalate if I said anything too alarming. As you say, there are things kids tell councillors that they might not tell parents or teachers. In my case, not much came up. It’s hard for me to see anything sinister in the experience.
My wife was anti-cruise for a long time. She viewed a cruise ship as a petri dish. Then the switch flipped for her for some reason, and now it's her preferred vacation. Megan is exactly right that the appeal is the ease of planning, especially if you live within driving distance of the port.
Also, the Royal Caribbean/Carnival party ship type of cruise only represents a small portion of all the cruises out there. Even if going to the Caribbean, a Disney cruise has a totally different vibe than Carnival or Royal Caribbean. I've been on a Mediterranean cruise where the "entertainment" was lectures on the Ottoman Empire by a Yale professor. Some cruises can be pretty uppity if that's what you're looking for.
I went on one and didn't love the crowds, especially to get offshore, but as a way to travel with extended family with different special needs and activities for different age groups and interests, I recognize the upsides. I didn't read the article but I'm friends with a couple, as snooty as they come, who secretly loves cruises because they can just check out during them. I would have much preferred to read an article about cruising from someone like one of them.
People who have never been on a cruise should refrain from judging it in such a snooty and condescending manner.
And the food is really very good on a cruise.
I am generally a fan of easy conversations but I do think that if you make a point as broad as you have, repeatedly, you owe listeners a true follow up.
What can be asserted without evidence can be dismissed without evidence, and I don’t think you have presented much evidence here or elsewhere, to back up your claim other than assuring us that despite its broadness your critique isn’t uninformed. That assertion isn’t enough when compared not to questionnaires of self reported mental health but many rct studies of especially cbt.
So I suggest you properly make your case or rest assured that most people will do well dismissing your claim as baseless (not because it has to be wrong, but because you refuse to make your case).
I loved the DFW cruise ship piece. It was fun how committed he was to renaming the ship from “The Zenith” to “The Nadir” - the passengers became “Nadirites”, the onboard newspaper became “Nadir Daily”, etc.
Acupuncture is just the placebo effect?! Sarah needs to stop Asian hate!!!! 😂
(Sarah probably already knows this, but fwiw acupuncture has been increasingly, if tentatively, accepted by Western doctors for decades at this point. Still, it sounds like she's either dismissing wholesale or not fully aware of the idea that, like ayurveda, traditional Chinese medicine is a different medical system whose adherents would say is actually supported by thousands of years' worth of empirical foundation. It's just that our system has been slow to recognize that foundation because it takes stepping out of one paradigm and into another to be able to synthesize both approaches. But lots of doctors trained in Western medicine have done just that. Today, you could practically throw a rock in the air and hit a doctor who's at least somewhat open to acupuncture.)
For anyone interested, there's a pretty robust debate/discussion with LOTS of back-and-forth between a bunch of MDs and RNs here: https://www.reddit.com/r/medicine/comments/12go3pq/whats_the_consensus_on_acupuncture/
And this individual anecdote is also interesting:
https://www.quora.com/How-accepted-is-the-Chinese-acupuncture-methods-among-the-medical-community
The prose sucked and the article was unreadable so trite.
Risking your reputation— like Atticus Finch.