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"Justman, Stewart"
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The nocebo effect : overdiagnosis and its costs
\"The Nocebo Effect documents the transformation of normal problems into medical ones and brings out the risks of this inflationary practice. One notable risk is that people labeled as sick may find themselves living up to their label through the alchemy of the nocebo effect\"-- Provided by publisher.
Book
Where Does Common Sense Come From? 'A Modest Proposal' and the Inoculation Controversy
Many a clinical trial boasts results with statistical, albeit not clinical, significance.1 For the hater of statistics Swift's \"A Modest Proposal\" is a locus classicus. \"4 That doctrine, in turn, plays out in the maximally provocative writings of Swift's contemporary and fellow satirist Bernard Mandeville, who was prepared to argue in all candor that \"In a free nation where slaves are not allowed of, the surest wealth consists in a multitude of laborious poor,\" from which it follows that the children of the poor must be kept ignorant and put to work as early as possible for the public good.5 Only so, argues Mandeville, can England \"out-sell our neighbours and at the same time increase our number,\" objectives dear to mercantilism. According to an axiom of mercantilism, people are the riches of a nation; and if this is so, then the untold grief and loss caused by a disease that depresses the population itself—such as smallpox—also represents an injury to the state. The number of the dead would be reduced seven parts in eight; and consequently, 2000 persons that are yearly cut off within the bills of mortality alone, and those generally in the beginning or prime of life, might be preserved to their king and country.11 While Jurin somewhat rhetorically invokes the mercantilist principle that the individual subserves \"king and country,\" he was anything but a mad calculator swollen with delusions of grandeur like the narrator of \"A Modest Proposal.\"
Journal Article
From blocked flows to suppressed emotions: the life of a trope
Internal blockages and build-ups cause disease: traditionally, this principle seemed intuitive both to professionals and the laity, explained conditions as diverse as melancholy and scurvy (among many others), and justified the use of evacuative treatments to get rid of noxious matter. With the collapse of humoral medicine and the establishment of the concept of specific causation, one might have expected time-honoured tropes of obstruction to die off. They did not die off, but moved with the times and adapted to new conditions. Emphasis swung from the noxious character of retained substances to the harms of suppressed urges and emotions—harms including disabling maladjustments as a result of sexual inhibition, and cancer as a result of emotional inhibition. In both cases the causal mechanisms resemble traditional blockages. Theories of noxious inhibitions or psychological blocks, which have a familiar and perhaps even intuitive sound because they have so much history behind them, can easily lead patients into fanciful methods of prevention and treatment.
Journal Article
Upbringing and Agency: Three Perspectives
According to the authors of the widely discussed Coddling of the American Mind, the protections received in childhood by today's college students made them the fragile souls who have demanded and often obtained protection from \"unsafe\" ideas. The authors' analysis implicates larger questions than they seem quite prepared to discuss—in particular, what it means to be an agent as opposed to a hapless product of one's upbringing. Investigating this issue, I consult two renowned works of literature that examine the constricted upbringing of women, who were understood as fragile beings long before iGen arrived on the scene.
Journal Article
The Guilt-Free Psychopath
The revolution that saw the introduction of an empirical diagnostic system in Diagnostic and Statistical Manual of Mental Disorders, 3rd edition, also shifted the focus of diagnostic interest from the psychopathic mentality to the particulars of psychopathic behavior. Usually thought to be an essential or defining feature of the latter is a pronounced lack of guilt—so pronounced it's as if the psychopath lacked even the capacity for guilt. However, reality may not conform to type; and in any case, the consensus that the psychopath lacks guilt probably rests not on close inspection of the subject's psyche but on inference, valid or not, from a pattern of behavior. Central to this article is the behavioral checklist for sociopathy (psychopathy by another name) in Lee Robins' 1966 study of the disorder's course—a checklist that nevertheless contains a \"lack of guilt\" criterion, and that I test against a contemporary description of the psychopathic mentality to see which better applies to a diagnosed psychopath in Capote's In Cold Blood (1965). The behavioral criteria provide a better fit. It is the Lee Robins specifications that underwrite the purely behavioral requirements for Antisocial Personality Disorder in the Feighner criteria, which in turn underlie the corresponding checklist in Diagnostic and Statistical Manual of Mental Disorders, 3rd edition. As an empirical matter, the antisocial person may or may not feel guilt; as an ethical matter, we should hesitate to impute a constitutional defect that can either automatically imply incorrigibility or automatically excuse the actor.
Journal Article
Fresh Thinking
[...]the same traits may be expressed differently, which is why people can score high on Psychopathy Checklist-Revised, whose constituent items derive from Cleckley, without resembling Cleckley's absurdists at all. Examples or cases have the merit of bringing the discussion down to mother earth, and in that spirit I offer, near the end of my article, the instance of Claude Brown, author of Manchild in the Promised Land, whose youth was a veritable handbook of warning signs and who seemed destined for a life of violent psychopathy, but comes to lament that he set \"such a bad example\" for his younger brother. [...]sooner or later lawyers will argue that their client's very lack of remorse simply proves that the client suffers from a disabling defect, as if ruthlessness had become its own exoneration.
Journal Article
A Slippery Preventive Slope
The problem traces back to the landmark Prostate Cancer Prevention Trial, designed to determine whether finasteride, originally used to treat benign prostatic hyperplasia, could cut the incidence of prostate cancer. According to Christopher Logothetis of M. D. Anderson Cancer Center, the virtue of finasteride is that it will reduce the overtreatment of prostate cancer.
Journal Article
Buried in Silence: Homosexuality and the Feighner Criteria
The diagnostic revolution that culminated in the third edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (1980) began with the publication in 1972 of the Feighner criteria, a set of rules for the identification of 16 disorders. Although Feighner et al. claim that their diagnostic categories rest on solid data, the fact is that one was soon to be removed by the American Psychiatric Association from its classification of mental disorders: homosexuality. However, the anomaly of an extinct category in a list of supposedly validated diagnostic criteria never became a point of discussion, quite as if the topic were unmentionable. It was in fact even more of an embarrassment than either side in the homosexuality debate seems to have realized at the time. Upon examination, the evidence offered by Feighner et al. in support of the diagnosis of homosexuality proves to be nil. Had there not been an informal embargo on discussion of the status of homosexuality in the Feighner document, the makers of Diagnostic and Statistical Manual of Mental Disorders-III might have recognized that the diagnosis fails all Feighner tests of validity. Had they attached greater importance to these tests, the concept of a disorder that was built into Diagnostic and Statistical Manual of Mental Disorders-III might have taken a different shape.
Journal Article
Placebo: the lie that comes true?
Over the decades of experimentation on the placebo effect, it has become clear that it is driven largely by expectation, and that strong expectations of efficacy are more likely to give rise to the experience of benefit. No wonder the placebo effect has come to resemble a self-fulfilling prophecy. However, this resemblance is considerably exaggerated. The placebo effect does not work as strongly as it is advertised to do in some efforts to elicit it. Half-truths about the placebo effect are now in circulation, reinforced by a number of other equivocations that it seems to attract. As the deceptive use of placebos has fallen into discredit, the use of half-truths and exaggerations—neither of which is technically a deception—becomes an ever more inviting possibility. However, there are risks and costs associated with the half-truth that the doctor possesses the power to make his or her words come true by the alchemy of the placebo effect.
Journal Article
Montaigne on Medicine: Insights of a 16th-Century Skeptic
Michel de Montaigne (1533-1592) viewed the medicine of his time with a well-merited skepticism and had remarkable insight into its best resource, the placebo effect. Because less separates biomedicine from its Early Modern counterpart than commonly supposed, Montaigne still has much to tell us about the workings of this potent variable. When people improve as a result of surgery that did not take place, or for that matter sicken as a result of fumes that elude detection, they behave much like their counterparts in Montaigne's world. But doctors as well as patients are subject to errors of perception and inference. It was the goal of correcting misleading impressions by more reliable knowledge that led mid-20th-century investigators of the placebo effect to propose the sort of methodologically demanding trials through which drugs are now run before being brought to market. Montaigne's awareness of the weak foundations of claimed knowledge, prominently including medical knowledge, was central to his philosophy of the human.
Journal Article