From ‘The Times’, 4 August 2011.
Don’t take it ill, but there’s no medical utopia
The search for a biological answer to all our problems is a false trail. We humans are more complicated than that
I’m not a scientist, not a doctor, not an economist, not an epidemiologist, not a statistician, not really an expert on anything, except maybe conspiracy theories. But one possible value that a gadfly like me can have is in noticing, over time, certain fashions and repetitions in thought and behaviour — certain cultural tics — and pointing them out. And this is the one that I have been sweltering over this hot August week.
Following the BSE crisis in the Nineties — as a non-expert — I watched a certain kind of populism take hold on the question of disease and medicine. I was first really aware of the turn that it had taken during the Frankenfood scare of 1998, when genetic modification became somehow an enemy of the people. GM was unnatural, untested, a product of a nexus between greedy Big Pharma and weedy, bankrolled politicians. Tom Archer heroically trashed his uncle’s experimental GM crops on Radio 4, Newsnight ran reports on a doctor who might have discovered harmful effects in potatoes, HRH expressed dismay, Michael Meacher and the new Labour Government bottled it and the British GM industry was more or less destroyed.
The counterpoint was the whole foods and organic products campaign, with its suggestion that if you ate “naturally” you would be healthier than if you imbibed “cocktails” of chemicals into your body. And just a few years later the MMR scare provided some of the exact same themes. Big Pharma and the vax-happy docs, together with neglectful, unlistening governments, had effectively delivered autism to thousands of children under the guise of helping them. Again something unnatural had been put into people, and this explained the otherwise inexplicable — why the incidence of autism appeared to be rising.
What was interesting here, as it had been about aspects of the anti-GM campaign, was the utter conviction of the campaigners that they saw and knew something that the authorities were denying. Added to this was the power of anecdote — the authentic knowledge on the part of parents that it was the MMR jab that had been responsible, and that to deny it was to deny their experience and their pain.
MMR added to the GM scare the extra dimension of an explanation for why things were as they were. But because the stakes were much higher for MMR — the real health of millions of children who might suffer from the reintroduction of measles, mumps and rubella — the backlash, though slow, was powerful. Andrew Wakefield, the champion of the non-existent autism link, went, in three years, from media hero to compromised villain.
What we are talking about here is why people believe what they believe. And it brings together two recurring ideas — that something comes from outside us to make us ill or unhappy, and that we can or have discovered what that something is. At which point, of course, we could act to expel it or cut it out. Added to these ideas, in recent times, is the notion that certain people wish to stop us gaining or applying this knowledge, for nefarious reasons of their own.
I was reminded of this when the discussion started last week about how difficult scientists and doctors were finding it to work in the field of chronic fatigue syndrome, as it is known in Britain, or ME (myalgic encephalomyelitis) as it used to be and still is in many countries.
It is the contention of many sufferers of these debilitating conditions (overwhelmingly women) that there is a direct but undiscovered physical cause of CFS/ME, and that lack of resource, care and commitment is what stands between them and a possible cure or prevention. The problem, as they perceive it, is that the medical profession has hung its hat on the belief that this often nebulous collection of symptoms is more likely to be a manifestation of an internal problem, located in the mind. This, to the sufferers, appears to relegate their disease “merely” to a psychosomatic condition, putting them in the same unliked group as depressives or schizophrenics.
It’s not an exaggeration to say that some CFS campaigners are desperate to discover an external cause for their suffering. They reject the alleviation that psychotherapeutic treatment is shown to bring, and they continue to cling to the one, unrepeatable, American study that seemed to connect CFS to a virus, XMRV.
The anxiety that CFS campaigners show for a clear, medical, physical (and hopefully, external) explanation for their illness has a fascinating counterpoint, I think, in the Happiness Lobby. This is the collection of writers, think-tanks, philosophers and others whose überthesis is that modern society is unhappy relative to previous societies, that this happiness/ unhappiness can be detected and measured through developments in neuroscience, and that policies can be adopted to tilt us back to joy.
One of the incarnations of happyism, a few years back, was that we were witnessing a declining capacity to produce the key substance, serotonin, and that the mass taking of Prozac (preventing the suppression of serotonin) would be a major way to reclaim our rightful bonhomie. Others, more recently, have suggested that greater social equality, more mutualism, more associative behaviour ( join the PTA, go to residents’ meetings, take one another’s kids out on jolly romps) would make us all happier. Thus we could defeat the epidemic of depression sweeping the Anglophone world.
But hardly have we begun a proper argument about happyism than neurodeterminism has come to town. This panacea variant promises (in its more vulgar forms) to tell you which bits of the brain and which chemicals are making you feel and behave the way you do. It’s the action of the amygdala, it’s the presence of dopamine, it’s the way our cortexes light up when we’re in love.
What we’re offered is another eventual explanation for all our syndromes, and now we reinvest our hopes in discovery.
But I am very sceptical that it is chemicals and brain functions that make us sad, angry, aroused or frightened. My bet is the other way round — that it is the emotion that is mother to the physical reaction. For, as the psychotherapist Adam Phillips has pointed out in discussing happyism, we are complex psychological organisms: bad things can make us happy, some people like unhappiness, and happiness is idiosyncratic.
This is not an argument against endeavour, but an argument against trying to reduce everything to a state of impossible clarity and imagining that we’ll solve everything. Our most intractable human problem stems from the fact that we can’t go back into our infancies and be perfectly remothered. Thus utopia — medical or happy — is never in our grasp. Better understanding, though, may be. I’ll settle for it.