The Problem with Randomised Controlled Trials (RCTs)

I have recently been debating the merits and problems of objective, quantitative research in mental health. (One of my interlocutors has posted a lengthy response here, arguing in favour of ‘objectivism’). RCTs are a methodological device introduced into mental health from general medicine. Whilst they are merely problematic in the latter, they are outright misleading in the former. Continue reading

Against ‘objective’ tests

One of the effects of the anti-subjective, objectifying approach in psychology and psychiatry is to leave subjects themselves in an alienated position with respect to their own suffering. Forms of misery which are by definition subjective – melancholia, grief, anxiety, or even physical pain, for that matter – can seem to have no validity unless ‘verified’ in some ‘objective’ form (a blood test, or psychometric scale, etc).

This is an unfortunate position, as it mistakenly treats that which is subjective as if it were non-existent outside of these tests. It leads to absurdity, as grief (for example) is no less real or horrendous for being impossible to quantify. The impulse to seek for ‘objective’ measures of pain implicitly devalues the speech of the suffering subject, and also implicitly posits their disposition, as one in which they are not personally implicated. After all, why examine your life if your most profound and intimate experiences are reducible to neurochemical effects? It also assumes that one person’s suffering is essentially the same as another’s – homogenous – and that it is merely a matter of numbers, of degree on a scale. It is true that speech and subjectivity are clinically and scientifically ‘messy’, but this does not justify rejecting them through objectification.

I cannot see anything in this demand for objectification that is respectful toward private suffering, supportive of therapeutic effects, or grounded in rigorous thinking.

On Shame and Shaming

In psychoanalysis, there is a clear distinction to be made between guilt and shame. Guilt implies a relation to the law. The law is the flipside of desire*, since its instantiation generates the possibility of its transgression (and hence of enjoyment through transgression). Thus, the law limits and regulates the very enjoyment it makes possible.

Shame, by way of contrast, involves no transgression, but it does always imply a relation to an Other. Continue reading

Anti-stigma campaigns that restigmatise…




When it comes to campaigns against stigma in ‘mental health’ that actually restigmatise their objects, Stephen Fry is not the only offender, or even the worst. He is one of the most famous, however, and has spoken openly of his own experiences. Nonetheless, the above comment, seemingly part of an anti-stigma campaign is, (with the exception of the words on friendship), utterly incorrect and a counsel of despair.

Depression, like all emotions, is defined principally by its subjective component. The psychiatric classifications make this a sine qua non condition of diagnosing the disorder.  Yet Fry, like so many anti-stigma campaigners, wishes us to believe that our own subjectivity is alienated, has nothing to do with us, is much like the weather. Not only is this false – there are vast numbers of reasons why people become depressed, and many ways in which they perpetuate their condition – it also makes those with depression the passive victims of their condition.

Fry is not the only one to peddle these kinds of fantasies in the interest of fighting stigma. Unfortunately, these sorts of campaigns tend to promote two key falsehoods: firstly, a reductionist (usually biological) distortion of a subjective condition, and secondly, the foreclosure of any ethical implication on the part of sufferers. We are led, absurdly, to a subjectless disorder of subjectivity, and one for which nobody has any responsibility. Individuals are constructed as the passive victims of problems beyond their control, a conception which is implicitly belittling. The logical corollaries of this are, of course, defeatism, drugs, and techniques of distraction.

This is a great shame, as there may be some benefit in supporting those with various difficulties in life in getting help. Nonetheless, they will be implicated in those very difficulties, and far from being stigmatising, this is a very good thing, as it means that even the most wretched of melancholies may yet have a way out. An attitude of bad faith to one’s own subjectivity – pretending that it is ‘like the weather’ – can only intensify alienation, and hinder the movement of one’s subjectivity to a better place.