Freudian Script Fortnight 25/04/17

A slightly delayed review of two weeks of mental health and disability in the news…

“Survival of the fittest” is bullshit, pass it on

As Petya points out later in the thread, the inverted commas are important here – this is a misuse of Darwin’s concept. It is “survival of the fittest” as used by survivalists, eugenicists and Nazis. It is arguably what drives the “American Dream” and Tory Britain – if you work hard and contribute, you will succeed.

Exploring this topic further, Darwin did not originate the phrase “survival of the fittest”. It was commentary by Herbert Spencer, which was incorporated into later volumes of Darwin’s work. It is used by biologists to refer to the survival of random mutations in a population.

One of my favourite examples is sickle cell anaemia. This is an autosomal recessive condition, which means you need a pair of defective genes to cause the disease. However, if people have only one gene, they can better fight malaria as young children. This is why sickle cell disease is common in people of Middle Eastern, Indian, Mediterranean and African heritage. The gene survives because there is an advantage to having it.

The point is: natural selection is happening on an unconscious genetic level. It is about sexual reproduction and the survival of traits. Humans have been interfering with this before we even knew what it was – agriculture is based on this interference, centuries before GM crops. This is also why I jump on the “childbirth should be natural” crew – because millions of women died in childbirth, often taking their babies with them. Does that mean we should leave them to die, “as nature intended”?

I became a doctor to fight natural selection. It seems our ancient ancestors had the same attitude. It’s a pity our government disagrees, but I will fight them too.


Prince Harry ‘in total chaos’ over mother Diana’s death (BBC)

Prince Harry struck a blow for mental health stigma by discussing his complicated grief following his mother’s death. I think this was particularly important coming from a high-profile man with previous military service and a family with a stiff upper lip.

Discussions online inevitably turned to his privilege and how he has access to resources that the average person cannot find, due to mental health funding cuts and the changes in the “benefits” system. He is also ostensibly improved, so is not asking anything of the British public except acceptance.

While I agree that money can improve access to psychological therapy, there are also disadvantages to being a celebrity with a mental health problem. Firstly, money cannot buy privacy, as much as it might try. People with a reputation have something to lose by having a mental illness, because of mental health stigma. Secondly, private psychiatry is not the best mental health care available. Why? Because it turns patients into customers, who can buy access to their clinicians and the treatments they WANT rather than what they necessarily need. Good psychological therapy relies on boundaries. It cannot function if a client can call up their therapist at any time and demand their attention, because it prevents people developing coping strategies away from their therapist.

Neither circumstance is ideal, though Prince Harry’s is certainly miles better than slowly starving without any mental health support. However, Harry telling his story is another battle in the war on mental health stigma. It is another victory in the fight for “parity of esteem” between physical and mental health conditions. These things are further evidence that mental health care should and must receive more funding, research and support across health and social sectors in order to help people be the best they can be.


United Airlines Uses The Police To Punish A Customer For Getting A Great Deal (Medium)

Further information has emerged about the circumstances surrounding the passenger who was hauled from a United Airlines plane because he “refused to volunteer” to give up his seat for crew. The article focuses on how the computer programme picked David Dao and claims it was because he was the least profitable customer, even though his demographic details (travelling with his wife, doctor working the next day) made him unlikely to oblige them.

A commentator on the article had this to say:

For those unfamiliar with the Milgram experiment, it goes like this: an authority figure (experimenter) commands a volunteer (teacher) to administer electric shocks to a subject (learner) as a punishment for mistakes. The shocks escalate in severity, with accompanying screams and physical protest from the learner, until they become unresponsive. If the teacher hesitates or expresses concern, the experimenter tells them to continue.

Unknown to the teacher, the learner was an actor and the experiment was designed to end if they refused to continue after four orders or they gave three shocks at maximum voltage. Milgram and his associates predicted that a very small percentage of people who administer the most fatal shock. It turned out to be 65%.

The reason this experiment drew so much interest at the time and why it continues to do so is the defence of “I was just following orders”. It was particularly relevant in Milgram’s time due to the concurrence of Nazi war crimes tribunals. It is relevant today due to the behaviour of DEA agents during America’s travel ban and now flight crew for United Airlines. It is also relevant in an increasing call for “patriotism” coupled with slurs against protest and dissent.

Sources of authority would prefer everyone was like the men in Milgram’s experiment. It is important to question why.

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