A couple of weeks ago I took Guardian journalist Hannah Jane Parkinson for the headline, “Samaritans Radar is a crude tool for flagging suicide risks – but it will save lives”. I baulked at the word “will” in the face of the app’s newness and its hugely problematic nature, and asked where her was evidence for this statement. Parkinson tweeted back that she didn’t need evidence, because it was an “opinion piece”. I understood that, but Parkinson wasn’t sharing her opinion; in using the word “will” she was making an assertion (as distinction she didn’t seem to be able to make).
Opinion: a view held about a particular issue; a judgement formed or a conclusion reached; a belief; a religious or political conviction
Assertion: The action of declaring or positively stating; declaration, affirmation, averment (source: Oxford English Dictionary)
If you’re asserting something, I continued, you need to be able to back that up. A few other people jumped in on the evidence issue, but Parkinson wasn’t for turning. In her view, her opinion (or “assertion” as the pesky old OED would have it) simply didn’t need evidence. Because everyone’s entitled to one of those and should be allowed to publicly air it.
Yesterday I learned that in the opinion of someone called Turhan Canli, “Major depressive disorder (MDD) should be re-conceptualized as an infectious disease” perhaps caused by “parasitic, bacterial, or viral infection”. It’s a startlingly left-field statement, not least because Canli is an Associate Professor of Psychology and Radiology (with sidelines in Humanities, Compassionate Care, and Bioethics) and not a specialist in psychiatry or, um, parasitology, bacteriology or virology. What evidence could he have for such an attention-grabbing headline?
Clicking through to the full article, his conjecture rests on little evidence. First there’s his point that depressed people exhibit “illness behavour” like low energy. Well, prescription drugs can reduce energy, as can other chemical issues like low blood sugar, or factors like insomnia, all without the involvement of pathogens. He also says that people with MDD display “inflammatory biomarkers”. This is based on two meta-analyses (a compilation of the findings of a number of studies). The first merely notes: “depression is accompanied by activation of the IRS” (inflammatory response system)” – there’s no speculation as to the nature of the association, so for all we know it’s the depression that causes a rise in these markers. The meta-analysis found levels of a different marker “were significantly higher in MDD patients than controls” but notes that “age, samples source and ethnic origins may play a potential role in heterogeneity”. In other words, the findings could be explained by something unrelated to the depression.
Next, Canli points out parasites, bacteria and viruses can alter people’s emotional behaviour. This is true. But so can drinking alcohol, listening to music, getting into an argument, becoming a parent or watching the John Lewis Christmas advert. They’re not form of infection (with the possible exception of the John Lewis Christmas advert). Lastly, Canli looks at possible inheritance of this depression infection. Maybe, “parasites could also add exogenous sequences to the human genome through the process of horizontal gene transfer” or perhaps we should look at the “estimated thousand species of bacteria reside in the human gastrointestinal tract” which could be passed during childbirth or through children living with their parents.
Wait, what? How am I supposed to have passed the depressive infection to my son, again? Is it in my genes, or did I give my child depression in second stage labour, as a woman with Strep B (group B streptococcus) might? Why didn’t I infect my daughter, then? So, big surprise, no real evidence for Canli’s theory (or set of theories) – but plenty of unwarranted inference and wild leaps of the imagination. Opinion as assertion, giving credence by publication in a journal.
This week the Maudsley Hospital held one of its regular debates on a mental health topic. On this occasion the issue up for a mauling was “Whatever happened to the stiff upper lip?” Batting for Team Psychiatry was Simeon Wessely, President of the Royal College of Psychiatrists. Captaining the Celebrity Pillshamers was novelist Will Self. Yep, that’s right. A novelist. Whilst I generally dislike debates, I do understand that for some there is a certain pleasure to be taken in putting forth an outrageous position purely the purpose of generating passionate argument. But a novelist? Really? Against the President of the RCP? What is his opinion on psychiatric prescribing worth, and why should it be worth any more than anyone who has taken psychiatric meds?
It seems there is a current trend to be so obsessed with the concept of “balance” that personal opinion opposing the prevailing view is often treated with as much dignity and weight as that founded on evidence. Programmes like Newsnight and Question Time pit politicians and experts in their field against people with no real credentials other than holding a strong opposing opinion on the evidenced stance. This has the effect of implying that all contributions matter equally, and that all opinions are similarly valid, whether you have spent decades studying the issue or are known simply for being “outspoken” on a topic.
Does this matter? Not in every topic of debate, perhaps. But when the topic are those that affect the lives of millions of people with mental health conditions, setting up assertion as opinion or treating spurious assertions as just as valid as an informed positions then yes, I think it matters. It especially matters if, like the examples above, the deliberation is about the issues affecting services users, without their involvement.
It matters if the ridiculous notion that depression is an infection is treated seriously, because it reinforces the unlikely notion that mental health conditions have purely biological roots and gives false hope that we will one day find a “vaccine”. It matters if someone is allowed to assert that that Samaritans Radar will save lives, because it steamrollers over huge level of concern within the mental health community that it will do no such thing without providing any evidence to the contrary, again potentially generating false hope as well as providing a skewed picture to those new to the topic.
It really matters if we say that, just for fun, we’re going to allow the opinion of a novelist to be pitted against the most senior psychiatrists in the land, because it reinforces the idea that in mental health, anyone’s opinion goes. Giving credence to the idea that meds are A Bad Thing may be a bit of entertainment for those who see medicine as intellectual exercise, but it feeds into and reinforces the uniformed opinions of those who thing pill-taking does more harm than good. And that harms real people, people who have to live with family, friends or colleagues who are mistrustful of drugs, who think we are weak for taking them or that we’re being turned into zombies with no authentic emotion. Besides which, debating the effects of psychotropic meds without the input of those who take them seems to be missing the entire point, something like judging Masterchef without asking the view of the people who tasted the food.
In my informed opinion.