杏吧原创

IN THE face of life鈥檚 inconvenient facts 鈥� alcoholism, drug addiction, depression and craziness, to name a few 鈥� pseudoscientific medical concepts allow us to cast difficult moral problems as simple factual questions, readily soluble in the lab and in the hospital. Gary Greenberg鈥檚 is an impressive and fascinating round-up of such pseudoscientific notions and the ways in which they have come to count as genuine illnesses.

For instance, explains how alcoholism鈥檚 transition from vice to disease was a welcome one, especially following Prohibition. It was long viewed as an allergy, though the specific allergen persistently failed to appear. Even today, neither its disease-nature nor any possible cures have manifested themselves. Regardless, people are happy to accept the idea that addiction is a medical illness, perhaps, Greenberg suggests, because of our ambivalence towards the role of pleasure and our uncertainties about free will and self-determination. 鈥淲ith the disease model we have an answer,鈥� he writes, 鈥渙ne that has the imprimatur of science; addiction isn鈥檛 wrong, it鈥檚 sick.鈥�

In the absence of scientific proof that addiction is a disease, is it wrong for medical professionals to perpetuate the idea? Not necessarily, Greenberg says 鈥� there are times when what is scientifically wrong, or at least uncertain, is morally right. 鈥淭here can be no doubt that the disease model has helped millions of people. If a made-up disease can be of such immense value, then we must consider the possibility that the truth is not what it鈥檚 cracked up to be. Perhaps, in the republic of medicine, the fiction that addiction is a disease is a noble lie.鈥�

Sometimes the noble lie works the other way round. In a chapter on homosexuality, Greenberg shows how humane concerns first led people to prefer a medical to a criminal definition, but conflict followed concerning the disrespect a medical definition implied toward what should perhaps be viewed as a free life choice. In 1973, following the and the start of the gay rights movement, the American Psychiatric Association deleted homosexuality from the Diagnostic and Statistical Manual of Mental Disorders (DSM), a move decided not by scientific facts but by political and moral attitudes. 鈥淚t may be the first time in history that a disease was eliminated by the stroke of a pen,鈥� Greenberg writes.

In each case he examines, Greenberg cites the strange and sometimes contradictory views that people struggling to clear up these questions often express. Laudably, he does not rest content with diagnosing paradoxes. Instead, he points out that these are truly hard problems, ones where it is not unreasonable for people to welcome any half-decent solution rather than living in total blindness. He approaches our dreadful contemporary tangles sympathetically and tries to understand fairly how the medical model is actually helping.

At times, though, he simply finds it baffling. Take, for instance, depression, which is widely considered a disease despite the fact that scientists don鈥檛 understand its biochemical origins. Psychiatrists usually treat this disease with serotonin-based medications, even though they don鈥檛 understand how serotonin deficiency causes depression, if it does at all. Perhaps, Greenberg says, the medical community鈥檚 noble lie about depression is the best way to give people a break. 鈥淏ut why so many people seem to need a Prozac break鈥� well, that鈥檚 a question that future historians are bound to puzzle out when this noble lie about our unhappiness gives way to the next.鈥�

Do we really have to await that enlightenment? The one point on which Greenberg seems to me a bit simple-minded is his reliance on that phrase, 鈥渘oble lie鈥�. This is actually a misleading translation of Plato鈥檚 words in the Republic, in which he wrote that the ideal state required a new myth (a 鈥渕agnificent myth鈥�, as F. M. Cornford renders it) to enlighten its citizens about their political role, telling them that they were made of different metals which fitted them for the particular work they had to do. Plato鈥檚 aim was not for people to take this story as literal fact, though he understood some of them might. He simply wanted them to grasp its symbolism 鈥� to use it, as the Greeks well understood myths should be used, to indicate a larger truth that lay behind it. His intention was not to deceive them, but to enlist their imaginations and ensure social harmony.

The 鈥渘oble lie鈥�, then, is not a pretence of science but normal, honest persuasion, a crucial function served by all sorts of imagery and half-conscious metaphors that we rightly use, and constantly alter, in shaping and reshaping our understanding of ourselves and our place in the world. As Greenberg says, 鈥渁ll accounts about human nature are necessarily stories鈥�. But that does not make them lies, noble or otherwise. The lie involved here is not the casting of moral ills as disease, but the claim that it is literal fact, endorsed by science. To call these myths equally 鈥渓ies鈥� suggests there is no truth in any of them, leading to a spineless and undiscriminating relativism.

Clearly this is not Greenberg鈥檚 aim. His reason for objecting so strongly to some of this scientific jargon is that it can actually mislead us. We ought not use apparently scientific terminology to cover up urgent questions about how we ourselves are shaping our society. In a fascinating correspondence with the clear-headed and callous murderer known as the , Greenberg tells Ted Kaczynski that he should never have been forced to accept the defence of schizophrenia at his trial, both because he believes Kaczynski was in fact 鈥渆vil and not sick鈥�, and because 鈥渉is very character seemed to bear the imprint of large social and historical forces鈥� which could not be investigated once he was classed as too mad to be taken seriously. Greenberg, a psychotherapist himself, is dismayed at the way in which treating offenders as patients stops us from attending to their wider social and moral situation. In this way, he says, psychologists have been given the power to dictate public morality, and the political is inevitably reduced to the personal.

鈥淧sychologists have the power to dictate public morality鈥�

鈥淎 society unaccustomed to understanding individuals鈥� behaviour as anything other than the result of their psychological states鈥� cannot account for the political dimensions of everyday life,鈥� he writes. 鈥淭he Unabomber case can鈥檛 force this much needed conversation if Kaczynski is merely a madman. Then it鈥檚 enough to know that he is not one of us. But he is.鈥�