Stowaway

on 19 March 2008 at about 14:46

Phenomenology, positivism, and prozac

[Cross-posted at CEMP - following Mike's responses (1) & (2) to the 'Hello world' post]

So we've had a few posts in which we've tried to locate notions of truth within competing knowledge practices, and seen phenomenological responses to the postmodern challenge to ontology. It might help (well, at least, it might help me!) to talk about a real world example to tease out these problems.

Recently there was a flurry of news coverage about the efficacy of SSRIs (Seroxat, Prozac, etc). Some researchers conducted a meta-analysis of both published and previously unpublished data on the use of SSRIs, and found that in the majority of cases, particularly where depression is not acute, SSRIs have no more efficacy than placebos. Now this kind of subject prompts a host of ethical and ontological problems, which force us to look at the overlap of medicine, media, and industry. Those domains all represent a veritable red rag of competing 'knowledge practices' and ethical concerns.

For starters, is it responsible for the media to provide mass coverage of a story, leading unavoidably to people using these medicines worrying that their medicine isn't 'real' medicine? If they start to think, maybe this medicine is just a placebo, then perhaps even the benefit gained from the placebo might be lost. Maybe it won't - the problem is a) no-one has a cast-iron understanding of what the 'placebo effect' is and how it works, and b) even if they did, the media isn't necessarily in the best position to make those kinds of calls. We might say, on balance, freedom of information is better than suppression, but we'd better be clear that we can defend that position when the mental health of millions of people is at stake.

Next up: what does it mean to say that the mental health of millions of people is at stake? Are we refering to a positivist analysis that says x million people have a condition called 'depression' which is merely a disciplinary discourse seeking to medicalise and subjugate a population in order to reify opportunistic power relations? Perhaps we are. But does that mean we have to discount the reported 'lived conditions' of those people whose phenomenological 'making-sense' of the world has at least been aided by a 'discourse of depression'? Don't we also have to acknowledge that there are cases where severe depression can arguably be treated through medicines, despite the possibility that the scientific understanding of chemicals and their interactions with the body might be imprecise, or even that that knowledge is 'socially constructed', and at some level reflects a historically contingent situation in which the body is subjected to disciplinary practices. We might find evidence that 'medicine works', both from 'reductionist, positivist knowledge practices' (where double-blind trials show statistical correlations between use of medicine and improvement in mental health) and from phenomenological analyses where participants taking such medicines report an improvement in their condition. These two different knowledge practices may be measuring entirely different things, but they might also happen to converge on a shared 'truth'.

So how do we handle situations where these different knowledge practices diverge towards different truths? Because they begin from different ontological assumptions, and because we are not in a position to fundamentally favour one ontology over another, we have to turn to other means to separate them. Might we say that because pharma-companies may be pulling a fast one by non-reporting of unfavourable trial data, we therefore bring an end to the reported benefits (albeit indistinguishable from placebo) that some people gain from those medicines? Do we say that the 'discourse of placebo' is a useful tool that people use in the experience of health practices, but it's only useful as long as we don't tell them what they're taking is a placebo? Would we then be forced to acknowledge that what we need is more medical research into what the placebo effect is, even though such knowledge practices are reductionist and take no account of patient's 'lived experiences'?

Of course, I haven't a clue, and none of these questions are intended to be rhetorical, merely to illustrate the problems that arise when different 'methods' produce different 'truths'.

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