“How could I not have known?” This question has been asked of me, as a psychiatrist, with regard to prescribing psychiatric drugs. All those problems. How could I not have known?
This question, when asked only of psychiatrists, comes with less-than-flattering assumptions. The thought that “not knowing” is a psychiatrist affliction implies that psychiatrists either have a brain that is different from other people or that they have dark hidden motives driving their lack of awareness.
Making these assumptions about psychiatrists could block collaborative relationships, especially for any person with a history of paddling in the “mainstream” of mental health care.
Broadening this question to encompass all people, rather than just psychiatrists, can give us a better understanding of how we all got into the situation of using drugs with more risks and less benefits than we were initially taught.
Since I believe that all kinds of people working together will be required for the necessary transformation of mental health care, I’m willing to take the risk and explore one possible answer to this question:
“How can any person not have known?”
This question, originally asked of me as a psychiatrist, mirrors questions that arise in my mind when I watch people engage in behaviors with well-known risks.
Here are three examples:
Cars are the number one cause of death among Americans up till the age of 34. Forty-thousand Americans die every year through the use of cars. We still drive a lot.
Despite the known risks of eating fast food, over twenty percent of Americans eat fast food on a daily basis.
Tobacco has mandated health warning labels on every package but people still use it.
It’s as if the information about risks doesn’t make it to the decision-making center of our brains.
So this question is not only about psychiatrists. This question relates to one of the basic thought processing functions we all share.
I have a metaphor that helps me understand how this could happen to anyone, how anyone could “not know”. My “head in a bucket” metaphor for information sorting reflects the sense I get when I think about this question.
It seems to me, some days more than others, as if everyone wears a bucket over his head. This is a substantial bucket with a variety of sizes and shapes of holes drilled through it. Some sizes and shapes of information get through. Others don’t make it past the bucket to the eyes and ears and into the brain. Some chunks of information must be the wrong shape or size to get through.
This head-bucket, with all its variety of holes, is part of the cognitive operating system we’ve all inherited.
From an information gathering and sorting perspective, one job our brain has to accomplish is filtering out unnecessary information. You would be swamped in data if every sound and flicker of light were allowed into your head every moment.
This filtering process includes assignment of relative value to information. This way your filter will be able to let in important information and keep out the dross. Emotional content is one key to assigning value to categories of information. Emotions help decide how inclusive or exclusive a hole needs to be on your filter bucket. For example, it’s important for a person with a bee sting allergy to avoid bees. Bees can kill, so bees are scary. This person will notice anything bee-like in the environment.
Our drilled head-bucket filters out information for us like a champ. It blocks anything out that doesn’t match our beliefs and lets in what does. Yours does it. Mine does it. Everyone’s head-bucket does it.
Einstein noticed this. He said “It’s the theory that decides what we can observe.” I would say that it’s the holes in the invisible bucket I wear over my head that decides what I can observe.
But how do these holes get drilled in our buckets?
This answer has been known by educators, leaders, and marketing wizards for a long time. Cognitive therapists know the answer, too.
The word “belief” can be used for each of the holes that are drilled through our perception-filter head-buckets. Repetition causes belief. Emotions power the drill.
We have holes drilled by parents, teachers and advertisers. We accumulate other holes in our head-buckets through life experiences. Some, we drill using our own private repetitive thoughts. This last way to get beliefs, by drilling them on our own with repetitive thoughts, can be a curse or a blessing, depending on how we drill them.
Control over the creation of our beliefs is wielded by anyone with a way to get repeated messages to us; media owners, teachers or our own selves.
Emotions power the drill. Any emotion will work. The stronger the feeling, the more drill power. An ad that annoys you works fine. So does one that’s burns with sex and longing.The bigger the hole in your bucket, the more similar information is allowed in.
We live immersed in repetitive marketing messages. We smell marketing messages when a deep fryer or bread oven vents into the grocery store. Our world of paid advertising drills our holes and hones our beliefs for us.
Here’s something to keep in mind about this head-bucket reality-filter of ours. Each one of us believes that we are more immune than other folks to the big-bucks marketing; too smart, too self-aware or too quick on the mute button to be effected. I thought so, too.
And we may mistake our filter holes for the truth. I have.
People have products to sell. The people that own the marketing drills sell access to those drills.
We’ve voted away government money for medical research and teaching hospitals. These are now funded with pharmaceutical dollars. Selling out medical research and education to drug companies would be like letting fast food chains feed our kids in school cafeterias or allowing them to pay for our text books. This would create a public health nightmare.
When you talk to a psychiatrist, remember that the high-end drills have been there ahead of you. There may be no hole through his bucket for your shape and size of message. You’ll have to change the shape, size, direction or velocity of your information. It still might not get through.
Please. Remember that you wear a filter-bucket on your head too. Your belief holes were mostly drilled for you by others. Some of the holes in your bucket could be a little off. Mine were. I’m sure that some of mine still are.
How could I not have known?
The real question is: How could I have known?
Related “In the News” Items:
Schizophrenia Outcome Still Better in Developing Countries
DSM-5 Field Trials Fail to Compare New Diagnostic Criteria with DSM-IV Criteria
Incoming APA President Emphasizes “Positive Psychiatry”
Antipsychotic Drugs and Relapse
Weak Field Trials Scuttle DSM-5 Diagnoses
Benzos Quadruple the Risk of Suicide in Schizophrenia
DSM-5 Retreats from Some Controversial Diagnoses
Ethics Complaints Over DSM Filed With the APA
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.