I had to miss a session on The Two Cultures, at last month’s Literature and Science conference in Oxford, because I was myself speaking in a parallel session (see previous entry).
Never having read CP Snow’s original 1959 lecture before, I did so, and was struck by several things which seem to have been filtered out in the huge amount of media and academic commentary it has spawned over the last five decades.
Barely having made a few opening remarks, Snow the promoter of science and scientists puts the boot in to ‘literary intellectuals’ by saying that uncritical admiration for fascist sympathising poets such as WB Yeats, Ezra Pound and Wyndham Lewis was an important cause of Germany’s extermination program in the Second World War.
Well, I happen to have looked at some rather large books on the historical causes of the Holocaust recently, and they did not mention Yeats, Pound, Lewis, or any other poets. That doesn’t necessarily mean that Snow was wrong, of course, but his judgement does not seem to have ‘stood the test of time’.
When he talks about scientists, Snow mostly mentions physicists, such as the atom-splitting Nobel-Prizewinning Rutherford, who he had known personally. Perhaps that just reflects how the wider role of science was discussed in the 1950’s, but it’s interesting that having mentioned the Holocaust and its causes, Snow does not make any point about the very dodgy biological and medical science of Nazi Germany, or the rather less dodgy (and also quite often Nobel-Prizewinning) biomedical science which meant that Britain had little resembling an extermination program itself.
I’m fairly sure that Bad Science, rather than allegedly Bad Anglo-Irish-American Poetry, was more prominently in the minds of those who thought up the Final Solution. To some extent this relies on hindsight, as it was only in the 1980s and 1990s that the British Historian Michael Burleigh more fully outlined the importance of German biomedical eugenics, sterilisation and ‘euthanasia’ of the mentally and physically disabled, as necessary steps which then led to racial genocide.
And as euthanasia (or ‘euthanasia’, as the medically-dominated pressure group Care not Killing might still write it) is very much part of today’s public biomedical discourse, I think that a proper updating of Snow’s Two Cultures argument about ‘literary intellectuals’ would have to properly take account of the general shift of public interest in science, away from atom-splitting and towards …(allegedly) disorder-mongering mental health professionals, perhaps?
This was the title of a talk by the philosopher and journalist Robert Rowland Smith, at London’s School of Life two days ago.
I have known Robert for a couple of years, during which he has published two books exploring how philosophy is relevant to the everyday dilemmas of modern life: Breakfast with Socrates and Driving with Plato.
The essence of the talk, I think, was that despite regular reminders throughout history of humanity’s less than fully rational nature, we still tend to overestimate our self-control. The constant development of technology not only distracts us from evidence to the contrary, but creates neurotic
dissatisfaction which we tend to worsen by seeking relief in materialism rather than by improving our interpersonal relationships.
I’m not sure that Robert is right in seeing the Western rational “Enlightenment” as perhaps now needing some sort of counter in the form of an Endarkenment”, because I think that contemporary philosophies and psychotherapies, as well as older Romantic Western culture, offer a whole range of ways to explore what Jung called our “shadow aspects”. And some people who are stuck in over-rational ways of life are suffering from biologically-based problems such as depression (1) or autistic spectrum disorders: they may need medication or other treatments to fully take part in philosophical or psychotherapeutic discourse.
It might seem odd that medical technology is sometimes necessary to enable a less technologically-dependent life. But in my view this is just a particular case of science liberating rather than oppressing (2). Philosophy too contains many paradoxes of this kind, such as Wittgenstein’s recommendation that we should simply stop chattering about “things of which nothing can be said”: his non-silence was required first, so that therapeutic silence could follow.
(1) In general the more severe and long-lasting the depression the greater is the need for medication. But some severe depressions may respond well to psychotherapy and/or philosophy, and some mild depressions may respond only to medication.
(2) Of course, technology and science are often used oppressively, or at least with neglect, whether deliberately or by mistake. Antidepressants prescribed after a ten-minute consultation with a GP (rather than a much longer consultation with a GP, psychiatrist or clinical psychologist), including little or no discussion of psychotherapy, amounts to state-sanctioned neglect in my view.
One of my past teachers is to be awarded the Nobel Prize for Medicine today.
Professor Robert Edwards, who developed In-Vitro Fertilization, gave an annual series of seminars on embryology to about a dozen Cambridge students specialising in physiology. I was a member of the 1982-3 class, when Edwards was a prominent public figure; not only as a scientist, but also because of his decision to publicly discuss the ethical aspects of IVF in a very proactive way.
Unlike other aspects of the course, where we did experiments on rats, pigs, cats, and ourselves, there were no “practicals” in embryology. So the seminars were, to be honest, a bit dry and theoretical. The realities of fertility only became apparent when I was a clinical student in obstetrics and gynaecology, a couple of years later.
But on one occasion, Professor Edwards’ partner, the pioneering obstetrician Patrick Steptoe, came to tell us about the early days of IVF in Oldham, and we heard also about how they overcame opposition from the various establishment bodies of the day. The scientist and the clinician both loosened up and brought the subject, appropriately enough, to life.
“…the scan which will enable doctors to diagnose autism more cheaply and quickly. The rapid test has already proven more than 90 per cent accurate in adults…”
“What the computer can do very quickly is to see that a patient has autism…even though their brain, to the naked eye, looks very normal.”
These bold statements appear on the website of the Maudsley Hospital’s national specialist services department (1). They appear to have been recycled from press releases and media interviews back in August, after publication of a study which looked at computerised pattern recognition of MRI brain scans, in adults with autism.
At the time, the “90% accurate” claim, and the suggestion that the scan could replace current clinically-based diagnoses, was heavily criticised by the head of the authoritative Oxford-based Centre for Evidence Based Medicine (2). A very different “5% accurate” was Dr Carl Heneghan’s view.
The key issue is that because the scan gives a “false positive” result in 20% of people without autism, it is unlikely ever to be useful, on its own, for diagnosis. If the prevalence of autism in the whole adult population is around 1%, then the “false positive rate” of the test would probably have to be at most 0.1% (3).
I wish the researchers (based at the Maudsley’s academic partner, the Institute of Psychiatry) the best of luck in getting their false positive rate down from 20% to this extremely low figure. I won’t be holding my breath.
What may be more feasible, and is implied by some of the comment back in August, is to combine the scan with a shorter (and cheaper) clinical assessment than the one which the Maudsley uses currently.
But I think patient groups, particularly the large and influential National Autistic Society (NAS), would want to see proper testing of such an approach.
Following the criticisms in August, the lead researcher responded: “we have clearly stated that we are not yet ready to make our approach available in the NHS just yet.” (2) (4).
So I was surprised to see the Maudsley website piece, dated November 4th, say “Adults who are interested in being scanned will need to ask their GP, consultant or health professional for a referral letter to the Behavioural Genetics Clinic. Privately funded assessments or scans are not available.” (1). There is no mention of any research showing the “Autism Scan” to have been improved.
Next week I am meeting with a board member (7) of DANDA (Developmental Adult Neuro-Diversity Association) (5), and will suggest that patient groups might want to clarify these apparently inconsistent statements (6) before recommending the “Autism Scan” to their members and supporters.
(3) That would mean about 1 false positive diagnosis in 1000 people, which I think would be the most any ordinary clinician would allow. To demonstrate such a small false positive rate would also require a much larger study than the one reported. Because the “Autism Scan” is said to be “90% Sensitive”, 9 people in 1000 with autism will be diagnosed correctly, while 1 person with autism will be “missed”.
Dr Heneghan does not mention the issue of the lack of so-called “confidence intervals” in interpreting the false-positive and false-negative figures from such a small study (20 patients with autism, and 20 controls without), but this seems important to me, especially for a test being offered to the NHS.
(4) Two “yet”’s in the original.
(5) The study also looked at whether the Scan could distinguish between autism and ADHD. It could, but even less well than between autism and no-autism. DANDA is concerned with the overlaps between autism, ADHD, dyslexia and dyspraxia, so I think this will be of interest to them.
(6) In addition to the other points, the 4th November piece (quoted in my first line) states “more than 90 per cent accurate”, but the abstract of the research paper (link from (1)) has “sensitivity…of up to 90%” [my italics]
(7) Changed from “the acting head” on 3rd December. My thanks to Erika Musselwhite of DANDA for pointing out that noone has yet taken over the national coordinator role which Mary Colley so energetically pursued until her recent much-regretted death.