Critical theory – a clear explanation by Nancy Fraser

‘To my mind, no one has yet improved on Marx’s 1843 definition of Critical Theory as “the self-clarification of the struggles and wishes of the age.” What is so appealing about this definition is its straightforwardly political character. It makes no claim to any special epistemological status but, rather, supposes that with respect to justification there is no philosophically interesting difference between a critical theory of society and an uncritical one. But there is, according to this definition, an important political difference. A critical social theory frames its research program and its conceptual framework with an eye to the aims and activities of those oppositional social movements with which it has a partisan though not uncritical identification. The questions it asks and the models it designs are informed by that identification and interest. Thus, for example, if struggles contesting the subordination of women figured among the most significant of a given age, then a critical social theory for that time would aim, among other things, to shed light on the character and bases of such subordination. It would employ categories and explanatory models which revealed rather than occluded relations of male dominance and female subordination. And it would demystify as ideological rival approaches which obfuscated or rationalized those relations. In this situation, then, one of the standards for assessing a critical theory, once it had been subjected to all the usual tests of empirical adequacy, would be: How well does it theorize the situation and prospects of the feminist movement? To what extent does it serve the self-clarification of the struggles and wishes of contemporary women?’

Nancy Fraser (1985, p. 97). What’s critical about critical theory? The case of Habermas and gender. New German Critique, 35, 97-131.

Judith Butler on the social construction of sex and gender

‘We are assigned a sex, treated in various ways that communicate expectations for living as one gender or another, and we are formed within institutions that reproduce our lives through gender norms. So, we are always “constructed” in ways that we do not choose. And yet we all seek to craft a life in a social world where conventions are changing, and where we struggle to find ourselves within existing and evolving conventions. This suggests that sex and gender are “constructed” in a way that is neither fully determined nor fully chosen but rather caught up in the recurrent tension between determinism and freedom. […] Gender theorists who call for gender equality and sexual freedom are not committed to a hyper-voluntarist view of “social construction”…’

Judith Butler, in New Statesman

The first mention of genderqueer in print

‘The fight against gender oppression has been joined for centuries, perhaps millennia. What’s new today, is that it’s moving into the arena of open political activism. And nope, this is not just one more civil rights struggle for one more narrowly defined minority. It’s about all of us who are genderqueer: diesel dykes and stone butches, leatherqueens and radical fairies, nelly fags, crossdressers, intersexed, transexuals, transvestites, transgendered, transgressively gendered, intersexed, and those of us whose gender expressions are so complex they haven’t even been named yet. More than that, it’s about the gender oppression which affects everyone: the college sweetheart who develops life-threatening anorexia nervosa trying to look “feminine,” the Joe Sixpack dead at 45 from cirrhosis of the liver because “real men” are hard drinkers. But maybe we genderqueers feel it most keenly, because it hits us each time we walk out the front door openly and proudly. And that’s why these pages are only going to grow. We’re not invisible anymore. We’re not well behaved. And we’re not going away. Political activism is here to stay.

‘So get out. Get active. Picket someone’s transphobic ass. Get in someone’s genderphobic face. And while you’re at it, pass the word: the gendeRevolution has begun, and we’re going to win.’

Riki Anne Wilchins, In Your Face No. 1 (Spring 1995)

Understanding trans non-binary gender

CW: medical examinations, surgery, transphobia.

I started pondering gender on a school playground in 1985 when I was five. One break time I realised that I wasn’t like the boys; I hated how they pushed and shoved and so I decided to hang out with girls. I didn’t think I was a girl; I just—in a moment, without a fuss—didn’t feel like one of the boys. I have many fragments of memories like this, who knows how reliable.

There are reliable digital traces of my more recent ruminations. For instance, in 2014 I wrote an insignificant email in which I identified in passing as “gender queer” (sic; space included). It’s strikingly throwaway, at the end of a list of other identities like my sexuality and profession. I’m not certain how I arrived at that identity, but I was reading Laurie Penny’s Unspeakable Things shortly before, which discusses genderqueer people, and I tweeted their article on genderqueer feminism a year later, so their writing surely helped me along.

A gradual process of reading, discussing, oscillating between outing and closeting my gender on social media and dating apps culminated on 10 August 2019 (postmodernist Jean-François Lyotard‘s birthday) with me changing my first name by deed poll from Andrew to the gender neutral Andi. I usually went by Andy so it was a trivial edit, but it significantly marked the occasion of affirming that I am trans non-binary. I am now classified as non-binary on work’s HR system, have changed my name with my bank and am slowly working through every other system and record I encounter. I am also applying for a non-binary gender recognition certificate from Ireland.

Now that I write this, it’s obvious and anticlimactic that I am non-binary—I feel a deflated yet relieved kind of oh, is that it? A weight off my shoulders. It feels like a conclusion but also the beginning of a different kind of struggle to work through contradictions and tensions which I am beginning to notice. This blog post is an attempt to write something about where I’ve got to.

What does it mean to be trans non-binary?

The most obvious part of my affirmed gender took the longest to recognise: trans. This just means that my gender is not the same as my sex assigned at birth. I used to think that trans people all had hormone therapy or surgery. Eventually I noticed that I was wrong; there is social as well as medical transition. Stonewall’s glossary entry for transitioning explains:

“The steps a trans person may take to live in the gender with which they identify. Each person’s transition will involve different things. For some this involves medical intervention, such as hormone therapy and surgeries, but not all trans people want or are able to have this.

“Transitioning also might involve things such as telling friends and family, dressing differently and changing official documents.”

(See also Julia Serano‘s glossary.)

Non-binary is defined in opposition to binary gender. Binary means 1 or 0, yes or no—formally, a discrete variable with two levels. Christina Richards, Walter Pierre Bouman, and Meg-John Barker (2017, p. 5) define non-binary people as

“simply people who are not male or female; but as ever things are more complex than that. In general, non-binary or genderqueer refers to people’s identity, rather than physicality at birth; but it does not exclude people who are intersex or have a diversity/disorder of sexual development who also identify in this way. Whatever their birth physicality, there are non-binary people who identify as a single fixed gender position other than male or female. There are those who have a fluid gender. There are those who have no gender. And there are those who disagree with the very idea of gender.”

The non-binary pride flag, designed by Kye Rowan (February 2014). Each colour represents a different facet of non-binary gender.

Explaining sex and gender

You are assigned a sex at birth based on the genitals you possess. The result you get is statistically though imperfectly associated with whether you have XX or XY chromosomes; however, your chromosomes usually aren’t tested at birth. Sex sounds solid, factual. A sprinkling of philosophy of science can helpfully disturb this, not by rejecting facts but by complicating what makes scientific facts about sex and gender true and how stable those truths are.

We can assume that there is a reality to people’s gender-relevant experiences and biochemistry which exists independently of our understandings. Taking this (to me obvious) stance is known as ontological realism. Theorising, about gender or otherwise, is done by people who have imperfect and indirect access to reality and theories evolve over time. Our vantage point—beliefs, biases, values, experience, privilege and oppression—has an impact on our theories, so two gender theorists doing the best they can with the available evidence can produce very different explanations (epistemic relativism). This is true of any science where multiple theories are consistent with evidence; in other words, the theories are underdetermined by evidence. Even with this relativist mess, manifesting as bickering in scientific journals and conferences, consensus can arise and one theory can be declared better than another (judgemental rationality). However, there are often many different ways to classify biological, social, and other phenomena, even with impossibly perfect access to reality (this has a great name: promiscuous realism).

The underdetermination of theories means that something beyond evidence is needed to decide how and what to theorise. Scholars in the critical theory tradition are required to pick a side in a social movement, for instance communism, feminism, anti-racism, trans rights, or an intersectional composition thereof. It’s not enough for a critical theory to be empirically adequate; it also has to help chosen social struggles make progress towards achieving their aims. Two theories may be empirically indistinguishable but one transphobic; from a trans rights perspective, the transphobic theory should be discarded.

I only recently realised that the philosophy of science applies also to theorising about myself. So we can engage in critical self-reflection using ontological realism, epistemic relativity, aligning with a particular social struggle, etc., to help us navigate. A salient feature of theorising selves is that the underlying reality changes as we understand more—we change. We are treated differently as we change how we identify and express our gender, i.e., gender is an example of a social kind which has a looping effect.

Biological facets of my gender

The female/male binary is challenged by being intersex—what medics pathologise as disorders of sex development (DSDs). You might have XX chromosomes but male genitalia; XY chromosomes but female genitalia; one ovary and one testicle; sperm-producing testicles which are in your abdomen rather than scrotum; and a range of other departures from the binary male/female dogma. The biology of sex and gender is fabulously non-binary and continuous, even if dominant folk conceptualisations are binary.

I was born with undescended testicles but was assigned male at birth (AMAB), presumably due to the presence of a penis. My testes were left inside my abdomen, contrary to current clinical guidelines (I’m unsure what the guidelines were in the early 1980s), and their location noted in my medical record. Some years later when I was nine (1989) one testicle ventured into my scrotum of its own accord. Suddenly I realised what classmates were referring to when they said the word “balls”, though mine was decidedly singular. When I reached 11 (1991) a GP visiting school had apparently noticed the official record of my genital geography and, without explaining, asked to examine me. I guessed what she expected. I felt like I’d been found out and hesitated to agree. A month or two later I had surgery and a pair.

When I say I am non-binary, I am not making a disembodied hyper-voluntarist claim (Judith Butler explains why I couldn’t). There is a biological facet to my gender as part of a biopsychosocial triad. I conjecture that my hormone levels affected how my body developed, including my brain, and how I feel and experience the world. This led both to my aversion to hanging out with boys and my testicles’ aversion to hanging outside me. I don’t know what biopsychosocial processes, probably part-inherited involving hundreds or thousands of genes (polygenic) and part-experiential, led to my hormones and other aspects of my biology being as they are. I was socialised as a boy, though. The biological, psychological, and social are interwoven in complex ways.

Non-binary expression

The degree of match between our gender identity, expression, and stereotypes of that gender’s expression part determines how people treat us. I currently express as some genre of male (stubble, relatively deep voice, flat chest, male-fitting t-shirts, etc.). Maybe a nerdy effeminate male (my narrow shoulders, hairless chest, and gestures are a giveaway). A nancy boy. A post-twink (on good days). I’m not the only one theorising my gender; people do it in the blink of an eye when they call me “sir” or utter a “fuck’s sake” under their breath when I ask not to be misgendered. (A not uncommon socially assigned gender these days feels like middle class lefty snowflake with a dick.)

Trans-inclusive writers theorise how non-binary gender should be expressed; for example philosopher Rachel Anne Williams argues that

“… there is no single way for nonbinary people to look […]. There is so much diversity in the community and we do ourselves a disservice by focusing only on androgyny and neutrality as the ideals of being nonbinary. There is room for the full spectrum of expression within the nonbinary label.”

This sounds wonderful in trans-friendly queer spaces. “I’m Andi; pronouns them/them” does suffice there. Unfortunately, much of my life is outside those spaces. “How can I help you sir ?” grates. I’m currently transitioning socially, and part of that involves negotiating social norms. I guess I am aiming for a state where people can’t decide whether to address me “sir” or “madam”. A moment’s hesitation will suffice; an instance of the gender panic described by Robin Dembroff when an airport security officer struggled to categorise them pink or blue as demanded by body scanner protocol.

I don’t particularly want to draw too much attention to myself out in cisgender land, though, given the prevalence of transphobic harassment and violence. However, maybe how successful I am in transitioning, contrary to Rachel Anne William’s utopian vision, will be indexed by the quantity of abuse I receive. I have had a glimpse of that abuse when I was a teen and most of my classmates subjected me to homophobic bullying for a year—what I now read as transphobia since it was really about my gender expression. I was failing to pass as a cisgender young man which (with a few decades’ distance) is almost as good as successfully passing non-binary. It sounds weird to feel that I need to open myself to more harassment and potentially worse to be me, but that is how I currently feel. Lisa Millbank expresses a similar paradoxical thought as a trans woman:

“Not receiving misogyny is nice, because misogyny is not nice, but it’s also a sign of not being considered a normal woman—i.e., it is a sign of being transgendered as a ‘freak’.”

Attempting to define gender

So far I have avoided saying exactly how I currently understand the concept of gender. I believe that gender is context dependent; as Robin Dembroff articulates:

“gender structures and practices vary across place and time, and are constructed in tandem with race, religion, class, ability, and other social identities.”

For example, being a postgraduate student in Edinburgh (2004–2008) meant I met people who were researching gender theory; I had amazing conversations about trans rights; I inhabited spaces which were trans-friendly many years before I had an inkling this might be relevant to me. Different concepts of gender currently operate in dominant society than do in trans-friendly communities and I have been exposed to both. I’m white, middle class, and have lived in Ireland, the UK, Austria, and Sweden and been exposed to a wide variety of ideas and opportunities relevant to gender. This all influenced how I conceptualise gender and how I identify.

I am drawn to theories which acknowledge that there are many conceptualisations of gender, many of which may be indistinguishable empirically (but recall the comment about critical theory above); that the conceptualisations could have been otherwise (the dominant binary in particular is not a universal fact), and that they will probably change over time (we are seeing this happen; even conservative workplaces allow people to identify as trans).

One approach to defining gender I love is Katharine Jenkins’ norm-relevancy account. Their overarching aims were to develop an account that is non-circular, respects first-person authority, and can help progress the aims of the trans rights movement, e.g., by being persuasive to people who don’t currently understand or agree with trans rights. It’s a critical theory.

Jenkins’ idea is that we all carry around an embodied and often tacit “map” of the gender norms which apply to us in particular situations. That map may include how we should walk, talk, what we should wear, whether we should shave our legs, what toilets we are allowed to use. We don’t have to agree with those norms; rather the idea is that we perceive norms of a particular gender (in a particular society, at a particular time) as relevant to us. Jenkins offers the following formal definition of the non-binary gender umbrella:

“A subject S has a non-binary gender identity [if and only if] S’s internal ‘map’ is neither formed so as to guide someone classed as a woman through the social or material realities that are, in that context, characteristic of women as a class, nor formed to guide someone classed as a man through the social or material realities that are, in that context, characteristic of men as a class.”

This definition works well in some important contexts, e.g., for understanding the toilets people feel they should use: neither male nor female toilets feel right for someone non-binary—for some they can feel very unsafe spaces and all-gender toilets are preferred. However, the definition can be read as meaning that no female norms and no male norms apply to non-binary people, which doesn’t seem to fit people’s experience (see Dembroff, p. 11). More analysis is needed to spell out the definition and I can’t wait to see how this develops.

Passing socialised privilege

It has been drummed into me from childhood that norms for men should apply to me. This socialisation is ongoing and pervasive, even including what colour umbrella I am allowed to carry now as an adult. I don’t feel like a man and I fail to be a man, though I have tried for decades to be one. The pervasive programme of socialisation, carried out by family, friends, bullies, and the media, has been massively distressing at times. However, my socialisation and assigned gender expression means I have benefited from male privilege and how it intersects with being white and middle class. In a system of binaries you are one or the other, and I usually land in the sir, gentleman, male side.

Part of my assigned privilege is what social roles I was excused from performing as a child, for example unpaid family caring roles, which gave me more time to pursue my own interests. This, in turn, led to opportunities that may have been blocked if I were a woman, such as studying computer science, which is still massively biased towards men. I rarely experience street harassment (except when dressing queer, e.g., wearing glitter); women often get harassed daily, irrespective of how they dress. Intimate partner violence is much more common against women than men.

I have biological privilege too: I can have sex with no (rather than merely low) risk of getting pregnant; I don’t have periods; and as yet there is no contraceptive pill for me to take, with all the psychological side effects they can have. But importantly note how this “biological” privilege is in a social and biotechnological context. If methods for birth control and stopping periods (or stopping undesirable aspects thereof like intense pain) were 100% effective and had zero side effects, the privilege would disappear. (As an aside: I also have a biological vulnerability now my very sensitive testicles are in my scrotum.)

These privileges, varying in the degree to which they are biological, always operating in the current social context, influence my gender identity and steer my onward journey. (See also Rachel Anne Williams’ article, Giving Up My Male Privilege.)

Tentative steps towards genderqueer identity

Originally I flirted with identifying as genderqueer. This proved to be too difficult for me at the time. Dominant societal structures and practices are relatively better equipped to deal with the more general ideas of trans and, to a lesser extent, non-binary gender. (They sound helpfully, relatively, boring in a way that genderqueer doesn’t.) But the idea of genderqueer still resonates strongly with me.

The genderqueer flag, designed by Marilyn Roxie (June 2011).

Robin Dembroff takes a thought-provoking personal, social, and political approach to understanding genderqueer as a kind. Firstly, they analyse the dominant UK/USA gender ideology as built upon three assumptions: someone’s gender is determined by their natal genitals (genital assumption); there are only two genders and they are mutually exclusive (binary assumption); and finally gender confers social roles (social assumption).

The next ingredient is the idea of a critical gender kind (not to be confused with “gender critical” which is a synonym of trans-exclusionary). A critical gender kind is one defined by members who collectively (not necessarily individually) resist a dominant gender ideology. There are two kinds of resistance: principled resistance, which is based on beliefs and moral values, and existential resistance, stemming from an individual’s affectively-laden lived experience of gender. Principled resistance may be carried out by allies whereas existential resistance requires you to be personally affected by the act of opposition. The genderqueer kind is defined as a critical gender kind in which there is collective existential resistance against the binary gender assumption. 

Dembroff gives some ideas for how this resistance can look (pp. 22-23):

  1. Use gender-neutral pronouns like they/them.
  2. Cultivate gender non-conforming aesthetics, for instance by taking elements from both dominant binaries.
  3. Asserting non-binary identity: “I am non-binary”.
  4. Queering personal relationships, e.g., by taking on both traditional female and male parenting roles and engaging in gender play in sexual relationships.
  5. Eschewing sexuality binaries, e.g., identifying as pansexual.
  6. Space switching: using both men and women’s toilets, moving between men and women friend groups.

This approach to understanding genderqueer identity leads to an anticipated worry about how political the definition is (p. 24):

“being genderqueer, on my proposal, requires that an individual must—to some extent and in some context—resist the binary assumption.”

To my mind this political dimension—how resistance is built in—is a reassuring guide to life, similar to Katharine Jenkins’ norm-relevancy idea. A critical gender kind gives ideas for how to act and norm-relevancy provides clues for how to decode social structures and feelings. The two seem to complement each other. 

Where next…?

I feel trans non-binary, on more radical days genderqueer too. I don’t ask for much. I just want to be recognised as non-binary in all areas of society from passport office to public toilet and be addressed using the pronouns they/them. I don’t want to be told to “man up”. I don’t want it to raise eyebrows if I choose to wear an item of clothing from a binary I wasn’t socialised to be. I am aware of the privilege I have of passing as male in many dominant spaces. I also feel a collective responsibility to open myself to harassment (and potentially worse) as part of an act of genderqueer resistance. It’s scary, but I am excited to learn more about what it means to be non-binary (X Marks The Spot, curated by Theo Hendrie, was massively helpful) and to experiment with different ways of expressing my identity.

 

Thanks Galina, Katharine, and Nine for incredibly helpful discussion on these topics.

Unsticking social research through lived experience and citizen control

Having lived experience and knowing people with lived experience are really effective way of researching social conditions—unavoidably, whether or not you want to—and lead to rich theory.

Compare what activist groups do versus a model of social research in which you have a central institute, running surveys and writing supposedly “independent” reports, making policy proposals. The latter leads to flat, superficial theorising if done without lived experience.

In activist groups with rich communication (e.g., chat groups and regular meetings) the “data collection” is continuous, doesn’t feel like research, and is inseparable from day-to-day individual support and activism. But traditional reports can still be important to get media and government attention: “What’s a Nice Girl Like You Doing in a Job Like This?” is a good example of research drawing on lived experience and traditional research skills.

To unstick social research requires holding onto all methodological advances whilst radically opening up research to citizen control. Sometimes getting a good estimate of the population prevalence and correlates of some form of oppression are important to highlight severity and likely causes. Advances in techniques and software for qualitative analysis can be useful too and ensure best use is made of material.

Academics without lived experience running convenience sample qualitative studies with small numbers of people and pretentious methodology are fundamentally limited in what they can discover. But the same sample from lived experience and lived theory is very different.

There are many professional researchers with lived experience (Max Weber, 1864-1920, was one, with experience of psychiatric inpatient stay). But higher education is a hostile environment now—you couldn’t design a better system to reward junk research and cause burnout if you tried. Such a system is deeply challenging for people who are oppressed.

Your various identities, privileges and oppression (due to race, man/woman/non-binary, cis/trans, wealth, monogamous/poly, how valued your labour skills are, property ownership, disabled, etc.) fundamentally constrain who will answer your calls for research participants, what social phenomena you can understand, who will listen to what you discover. They literally change what you see and hear and what you can research. (Epistemic relativism is a useful concept to make sense of this.)

Some researchers break free of these constraints thanks to contradictory locations; for instance, being articulate and well connected can be used to resist a position of oppression. Though then you can end up being attacked for having helpful privilege, even by “your own side”.

Academics with more secure positions can help, for instance:

  1. Support PhD students and colleagues who are oppressed in various ways: grants, decent pay, and mentoring are helpful.
  2. Instead of “giving voice” to people through interview excerpts, give a platform.
  3. Cite blog posts and reports from activists with lived experience.

Ludicrously-large sense-of-self as a way to have free will

Galen Strawson (1994) provides a succinct argument for why we can’t be truly morally responsible for any action. It goes:

(1) Nothing can be causa sui — nothing can be the cause of itself.

(2) In order to be truly morally responsible for one’s actions one would have to be causa sui, at least in certain crucial mental respects.

(3) Therefore nothing can be truly morally responsible.

Intuitively (and arm-waving wildly) this speaks also to the impossibility of free will. This impossibility thesis holds irrespective of whether determinism holds, i.e., whether everything we do “has a cause, and hence an explanation; even if the explanation is inaccessible to us” (Strawson, 1989/2008, p.338).

The gist is that under determinism we and all the actions we take are caused by something outside of us and consequently causa sui fails. Under indeterminism then some randomness — inside or outside our bodies — contributes to an event happening, which doesn’t feel like we are in control either.

This makes a lot of sense to me, and taking it seriously leads to interesting ways of thinking about and coming to terms with the reality in which we find ourselves (if that’s your thing, of course — plenty of people don’t bother). We must find meaning without relying on us being the originator of our actions. Deep curiosity about what happens next seems to be one attribute that runs deep — hence why we watch films even though we know the ending has been predetermined. I’ve recently discovered a Yiddish proverb which goes along these lines: “You should go on living — if only to satisfy your curiosity.” Also if you experience or do something pleasant or important or desirable, accepting that you did not cause it to happen but rather that a universe-old causal chain led to it happening is pretty groovy. This is a potential way to ponder meaning (if you want).

But recently I have been wondering what exactly this something that supposedly cannot be a cause of itself actually is. Intuitively, when I think about whether or not I have free will I think of my Self as encased in a body. The aspects of me of which I am consciously aware feel like me, as do unconscious aspects which I cannot experience but which I know are there: all the gory bodily processes which keep me running like my bladder’s internal sphincter.

Much of what comprises my Self comes from outside me. My genes came from my parents. My experiences come from the world around me. Each of the cause-effect chains stretching back to the beginning of time is clearly outside my body. There is a tradition of pondering where self begins and ends, for instance as popularised by The Extended Mind by Andy Clark and David Chalmers. Consider how much we rely on things in our environment to get things done. Clark and Chalmers discuss a chap called Otto who, like most of us, supplements his skull-based memory with a notebook.

“Most of us already accept that the self outstrips the boundaries of consciousness; my dispositional beliefs, for example, constitute in some deep sense part of who I am. If so, then these boundaries may also fall beyond the skin. The information in Otto’s notebook, for example, is a central part of his identity as a cognitive agent. What this comes to is that Otto himself is best regarded as an extended system, a coupling of biological organism and external resources.”

Kusch (1999, p. 359) also illustrates how stuff going on outside us can get under our skin: “at least some states of the brain might well be called social states. […T]hey predispose us to differ in the intensity, quality, and duration of some of our sensations.” There is a long tradition of this kind of thinking; those of a psychoanalytic persuasion might cite Bion and others.

Here is where the Ludicrously-Large Self (LLS) Thesis comes in. Under LLS, whether or not determinism holds, everything causally implicated in who we are and what we do becomes part of the Self. We certainly cannot be consciously aware of the vast majority of this since it extends spatially and temporally back to the beginning of time (hence Ludicrously Large). The consciously aware bit does not bother me — I feel quite attached to my bladder’s internal sphincter, even though I have no awareness of it. Now Strawson’s first proposition, “Nothing can be causa sui“, melts away. With the neatly encased model of Self, external cause-effect chains lead to who we are and what we do, whereas now under LLS we take each of those events as part of us — hence we are causes of ourselves. This is a radical challenge to our sense of identity; e.g., “even the phrase ‘each other’ doesn’t make any sense” (Rumi).

What happens when you write to the Daily Mail about factual inaccuracies

On 23 October 2018 16:18 I used the DM factual inaccuracies contact form to complain about an article on using hot baths to cure depression.

Here’s what happened.

I wrote:

There are several problems with this article.

Firstly, it notes that “The research was published in the journal bioRxiv.” This is misleading. bioRxiv is not a journal; it is “a free online archive and distribution service for unpublished preprints in the life sciences” – it is not yet a published paper.

“Articles are not peer-reviewed,” adds the archive’s About page.

Secondly, this is one study with a small sample size and large dropout in one group. There was no statistically significant difference at 8 weeks – and that’s according to a very weak notion of statistical significance which is relatively easy to achieve (p < .05).

Thirdly, even if taking a bath is better than exercise, is exercise an appropriate control group for a study of treatments for depression? Readers might hope you would consult an expert. What do NICE guidelines currently recommend for patients whose depression is as severe as those in the study?

They replied on 24 Oct 2018 at 16:02:

Thank you for your email.

The following article is a description of the bioRxiv report. We are conveying the results of their report, and many of the issues you raise are ones with the bioRxiv report which we do not claim to endorse or state as unequivocal fact.

It is always good to receive feedback from readers, whether positive or negative. The contents of your email have been noted and have been passed to our editor for review.

I can confirm the article has been updated.

We appreciate you taking the time to get in touch.

I’m not reassured very much by the edit, but sharing details of the process in case helpful…

What is love?

“… romantic love is a syndrome because it is an arational, projected attitude with a plethora of symptoms that vary across cultures and individuals. Some core symptoms have been identified by Tennov’s concept of limerence, including obsessive thinking and idealization.”

“… all norms applicable to romantic love are extrinsic rather than intrinsic to it because romantic love is arational. For this reason, it is up to the lovers to accept, reject, and modify the norms that govern their loves.”

This looks an interesting doctoral thesis, by Arina Pismenny (2018), The Syndrome of Romantic Love.

A psychoanalyst walks into a bar(red subject)

A psychoanalyst walks into a bar with a book on logic and set theory. He orders a whisky. And another. Twelve hours and a lock-in later, all he has to show for the evening is a throbbing headache and some indecipherable nonsense scribbled on a napkin.

That’s the only conceivable explanation for these diagrams from The Subversion of the Subject and the Dialectic of Desire in the Freudian Unconscious, by Jacques Lacan (published in the Écrits collection):

But, I hear you ask, surely this notation means something? After all, Lacan is famous and studied across the world, and f(x) is well-recognised as a function, f, applied to argument x. So the I(A) and s(A) must mean something?

Here is a brief interlude on functions. The Fibonacci sequence, which pops up in all kinds of interesting places in nature, can be defined as following:

f(0) = 0,
f(1) = 1,
f(n) = f(n-1) + f(n-2), for n > 1.

In English, this says that the first two numbers in the sequence are 0 and 1. The numbers following are obtained by summing the previous two: 0, 1, 1, 2, 3, 5, 8, 13, 21, 34, …

If you tell it a number (e.g., 0, 1, 2, …) then it replies with the respective number in the sequence (first, second, third, …). It might look a bit scary if you haven’t seen the notation before, but check out these examples demonstrating how the arithmetic is carried out:

  • f(0)  =  0
  • f(1)  =  1
  • f(2)  =  f(1) + f(0)  =  1 + 0 = 1
  • f(3)  =  f(2) + f(1)  =  1 + 1 = 2
  • f(4)  =  f(3) + f(2)  =  2 + 1 = 3
  • f(5)  =  f(4) + f(3)  =  3 + 5 = 5
  • f(6)  =  f(5) + f(4)  =  5 + 3 = 8

The point here is that the function notation “does something”. It provides a way of defining and referring to (here, mathematical) objects.

Less well-known, but appearing in university philosophy courses, is the lozenge symbol, ◊, which means “possible” in a particular kind of logic called modal logic. It seems plausible that there is something meaningful here in Lacan’s use of the symbol too.

Here is Lacan, “explaining” his notation for non-mathematicians:

Huh?

Lacan doesn’t try to explain what the notion means; he doesn’t seem to want readers to understand. Maybe he is just too clever and if only we persevered we would get what he means. However, elsewhere in the same text Lacan uses arithmetic to argue that “the erectile organ can be equated with √(-1)”. Personally, I am unconvinced.

Alan Sokal and Jean Bricmont have written a book-length critique of Lacan’s maths and others’ similar use of natural science concepts. Having read lots of mathematical texts and seen how authors make an effort to introduce their notation, I think it’s entirely possible Lacan is a fraud. That might sound harsh, but just look at how he writes. I reckon anyone can see for themselves that Lacan is writing nonsense if they take a look and forget for a moment how famous he is.

 

Lightly edited 18 Sept 2018, hopefully making clearer!

NHS England mental health clustering implementation “disappointing”

A document is circulating from NHS England and NHS Improvement (13 Aug 2018) on the current state of payment systems and clustering in mental health services in England.

It cites “local pricing rule 7” from the 2017/18 and 2018/19 National Tariff Payment System (NTPS) and reports on a survey of progress towards implementing the rule.

Here is what rule 7 said (p. 114):

Rule 7: Local prices for mental health services for working age adults and older people
a. Providers and commissioners must link prices for mental health services for working age adults and older people to locally agreed quality and outcome measures and the delivery of access and wait standards.
b. Providers and commissioners must adopt one of the following payment approaches in relation to mental health services for working age adults and older people:

i. episode of care based on care cluster currencies
ii. capitation, having regard to the care cluster currencies and any other relevant information, in accordance with the requirements of Rule 4(b) to (e)
iii. an alternative payment approach agreed in accordance with the
requirements of Rule 4 (b) to (e).

Commissioners and providers (233 in total) were asked, “What payment approach do you have in place with your contracts for working age adults and older people in 2017/18?”

Here are the results:

So only 14 out of 223 responses (6%) reported a move away from block contracts – the whole point of the new payment systems! The report notes, “The results were disappointing.”

Reasons given by respondents for the poor implementation included:

  • “limited local capacity to implement a new payment approach”
  • “lack of shared confidence in cost and activity data”
  • “uncertainty about how the proposed payment approaches would relate to the new operating models that would develop as part of integrated care systems.”

Services are supposed to be “clustering” the patients they see, irrespective of whether the clusters are used for payment. Rule 6 (p. 114):

Rule 6: Using the mental healthcare clusters
All providers of services covered by the care cluster currencies (see Annex B3) must record and submit the cluster data to NHS Digital as part of the Mental Health Services Dataset, whether or not they have used the care clusters as the basis of payment. This should be completed in line with the mental health clustering tool (Annex B3) and mental health clustering booklet to assign a care cluster classification to patients.

The research on clusters is damning. A recent study (Jacobs, et al., 2018) found that clusters were not very good at characterising the costs of different kinds of treatment and support (p. 7):

“Clusters are therefore not performing very well as a classification system to capture similarities and differences between patients. The categories of the current classification system appear to be neither case-mix nor resource homogeneous. We find evidence of large variation in terms of activity and costs within clusters and between providers.”

Surprisingly, the authors argue that clustering should continue (p. 7):

“… any payment approach needs to be underpinned by a solid classification system and to abandon the clustering approach now will thwart all progress. The clustering approach is already relatively well-established among most providers. Scrapping it all and starting from scratch risks putting mental health services back a decade in terms of developing a more transparent and fair funding system.”

Given the survey results above, it’s unclear how much progress would actually be thwarted by ditching clusters.

 

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