PC, M.D.: How Political Correctness Is Corrupting Medicine

Dr. Satel, a noted conservative psychiatric essayist, has constructed a thorough and, in some ways, persuasive argument that an unwitting reader is likely to see as evidence that our health care system is being taken over by radical feminists, social reformers, and unruly consumers. The premise of PC, M.D. is that a great number of unscientific and potentially harmful health care practices are being promoted by various individuals and groups, primarily for political purposes.

In carefully selected and researched topics organized by chapter, Satel takes on the public health establishment, the mental health consumer movement, the nursing profession, feminist health advocates, civil libertarian defenders of the rights of drug addicts, social and health scientists who are concerned about racial disparities in health care delivery, and persons who promote treatment for psychological trauma. She decries how, in many cases, the zealous progressive liberal agenda is contaminating a reasonable and scientific approach to various health problems. In some cases, such politically doctrinaire attitudes seem to be preventing people from getting proper treatment. In other cases, this unscientific intrusiveness forces health care providers to give dangerous treatments or prevents them from stopping such harmful practices.

Interestingly enough, Satel has identified many legitimate concerns, and in some cases she has a solid argument for the political contamination she sees under so many rocks. However, in too many instances, she paints her subjects with such a broad brush that a number of potentially damaging or unjust accusations emerge.

One of the main problems I have with the book is that although Satel may correctly identify some outrageous notions or practices—such as the views of those in the mental health consumer movement who would do away with all psychiatric care, or the complete aversion that some people have to the use of leverage in the treatment of substance dependence—she then extends her criticism to other associated practices—for example, trashing most alternative therapies because there is no scientific support for the questionable practice of "therapeutic touch." She also extrapolates the political agenda of some adherents of a nonscientific treatment or policy to all supporters of the practice, thus making the dominant or exclusive reason for its popularity a political one.

I also have problems with the selectivity with which she cites the egregious statements and beliefs of some of the practices' adherents. In some cases she takes comments out of context and, by isolating them and speculatively extrapolating from them, emphasizes her contention that the spokesperson is wildly irrational or primarily politically motivated. This is clearly the case with some of the data she provides to undermine the legitimacy of the mental health consumer movement; she quotes some individuals whom I know and work with and presents a rather distorted characterization of their views.

It is important to expose charlatanism and potential harm from inappropriate treatments and policies, but the fact that Satel has selected only issues that seem associated, at least in her worldview, with liberal or progressive political issues undermines the power of her arguments. Where is the criticism of the antiabortion movement and its rabid opposition to abortion in all cases and to the introduction of RU-486? Why is there no mention of the movement to block important stem cell research? Why is her critique of the substance treatment system focused solely on the need to make individuals responsible for their actions, as opposed to looking at the popular cultural forces that reinforce the addictive drives in so many substance-abusing people? Where is the outrage over the drug industry's unscientific use of direct-to-consumer advertising to interfere with the doctor-patient relationship? Why has she said nothing about the fact that the protection and preservation of the so-called free market has left us without a comprehensive health care system and with 45 million uninsured people?

Rather than simply identifying the practices that she finds offensive and destructive, and rather than demonizing people who may or may not have complicity with these practices, it would be far more productive for Satel to apply some of her talent for research and analysis to identifying why these activities are so popular. She should try to understand these movements in relation to the shortcomings of medicine, physicians, the health care system, and maybe even some of the political assumptions that underlie her preferred health policies.

In the end I think she is hoist with her own petard, for her aversion to the "PC" nature of some activists reveals her own political and ideological bent. It seems that Dr. Satel is, despite her intelligent and carefully reasoned rhetoric, succumbing to the process identified by Anna Freud many years ago: she objects to the defense mechanisms in others that appear to be most like her own.