Abstract
Jay Kuten, Wanganui, New Zealand:
Scientific progress is not made by the timid. But the history of ideas is sadly marked by episodes of repression of new thought through fear and intimidation. That is why it is particularly unpleasant to read of a new attempt to close off avenues of research by name calling in the place of scientific discourse.
The journal published just such an instance in its February 2000 issue [1]. It purports to find white male New Zealand trained pschiatrists of some 10 plus years’ experience guilty of ‘racism’ based upon their answers to a survey consisting 15 closed end questions and four open-ended ones.
With flawed methodology, the authors have chosen to pursue a political agenda and replaced objectivity with name calling. Failure to adhere to known principles of fairness opens the authors to a charge of being unethical.
The basis of the published paper is the questionnaire of Miss Johnstone, part of her research requirement for a Master's degree in psychology, whose stated intention was to obtain, ‘Psychiatrists’ opinions on issues of Maori Mental Health’ and ‘A list of recommendations of the types of training needed to work effectively with Maori clients’. The questionnaire specified the expectation that some 10–20 min would be sufficient for completion.
In selecting as potential respondents those psychiatrists whose names are on the membership list of RANZCP, the researchers have a sample bias if they intend as stated to survey psychiatrists working in New Zealand. First, many New Zealand members do not work in New Zealand. Second, 50%% of the psychiatric workforce in New Zealand (according to the Medical Council of New Zealand) is made up of foreign-trained doctors, most of whom are not members of RANZCP.
In four of the five tables the authors describe the respondents as having been ‘interviewed’. This is far from accurate as no follow-up and no face-to-face interactions took place. Dr Read responded to my email question about this terminology as a typographic error of the Journal editors. While I can hardly doubt that this is true it is also true that no attempt appears to have been made to correct the false impression given by the term ‘interviewed’. No erratum appeared in the Journal nor is there a correction in the copy of the article which I received at my request directly from Dr Read. In its present form, the term ‘interviewed’ lends a greater weight to the responses described than is warranted on the basis of 10–20 min actually given to the entire questionnaire by the respondent psychiatrists.
While the aim of the questionnaire deals with information gathering from psychiatrists on Maori mental health and on training to work with Maori, the paper itself indicates a change in focus. The conclusions focus heavily on the alleged racism which the authors find in the responses of white male psychiatrists with more than 10 years experience. And in their summation they recommend a greater selectiveness to screen out of training ‘applicants with overtly racist attitudes’.
Eliminating from training those with racist attitudes may or may not be a laudable purpose. It is certainly a complex one. Such a task is well beyond the maturity of a young graduate student whose respondents answered the single question: ‘Why do you think Maori are over represented in psychiatric hospitals?’ The 1–2 min allotted to this question simply will not satisfy as a means for so serious an enterprise as screening for ideologic attitudes of any kind.
More disturbing is the serious logical flaw in this central argument. From the finding that 28 psychiatrists (all New Zealand-born, male and with more than 10 years experience) are willing to consider genetic predisposition as a basis for Maori over-representation in psychiatric hospitals, the authors take the next step. They pose the rhetorical question, ‘Is the belief that a particular race is more genetically predisposed to ‘madness’ than other races any less racist than the belief that a race is genetically/biologically inferior?’
Apparently the authors answered their own question in the negative. They go on to pose a need to reform entry procedures to professional training based upon the ‘alarming findings’ and ‘ignorant comments’ they received.
Let me state it quite flatly. Entertaining the possibility of a genetic predisposition among Maori for some types of mental disorder is no more an acknowledgment of ‘biologic inferiority’ or indeed significant of ‘racist attitudes’ or even ‘ignorance’ than is say, the recognition of the genetic predisposition of ‘Nordic races’ i.e., Scandinavians, to the hematologic substrates productive of Pernicious Anemia, or say, the genetic pre-disposition of Sephardic Jews to Tay-Sachs disease.
Rather the opposite may be true. To fail to consider among predisposing factors to mental illness genetic or familial contributions is automatically to condemn the affected group to loss of opportunities for development of new therapies that such knowledge might one day allow.
By means of the logical failure inherent in conflating ideas of genetic possibility and racial dogma the authors have succeeded only in name calling and, by an ironic twist, becoming themselves liable to a charge of ‘reverse-racism’, if that piece of name-calling can itself have meaning in this context. After all, it is these authors who attribute biologic inferiority to persons with mental disorders, and not necessarily the respondents whose quoted responses say nothing stigmatising about the mentally ill.
Two immediate questions of the authors’ conclusions come to mind. They posit that no female psychiatrist nor males with less than 10 year's experience ‘shared this belief in genetic inferiority’. Quite apart from the rhetorical elision of this last phrase, the absence of genetic consideration by these psychiatrists, younger, and/or female, may reflect any number of attitudes, from caution in responding to such a questionnaire (the junior author could exactly identify respondents) to a risk-aversiveness in thinking, with implications for conformity versus originality. Surely those are reasonable alternative hypotheses.
But much more important is the question of the duty owed to respondents to inform them that they might be held up to critical scorn before colleagues for ‘racism’ and ‘ignorance’ because of their participation.
The term ‘ignorant’ is disturbing in itself. The authors have highlighted several intemperate critical comments whose full context is undisclosed. To this reader some of these statements seem plausibly to be in response to an invitation to respondents who chose not to participate to give an open-ended explanation of their choice.
What psychiatrists can easily and quite properly conclude from such an experience is simple. Don't answer questionnaires in which full disclosure both of purpose and end-usage of all data including free-form comments, is not made. If cooperation is your choice, then, either caveat emptor, or, if there is abuse of trust, it should be addressed in a proper venue, such as the credentialling body or the university of origin of the research. Most universities today maintain ethics committees to deal with research. Their guiding principle, like our own, is first, do no harm.
I wish to acknowledge my debt of gratitude to Dr Read for his forthright responses to my emailed questions and for providing me with copies of both paper and questionnaire.