Denying to the Grave is an exploration of science denial that focuses on health, medicine, and the psychological and neurobiological mechanisms underlying how people make decisions that can affect their health. This book, written by public health specialist Sara Gorman and her psychiatrist father Jack Gorman, uses evidence from psychological research to describe the many factors that lead people to reject scientific data. The book also proposes seven guiding principles and six solutions to help sway people in the direction of accepting scientific evidence and rejecting the allure of “junk” science.
The authors use recurrent examples of so-called controversial scientific topics to serve as prototypical examples of science denial. These topics include the safety of vaccines, the risks associated with guns, the debate about genetically modified food and antibiotic misuse, the safety of nuclear power, the risks of unpasteurized milk, and the safety and efficacy of electroconvulsive therapy. In the introduction, the authors explain their views on each of these topics and offer an overview of what is to be discussed in each chapter.
In the opening chapter, “Conspiracy Theories,” the authors contrast two well-known distorted scientific claims aimed at obfuscating science for financial or political gain. The first is an examination into the claim that tobacco companies and a group of scientists conspired in the 1960s to hide evidence of health risks associated with tobacco use. The second is the claim by Dr. Andrew Wakefield that vaccinations are harmful and that pharmaceutical companies and doctors are misleading the public. This chapter highlights the myriad characteristics that make people more prone to believe conspiracy theories and suggests strategies for how scientists can respond to antiscience conspiracy theories. Forensic psychiatrists can be expected to encounter conspiracy theorists because they often become entangled with the legal system. It has been suggested that a distinction should be made between extreme overvalued beliefs and delusions, which is a critical but often challenging task because of the implications for the diagnostic and legal processes.1
Chapter Two, “Charismatic Leaders,” elaborates on the group psychology that fosters conspiracies and science denial, specifically exploring leaders of such groups, what they have in common, and what makes them successful in amassing a following. The authors present Peter Duesberg, Andrew Wakefield, Jenny McCarthy, Gilles-Eric Séralini, and Wayne LaPierre as illustrative examples of the various strategies that compelling individuals utilize when propagating a message.
Chapter Three is arguably the most relevant to forensic psychiatric practice and focuses on confirmation bias or “our tendency to attend only to information that agrees with what we already think is true” (p 107). The authors argue that while this can be a useful adaptive trait in everyday life, it can also have devastating effects on the scientific method. Confirmation bias is often the hurdle that expert witnesses must overcome in court when testifying to a lay public that has been shaped by historical misinformation about mental illness and its treatments. In a similar fashion, such implicit biases have been linked to racially biased policing and criminal sentencing, and to the fallibility of eyewitness accounts.2
In the next two chapters, the authors examine basic principles of the scientific method, including cause and effect, how a scientific hypothesis is generated and tested, and different types of error. This examination is done in simple language intended to be clear to the lay reader. This type of language can be readily utilized when challenged on the witness stand and when experts are asked to explain the basis for their conclusions to lay jurors. The authors argue that the complexity of certain aspects of the scientific method can often be a barrier to the general public's understanding scientific literature.
Chapter Six, “Risk Perception and Probability,” explores why people overestimate small risks (e.g., an adverse reaction to a vaccine) but underestimate much larger risks (e.g., traffic accidents). The authors argue that people (even scientists) have a tendency to favor anecdotes and stories over statistics when they are presented with new information. Stories readily capture a reader's attention and utilize the recipient's emotion to reinforce the information's significance. The overlap with the work of forensic psychiatrists in this chapter is clear to see. It is the job of the psychiatrist to not only gather, review, and analyze the relevant facts, but, perhaps of greater importance, to provide a narrative history that ties all of the relevant facts together in a cohesive package.3
In the final chapter, the authors present “guiding principles” that are the major takeaway points of the book and nicely summarize the authors' main arguments. The authors also propose a series of solutions and strategies that can be used to help people make informed medical decisions and prevent the spread of misleading and inaccurate information.
Overall, Denying to the Grave is an easy and enjoyable read thanks to a lighter tone and a generous use of interesting examples and anecdotes. The case studies on charismatic leaders in Chapter Two are particularly thought-provoking. The bibliography section at the end of the book is a great reference for further reading on the plethora of data cited throughout the book. For the forensic psychiatrist, this book offers a view into factors that affect people's decision-making process and influence an individual's opinions. Beyond that, it offers strategies that can be utilized to help experts make the most compelling argument and communicate in a manner that best reflects and articulates their position when testifying in court.
Footnotes
Disclosures of financial or other potential conflicts of interest: None.
- © 2020 American Academy of Psychiatry and the Law
