Psychology Tomorrow

Psychology more than any other science has had its pseudo-scientific no less than its scientific period. James Baldwin

As I sit here reading a paperback copy of Psychology Gone Wrong: The Dark Sides of Science and Therapy by Tomasz Witkowski and Maciej Zatonski (not the accordion duo), I can’t help but notice myself agreeing with many aspects of this polemic work. However, as a practicing psychotherapist who has always accepted the empirical limitations of psychology, it doesn’t obliterate my appreciation for what I “feel” are the philosophically vital and essential elements (unshakeable bulwarks) of psychotherapy. For the sake of analogy, all partial differential equations in physics are deterministic, but their measurements are subject to stochasticism (randomness), and the randomness of how the human mind operates is primarily why I find psychology interesting. No special pleading should be necessary to historically demonstrate that cognition and behavior can be altered effectively through psychotherapy. Nevertheless, an analysis of long-term treatment methods in various forms of therapy is often confounded by the subjective experiences of clients combined with biased reasoning or questionable motivations by therapists—factors that significantly complicate the investigation of proposed treatment mechanisms. To be fair, subjective experience is partly why studying human consciousness has been referred to as “the hard problem,” but subjectivity in therapeutic treatment settings can undoubtedly be diluted by suggestibility and gullibility.

Most clinically approved and evidence-based forms of psychotherapy used today (i.e., Cognitive Behavior Therapy and Dialectical Behavior Therapy) allow clients to engage in discursive reasoning while providing theoretically-based guidance and emotional support to assist “processing” with the goal of behavioral modification. Finding solutions for optimizing functioning, resolving emotional dilemmas, and establishing well-being often requires an open dialogue (e.g., brainstorming) for sifting through useful or logically cohesive information while examining thought processes and behaviors that are counterproductive. I also believe that philosophical thought experiments can be constructive for abstract problem solving—albeit for higher-functioning clients. However, a trap door in psychotherapy begins to open if the practitioner ignores the role of non-specific effects (the therapeutic interaction, setting, and suggestive narratives) during the application of various treatment methodologies while overestimating, or conveniently fabricating, the specific effects (any proposed mechanism of treatment that is falsifiable). In addition, clinical transparency becomes problematic if pseudoscientific modalities and deliberate cases of fraud are not weeded out through a peer-reviewed framework of empirical restraints. As it currently stands, non-specific effects, self-report, and positive correlations are endemic in psychotherapy-based research. Furthermore, biased interpretations of clinical outcomes with a propensity to rely on anecdotal evidence automatically degrades discussions about the actual mechanisms of psychotherapy interventions. Given these factors, mental health therapy constitutes a wide range of clinically informed, but not always accurate or predictive, efforts to elicit shifts in cognition and behavior. After all, “soft” science should be expected to be malleable—especially when the margin of error is much greater than in other scientific fields such as molecular biology. However, what remains the subject of scrutiny, criticism, and debate are exaggerated claims regarding treatment efficacy that seem conveniently disproportional to the available evidence, such as research with reproducibility problems, uniformed clinicians, and unambiguous cases of deception, fraud, or abuse.

Another important consideration is that “evidence-based” practice in the field of psychology or psychotherapy is not the same as evidence-based practice in chemistry or internal medicine (e.g., the plausibility of certain concepts and applications would be more readily dismissed in modern chemistry than in modern psychology). Although it’s true that “different things work for different people,” an unwillingness to concede the influence of placebo effects or non-specific effects appears to be more common since the advent of New Age marketing, and there is certainly no deficit of “alternative” therapies promoting self-help via “cutting edge” psychology at the hands of “enlightened” life coaches. Given this unfortunate trend, it’s easy to see how clients can be exploited and taken advantage of by practitioners—even if the intention of treatment is not spurious. Consequently, any effective psychotherapy is dependent on client receptivity, and there is no empirical way (that I know of) to calibrate levels of sincere receptivity (lie detector devices are not reliable and certainly not admissible). In fact, it’s much easier to negate criticism of interventions by asserting client resistance when modalities prove less than effective. However, it’s true that client participation is crucial regarding treatment outcomes during all therapeutic interactions. More importantly, a distinction between uniformed practitioners and unethical practitioners is also beneficial in these critiques. For example, uniformed practitioners may believe that a bogus intervention is valid, whereas unethical practitioners may “know better” but aren’t discerning when it comes to achieving their primary motivation (profit).

Many mental health topics that formerly belonged to the domains of psychology and psychiatry are now being imbricated with advances in neuroscience for the potential remediation of unverifiable propositions. To paraphrase director Thomas Insel of the National Institute of Mental Health (NIMH), the future of psychiatry is moving towards clinical neuroscience, and clusters of symptoms will be soon be usurped by clusters of data. Additional interventions such as optogenetics and neoteric studies involving brain mapping are attempting to fine-tune or abrogate the armchair deductions (and inductions) that dictated so much of twentieth-century psychiatric research. There is a long line of academic disciplines waiting impatiently outside the patent office for a wax seal of scientific validity.

As the zeitgeist shifts on the clinical landscape, a natural selection process will invariably occur to “trim the fat” on the principles and practices of tomorrow’s psychology. The caveat emptor is not to abandon mental health treatment or the insights available from studying human psychology, but to abandon the unconstrained credulity that can emerge from both sides of the couch.

Unreasonable Reasoning

Every individual acts and suffers in accordance with their particular teleology, which has all the inevitability of fate, as long as they do not understand it.Alfred Adler

The phrase “everything happens for a reason” is a perniciously irksome expression. It would be better to say that everything happens because of assorted causation, but I suppose that doesn’t have enough poetic appeal. For example, if a tornado descends on a family of five—sparing only the youngest child—we should comprehend this misfortune as being caused by a rotating column of air near the earth’s surface (a tornado will demolish a home or community center with as much indifference as it would a liquor store). There is no need to say that the tornado happened for the child to learn a valuable lesson about bereavement while creating an opportunity to connect with an estranged relative. Likewise, it’s not very nice to tell children born with neurofibromatosis or leukemia that it happened for a reason. Manufacturing meaning to explain tragedies is not why tragedies occur in the first place; rather, the “meaning” represents a psychological buffer that promotes self-satisfied solace (albeit temporarily) in the wake of destruction. However, this type of specious perspective is short-sighted, conspicuously simplistic, and can appear distastefully insensitive to those whose suffering cannot be ameliorated. When used as a teleological anodyne, creative interpretations of trauma are simultaneously dishonest and intellectually bankrupt.

False consolation and convenient narratives, however well-intended, prolong our misunderstanding of reality and compromise human resilience for enduring future catastrophes. Furthermore, to say that everything happens for a reason diminishes the horror and sociopolitical responsibility with such historical atrocities as the Holocaust, the plight of Native Americans, slavery, and the Spanish Inquisition. There is no cosmic blueprint hanging on a ledge in the outer reaches of space providing intrinsic meaning to all random and non-fortuitous events. This is not to say, however, that wisdom cannot be gained from traumatic experiences. More importantly, we must learn to adapt to experiences that are not imbued with grandiose meaning via radical acceptance.

In conclusion, if your observational propositions do not align with reality, you may want to adjust your interpretive lens (altering reality is not an option). Cultivating compassion and solidarity starts with not lying to ourselves, or anyone else, about the nature of circumstance.

From Dorothea Dix to Dorothea Puente: The Incremental Evaporation of Altruism

Hypocrisy is the compliment vice pays to virtue. — Francois de La Rochefoucauld

It’s not too difficult to understand how cultural values influence and reinforce personal values. In America, a top-down approach to formulating values is driven by solipsistic avarice, inequitable wealth, and the insatiable demand for external validation as manifested through consumer materialism. The wrong incentives are conditioning a society towards relative indifference when it comes to the suffering of others—meanwhile, social and economic inequality ensues at unprecedented levels. Inconvenienced by having to admit that private-sector political interests and time-honored structural systems perpetuate disenfranchisement, a popular position is to blame the unfortunate for all of society’s transgressions while denying or ignoring the unsustainable nature of unmitigated greed. This is why the fundamental attribution error is absolutely fundamental to understanding how rationalization precipitates solution aversion.

In an earlier post entitled Can’t Get There From Here, I discussed how institutionalized systems of injustice encourage us to be complicit with the status quo by internalizing imbalances of power. Likewise, imbalances of power are a one-way street designed to maintain undisputed leverage for some at the expense of many others. For example, a recent paradigm in community mental healthcare involves fee-for-service commodification of the clientele. When human flourishing is reduced to high-volume billable services, the incentive for establishing social welfare is usurped by a competitive motivation for profit. Similarly, if a client’s eligibility to receive treatment services and community resources is based on their reimbursement potential via subsidized revenue and insurance benefits, it becomes easier to think of people as interchangeable assets or financial liabilities. This motif extends to employees when corporate interests reduce the value of workers to fixed or variable costs. The distance from being indispensable to becoming disposable seems to be diminishing with unregulated intensity given today’s cultural milieu.

When it comes to the spectrum of compassion versus the spectrum of inhumanity, two women with diverse interpersonal “styles” immediately come to mind. One woman was an advocate for humanitarianism; the other was a purveyor of short-terms gains, dehumanization, and annihilation. Dorothea Dix was a renown United States activist who worked tirelessly to reform hospital conditions and treatment for the mentally ill during the nineteenth-century. Following the Civil War, Dix expanded her efforts even further to improve conditions for prisoners and the disabled while focusing on legislative campaigns to reduce suffering among indigent populations. Dorothea Puente, conversely, was a twentieth-century “caretaker” and boarding house manager in Northern California who murdered at least nine elderly and mental health residents from 1982 until 1988. Puente had a peculiar talent for cashing the Social Security checks of her victims shortly after burying these unlucky guests in her backyard.

Efforts to establish a global civil society seem futile when provincial, regional, and national sentiments are reduced to pathological self-interest. Even worse, fabricating compassion to achieve monetary interests only magnifies the loathsome commonality of duplicitous agendas. If the moral trajectory of society resembles anything like its current state of unsustainable affairs, it won’t be long before rank-and-file citizens become surrogate apologists for humanicide.