The Importance of Being Scientific, an Earnest Reflection

by Philippe Grisar on December 8, 2011

Psychoanalysis is often refuted for not being scientific. Of course it isn’t scientific when one restricts science to neo-positivism. Neo-positivism is an epistemology, a theory of science. This stands for the ideas of how the world should be studied so that one may claim observations and deduced laws as true or false.

Neo-positivism, proposed by Karl Popper, uses observation (of supposed laws of nature) and verification (of a hypothesis). Neo-positivism permits the overlooking of the nature of observation: every observation is biased by interpretation, the senses or instruments.

The methodology of psychoanalysis is not the same sort of observation. It is ‘listening to the unique speaking being’. Sigmund Freud began his observations this way and founded the theory of psychoanalysis on what he heard. He hoped that his invention would become part of the natural sciences.

Psychoanalysis is not a fixed body of knowledge. The theory is still moving on – developing. Jacques Lacan, one of the most important innovators of psychoanalysis, turned mainly to the science of language, linguistics and logics on which to found his theory of psychoanalysis.[1] That is quite another episteme to Popper’s.[2]

Studying the human being always begins with founding an episteme and there is more then neo-positivism or psychoanalysis: there is or was pragmatism (what works is true), idealism, constructivism, cybernetics…

Repudiating psychoanalysis as pseudo-science is a popular pastime. Yet it restricts the study of the social sciences to one view, to The One Truth.[3] That sounds like a convenient truth – if you allow me an exaggeration – where man is subject to his genes, his brain or is just instinct driven. Whatever you do, you can blame it on your neurobiological predisposition, (Sorry, I hit you but it were my genes, not me…). Or, worse, one may select and reinterpret on the basis of an ADHD diagnosis, what has occurred beforehand …  Further more, research of the human condition becomes laboratory-standard . That is the dream of many researcher.

Often the unexpected outcome of studies[4] or the inexplicable suffering of otherwise happy people (like becoming depressed without reason), is explained by an ill-functioning brain. (Untraceable) Brain dysfunction and a sudden lack of good working serotonins as causes for respectively, ADHD (Attention Deficit Hyperactive Disorder) and  Depression, has yet to be a proven hypothesis. Indeed, there are a lot of controversies and ever-changing explanations as to why and how the brain causes ‘deviant’ behavior. Brain functioning and its repercussions on the human being remains for a significant part unexplained: much like the universe.  But the consequences differ…

Karl Popper’s meticulous approach is very valuable and will not be discarded as no(n)-sense by the psychoanalysts. But the difference in epistemology, makes it impossible to fit the one (meticulous approach) into the other (Psychoanalysis). Psychoanalysts will not use neo-positivism. However, certain aspects, e.g. the plasticity of the brain, derived from this approach, do not contradict a psychoanalytic viewpoint, on the contrary.

Those who claim that ‘cognitive behaviorism’ is strictly ‘scientific’, are overlooking the fact that it isn’t quite like this. How often does a therapist fall back on non-scientific treatments or protocols[5] to treat, for example anxiety or depression? Who can explain and prove black-on-white-Exposure (to overexcite a client by stimulating their phobia), Eye Movement Desensitization and Reprocessing Therapy (EMDR, this is very much like hypnosis as used for the treatment of Post Traumatic Disorders) or Mindfulness (meditating without Buddha) as scientific[6]? Yet they are chosen instruments by those who cling to Popper’s neo-positivist view.

To keep these procedures within the positive sciences, someone came up with the argument of Evidence Based Medicine. “The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.”[7] In other words: who-does-what-with-whom to have the best relief of symptoms? Or for the sake of health policy, which therapeutic model (the most cost-effective standardised protocol) should be supported. Therefore ‘scientific’ proof is needed!

On this line of reasoning, psychoanalysis must surely be included. But there seems to be a bias in this scientific research. Because psychoanalysis does not aim at symptoms as such, but the whole human being (the suffering, the human condition). That is harder to include into a strict methodology that focuses on a well defined symptom or disorder within a given time.

Symptoms do disappear in psychoanalysis, but its effects are broader than this, offering the speaking being a ‘savoir faire’ and a kind of independence, a way to differ. That is the opposite to disorders and the Vermassung of protocols to deal with them. Psychoanalysts prove their worth in many clinical settings and give testimony in their daily clinic and many publications.[8] But, as said, psychoanalysis (or psychoanalytic psychotherapy) is not really into DSM-diagnoses, nor do they count symptoms, worry about the time or number of sessions elapsed. What is at stake is the particular history of the unique patient.

This, so it appears, prevents scientists from setting up statistical designs and then measuring outcomes (although it is done with a positive evaluation[9]).

This focus on symptoms and disorders make statistics possible. The fear of dogs or driving a car, the panic attack, the depressed feelings, etc. may be scored on a scale. Then, a limited number of sessions later, the (diminished) symptoms are scored again. The method used, which shows the best and cheapest outcome for the most patients within the shortest time, is elected as winner. Of course psychoanalysis looses in such a setting. It just doesn’t fit that kind of ‘set up’. At the same time the winning protocol is proven to be ‘scientific’ as there is evidence that it works… Is this Popper’s science or pragmatism?

Patients, who do not benefit from the winning treatment have bad luck (bad brains…). In the system, based in short-term cost-effectiveness measures, there will be only one recommended evidence-based-treatment. Any particular suffering or presentation of idiosyncratic symptoms will be fit into a set Disorder, neatly numbered in the Diagnostic Manual. Every number will recommend one protocol or medication of course, for the cure.

In fact, most patients are left in the lurch. Their subjectivity disappears behind the disorder, they become the diagnosis and get the standardized treatment. Do we agree that psychological treatment is reduced to the alleviation of symptoms, so that ‘clients’ can take up their tasks in society (become economically active)? One hopes that there is at least someone who cares that happiness is more than prosperous citizens, (the electorate) fed with gadgets or medication to keep them going. Making a comparison with Huxley’s Brave New World goes too far, doesn’t it?

Anyway, ‘Mindfulness’, for example, is an evidence-based-medicine winner within cbt (cognitive behavioral therapy) for therapy-resistant depression.[10] Scientifically proved and approved, it is happily integrated into psychiatry. Meditating without Buddha has become standard. Maybe it is not ‘science’ but it is at least ‘scientifically’ proved!… Quite a reversal which seems to go unnoticed!

In a way, this reminds me of children playing a game with an adult: every now and then, when they feel they might loose, they change the rules and at the end, they exclaim: “Oh, but you cheated!”  For the child, the stake is their self-esteem.

For psychology and psychotherapy the stake is government-regulation.

If you know that many researchers have found that any kind of psycho-therapy can be effective as long as the therapist is good (the famous Dodo-effect), what then are the selection criteria for choosing a particular flavour of therapy?

Is the claim for science, a claim for being Ernest?

[This is a revised version posted on 31st December, 2011]

Endnotes:



[1] Miller, J.A., La psychanalyse, sa place parmi les sciences, in Mental, revue internationale de psychanalyse, « Psychanalyse, science et scientisme, no. 25, March 2011, pp. 11-33.

[2] For his own theory of science , Popper had to seek refuge to philosophy – thus in his way he turns the scientists vision towards what he considers as real i.e. empirism. In this it seems that he tries (probably without his knowledge) to find an answer to Lévi-Strauss’s criticism on psychoanalysis in the latter’s famous article on the Efficacy of symbolism. In a way, this is what Lacan did but from a different angle i.e. rationalism.

[3]  That is called by other philosophers of knowledge as Elitarism (cf. Irme Lakatos).

[4] Or it is simply not published.  See for example: Turner, E. H., Matthews. A. M., Linardatos, E., Tell, R. A., and Rosenthal, R., Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy, in The New England Journal of Medicine 358;3 www.nejm.252 org January 17, 2008. And available here.

[5] The number of articles prove the research for a neurobiological foundation of the therapeutic effects of the therapy. There isn’t yet actually one that may claim the hypotheses to be true.

[6]  A protocol is a strictly designed procedure or treatment for a strictly defined mental illness. The latest reports on protocols claim that the enthusiasm of person in charge, is a very important factor in a positive outcome. Yet this is not measurable I’m afraid.

[7] Sackett, D.L., Rosenberg, W.M.C., Gray, M.J.A., Haynes B.R., Richardson, W.S.Evidence based medicine: what it is and what it isn’t, BMJ 1996;312 – available here

[8]  Mental: Revue internationale de psychanalyse, vol 26:”Comment la psychanalyse opère”, June 2011 ; Psychoanalytical Notebooks of the London Society of the NLS  & Hurly-Burly, The International Lacanian Journal of Psychoanalysis, in English. (See www.lacanianworks.net/case studies for Philippe Grisar’s (here) and Jo Rostron’s (here) which are also published in Mental & Psychoanalytical Notebooks.)

[9] Leichsenring, F. & Rabung, S., Effectiveness of long-term Psychodynamic Psychotherapy, A Meat-analysis, JAMA, October 1, 2008—Vol 300, No. 13, pp. 1551-1565.  And available here.

Leichsenring, F., Rabung, S., Long-term psychodynamic psychotherapy in complex mental disorders: update of a meta-analysis,  in The British Journal of Psychiatry (2011), 199, 15–22. And available here.

Cuijpers, P., van Straten, A., Andersson, G., van Oppen, P., Psychotherapy for Depression in Adults: A Meta-Analysis of Comparative Outcome Studies ,in Journal of Consulting and Clinical Psychology, 2008, Vol. 76, No. 6, 909–922. And available here

Shedler, J.The Efficacy of Psychodynamic Psychotherapy, in  American Psychologist, February–March 2010 (American Psychological Association), Vol. 65, No. 2, 98–109. And available here.

[10] Allen N.B., Chambers R.,  Knight W., Blashki G., Ciechomski L., Hassed C., Gullone E., McNab C., Meadows G., Mindfulness-based psychotherapies: a review of conceptual foundations, empirical evidence and practical considerations, 2006, Vol. 40, No. 4 , pp. 285-294   And available here.