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Why psychiatry has failed

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  • Ian Pitchford
    New Statesman Why psychiatry has failed Peter Watson Monday 1st July 2002 We can fly to the moon and tap genetic secrets, but human beings are as badly behaved
    Message 1 of 10 , Jul 1 6:25 AM
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      New Statesman

      Why psychiatry has failed
      Peter Watson
      Monday 1st July 2002

      We can fly to the moon and tap genetic secrets, but human beings are as badly
      behaved and as miserable as ever. Is it because shrinks rely too much on words?
      By Peter Watson

      One hundred years ago, in The Interpretation of Dreams, Sigmund Freud unveiled
      the unconscious, and "the psychological century" was born. It has turned out to
      be a huge disappointment. The gene and the quantum were conceived at the same
      time as Freud conceived the unconscious; yet, although they have led to
      sophisticated technologies, psychology and psychiatry, by most standards, are
      failures. More people than ever are on anti-depressants; drug abuse is rampant;
      psychotherapies don't work; our jails are fuller than ever.

      What happened? Where did it all go wrong? Jerome Kagan, a professor of
      psychology at Harvard, thinks he has an answer. In his newly published book,
      Surprise, Uncertainty and Mental Structures, he argues that we have been
      ignoring what goes on inside our heads.

      Consider the following experiments:

      Full text
      http://www.newstatesman.co.uk/200207010018.htm

      Surprise, Uncertainty, and Mental Structures
      by Jerome Kagan
      Hardcover: 256 pages ; Dimensions (in inches): 1.01 x 8.50 x 5.74
      Publisher: Harvard Univ Pr; ISBN: 0674007352; (April 2002)
      AMAZON - US
      http://www.amazon.com/exec/obidos/ASIN/0674007352/darwinanddarwini/
      AMAZON - UK
      http://www.amazon.co.uk/exec/obidos/ASIN/0674007352/humannaturecom/
      AMAZON - CA
      http://www.amazon.ca/exec/obidos/ASIN/0674007352/humannaturere-20/

      Book Description
      When we are startled by the new, confronted with discrepancies, our knowing
      gives way to uncertainty--and changes. In the distinctive manner that has made
      him one of the most influential forces in developmental psychology, Jerome
      Kagan challenges scientific commonplaces about mental processes, pointing in
      particular to the significant but undervalued role of surprise and uncertainty
      in shaping behavior, emotion, and thought. Drawing on research in both animal
      and human subjects, Kagan presents a strong case for making qualitative
      distinctions among four different types of mental representation--perceptual
      schemata, visceral schemata, sensorimotor structures, and semantic
      networks--and describes how each is susceptible to the experience of
      discrepancy and the feeling of surprise or uncertainty. The implications of
      these findings are far-reaching, challenging current ideas about the cognitive
      understandings of infants and revealing the bankruptcy of contemporary
      questionnaire-based personality theory. More broadly, Kagan's daring,
      thoroughly informed, and keenly reasoned book demonstrates the risks of making
      generalizations about human behavior, in which culture, context, and past
      experience play such paramount and unpredictable roles.

      About the Author
      Jerome Kagan is Daniel and Amy Starch Professor of Psychology at Harvard
      University.
      http://www.necsi.org/faculty/kagan.html

      Table of Contents

      Introduction
      1. Discrepancy and Schemata
      2. Inconsistency and Semantic Networks
      3. Event-related Potentials
      4. Implications for Development
      5. Implications for Creativity and Personality
      Epilogue
      Notes
      Acknowledgments
      Index
    • Leif Edward Ottesen Kennair
      I believe the answer to why psychiatry failed to be an answer to a false question. Neither psychology nor psychiatry has failed. And brain states and words
      Message 2 of 10 , Jul 1 11:16 AM
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        I believe the answer to why psychiatry failed to be an answer to a false question. Neither psychology nor psychiatry has failed. And brain states and words important - but Kagan's perspective is also interesting.

        The problem is not that psychotherapies do not work - they do. But some do not work for certain disorders, and some work wonders for specific disorders. And that is the major problem: Too many psychologists and psychiatrists forget to base their practice on science and base it on tradition, common sense and psycho-folk-lore.

        The reason clinical psychology and psychiatry seemed as though they were going to fail was that they used half a century turning into real empirical science! (And had an uphill battle against the traditions and power bases in psycho-folk-lore after that.)

        This is changing. And thus this piece on the failure of psychiatry and psychology ends up being based on false premises.

        Cheers,

        Leif Edward


        > One hundred years ago, in The Interpretation of Dreams, Sigmund Freud unveiled
        > the unconscious, and "the psychological century" was born. It has turned out to
        > be a huge disappointment. The gene and the quantum were conceived at the same
        > time as Freud conceived the unconscious; yet, although they have led to
        > sophisticated technologies, psychology and psychiatry, by most standards, are
        > failures. More people than ever are on anti-depressants; drug abuse is rampant;
        > psychotherapies don't work; our jails are fuller than ever.
        >
        > What happened? Where did it all go wrong? Jerome Kagan, a professor of
        > psychology at Harvard, thinks he has an answer. In his newly published book,
        > Surprise, Uncertainty and Mental Structures, he argues that we have been
        > ignoring what goes on inside our heads.
      • Maurizio Tirassa
        ... I agree that clinical psychology and psychiatry are not bankrupt, but I see a big problem in the lack of a coherent theoretical foundation and a bigger one
        Message 3 of 10 , Jul 1 1:43 PM
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          At 20:16 +0200 01.07.2002, Leif Edward Ottesen Kennair wrote:
          >I believe the answer to why psychiatry failed to be an answer to a
          >false question. Neither psychology nor psychiatry has failed.....
          >
          >....that is the major problem: Too many psychologists and
          >psychiatrists forget to base their practice on science and base it
          >on tradition, common sense and psycho-folk-lore.
          >
          >The reason clinical psychology and psychiatry seemed as though they
          >were going to fail was that they used half a century turning into
          >real empirical science!

          I agree that clinical psychology and psychiatry are not bankrupt, but
          I see a big problem in the lack of a coherent theoretical foundation
          and a bigger one in the lack of a nosography based on such
          theoratical foundation. The DSM is just a collection of "tradition,
          common sense and psycho-folk-lore". Maybe it's my degree in Medicine
          speaking here, but when I think back to those clear-cut taxonomies of
          "bodily" (as -- incorrectly -- kept distinct from "mental")
          diseases, I definitely tend to become envious....

          Of course, part of the problem with the DSM (ie, with clinical
          psychology and psychiatry) depends on the attempt to keep together
          disparate "paradigms", ranging from Freudian orthodoxy to cognitive
          psychology to various sorts of eliminativism to constructivism and so
          on. On the other hand, precisely this situation is one symptom of the
          problem with theoretical foundations which I mentioned earlier.

          Regards,

          - MT

          --

          Maurizio Tirassa, Ph.D.
          Associate Professor, General Psychology

          Università di Torino phone +39.011.6703037
          Centro di Scienza Cognitiva fax +39.011.8159039
          via Po, 14 mailto:tirassa@...
          10123 Torino (Italy) http://www.psych.unito.it/
        • Beckie Child
          Perhaps, we are talking semantics here...but I know that what I was taught in school about psychology and psychiatry is not anything compared to what I have
          Message 4 of 10 , Jul 1 11:46 PM
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            Perhaps, we are talking semantics here...but I know that what I was taught
            in school about psychology and psychiatry is not anything compared to what I
            have learned first hand as a client.

            If you that psychology and psychiatry have not failed, would you say then
            that it has not succeeded either?

            I would say that psychology and psychiatry are not successful either. And
            therapies can be helpful, but if they are provided in a power over
            relationship, then they are harmful.

            For people who got to experience the wonderful delights of insulin shock
            therapy, I would say that psychiatry was/is an abominable failure.

            If you take the relationship out of psychiatry and psychology, then you have
            a hollow science without a soul.

            I cannot tell you how many times I've appreciated (extreme understatement)
            being told I don't know what I'm talking about when it comes to my distress,
            and that because they did x therapy, and I'm not better, it's my fault.

            Psychology and psychiatry pride themselves on evidence based treatment that
            does not ask the person who experiences the distress or "supposed" distress
            whether or not they benefited from the treatment. I wonder why? Would
            people say that they found the "cure" worse than the illness?




            At times, I would.


            beckie
          • Leif Edward Ottesen Kennair
            Maurizio, I cannot disagree with what you write - but parts of the DSM or ICD systems do work - notably those based mostly on functional and comparative
            Message 5 of 10 , Jul 2 12:36 AM
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              Maurizio,

              I cannot disagree with what you write - but parts of the DSM or ICD systems do
              work - notably those based mostly on functional and comparative research: the
              anxiety disorders... I believe the combination of the two current lists may
              solve the problem in the end. And of course - not being perfect yet, and
              having failed are two different things. No science of genetics is perfect,
              neither physics, so the two sciences presented as models are in no way
              finished collecting the relevant data and building the best theories possible.
              I think the research in treatment of anxiety disorders is almost as good as
              most genetic research, but for other disorders - due to the lack of good
              empirical work we have further to go... but, I repeat, that is not failure.

              Cheers,

              Leif Edward

              >========== Original Message From Maurizio Tirassa <tirassa@...> =========>At 20:16 +0200 01.07.2002, Leif Edward Ottesen Kennair wrote:
              >>I believe the answer to why psychiatry failed to be an answer to a
              >>false question. Neither psychology nor psychiatry has failed.....
              >>
              >>....that is the major problem: Too many psychologists and
              >>psychiatrists forget to base their practice on science and base it
              >>on tradition, common sense and psycho-folk-lore.
              >>
              >>The reason clinical psychology and psychiatry seemed as though they
              >>were going to fail was that they used half a century turning into
              >>real empirical science!
              >
              >I agree that clinical psychology and psychiatry are not bankrupt, but
              >I see a big problem in the lack of a coherent theoretical foundation
              >and a bigger one in the lack of a nosography based on such
              >theoratical foundation. The DSM is just a collection of "tradition,
              >common sense and psycho-folk-lore". Maybe it's my degree in Medicine
              >speaking here, but when I think back to those clear-cut taxonomies of
              >"bodily" (as -- incorrectly -- kept distinct from "mental")
              >diseases, I definitely tend to become envious....
              >
              >Of course, part of the problem with the DSM (ie, with clinical
              >psychology and psychiatry) depends on the attempt to keep together
              >disparate "paradigms", ranging from Freudian orthodoxy to cognitive
              >psychology to various sorts of eliminativism to constructivism and so
              >on. On the other hand, precisely this situation is one symptom of the
              >problem with theoretical foundations which I mentioned earlier.
              >
              >Regards,
              >
              > - MT
              >
              >--
              >
              >Maurizio Tirassa, Ph.D.
              >Associate Professor, General Psychology
              >
              >Università di Torino phone +39.011.6703037
              >Centro di Scienza Cognitiva fax +39.011.8159039
              >via Po, 14 mailto:tirassa@...
              >10123 Torino (Italy) http://www.psych.unito.it/
            • Leif Edward Ottesen Kennair
              Dear Beckie, I attempt to prevent answering personal notes on the net. This will of course make me seem callous - and confirm your worst expectations, still
              Message 6 of 10 , Jul 2 12:57 AM
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                Dear Beckie,

                I attempt to prevent answering personal notes on the net. This will of course
                make me seem callous - and confirm your worst expectations, still this is the
                approach I believe is correct. I will attempt to answer your questions in
                general.

                >If you that psychology and psychiatry have not failed, would you say then
                >that it has not succeeded either?

                These are not perfect sciences or crafts - but compare favourably to most
                forms of treatment/ medicine. There is quite a good deal of success, as there
                is certain lack of success. One would probably be correct in stating that
                these services, when performed to the best of our current knowledge, have
                never been better - and that many people are helped.

                >I would say that psychology and psychiatry are not successful either. And
                >therapies can be helpful, but if they are provided in a power over
                >relationship, then they are harmful.

                This is true of course. But this is not typical, it is not good treatment, or
                treatment performed to the best of our current knowledge. Thus it it not
                correct to equate such treatment with clinical psychology or psychiatry in
                general.

                >For people who got to experience the wonderful delights of insulin shock
                >therapy, I would say that psychiatry was/is an abominable failure.

                I would not agree with "is". And one does not measure "failure" within a field
                by what has happened in the past, but by what is current best practice.

                >If you take the relationship out of psychiatry and psychology, then you have
                >a hollow science without a soul.

                Yet again, according to all empirical knowledgebased evidence and
                evidencebased knowledge - any practice that attempted to neglect the
                relationship is NOT CURRENT BEST PRACTICE.

                >Psychology and psychiatry pride themselves on evidence based treatment that
                >does not ask the person who experiences the distress or "supposed" distress
                >whether or not they benefited from the treatment. I wonder why? Would
                >people say that they found the "cure" worse than the illness?

                I hope this is not the general experience - it is not the general experience
                among the patients at this institution. Note: Evidencebased practice and focus
                on the working-relationship between therapist and patient is typical, not
                opposed. The most efficient treatments get the best relationship ratings.

                Cheers,

                Leif Edward
              • Kathy W. Keith
                Ok, I ll chip in my two cents. I think psychologists and psychiatrists would practice from science if there was a solid science from which to practice. Instead
                Message 7 of 10 , Jul 2 8:02 AM
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                  Ok, I'll chip in my two cents. I think psychologists and psychiatrists would
                  practice from science if there was a solid science from which to practice.

                  Instead of faulting just the clinicians who champion science but practice
                  philsophy, let's take the research end to task, too. Many studies are so
                  specific they are difficult to translate to practice and most researchers do
                  not consider translational studies to be a priority; Broader studies often
                  wind up concluding that the result is indefinite - and, of course we all know
                  duplication studies won't be published; the research field of
                  psychology/psychiatry is chronically underfunded and understaffed (due
                  largely to a lack of results), especially when considering the subject is the
                  most complex thing on the planet; and, the leading solution to date,
                  neuropharmocology, requires neurobiochemical degrees in addition to
                  traditional psychological backgrounds - as things are now, that would be a
                  degree program lasting a decade.

                  Psychology is more a loose collection of over-specialized, territorial
                  individuals working at cross purposes, than an organized body working at a
                  unified mission. I believe the members have adequate intellectual talent and
                  motiviation, but our efforts (including training and education) lack
                  effective priority and direction. And, I think the rest of the world is
                  figuring this out and our credibility is sinking fast. People expect us to
                  provide answers, not just perspectives, to human problems and we simply are
                  not doing it.

                  Kathy W. Keith
                  University of North Texas
                • Roy Sugarman
                  Hi I think, as Kandel has proven, that words and information containing those words, can change the brain, by changing the way DNA is expressed in the brain.
                  Message 8 of 10 , Jul 2 4:18 PM
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                    Hi

                    I think, as Kandel has proven, that words and information containing those
                    words, can change the brain, by changing the way DNA is expressed in the
                    brain. However, Beckie's plight plucks at the strings of any therapist.

                    It seems to be that there is a difference between a 'craft' and an 'art'.
                    If we treat based on best practice, we hone a craft to its formulaic best.
                    However, patients have complained to me over the past decade that this was
                    not enough for them: our practice of an overlearned set of crafted
                    principles left them feeling relieved to a certain extent, but also unheard
                    and uncontacted. On the other hand, 'art' is not formulaic, and represents
                    a kind of ideational Darwinism: there becomes, in the working of the
                    therapy, a form of co-constructed reality which allows for far more
                    expression of emotional creativity as far as patients are concerned, a kind
                    of 'heart of darkness' trip best not done alone, or alone in a formulaic
                    relationship. Is there then a place for co-constructed reality in the
                    expression of the DSM? One of my colleagues is a hopeless therapist, but
                    such a nice guy that over the last ten years the vast majority of his
                    patients have got much better on embarrassingly small doses of medication,
                    and huge amounts of well choreographed change driven by a genuine warmth and
                    empathy that is nowhere seen in the Barlow studies. I spend my life reading
                    and applying neuroscience to my therapies, but the contact is a developing
                    set of skills that depart from formula and invariant structure, have a life
                    of their own, and allow for a unique experience for me and for the patient,
                    every time. Where that coconstruction of art hasnt happened, the craft
                    didnt change anything for anyone....was that it for Beckie? Hmmmm.

                    Roy

                    Roy Sugarman PhD
                     Senior Clinical Neuropsychologist
                    Glenside Campus/RAH
                     Clinical Lecturer
                    Dept of Psychiatry
                    Adelaide University
                     
                    (08) 8303-1201
                    Page: 8378-1111 code 115457
                    Mobile: 0403-289092


                    -----Original Message-----
                    From: leiedoke [mailto:leiedoke@...]
                    Sent: Tuesday, 2 July 2002 5:28
                    To: Beckie Child; psychiatry-research@yahoogroups.com
                    Subject: RE: [psychiatry-research] Why psychiatry has failed


                    Dear Beckie,

                    I attempt to prevent answering personal notes on the net. This will of
                    course
                    make me seem callous - and confirm your worst expectations, still this is
                    the
                    approach I believe is correct. I will attempt to answer your questions in
                    general.

                    >
                  • Dr. Joe Hoelscher
                    Kathy... marvelous comments. You say that psychologists and psychiatrists would practice from science if they had a solid science from which to practice.
                    Message 9 of 10 , Jul 2 8:44 PM
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                      Kathy... marvelous comments. You say that psychologists and
                      psychiatrists would practice
                      from science if they had a solid science from which to practice. Well,
                      we have psychometrics
                      and we have psychopharmocology. As Adam Sandler would say: "Not too
                      shabby!"

                      Yes, I have a minor in philosophy and when I do "talk" therapy, I do
                      more philosophy than anything else. Let us never forget that psychology
                      evolved from philosophy which studied the mental processes many
                      generations ago. Epistemology - the study of knowledge and learning.
                      This of course is philosophy and we in our time have made it
                      psychology. Now, you become critical of research because it is so
                      specific that it cannot be applied. Yes, to some degree that is very
                      true. But, the academics control this and you have to be so unique to
                      get a dissertation published. You have to be so specific. So, if you
                      are an academic, then let your students have some freedom to replicate
                      studies and generalize from them. Don't be critical... do something
                      about it.

                      I do not see psychologists working at cross purposes. We work at what
                      we are good at. I rely on others in the field to do research while I am
                      busy in the field evaluating individuals based on the best and most
                      recent data available. Many have been critical of projective tests.
                      They say there is no validity or little validity. I have been using
                      projectives for over 30 years and will continue to use them because they
                      are valuable and give us a glimpse inside a person's feelings and
                      thinking which we would not otherwise have. I have shared resutls with
                      parents of students.... yes they say... that is my son or daughter. I
                      have shared these results with adults... yes, that is me they say.
                      Someone (me) has put down in black and white what they always felt.
                      They are grateful for the validation.
                      As a professor told me a long time ago, you never draw conclusions from
                      one instrument but when you start to see a pattern emerging from a
                      number of instruments, your diagnosis and conclusion is much more valid.
                      I get my feedback from my students and my patients. I know I am
                      helping folks become more knowledgeable about themselves and having
                      knowledge is necessary for action.

                      There is light at the end of the tunnel. You and I as professionals
                      have to be willing to turn it on.


                      >
                      > Psychology is more a loose collection of over-specialized, territorial
                      > individuals working at cross purposes, than an organized body working
                      > at a
                      > unified mission. I believe the members have adequate intellectual
                      > talent and
                      > motiviation, but our efforts (including training and education) lack
                      > effective priority and direction. And, I think the rest of the world is
                      > figuring this out and our credibility is sinking fast. People expect
                      > us to
                      > provide answers, not just perspectives, to human problems and we
                      > simply are
                      > not doing it.
                      >
                      > Kathy W. Keith
                      > University of North Texas
                    • Al Turner
                      ... Might I draw your attention to the following all time favorite article of mine: http://www.ustanova-iboga.si/html/love.html NUMBER: 9606274115 AUTHOR:
                      Message 10 of 10 , Jul 3 5:52 AM
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                        Roy Sugarman wrote:
                        > One of my colleagues is a hopeless therapist, but
                        > such a nice guy that over the last ten years the vast majority of his
                        > patients have got much better on embarrassingly small doses of medication,
                        > and huge amounts of well choreographed change driven by a genuine warmth and
                        > empathy that is nowhere seen in the Barlow studies.

                        Might I draw your attention to the following all time favorite article
                        of mine:

                        http://www.ustanova-iboga.si/html/love.html

                        NUMBER: 9606274115
                        AUTHOR: Bemak, Fred; Epp, Lawrence
                        TITLE: The 12th curative factor: Love as an agent of healing in group
                        psychotherapy.
                        SOURCE: Journal for Specialists in Group Work. v21 n2, May 1996, p.
                        118. 10 pages
                        PUBLISHER: American Counseling Association
                        STANDARD NO.: 0193-3922

                        THE 12TH CURATIVE FACTOR: LOVE AS AN AGENT OF HEALING IN GROUP
                        PSYCHOTHERAPY

                        In this article, we are proposing love as a curative factor in group
                        psychotherapy. Transference within a group may originate with the need
                        and the desire for love. Through the unmasking of transference,
                        subsequent healing may arise from a process of mourning in which group
                        members recognize how their projection of past love onto comembers and
                        the psychotherapist is reenacted in their current relationships. This
                        article explores the dynamics of love and the healing power of love in
                        group psychotherapy.
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