Is Psychology a real science?

[mistermack]

Actually, I've noticed that I didn't link the sites with comments sections that I referred to, so here they are :
http://neurocritic.blogspot.com/2009/07 ... hless.html

http://psychcentral.com/blog/archives/2 ... r-anxiety/

Like I said at the top of that post, there is plenty of support for CBT but it's not universal by any means, and it's virtually always in concert with drugs.

I know that some kind of CBT does work to control panic attacks because I've controlled my own, very effectively in the past. (using my own routine, nothing to do with any established method).
So I know that the potential is definitely there.

[hadespussercats]

I never said anything about "purely physical"-- but there are certainly physical aspects to mental illness. This doesn't preclude the effectiveness of non-pharmacological interventions. There are all sorts of non-medicinal interventions that are effective for physical ailments. But if the illness isn't physical, where does it reside? Are you implying that someone can be spiritually sick?

I see where the confusion is now. All behaviors are the result of physical processes in the brain, but not all problem behaviors are a result of a physical problem in the brain.

I recognize that various scans/examinations of brains might reveal no difference between a healthy person and one with, say, a mood disorder. But... something is causing the disordered thinking. Something is changing in response to this medication, or that treatment. What is it?

[Mr.Samsa]

I don't think I cherry picked. I googled "is CBT effective?".

My "cherry picking" comment was more about the studies chosen by the authors of the paper you mentioned. But still, obviously you'd need to understand that with whatever medical treatment we mention, there's going to be negative results. What we do is weigh the evidence, and the vast majority of studies and metaanalyses suggest that CBT is effective.

And the bit about patients being on CBT for many years was taken straight from comments of the patients who were on it.
It was nothing to do with what I know or don't know.
You mentioned the comments section, if you'd looked, you would read a comment of a SUPPORTER of CBT who had been with the same therapist for 10 years. And there were plenty more.

I had a look and it seems like the person you're referring to is "Wendy Aron". I have no idea why she would be with a psychologist for that long, but quickly googling her suggests that she has been with a psychiatrist for over 20 years, not a psychologist practicing CBT, and has been hospitalised numerous times. The reason why she has to stick with her psychiatrist for so long will likely be because she is on a number of medications, and she would have to keep going back to check that there are no negative health effects, and to adjust the dosages if necessary. If she was literally having 20 years of CBT, then it's obviously not working and she needs to move on.

I never saw one comment of a person who only received a few sessions.
I'm only reflecting what I read.

Sure, but those are of course anecdotes. From the stats on CBT, very few people receive more than 20 sessions because there's simply no advantage to going on for that long. CBT is just a set of rules, and if you haven't learnt the simple rules by then, then you have something that isn't helped by CBT or you're doing it wrong. Either way, it would be time to find another treatment.

Also, you rubbished the study, but gave no reason as to why they should deliberately try to produce errant results.
The authors were well qualified, so there is no reason to think that they are incompetent.
You seem to be hinting that they wanted a certain result, and were able to produce it.
But when I suggested that that could happen, you rubbished that.

I have no reason to suspect that they were deliberately trying to produce errant results, all I know is that they did. This could simply be incompetence. They might be well-qualified, but not in psychology it seems (only one of them is a psychologist, by the looks of it, and that was the 4th-leading author). And I only rubbished the idea that someone could fake a result using sound methodology, which implies that I think it's possible to fake your results when you use unsound methodology - like claiming to be reviewing CBT and using 5 out of 9 studies which have absolutely nothing to do with CBT.

Look at it in very simple terms, you don't even have to know or understand anything about psychology to understand this. I have a new treatment called X and a number of people have studied it. A researcher comes along to review all the studies to see what the overall trend is in the data. He uses 9 studies; 4 of them look at how treatment X affects patients, and 5 of them looks at how treatment Y affects patients. Treatment Y has absolutely nothing to do with my treatment X, yet their negative results outweigh the positive results of the studies looking at treatment X.

Is this is a fair way of assessing the effects of treatment X?

Like I said at the top of that post, there is plenty of support for CBT but it's not universal by any means, and it's virtually always in concert with drugs.

This is because it's more effective with drugs, not that it isn't effective by itself. If CBT could not be demonstrated to be effective by itself, then it wouldn't be recommended at all (by itself or in combination).

I know that some kind of CBT does work to control panic attacks because I've controlled my own, very effectively in the past. (using my own routine, nothing to do with any established method).
So I know that the potential is definitely there.

The potential is definitely there, as CBT is based on a massive mountain of both theoretical and practical evidence, that we'd basically have to rewrite a number of behavioral laws just to try to make sense of a negative result of CBT.

I never said anything about "purely physical"-- but there are certainly physical aspects to mental illness. This doesn't preclude the effectiveness of non-pharmacological interventions. There are all sorts of non-medicinal interventions that are effective for physical ailments. But if the illness isn't physical, where does it reside? Are you implying that someone can be spiritually sick?

I see where the confusion is now. All behaviors are the result of physical processes in the brain, but not all problem behaviors are a result of a physical problem in the brain.

I recognize that various scans/examinations of brains might reveal no difference between a healthy person and one with, say, a mood disorder. But... something is causing the disordered thinking. Something is changing in response to this medication, or that treatment. What is it?

Well it's important to note that "disordered thinking" isn't quite an accurate description of what's going on - it's perfectly normal thinking, generalised to an inapplicable situation. Most medications change general brain processes, which set up conditions to allow for new thought processes. In other words, antidepressants don't cure you of negative thought patterns, but they pump you full of enough happy juice to be more able to accurately assess your thinking.

The fact is that neuroscience will never be able to replace psychology, and if everything was a "biological problem" in the brain, then it should be able to. The problem is that medications don't change thought processes, and instead they're crude ways of just making certain thoughts more or less likely. Like having a broken car that won't run - instead of fixing the engine, medication would be like picking it up and putting it on a downwards sloping hill. Sometimes the speed generated on the hill might be enough to get you to a service station to fix your engine problems.

Perhaps to think of it another way, keep in mind that mental disorders differ from culture to culture. So not only can we have a healthy brain with a mental disorder, but we can have a brain identical to an "unhealthy brain" that doesn't have a mental disorder in a specific culture. For example, a number of indigenous tribes view seeing your dead ancestors as a positive and normal experience, so common occurrences of auditory and visual hallucinations are not a mental disorder. Yet someone have the same experiences in the middle of New York would be suffering from a mental disorder. This is essentially because (in a nuthshell) a mental disorder is defined solely as something which affects our ability to function in society - if society views hallucinations as normal, then you don't have a mental disorder.

[hadespussercats]

The fact is that neuroscience will never be able to replace psychology, and if everything was a "biological problem" in the brain, then it should be able to.

Well, I don't have the ability to refute this, but it's a bold claim that leaves no room for nuance or doubt. I'd be happy to see it proven wrong.

This is not to say that medications are the only answer to mental disorders-- more, I'm hopeful that we'll eventually understand the mechanics of the brain that way we understand the mechanics of the heart, where sometimes beta-blockers are the answer, but sometimes it's just stress reduction and exercise.

[Mr.Samsa]

The fact is that neuroscience will never be able to replace psychology, and if everything was a "biological problem" in the brain, then it should be able to.

Well, I don't have the ability to refute this, but it's a bold claim that leaves no room for nuance or doubt. I'd be happy to see it proven wrong.

It's not really a bold claim because it requires no fore-knowledge or predictive abilities on my part; that is, I'm not making claims about what neuroscience is and is not capable of, but simply commenting on levels of explanation in science. Basically, neuroscience and psychology are two different areas, and whilst they both might provide an explanation for a behavior, one is not 'better' or 'worse' than the other, it just operates at a different level. Neuroscience cannot replace psychology in the same way that physics cannot replace chemistry - as we move up the level of explanation, we add more variables and the systems become more complex. In other words, neuroscience (alone at least) cannot explain our behaviors because our behaviors are not solely caused by chemical reactions and general processes in the brain, there is another element that it cannot account for purely on the basis of its subject area. This is not a spiritual or philosophical argument, but instead just highlighting the fact that our behaviors are the product of both our biology and our environment - these environmental variables cannot be studied by neuroscience because they are beyond their scope of interest.

To explain it another way, it will never be satisfactory to say something like, "Bob voted for Obama because a specific neural pathway fired in his brain" when answering the question, "Why did Bob vote for Obama?". It's the wrong level of analysis. Instead we'd explain it in terms of environmental factors, social norms, reinforcement contingencies etc, and when we ask how these variables interact in order to produce the result of Bob voting for Obama, then our deeper neuroscientific answer becomes relevant.

This is not to say that medications are the only answer to mental disorders-- more, I'm hopeful that we'll eventually understand the mechanics of the brain that way we understand the mechanics of the heart, where sometimes beta-blockers are the answer, but sometimes it's just stress reduction and exercise.

Certainly. And the thing about the brain is that we don't need medication to change the structure or formation of our brains, simply setting up new thought patterns can radically alter our brain physiology. This is some of the difficulty in figuring out whether a disorder has a biological cause or not because even if we find a common abnormality in a set of people with some diagnosis, like schizophrenia for example, it doesn't necessarily mean that it is the abnormality that is causing the disorder. It's also possible that the mental disorder (thinking in a certain way for a prolonged period of time) has resulted in the atrophy of certain structures. This is one of the big problems with studies that come out saying "Problem X is a brain problem, not a 'mind' problem!", because of course there will be neural correlates to whatever behavior we're interested in simply as a result of the fact that we're not mind-body dualists and we understand that our brains control our behavior. Neuroskeptic has a good article on that topic: Brain Scans Prove that the Brain Does Stuff.

[mistermack]

Mr Samsa,
thanks for the wealth of info. I started the thread as a question, and I've picked up a lot from your input.

I would have to answer yes to the question now, so I'm no longer a don't-know on that score.
Clinical psychology obviously isn't a science, but an application, like medicine as you said.

I'm on the sceptical side so I'll always question claims made in any health-related field, because of the rich history of dyed-in-the-wool treatments that eventually got discredited, but I have to agree that the positive evidence is pretty strong too.

I did mention earlier that I'd controlled my own panic attacks with a mental routine.

One was a pretty simple case of hyper-ventilation when I was waiting for a plane to take off.
I was actually enjoying looking forward to take-off, not consciously scared, when my heart started pounding like it was going to burst, and I could hardly breathe. It got so bad, that I thought I was going to have to run off the plane. I couldn't understand it, because I wasn't conscious that I had any fear of flying.

It was just as I was going to have to demand to get off, because I thought I could actually have a heart attack, when it dawned on me that it might be hyper-ventilation.
I forced myself to breathe out, and then stop, and hold it for as long as possible.
I kept doing that for about a minute, and it cured it. It was amazing how effective it was.
I must have been breathing too fast without knowing it while waiting for take-off.

The other occasions that I think of as panic attacks seem to be linked to a touch of Tourettes, if that's possible.
Now and again I get an overpowering urge to do something totally inappropriate.
One that I remember was when I and a business partner were renovating an old house.
We needed to point a little bit of brickwork round a corner, two stories up. Rather than bother with more scaffolding, we stuck a plank out, and I stood on one end, and he could just get out far enough to do the job.
I suddenly thought what would happen if I stepped off the plank, and was immediately plagued by an overpowering urge to do exactly that. It took all of my willpower to fight it, and I was hugely relieved when he finished.
The other time I get it regularly is when I'm at the dentist. I get this huge urge to bite his fingers. As soon as it comes into my head, I have to fight it, and it happens every time.
I manage to keep it away with a few mental pictures that I use to obliterate the thought, and fill in the time till he's finished. Same routine works every time. (so far).

It's the forbidden nature of something that seems to spark it off.
I watched a tv program on some pretty bad Tourettes cases, and I was just bent double laughing. ( I couldn't help it ) but at the same time, I could see exactly what they were going through.

But anyway, I know how a prepared mental routine can keep it under control.
.

[Schneibster]

Neuroscience cannot replace psychology in the same way that physics cannot replace chemistry - as we move up the level of explanation, we add more variables and the systems become more complex.

Well said.