It
seems unlikely to many that science can provide us with any kind of
real guidance about how to live a happy and successful life. Science
is a cold, dispassionate and objective discipline practised by
white-coated professors, working long hours in dull laboratories. It
can tell us a great deal about the visible natural world maybe, but
little about the things that really matter; happiness, love, loss,
morality, ethics and our less favourable characteristics too,
jealousy, aggression, malice. Evolutionary psychologists I’m sure
would want to tell us about natural selection’s role in shaping
these characteristics but can they tell us anything of the essence of
these qualities or how to survive them?
If
I may now get philosophical, what is happiness and how do we know
when we have it - can we ever know? In contemporary western societies
those charged by the State with measuring and improving people’s
happiness aren’t mystics or clergymen, but therapists,
psychologists and psychiatrists. And most of these work within the
NHS.
Psychologist
Ivan Tyrell suggests that realisation in the following areas leads to
overall human happiness: security, autonomy and control, emotional
connection, a sense of community, friendship and intimacy, privacy, a
sense of status, competence and achievement, and a life of meaning
and purpose are the benchmark for psychological contentment and
well-being. These principles hopefully aren’t simply conjured up
but have some basis in science and research.
A
reasonable question might be: Can science tell us anything about
happiness and how to get it, via therapy or in other way? Research
psychologists certainly try to. A researcher may not be able to
measure happiness under a microscope but he can analyse qualitative
measures. Researchers are forever asking therapy clients questions
such as: do you feel happier after your therapy? Do you feel that you
have now mastered more control of your difficulties? Did you find the
therapy useful? Answers to these questions and others like them are
compared to peoples self-rated happiness scales who have not had
therapy, or to those who have had different therapies. Large numbers
of responses are statistically compared across a range of therapies
and no therapy. These results form the basis of the research
evidence. It is in fact relatively easy to find out how helpful
people subjectively considered their therapy to be.
Science,
and research particularly, have already made a huge impact on the
NHS. Since 1995 all treatments provided by the NHS have required
explicit authorisation and endorsement from the National Institute
for Clinical Excellence [NICE]. Only treatments, investigations,
tests and therapies supported by the best available research evidence
receive approval.
NICE
expects all therapists to support any claims that their preferred
model of therapy works with research evidence to support it. And if
it does not, it could cease to exist, at least within the NHS. It is
not difficult to imagine how this idea makes psychotherapists
nervous, particularly if their preferred therapy does not have NICE
backing, and there are in fact a lot that don’t.
It
might be reasonable to assume that the NICE recommendations act as a
useful guide for both patients and service commissioners. But NICE
and the scientific method themselves are not without their
detractors.
For
example, many psychoanalysts see an irreconcilable contradiction
between therapies that explore the unconscious and irrational drives
and scientific models that emphasise objectivity and empiricism. By
definition the unconscious mind can only rarely be known and never
seen; attempts to observe and quantify it therefore must be futile.
The objectification of human experience into calculable scientific
chunks is impossible and to be discouraged, so the argument goes.
There can be no room for a value-free science when it comes to
examining therapy and also outcomes for therapy. This is a commonly
held view and a cursory glance at any psychotherapy journal will
reveal it.
Many
psychotherapists remain passionate in their conviction that their
therapies are healing, nurturing and empowering and also that they
sit outside of any kind of scientific discourse. And for many
patients this may be true, but do therapists have a right to this
general claim, and is it credible?
This
might be an acceptable position if psychotherapy, psychology and
psychiatry were not littered with the stories of failed, unhelpful
and sometimes even harmful treatments. Thomas Szasz said that if a
therapist believes that they are doing the right thing then a mental
patient can be subjected to any kind of abusive treatment in the name
of helping. Why? - because the therapist knows he is doing the right
thing and because they are inherently good people, of course.
But
patients typically are not given access to all of the information
they need to make an informed judgement about the right therapy for
them. When they do have it, they may not have the power to say no,
even when it would be in their interests to do so.
Bruno
Bettelheim was an Austrian-born American child psychologist and
writer. He gained an international reputation for his work on Freud,
psychoanalysis, and emotionally disturbed children. He was at the
forefront of many psychoanalytic theories, including those that
promoted the notion that cold, frigid and emotionally disengaged
mothers caused autism in their children. Bettelheim’s idea took
root in the US in the 1960’s and 70’s and led to many young
people receiving treatments, therapies and often long term
institutionalisation as a method to cure them of their autism. The
idea was that the removal of an autistic child from a cold mother
could be curative in itself.
There
is only one problem with the ‘frigid mother’ theory and that is
that there is a not a shred of evidence to support it. A simple
examination of the logic used to construct the argument would reveal
it to be nonsense and the available evidence base, around even in the
60’s should have completely destroyed it. One of the saddest parts
of the story, for me, is that many parents were so desperate for
help that they were happy to be coerced by Bettelheim into thinking
that long term institutionalisation was a reasonable step to take.
Often relationships between parents and their children never
recovered from the prolonged separation.
Many
of these institutionalised children are now suing the Bettelheim
foundation, claiming it was them and their theories that abused them
and not their mothers. Good luck to them! Many of these children were
denied an opportunity to stay at home with loving and caring parents.
So
why did the idea survive as long as it did and why does it still have
influence in some areas of psychotherapy today, particularly on the
continent? Because people want it to be true and believe it
ought to be true. The scientific model could have told us
very readily that psychotherapy treatments for autism don’t work
and secondly that the huge weight of evidence supports a biological /
neuro-developmental cause for autism.
‘Cold
mother’ theory and Bettelheim himself, of course, are not the only
examples of bogus therapies that could have been checked by proper
scientific investigation. Another involves ‘attachment based
holding therapy and rebirthing’. It was promoted and still is as a
cure for entrenched relationship difficulties between parent and
child. Holding therapy advocates the enforced holding of a child by a
parent in the hope that eventually a child begins to make a
successful bond with a parent/carer or adopter. These holds, in a
variety of forms, can go on for hours. Again this abusive and harmful
treatment, with absolutely no research evidence to support it, is
vigorously promoted by its proponents.
Unfortunately
in its more extreme forms it has led to the deaths of children in the
US. In one case a child was bound so tightly in a carpet [this is a
modification of holding therapy called rebirthing] that the child
suffocated and died. The Candace Newmaker scandal makes for a
thoroughly miserable read. Again scientific research was showing that
the theory behind holding and rebirthing was nonsense and that there
were clearly no beneficial effects.
Many
of the founding fathers of therapy have been at the receiving end of
this kind of critique including Freud, Klein, Bowlby, Erikson and
many others besides. It would be wrong to say that all therapists who
don’t embrace science and research are necessarily engaging in
harmful practice. But it is right perhaps to say that science adds an
important safeguard to the excesses of therapy evangelism; and
therapists seem particularly susceptible to evangelism for reasons
best left to the therapists’ therapists to understand. A more blunt
reason for their reserved nature could simply be that they know that
science is about to expose their emperor’s lack of clothes. As a
fan of Occam’s razor I am quite happy to endorse that idea.
All
is not lost however, as science is showing that many therapies do in
fact work and can improve happiness. Cognitive Behavioural Therapy is
one, Family Therapy another. Unfortunately however psychotherapy
continues to offer treatments with little empirical support. This at
worst is harmful, at best a simple waste of time and money. Patients
have a right to be protected from phoney treatments and the sooner
science rids us of them the better. Only then can we really
concentrate on what can make a difference.
Toby
Humphreys
Philosophy Takeaway Newsletter 66
