David F Marks: Psychology - Science or Delusion?

In spite of the lack of empirical support, the Psychological Theory of ME/CFS lives on. ME/CFS patients are subjected to CBT and GET. Patients and patient organisations protest about the treatments and are opposed to the Psychological Theory. Perhaps Psychologists needs to turn the Psychological Theory of unhelpful beliefs upon themselves. If ME/CFS has a physical (e.g. immunological) cause, then once the cause has been established, patients will have the chance of an effective treatment and decent care and support.

 

He blames psychology. Is psychiatry any better?

 

No, psychiatrists may be no better, but tend to blur the distinction by including them all as contained in the Psychology Dept these days.

 

Psychiatry could be described as psychology applied to medicine. The term psychological medicine is sometimes associated with psychiatrists.

 

The main claim to science from psychiatry is from psychopharmacological research. Its problematic, much of it dubious, but not all of it is bad. Just most. We still do not understand the brain, and even lack the technology to properly study it.

 

Yes, psychiatrists like doctors go to medical school and are able to prescribe drugs, and they also tend to deal with the more severe end of mental health. Psychologists tend to deal with milder mental health issues, and treat these with behavioral or psychological interventions; they do not go to medical school.

There is no good term I am aware of that refers to both psychiatrists and psychologists collectively, except perhaps the informal term "psychs".

 

I don't see a fundamental difference between psychology and psychiatry, apart from the drug prescribing rights, and I think some psychologists in some countries have limited prescribing rights.

They are certainly no different on the non-pharmacological treatments.

 

Look at the number of academic psychologists working at your local university and you will be shocked. They all have to justify their existence with research........ Perhaps if they spent more time in the real world and helped out our grossly overworked social workers, family support workers etc etc they would do more good (. Brian Hughes is an exception!)

 

I think there is an important difference. Psychologists are to psychiatrists what physiologists are to physicians.

The first is someone who has theories - abut how minds work or about how the body works.

The second is someone who treats illnesses of the mind or of the body. In both cases that may draw on theory of how things work but it may not. It may simply be a matter of what has been found to help in practice. The difference may be that you do not let a physiologist loose in A/E unless they are medically qualified. It seems to be acceptable to let psychologists loose anywhere they like.

It is perhaps interesting that when a psychiatrist delegates the use of treatments that are based on pragmatic experience of what works (whether informal or through trials) the person delegated to is called a psychiatric nurse or psychiatric social worker. When they delegate the use of treatments based on theories of how minds work the person is called a clinical psychologist.

What I think Marks is saying is that theories of how minds work are made up rubbish - which they are. Whether psychiatric treatments are good or bad is a different issue relating to evidence of effectiveness.

 

Although agreeing with Marks on his assesment of PACE, I would argue that though it is bad science, it is still science. Indeed careful analysis of the PACE data provides weak evidence that CBT/GET are unhelpful for people with ME/CFS.

However Marks goes further and argues that the faults of such research are so irremediable that it does not constitute science. I disagree and argue he presents insufficient evidence to support this. That a large percentage of psychological research is bad science, does not mean that it is a priori 'not science'.

He does argue further that the lack of any unifying 'general theory' of psychology means it is not science. I am afraid I don't follow the logic of this. Many sciences have a range of conflicting or inconsistent theories, psychology has more than most and some theories are undoubtedly unfalsifiable so a priori not science in a Popperian sense, but that does not justify a blanket statement that all psychology is not science.

 

Science is only science if it follows a set of rules to test a hypothesis.

Psychology doesn't appear to do this, hence not a science.

At best IMO it's a series on anecdotes/truisms that can be used to manipulate societies, and in some cases, people.

 

I would argue its not absolute, it does not always follow good scientific practice, but that is not all the time.

 

Psychology certainly seems to be a crossroads at the moment, and needs to do a bit of soul-searching to decide what it actually is, and what it wants to be. And in particular it needs to consider whether it actually wants to be a science, or something else.

Science is not the be all and end all of human understanding and enterprise. Indeed, I think the fact that psychology often does not meet the criteria for being a science is part of its virtue: great novels and literature are not science either, but that does not mean you cannot learn a great deal about human existence, life, and your own inner self from reading good novels.

Religions are not a science either, but nevertheless provide guidance (eg, moral, emotional and spiritual) on how to live life and how to behave and how to treat others.

The difference between science and religion is that the former is descriptive and the latter prescriptive. Science always describes what is, but human beings require more than that: we need to know what should be, and that's when the prescriptive function of religions, as well as the prescriptive function of our parents' instruction, the culture of the nation we were born in, or any other value system we may be exposed to, comes into play.

If you read the personality theorists — Freud, Jung, Rogers, Maslow, Eysenck, etc — their writing and observations on the human psyche are as much prescriptive as they are descriptive. Like great novels and literature, there is an essence of human truth to be found within the writings of the personality theorists, but you would not really call these personality theories precise science, just as you would not call Shakespeare precise science.

I don't think anyone would complain about the prescriptive role psychology takes; indeed, this may be considered as a valuable contribution to society. And I don't think anyone would complain when some areas of psychology try to follow as best they can the scientific method.

But the issue is the problem that Prof David F Marks is highlighting: where psychology comes face to face with biomedical science. In terms of trying to understand the causes of serious mental health conditions such as schizophrenia, or in terms of trying understand the causes of MUS diseases like ME/CFS, I think psychology must yield to biomedical science, which is a much harder science and has an increasing array of technological tools which will enable it to eventually get to the root cause of these diseases.

Biomedical science must be given priority and primacy when it comes to researching MUS diseases, as well as serious mental health conditions (which increasing evidence suggests are organic biologically caused illnesses).

 

I agree with much of what you say above @Hip

However, an observation - the prescription of religion has often been divisive among those from different religions. In addition they have shown a marked intolerance of individuals from within their own group who don't fit the mould.

Similarly, psychology, in it's treatment of that which seems different and has yet to be explained, has also shown itself to be hard on those who do not appear to conform, for whatever reason. So for ME patients, the disbelief they face, the ridicule and downgrading in status, the bullying the individual into behaving in the very way that harms them.

Like the denial that the earth moved around the sun, some (many?) psychologists today seem to believe they are sophisticated scientists, using their knowledge with the skill and accuracy of a surgeon's scalpel to cut to the truth. In reality they are using very poor, blunt and inaccurate tbeories to inflict their own biases and beliefs onto patients.

Like the flat earthers, many are in denial and so slow progress in their own field and inflict suffering on those who won't, or can't, conform.

 

I think that this feature of psychiatry, of dealing with the most severe cases of abnormal behavior, is what makes them unable to deal with us. There are only so many ways normal behavior presents itself, but an almost endless combination of disturbed behavior.

Then when they see patients acting normally given their context but where they reject the premise that the context is real, all they can do is try to explain the abnormal behavior and since there are so many ways this could go there simply isn't any stop function to their work, the goalposts just keep moving like bad prophets swearing that this time they got the end of the world timed correctly.

The broader issue is that it is used to justify blocking all research funding. This is where it fails at being a legitimate science. It shouldn't be this way but that is how they choose to function and thus is their own fault.

I'd say it's really just the appearance of science. Ultimately the problem we see with the psychosocial research on ME is that they absolutely refuse to falsify their own assumptions and reject all data that is contradictory to the conclusions they are trying to build. This kind of research tries too hard at proving themselves right, whereas the scientific method is about failing to prove yourself wrong.

By categorically rejecting the numerous cases that completely falsify their assumptions, they are in fact not practicing science. Not all research in clinical psychology is guilty of this, but the PS BS researchers have done so for decades, refusing to even acknowledge that any part of their work is flawed, which is just plain hubris and as anti-science as it gets.

It's also notable in the case of psychosomatic research that they are assumptions that have failed time and time again on what we now know are organic diseases. Yet they refuse to even consider why this could be significant and why it is potentially dangerous for patients to box them in a research dead end. In this they are not only failing science but the most basic reason of medicine: to help the sick, not to build careers.

 

Yes I agree, although there are areas where psychologists do a good job. Psychology is split into into two major fields: normal psychology (which studies normal life areas like sexuality, falling in love, bereavement, etc) and abnormal psychology (which studies mental health conditions).

I think psychology does a much better job at observing and explaining normal life than it does trying to explain mental health illnesses. The reason is because most mental health conditions will, I think, turn out to be caused by organic biological dysfunction in the brain, so unless you get to grips with brain biology (which is not the remit of most psychologists), I don't think you are ever going to make any inroads into understanding abnormal psychology, and the causes of mental illness.

Of course not all mental illness is caused by biological factors; we know that depression for example can be caused by psychogenic factors; but generally speaking I don't think you can address abnormal psychology without bringing brain biology into it. And this is why psychological theories of mental ill health are for the most part useless.

Whereas in normal psychology, you don't really need to bring in brain biology much; so that's why normal psychology has been much more successful than abnormal psychology.

I think psychologists should exit the field of abnormal psychology (except for observing and describing the symptoms of mental illness), and leave it to the biomedical scientists to uncover the actual causes of mental illnesses.

 

I have little to no experience of normal psychology and how that might aid the human race. However, time and again, I have seen people who should know,or have been taught better, attribute incorrect meaning to someone's behaviour. So, because they "know" , or have read about people, they assume they possess a level of understanding that just isn't there.

A person's behaviour, feeling and attitude are rooted in context. Just because one has studied psychology, doesn't mean one will understand the full context, or life situation the person is currently in or has experienced. However, the psych may not know they don't know, or may be over confident in their education.

For my money, if you want advice on life, real messy life, you talk to an older person who has lived it and seen others go through it. Not necessarily someone who has viewed it with an academic detachment.

 

I think the biggest trap that psychs have fallen into, is their false belief that extreme fatigue/exhaustion can only ever be due to some other medical condition; that the fatigue etc. can only ever be a secondary symptom of something else. So they have to invent that something else - deconditioning, behavioural issues preventing reconditioning, etc. They just cannot fathom, nor do they want to fathom, that the extreme fatigue/exhaustion etc. is itself the primary condition; it is not secondary to anything else, there is no other thing for them to fix. The problem they need to fix is inside their own heads.

Yes there may be some people misdiagnosed, with a different problem, that they can help, but for those correctly diagnosed they are a dangerous liability.