Thursday, May 21, 2020

A Concise Christian Appraisal of Psychology and Psychiatry

Fifty years ago Jay E. Adams, the father of the modern biblical counseling movement, concluded that psychology and its “illegitimate child” (i.e., psychiatry) are in serious trouble.[1] The basis for Adam’s assertion was that despite its grandiose claims to the contrary, the interventions offered by psychology and psychiatry didn’t work. Today, the conclusions Adam’s drew in the 1970s have been validated ad infinitum by the crises in psychology and psychiatry. This essay seeks to provide a concise articulation of a few of the problems within these disciplines, demonstrating that the evaluation issued by Adams in the 1970s has continued to find validation.

The Unscientific Science

In 2012, Ed Yong, a science journalist, published an article in Nature which outlined a few of the significant methodological problems inherent in research psychology. According to Yong, the vast majority of research results published in major psychology journals are actually incapable of being reproduced.[2] Yong cited Chris Chambers, Professor of Cognitive Neuroscience at Cardiff University, who noted that “High impact journals often regard psychology as a sort of parlour-trick…When we review papers, we’re often making authors prove that their findings are novel or interesting.”[3] Chambers continued, “We’re not often making them prove that their findings are true.”[4] Similarly, Scott Lilienfeld and Irwin Waldman have recognized the scandalous nature of this crisis:
Indeed, in the pages of our field’s most prestigious journals…scholars across diverse subdisciplines have maintained that the standard approaches adopted in published psychological investigations tend to yield a disconcertingly large number of false positive findings.[5]
How significant is this problem? In 2015, the Open Science Collaboration (OSC) published an assessment of the replications of one hundred studies published in three of the most prestigious psychological journals. OSC found that “A large portion of replications produced weaker evidence for the original findings despite using materials provided by the original authors, review in advance for methodological fidelity, and high statistical power to detect the original effect size.”[6] Further, OSC found that only one-third of the replications attested to the findings of the original studies.

Trust Us, We’re the Experts…

Despite being repeatedly outed as about as scientific as alchemy, research psychology and its resultant therapies still find considerable support within both the church and the general public. This is partially due to psychology’s continual effort to market itself as a necessary and effective means unto human flourishing. Articles frequently emerge touting the effectiveness of psychotherapy, reinforcing psychology’s place as a bona fide science. One such article, published by the American Psychological Association (APA), claimed, “Psychotherapy is effective, helps reduce the overall need for health services and produces long-term health improvements.”  To substantiate its claim, the APA cited “more than 50 peer-reviewed studies.”[7] That is, the same psychological establishment whose studies have been shown to be legitimate only one-third of the time has also claimed upon the basis of “more than 50 peer-reviewed studies,” that its therapies work. Moreover, several bombshell studies have emerged that suggest psychology’s confidence is vastly misplaced. For instance, one study published in 2015 concluded that the efficacy of psychology’s interventions for depression have been significantly overstated.[8] Purveyors of cognitive-behavioral therapy (CBT), the current “gold standard”[9] in psychotherapy, have been shown to massively exaggerate the effectiveness of CBT. One meta-data study indicated that only seventeen percent of trials of CBT for depression and anxiety were shown to be effective.[10]

One might imagine, given this sordid state of affairs, that psychology would dampen its enthusiasm for itself. Hardly. Brian Hughes, Professor of Psychology at the National University (Ireland), has observed that even though psychology “considers itself agile at producing authentic insights about the human psyche,”[11] it actually suffers from “excessive self-esteem:”[12]

As attempts to replicate their research produce a mounting series of damp squibs, you might expect that by now psychologists will have become quite cautious. Psychologists should be nervous about the way their popular paradigms contradict each other: they should surely realize that one theoretical explanation is difficult to defend alongside another that is its exact opposite. Psychologists should be equally apprehensive about their vague and imprecise approaches to measurement. They should be obsessed with equivocation: after all, those margins of error must mean something. Their statistical struggles…should breed additional trepidation. Psychologists should surely react by limiting the ambition of their inferences. And each time they remember that their research captures just a thin snippet of the world’s population, psychologists must feel the torrents of collective embarrassment running down their spines.[13] 
Psychiatry similarly suffers from a self-esteem problem. Electroconvulsive therapy (ECT) or what is more popularly known as “Shock Therapy,” is a well-hyped intervention designed to aid people with either severe or persistent emotional disorders.[14] In ECT, epileptic seizures are introduced to the brain while a person is under general anesthesia through the use of a device.[15] Eighty-five percent of those who undergo ECT are seeking relief from depression.[16] This, in itself, is curious since there is no known pathology that causes depression.[17] Thus, introducing seizures into someone’s brain in order to “cure” depression is obviously misguided.

Like biogenic theory, ECT also relies upon a reductionistic view of the human person that rejects the existence of the immaterial soul. What the anxious or depressed person needs is the wisdom of God’s Word, sound teaching, compassion for their suffering, and prayer—and not a brain seizure.
[18] Moreover, the terrible side effects of ECT are numerous and well documented.[19] Scientifically, ECT and its supporting studies have been shown to have grave problems. In 2010, Drs. John Read and Richard Bentall conducted a meta-data study that analyzed all scholarly literature published on ECT with particular emphasis on depression. In this study, Read and Bentall noted that the vast majority of ECT studies neglected to include a placebo.[20] Further, Read and Bentall found several other methodological problems with almost all of the other ECT studies. After their comprehensive review of the literature, Read and Bentall concluded with another scientist who wrote, “There is no evidence at all that the treatment has any benefit for anyone lasting beyond a few days…The short-term benefit that is gained by some simply does not warrant the risks involved.”[21]

Marketing Illnesses

We might ask, “Hasn’t the world benefited from psychology’s identification of mental illnesses?” The innumerable disorders present in the Diagnostic and Statistical Manual, 5th Ed. (DSM-V), have been well observed to be, shall we say, over the top.[22] Do you really need that cup of coffee in the morning? You likely have “Caffeine Use Disorder.”[23] Obsessed with that new video game? You’ve got “Internet Gaming Disorder.”[24] Or, are you nervous in situations where you might be embarrassed? According to the DSM-V, you may have “Social Anxiety Disorder. Given the DSM-V’s range of “disorders,” it is no wonder why one in four to five adults in the U.S. are said to have a mental illness.[25]  

Psychology and psychiatry have effectively marketed the existence and even causality of certain major DSM-V disorders to the general public and this without basis or warrant. Bipolar disorder, in its various iterations, is a case in point. Bipolar is something of a catchall diagnosis that is dependent upon a perceived set of symptoms.[26] There is currently no known pathological cause for bipolar, and subsequently, there is no treatment known to the medical community “that provide[s] sustained, symptomatic, and functional recovery.”[27] Indeed, the scholarly assessment of bipolar has concluded, “From a neurobiological perspective there is no such thing as bipolar disorder.”[28] Yet, bipolar is routinely characterized as a “brain disease” by the psychiatric and psychological communities. While the symptoms experienced by those who are said to have either bipolar I or II are entirely genuine, misidentifying these symptoms as a “brain disease” is antithetical to providing genuine help.

Psychotherapy’s Moral Vacuum

Steaming from Freud’s insistence that psychotherapy lands within the realm of the scientific[29] (i.e., as a clinical expression of psychological science), psychotherapy has sought to portray its practice as an objective and “value-free” discipline. However, it is undeniable that there exists a set of moral presuppositions that underly psychotherapy. One cannot give a word of counsel without presupposing what is right and wrong. One cannot quantify therapeutic effectiveness or even “mental health” without first rooting these concepts in a system of moral truths. The question is, therefore, from whence do these morals come? What is the moral grounding for the psychotherapist’s counsel? Are the relevant moral commitments of therapists divulged to their counselees prior to the giving of counsel? More likely, psychotherapists merely impose their personal moral commitments upon their clients under the pretense of “science.”

CBT, for example, operates upon the basis of a great variety of undefined moral concepts (e.g., “meaning,” “dysfunction,” “good/bad thoughts,” “improved behavior”):
In a nutshell, the cognitive model proposes that dysfunctional thinking (which influences the patient’s mood and behavior) is common to all psychological disturbances. When people learn to evaluate their thinking in a more realistic and adaptive way, they experience improvement in their emotional state and in their behavior.[30]
Never are these moral concepts fleshed out in the literature and are instead merely assumed in practice by the therapist or counselee. Tellingly, some researchers in the field have proposed ethical training for therapists in order to fill the moral vacuum.[31] Others have proposed the equivalent of a married bachelor: moral neutrality.[32]

Conclusion

In many ways, psychology and psychiatry are akin to those chained within the confines of Plato’s cave: Both are disciplines which confidently assert their ability to understand and aid the public while failing to apprehend basic truths. The findings of these disciplines are often both contradictory and dubious, and many of the therapies purported to help hurting people are, in reality, ineffective and detrimental.



[1]
Jay E. Adams, Competent to Counsel (Grand Rapids, MI: Zondervan, 1970), 1.

[2]
Ed Yong, 5/16/2012, “Replication Studies: Bad Copy,” Nature, 485.7398, 299.
[3]
ibid.
[4] 
ibid.
[5]
Scott O. Lilienfeld, Irwin D. Waldman eds., Psychological Science Under Scrutiny: Recent Challenges and Proposed Solutions (Hoboken, NJ: Wiley-Blackwell, 2017), xxi.
[6]
Open Science Collaboration, 08/28/2015, “Estimating the reproducibility of psychological science,” Science, 349.6251.
[7]
2012, “Research Shows Psychotherapy Is Effective But Underutilized,” American Psychological Association, https://www.apa.org/news/press/releases/2012/08/psychotherapy-effective.
[8]
Ellen Driessen, Steven D. Hollon, Claudi L. H. Bockting, Pim Cuijpers, Erick H. Turner, 09/30/2015, “Does Publication Bias Inflate the Apparent Efficacy of Psychological Treatment for Major Depressive Disorder? A Systematic Review and Meta-Analysis of US National Institutes of Health-Funded Trials,” PLoS One, 10.9, https://doi.org/10.1371/journal.pone.0137864.
[9]
Daniel David, Ioana Cristea, Stefan G. Hofmann, 01/29/2018, “Why Cognitive Behavioral Therapy Is the Current Gold Standard of Psychotherapy,” Frontiers in Psychiatry, 9.4, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5797481/.
[10]
Falk Leichsenring, Christiane Steinert, 2017, “Is Cognitive Behavioral Therapy the Gold Standard for Psychotherapy? The Need for Plurality in Treatment and Research,” Journal of the American Medical Association, 318.14, 1323-4.
[11]
Brian M. Hughes, Psychology in Crisis (London, UK: Palgrave, 2018), 119.
[12]
ibid., 120.
[13]
ibid., 119.
[14]
Max Fink, Electroshock: Healing Mental Illness, (New York: Oxford Univ. Press, 1999), 1.[15] ibid.[16] A. Rajendran, V. S. Grewal, Jyoti Prakash, 04/2015, “Does Criticism of Electroconvulsive Therapy undermines its benefits: A Critical Review of its Cognitive Adverse Effects,” Delphi Psychiatry Journal, 18.1, 160.
[17]
Gregor Hasler, 10/09/2010, “Pathophysiology of Depression: Do We Have Any Solid Evidence of Interest to Clinicians?,” World Psychiatry, 9.3, 155-61.
[18]
Psa. 23:4; Prov. 12:25; Matt. 11:28; 1 Pet. 5:7.
[19]
ibid., 160-3, John Read, Richard Bentall, 2010, “The effectiveness of electroconvulsive therapy: A literature review,” Epidemiologia e Psichiatria Sociale, 19.4, 342-4.
[20]
ibid., 334.
[21]
ibid., 344.
[22]
Allen Frances, Saving Normal: An Insider's Revolt Against Out-Of-Control Psychiatric Diagnosis DSM-5 Big Pharma and the Medicalization of Ordinary (New York: William Morrow & Company, 2014).
[23]
Diagnostic Statistical Manual, 5th Ed. [DSM-V] (Washington, DC: American Psychiatric Publishing, 2013), 792-3.
[24]
ibid., 795.
[25]
Kathleen Ries Merikangas, Marcy Burstein et al.,  2010, “Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication--Adolescent Supplement (NCS-A),” Journal of the American Academy Child Adolescent Psychiatry, 49.10, 980‐9.
[26]
DSM-V, 121-39.
[27]
Vladimir Maletic, Charles Raison, 08/25/2014, “Integrated Neurobiology of Bipolar Disorder,” Frontiers in Psychology, 5.98, 1.
[28]
 ibid.
[29]
Jeremy Holmes, 1996, “Values in Psychotherapy,” American Journal of Psychotherapy, 50.3, 259-60.
[30]
Judith S. Beck, Cognitive Behavioral Therapy: Basics and Beyond, 2nd Ed. (New York: The Guilford Press, 2011), 3.
[31]
E.g., in her study, Popescu has noted that, “Ethical questions and moral dilemmas are an important part of the therapeutic or philosophical counseling process that cannot be neglected…Existential issues are of utmost importance in both types of practices, since issues like meaning, scope, death, freedom and isolation are intrinsic to the human conditions…” Beatrice A. Popescu, 2015, “Moral Dilemmas and Existential Issues Encountered Both in Psychotherapy and Philosophical Counseling Practices,” Europe’s Journal of Psychology, 11.3, 520. Cf. Michelle J. Pearce, Harold G. Koenig et al., 03/2015, “Religiously Integrated Cognitive Behavioral Therapy: A New Method of Treatment for Major Depression in Patients With Chronic Medical Illness,” Psychotherapy, 52.1, 56-66.
[32]
Richard C. Springer, 1994, “Morality and the Practice of Psychotherapy,” Pastoral Psychology, 43, 81-91.

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