Is psychoanalysis pseudoscience ?

zoobyshoe

I got impatient and googled. Wikipedia reports that Cognitive Psychology is unique among psychologies in its "acceptance" of the scientific method:

However, from the rest of the article we see it is extremely limited in scope compared to all the other psychologies:
(They contrast Cognitive Psychology to Freudian in that the CS "accepts" the scientific method, as if Freud rejected it, which he didn't. He realized, as I said earlier, that most of what he proposed couldn't be scientifically tested, and warned potential students that this was the case. Acceptance or rejection of his ideas was a matter of them making sense to you or not.)

zoobyshoe

Is it? Talk therapy certainly still exists, but I'd be surprised to find out there were any Freudian Psychoanalysts still out there.

Number Nine

Comparing cognitive to Freudian psychology is a bit misleading. Early "schools" of psychology (Freudian, behaviourism etc.) were defined largely by their particular views about the nature of consciousness and behaviour; they were, essentially, theories or models (often, poor ones). Cognitive psychology is a discipline; it's a branch of psychology that studies cognitive processes. Comparing the two is a bit like comparing the standard model of particle physics (psychoanalysis) to fluid dynamics (cognitive psychology); one is a model, the other is a field.

Cognitive psychology, today, is probably one of the most diverse and successful of the behavioural sciences. Wiki's description of mental "information processing" is a bit unusual here; cognitive psychology has been extremely heavily influenced by cognitive neuroscience and neuropsychology (my personal interests lie in computational neuroscience, and most of the professors I've known who work in cog psych base their work carefully around developments in neuroscience), and it has adopted into itself the notion that any proposed cognitive process has to be implemented by the brain by some mechanism. Since many of the major processes that interest cognitive psychologists (learning and memory, for instance) have been extensive researched by neuropsychologists using brain damaged patients, who have demonstrated that many characteristics of these processes can be very selectively and independently knocked out*, a lot of the work in cog psych assumes that the way the brain is implementing these processes is modular, to some extent.

* One of the most dramatic examples (though not really the most informative from a cog psych standpoint) is the fact that I can, very reliably, damage your brain in such a way that your vision will remain fully intact, you will completely retain the ability to write, and yet you will lose the ability to read. Aphasias in general provide some very nice examples of the modular arrangement of mental processes.

Very few. There are a few Freudian/Jungian practitioners out there, but their generally regarding as being somewhat...er...off by everyone else. I'd be very surprised and disappointed if any accredited programs in clinical psychology still taught Freudian psychoanalysis.

zoobyshoe

I'm familiar with all this from casual reading (Sacks and Ramachandran, most notably), but somehow classified it in my mind under "neuropsychology" or, alternately, "neuropsychiatry". The term "Cognitive Psychology" slipped by me. Obviously there's a great deal of overlap of all of these.

All this was born with the attention paid to the grotesque personality change suffered by Phinneus Gage after his frontal lobe brain damage. My own introduction to it was reading about Geschwind's Syndrome, the constellation of personality changes that often accompanies the onset of Temporal Lobe Seizures.

My impression is that what best survived of Freudian Psychology are the Ego Defense Mechanisms. I believe these are still taught in accredited programs.

The interesting thing about Freudian Psychology is that it got disseminated into popular culture in discrete bits and pieces and you find people who would categorically condemn him never-the-less betraying acceptance of a lot of his notions without realizing their origin. Same is true of Jung. A Freudian dynamic might be quietly worked into the plot of a film or novel, for example, and go unquestioned as realistic while a verbal statement of that dynamic would be criticized. The psychiatric examinations on the TV show "Law and Order", for example, are essentially Freudian: he asks questions intended to get the subject to reveal things about their motivations and mental state that they, themselves, are not aware of. Freud pioneered that. (Of course, the TV shrink isn't out to effect any cure, but he is in the important position of having to asses their relative degree of responsibility for the crime.)

Mr.Samsa

Freud was famous for making up case studies to suit his own intuitions about how behavior works and why certain disorders develop. What he suggested was very backwards for his time, as the science of psychology was thriving and there was really no need to reject the empirical evidence that had been gathered in favour of armchair philosophical musings. Most of his concepts have been outright disproved (memory repression), or never accepted in the first place (his version of the unconscious), and the ones that still stick around are generally broad concepts that have been accepted for a while (e.g. some defence mechanisms).

If you were interested in studying psychology though, or the history of the subject, you can skip Freud and the psychoanalysts completely though, as they added nothing of importance to the field.

With that said, there is a fairly new movement called "psychodynamic psychotherapy", which has vague roots in Freudian theory but it is not psychoanalysis. There has been some positive evidence coming from the area, and some negative evidence, so it's difficult to tell whether it's a successful treatment for some mental disorders or not. The overall trend seems to be suggesting that it has some positive effect.


The fact that there are issues with applying CBT to schizophrenia and bipolar aren't really a reason to be skeptical of CBT as a treatment, given that these are new areas that CBT is being tested in and haven't really been adapted to meet the demands of such disorders. With things like schizophrenia as well, where many of the symptoms are biologically caused, we shouldn't expect to see a massive effect size or change in rates of relapse.

The Lynch paper has also been criticised for the inclusion/exclusion criteria for their section on CBT's effect on depression. Specifically, the definition of CBT that Lynch used was quite rigid and really only focused on one brand of CBT (remembering that CBT is a collection of therapies with a common approach, not a treatment in itself) so the results are a little skewed there. The well-controlled studies are also lumped together with community clinic studies where the therapists self-label what approach they are using, which is a major problem. And the studies included did not attempt to control for severity of symptoms, which we already know is a major component of how successful CBT will be, including whether the depressive episodes are chronic or not.

Also, it's a little inaccurate to say that patients must practice CBT for the rest of their lives, as the purpose of the therapy is for it to eventually become an automatic process. So whilst it's true that patients will technically be 'practicing CBT for the rest of their lives', they will rarely have to consciously practice CBT. It's basically about changing habits - if you get out of the habit of biting your nails, then you don't need to keep applying some foul tasting substance to your nails for the rest of your life to stop yourself.


All of psychology is falsifiable. It's important though to remember that there are two broad areas of psychology: experimental and applied. The applied area is what is mostly being discussed in this thread. That is, we're discussing clinical psychology; the study and treatment of mental disorders. The rest of psychology, the experimental side, has little to do with mental disorders and often has no interest in humans at all.

The experimental-applied divide is comparable to that between biology and medicine. Medicine is not a science, so it is absurd for people to criticise it for lacking scientific rigour or not being falsifiable, etc. It is, of course, based on science and is evidence-based (especially in the research that underpins its treatment options), but it is not a scientific field. The same applies to clinical psychology. In a broad sense though, these fields still make falsifiable claims in the sense that they say, "Treatment X is effective", which can be empirically tested and disproved.

There are a couple of fields of psychology which are widely considered hard/natural sciences: neuroscience, and behavioral psychology. Cognitive psychology is also often considered a hard science as well, but there can be softer areas within it.

This is untrue. No psychologist or psychiatrist considers mental disorders to be organic brain disorders. This was true in the 50s-60s (and some time before that), but it became patently obvious to everyone in the field that thinking of them as brain diseases was wrong and was so mistaken that it was causing too much harm to the patients. This was why there was a shift in nomenclature around the 70s, where we stopped referring to them as "mental illnesses" and instead started calling them "mental disorders". It wasn't an act of political correctness, but rather an attempt to clarify the thing we are studying and treating by applying a more accurate label that does not have the connotations of a biological disease.

Of course, all of our thoughts and behaviors are generated by our brain, but it's an illogical leap to assume that problem thoughts and behaviors are generated by brain diseases or abnormalities. You can have entirely normal and functional brain processes giving rise to dysfunctional thoughts and behaviors.


Have a flick through the Journal of the Experimental Analysis of Behavior.


The wiki article is poorly written there, so it's easy to think that it's saying previous psychological approaches didn't apply the scientific method. Psychologists have been using the scientific method to study psychology since the mid-1800s, with the psychophysicists like Helmholtz and Wundt studying perception, and then Pavlov and the behaviorists like Watson and Skinner came along to solidify psychology as a science. Introspection was still accepted by some early psychologists, like William James, but the rejection of introspection wasn't something unique to cognitive psychology, and neither was the application of the scientific method.

Devils

Thats not quite true either. We know that severe depression is linked with BDNF amd a shrinking hippocampus.
http://en.wikipedia.org/wiki/Brain-d...tor#Depression
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC60045/

Some schizophrenics have measurable brain changes with CAT/MRI scans.

I would say mental illnesses are psychosocial. For a particular stressor, one person may have severe anxiety, but more resilient person may have no effect. This is evident for example, in how people coped after being released from concentration camps.

lisab

The only place I ever hear about people doing psychoanalysis is in Woody Allen movies.

zoobyshoe

Woody may well have single handedly killed it by ridiculing it to death, yes.

zoobyshoe

The unfortunate fact is that there's no accepted objective explanation, just current models. Schizophrenia isn't diagnosed by brain scan because a lot of schizophrenics don't have enlarged ventricles, and, a lot of people with enlarged ventricles don't have schizophrenic symptoms. Psychiatry is a pseudoscience. Medication is currently prescribed by trial and error on the currently relied upon assumption that mental illness is caused by 'an imbalance of chemicals in the brain'. There's no test for any suspected imbalance or any objective way to justify any given medication. If you read up on a med you'll find it says "Studies indicate..." and "It is believed that..." followed by the suspected chemical mechanism.

That's psychiatry, though. Psychology is aimed at problems thought to result from 'software' as opposed to 'hardware' glitches, to use the usual bad computer analogy.

Pythagorean

I think you'r first and last paragraph's are a little hair-splitty, but thanks for bringing up the problems with the Lynch paper.

Ultimately, my feelings on CBT are an appeal to authority. In my psychology department, (which awards clinical PhD's) the professors (who are experienced clinicians) generally talk about the challenges to CBT

To specifically address your last paragraph, they claim that once patients leave treatment, their problems often return and that only about 1/N (I want to put N=10 but I can't remember the number) actually adapt the cbt into their regular behavior.

I have no experience in clinical setting (nor is it my interest, I'm a black sheep at my university, more interested in theory) so I take the word of my mentors until evidence is provided. Perhaps you can provide some studies for a comparable range of mental disorders.

Also a caveat. The text book we were using had CBT as the treatment for EVERY mental disorder in the book and that's what our teachers were responding to, saying that the psychology community was moving away from CBT as a general treatment.

zoobyshoe

I had a much closer look at Turner and it seems to me they did more than "detect" the unpublished studies. They actually hunted them up and read them.

To characterize it properly the "main message" of Turner was that they uncovered a clear publication bias in favor of anti-depressants that they found misleading, and they chastised the responsible parties. The still-better-than-placebo angle is something you found salient, not the main message. Let's not miss the fact this paper is saying anti-depressants have been over rated.
This abstract:

http://www.ncbi.nlm.nih.gov/pubmed/19490745

leaves me with many unanswered questions. I don't understand from it what psychotherapy is being compared to, placebo or anti-depressants, and I don't understand what they are including under the term "psychotherapy" (something whacky like, hypnotic recovery of repressed memories? Is that included?).

Additionally, this Kirsch 2008 paper:

http://www.plosmedicine.org/article/...l.pmed.0050045

is damning anti-depressants with faint praise, so to speak, finding only, "a relatively small difference for patients with very severe depression". Better than placebo, but just barely.

You can't be aware of anything without it having a biological effect on the brain in the sense you're referring to. Is this important? If you post something that makes me happy, should I compare you to an anti-depressant?

I seriously question whether they are seeing the effects of either therapy or just decreased stage fright from having already encountered and lived through the greater terrors of the experience.
I'm really only interested in CT. There are a lot of whacky psychotherapies out there that I wouldn't try or recommend. If the Cuijpers P, et al paper from 2010 is including these kinds of psychotherapies, then I wouldn't consider it worth bringing into the discussion since no one here is endorsing things like that.

Ryan_m_b

This thread has gone nowhere and is attracting posts that violate our rules.