The Science of Psychotherapy

Recently, I read a special issue of a French magazine that was mostly about the history of psychotherapy. Whether talking about history or psychology or any of the other human sciences, the professional journalists who work for that magazine always try to do a good job of presenting to the general public the gist of recent work from scientists all over the world. In this particular issue, they reported on on all the different ways that mental illness has been treated over the centuries, focusing on the various kinds of psychotherapy that have been developed since the scientific method began to be applied back in the nineteenth century.

Their survey confirmed many of the suspicions that I had already gleaned from reading dozens of other articles and books on the subject in the past. The coordinated efforts of hundreds of researchers and clinical practitioners in the field of mental illness have not produced anything like the kind of progress that has taken place in most of the physical sciences, or in treating most physical diseases. Although some progress has been made in treating some kinds of mental illness, using various branches of psychotherapy and quite a few useful drugs, the advances made so far have been quite disappointing.

Unfortunately, it seems that more than a few people in that field have reacted to that relative lack of progress by themselves regressing like some of their patients often do.

Many of them have gone so far as to abandon the scientific method itself, and have let themselves be influenced by ancient religions, particularly the buddhist religion, and even in some cases by shamanism and other prehistoric methods of “treatment”.

Those influenced by buddhism seem mostly to be concentrated within one of the more recent branches of therapy, sometimes described as the third generation of the combined cognitive-behavioral approach. Many of those people are using meditation techniques to treat their patients, particularly  a method called mindfulness, which appears to be an attempt to induce patients to concentrate all their efforts on their own immediate problems and not to let themselves be influenced any more by anything going on in the larger world that surrounds them. Cutting oneself off mentally from the rest of humanity, however, looks quite similar to ancient monastic attempts to get away from the corrupting effects of urban-based civilization by living in self-sufficient agricultural settlements (monasteries) far away from normal society.

It is difficult to see how those professional therapists can reconcile such an approach with the scientific training that many of them received during their university education in modern psychology or clinical psychiatry. Even more dumbfounding is how the university faculties or hospitals to which those people are still often administratively attached could possibly condone such obvious atavism. After having spent the past few centuries since the Enlightenment trying to free human thought from religious and ideological prejudices, it is hard to imagine why the people who are supposed to be running those programs allow this kind of regression to continue moving farther and farther away from more obviously evidence-based methods of intervention.

Even more disturbing are some of the more recent trends within what is sometimes called ethnic psychiatry. One of the articles in the French magazine I was referring to earlier was a polemic in favor of treating people under the influence of shamans from animist religions, in a different way than those used when treating people coming from a Western-oriented, post-Christian, secular tradition. The idea being promoted in that article was that psychologists and psychiatrists trying to treat people from an animist culture should temporarily pretend to support the use of magic and incantations in order to help mentally unbalanced people from those cultures overcome their psychological problems. This was seen as a method of gaining such people’s trust, who would presumably never accept advice from anyone openly promoting any kind of scientifically based approach. The author of that article also felt that people living within an animist culture were simply not capable of identifying with any rational approach, or being helped by it in any way.

Unfortunately, it seems to me that this sort of thing is just a special case of the negative influence of politically correct ways of thinking. What is implied in articles like this one is that anyone trying to use scientifically based methods with people from animist cultures is necessarily a racist. To fight this racism, a culturally accommodating therapist must therefore be someone who accepts the “fact” that science is just another competing method of human communication, not any more nor less effective against mental illness than trying to drive away evil spirits with magic incantations.

Clinical practitioners under the influence of such cultural relativism seem to believe that modern science is not a universal method that all cultures have been adopting, at least recently, but is instead an exclusively Western-based anomaly that must necessarily produce racist attitudes when used outside post-Christian, secular societies. The cultural relativists seem to have entirely forgotten that all the Western countries themselves left behind firmly established belief in ancient religions and/or animist beliefs only very recently. Most of those countries also include large populations of true believers even nowadays, not only because of recent immigration from various parts of the Third World, but also because they all harbor their own home-grown animist populations. Not to mention millions of fundamentalists, combining forms of Christian literalism with magical beliefs of prehistoric origin such as speaking in tongues.

Instead of trying to accommodate themselves to pre-scientific modes of thought, the ethnic psychiatrists would be better off trying to gradually integrate their patients into a more up-to-date way of ascertaining reality. Taking the cultural relativist short-cut is nothing but a dead-end. The very definition of mental illness, after all, lies in losing touch with human society as it is currently constituted. Neither mindfulness nor cultural relativism are capable of helping someone connect properly with today’s world, but instead lead people in quite the opposite direction.