Herewith, occasional and largely informal commentary on issues relating to psychology as a discipline and a profession, including mental-health policy issues.
Link to a letter to the editor published in the New York Times (December 15, 2001), and expanded commentary.
Link to a letter to the editor of the Wall Street Journal (submitted June 20, 2002).
A very ill-conceived idea. Link to PDF.
On January 13, 2005, I circulated a message to three listservs, the Society of Experimental Psychologists, the Society for a Science of Clinical Psychology, and the Society for Personality and Social Psychology, inviting listmembers to contribute short lists of fondly remembered, perhaps life- or career-changing textbooks, read either as undergraduates or graduate students, along with a sentence or two about the effect they had on them. Link to the results of the poll.
Does Neuroscience Constrain Social-Psychological Theory? Link to an invited commentary published in Dialogue, the newsletter of SPSP (2006).
Regarding my chapter in the volume, Evidence-Based Practices in Mental Health, a few individuals have written to question my strong position favoring EBPs.
I don't mean to imply that palliative treatments aren't effective and not respected. When a disease is incurable, palliation is one possible approach. But I think that the goal of medicine, including mental health, should be to move beyond palliation with all deliberate speed -- to cure disease when possible, and when it is not, to maximize symptom relief; actively help the patient manage chronic illness, and promote rehabilitation where appropriate. In many cases, there is much more that we can do besides palliation, and when there is, we should do it. And I think that where palliation is the choice, the provider has the obligation to make sure that the palliative treatment actually -- well, palliates. So even in the case of palliative care, we need EBPs to make a rational choice among treatment options in the best interests of the patient. Palliative treatments that work are beneficial. Palliative treatments that do not work are not, and should be abandoned.
Yes, but hospice care is an extreme measure, to ease the situation of a dying patient for whom nothing more can be done. Excepting suicide, nobody dies from mental illness, so hospice care is not a good analogy. Whether MD or PhD, the doctor's first task is to do no harm; his/her second task is to make the patient well, or at least better. Now, it may be that in some cases of chronic mental illness, long-term hospitalization is the best alternative for the patient, and these costs should be reimbursed by third-party payers, just as long-term hospitalization for, say, polio or tuberculosis would be (it is clear now that it was a mistake to empty the state mental hospitals, instead of improving the conditions of the patients housed in them). But even in that case, I believe that there is an obligation to deploy EBPs directed toward management and rehabilitation (which is what should have been done).
I stand by my statement. Patients have a right to seek out any treatment they wish, and to pay for it out of their own pockets; but providers have an obligation to provide treatments that are effective, and third-party payers are under no obligation to pay for treatments that are ineffective.
My position is very simple: the status of clinical psychology as a profession, including its autonomy from psychiatry and its eligibility for third-party payments, depends on its adherence to its scientific base. Or, put another way: if someone had cancer, or heart disease, they'd insist that their doctor try a proven method. Why would anyone treat their mind differently than their body?
I agree that clinical trials pose some difficult statistical issues,
epitomized by the difference between statistical and clinical significance, and
the fact that we're dealing with average outcomes, which may hide the fact that
even an effective treatment doesn't work for everyone who gets it. But
these problems shouldn't serve as an excuse for doing nothing about the
scientific basis of clinical practice -- which, frankly, is the position taken
by a number of leading figures in the American Psychological Association, some
of whom are authors in the Norcross book. As I've said many times,
clinical psychology owes its professional status, including its autonomy from
psychiatry and its eligibility for third-party payments, to the assumption that
it's practices are justified by a firm scientific base. But all too many
of the leaders in clinical psychology want to practice business as usual.
I'll defend the Rosenblatt/Atkisson cube as a model for representing consumer interests in EBP. Yes, they focus on severe mental illness, but their basic point is that in any case of mental illness, there are a number of different consumers -- the patient him- or herself, his/her family, employer and colleagues, neighbors and the larger community, all of whom have an interest in whether the patient gets well. Whoever the consumer is, beginning with the patient, consumer interests are best served by providing services that are both effective and cost-effective. And the only way we have to identify those services is scientific research, modeled on clinical trials.
Link to some comments on the "godfather" of cognitive psychology, who died on February 17, 2012.
On July 14, 2012, I sent the following letter to the Editor of the New York Times Book Review, concerning a review by Daniel Menaker of Free Will by Sam Harris. Daniel Menaker seems too willing to accept Sam Harris’s conclusion that free will is an illusion – and not even a necessary one, at that (“Have It Your Way”, July 15, 2012). But the relevant science does not support Harris’s view. Benjamin Libet is no longer alive to defend his experiment, but the latest evidence indicates that his results were wholly an artifact of his procedures. And while a host of evidence in cognitive and social psychology shows that automatic, unconscious processes play some role in our experience, thought, and action, none of it demonstrates that they overwhelm conscious control. So Harris's arguments about free will are based more on ideology than evidence. How free will works is indeed a problem for neuroscientists. But they’ll never solve it so long as they keep denying it.
Duncan and I didn't have too much in common: I barely can do a t-test, after all. But he was a great colleague during my time at Harvard. I was appointed in the Personality and Developmental Studies area, at a time when the Department was just being put back together and those institutional distinctions actually still meant something. But the only available office space was on the 9th floor of William James Hall. A big corner office, and I was happy to have it, but it was embedded in the Laboratory of Psychophysics, where I felt a little like a fish out of water. Maybe it was the Penn Connection, but Duncan and Dave Green (and Douwe Yntema and Edwin Newman) were very friendly and supportive, and even invited me to Fechner Day celebrations. Later, after I had left Harvard, I had the privilege of working with Duncan on an NRC project to identify the "Leading Edges in Behavioral and Social Science". There I learned just how broad Duncan's interests were -- it turned out that we had more in common than I had imagined at the outset.
This page last revised 08/14/12 02:10:37 PM.