Re: Psychology vs. Medicine

From: Harnad, Stevan (
Date: Fri Feb 24 1995 - 15:34:18 GMT

> From: Nick Maguire <>
> Date: Fri, 24 Feb 1995 15:26:18 GMT
> Medicine in Western cultures has historically taken a systems approach
> to explanation of ill-health, and this seems to have been served best
> by a didactic method of instruction - possibly because many examples of
> ill health are attributable to specific pathogenic causes (e.g.
> bacteria or viruses) or behaviours (e.g. stress or smoking).

I don't know about methods of instruction, but for some ailments, at
least, medicine has found a reliable method (better than chance or time
alone) of making people better.

> This system just wouldn't work with most areas of psychology (apart
> perhaps from certain areas of neurological insult), as it is so
> difficult to tie specific areas of the brain to function, and if we
> limit our study to function or cognition, how would a systems approach
> help; we are not working in the physical world.

Again, I don't know about instruction, but I would say that there are
other ailments for which neither medicine nor any other discipline has
yet found a reliable way of making people better. Perhaps we should
just call it that, then, rather than trying to make it into more than
it is.

Maybe the problem is with the notion of "ailment" -- because there are
some ailments, like infection, that are unambiguous ailments, and
others, like Angst or Weltschmerz that may not be -- and the bigger the
psychological element, the bigger the doubt.

But never mind that. Maybe the problem lies here: Suppose I am feeling
"hurt," and what you say makes me feel better. I'd call that life,
but perhaps it should be seen as continuous with medicine. You "cured"
me. It seems to me that that is only a useful description if you wish to
make any generalisations, and apply them to others, with similar
ailments, cured by still others. To the extent that there are such
principles, such that, when applied in practice, they reliably make people
better, there is no problem about (clinical) psychology and medicine.

But if we want to change the rules -- if we ignore or don't bother to
test and control for the effects of chance, time, placebo, suggestion,
self-fulfilling prophecy etc. -- we move further from Medicine and into
the waiting embrace of the Hermeneutic Circle (which, as you know,
could amount to no more than a folie a deux, shared by you and me, and
have nothing to do with anyone or anything else: some, by the way,
revel triumphantly in this "uniqueness" and "individuality," not
realising that it guarantees that there's absolutely no need for anyone
to pay any attention to it at all, much less teach it to others,
whether didactically or polemically; because it's just true for you and

> So we are left with abstract ideas and models to work with, and
> therefore a polemic method of instruction, which, I would argue, is
> closer to philosophy.

But what are we teaching? Something that, as in medicine (or science),
can be applied in general to any specific case meeting the specified
boundary conditions? Or something that one can subscribe to or not,
depending on whether one feels inclined to buy into the interpretative

Because the abstract ideas and models of empirical science are testable
and answerable to an outer world of hard facts rather than just an inner
world of pliable opinions...

Nor is Psychology Philosophy, because Philosophy does not claim to
explain how the mind works, much less how to cure it.

> In fact there is much evidence coming out now that seems to indicate
> that an enabling approach (such as that of counselling or cognitive
> restructuring) is more successful in the long term than a
> pharmacological intervention, assuming the patient has some insight
> into their illness or state of mind.

Nick, these journalistic generalities are not the way to come to a
reliable conclusion about such things. Let me put it very starkly:
Suppose what was at issue was a virulent form of cancer in someone you
loved, and your decision about whether to recommend one form of treatment or
the other were based on the strength of the evidence above: Would you
feel comfortable recommending against pharmacology and in favour of
the (counterpart of) the "enabling" approach based on what you have read
in favour of one and the other so far?

Because that's how it is with (for example) severe, chronic, suicidal
depression, for which the evidence indicates that the pharmacological
appoach has a very high success rate, whereas counseling/cognitive
approaches have so far not been shown to be better than chance.

> This leads me on to a point that Mark made about the anomaly of time
> lapse etc. in pharmacological treatment of depression. This surely
> indicates that the biological model is fundamentally flawed, and cause
> and effect have not yet been reliably established. Again a disparity
> between the two disciplines of psychiatry and psychology is
> demonstrated; psychiatry talking in terms of neurological chemistry and
> therefore treating with drugs (depending on the consultant), and
> psychology using a far more holistic discourse. I believe that
> psychology will increasingly be proved to be nearer the mark, if they
> can wrest some degree of control from the medics, and persuade the
> drugs industry to let go of their stlgmillions in profit.....

The mechanism of the beneficial effects of antidepressents is not fully
(or even partially) understood; hence the mechanism of the delay is not
understood either. But the antidepressents work, and the alternatives
don't. Dwelling on the mystery of the delay reminds me a bit of the way
Creationists dwell on the mystery of the absence of "intermediate forms"
in Evolution: Yes, there are many gaps in our understanding that still
need to be filled, but in many cases the handwriting is already on the
wall anyway...

Chrs, Stevan

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