Portrait of Sigmund Freud – by Salvador Dali
At the risk of waking up to find a horse’s head strapped to a red leather couch amongst my Christmas presents I’m going to let you into a few trade secrets.
By training I’m a psychologist.
No, that’s not a secret – although perhaps it ought to be – it just means that for my considerable and multitudinous sins my time at university was spent learning to fathom out the intricacies of the human mind. I don’t actually practice as a psychologist, never have, not because I couldn’t do the job just as well as anyone else with my background and training but because nothing I did learn left me feeling confident in taking on the responsibility for what goes on inside the head of anyone other than myself.
Let me illustrate what I mean.
Like most degree courses, psychology follows a pretty standard format. You spend the first six months covering a few introductory basics to get everyone on the course up to the same starting level (as with any number of other subjects, psychology attracts a sizable number of students for whom the degree course is their first serious entrée to the subject – A level courses in Psychology are not that widely available and, in any case, what you learn to cram at A level and what you’re expected to understand for a degree are two very different things). After that, and the mandatory lecture on professional ethics, you get to study the subject proper, spending the next year and a half covering foundation topics before finally getting to specialise in your final year.
One of the first, if not the first, foundation topic you cover is ‘theories of personality’ – note the plural, it’s important – a series of around twelve to thirteen lectures on the nature of personality and the various theories that try to explain what it is an how it works, which takes you through many of the ‘big name’ in the profession – Freud, Jung, Pavlov, Skinner, Kelly, Rogers, Maslow et al – all with the own distinct ideas of what personality is, what it does and how, as a psychologist, you might eventually learn to influence it’s development.
If that part of the course teaches you anything it’s that’s while psychology is by no means short of ideas, theories and conjectures on the subject of personality, no one really know what it is or how it works – if a psychologist says to you that they’re a ‘Freudian’ or a ‘Jungian’ or a ‘Behaviourist’ or whatever all they’re really saying is that when they sat down to consider what personality is, they simply liked a particular theory best and found it a bit more interesting than the others so that’s what they decided to go with. You could just as easily pick one at random for that it provides any semblance of a definitive view of personality.
(Personally, I always found that Kelly, Maslow and the other existentialists and iconoclasts like R D Laing suited me best, but that’s just my own view of things)
I mention all this in response to yet another brilliant commentary from Dr Crippen on the subject ADHD (Attention Deficit Hyperactivity Disorder) in which he expresses, in my opinion, what are well-founded and well-judged concerns about the growing practice of medicating children for no better reasons than their parents (and often schools) find them a bit ‘difficult’. It’s an issue in which, I must confess, I have a considerable personal interest as my own five (soon to be six) year-old daughter is one such child who falls into this category – although never once have I asked for or wanted her to be medicated because of it.
I’ll get back to my daughter and our experiences of ‘the system’ in a while, but first there are few more observations on the nature of the ‘profession’ I should make first.
I suppose I should try and give some sort of overview of what psychologists – and psychiatrists for that matter – actually know about the workings of the human mind.
Don’t get me wrong, we know quite a bit about how the brain works.
We know what chemicals the brain produces (neurotransmitters) and have a fair idea of what happens in situations where it produces a bit too much or too little of a particular chemical and also what happens if you introduce the brain to all manner of other chemicals from the outside world – nicotine, alcohol and whole bucket load of prescription and non-prescription drug, legal and illegal.
We know all about the electrical activity that take place in the brain. We can map it to show that different patterns occur in different places when we do different things. We even know that we can make certain things happen if we go poking around in particular locations in the cranial cavity with electrodes – prod here and a finger twitches, prod there and you get the taste of strawberries.
We even know, roughly speaking, which bits of the brain control which functions; mostly as a result of studying various types of brain injury. Damage this bit a speech goes out of the window, here and you can’t remember anything for more than a few seconds, here and all aggression goes and you guarantee docility – that last one was once a big favourite, back in the days when it was thought reasonable to try to ‘cure’ criminality by liberal use of pre-frontal lobotomies.
We also know that despite it being long thought that the brain was incapable of making new brain cells and replacing damaged cells (neurons) its actually does make some new cells all the time – in the hippocampus – all of which appears linked to how the brain stores memories and, if injured, it does try to repair itself. I was actually at University and taking the module in neuropsychology at around the time this was discovered. Back then it was called simply ‘sprouting’ – cells around the area of injury respond by growing new connections to other undamaged cells in an effort to reconnect across the damaged area, often resulting in the partial recovery of functions otherwise lost to injury.
None of this, however, tells us anything in particular about the process of thought and thinking, which is what psychologist and psychiatrists, in the main, are concerned with – its what’s called the ‘mind-body’ problem, something that has occupied the thoughts of psychologists since the profession came into being in the 19th Century and philosophers certainly since the enlightenment and, perhaps, before. We can study and uncover the physiology of the brain and its pathological functioning fairly well, we just have no real idea how that all relates back to the way we think – not that that’s ever stopped people trying to link the two together, from which we’ve derived both pseudoscientific drivel (phrenology, the ‘science’ of reading ‘bumps’ on the head) through assorted forms of medical barbarity (lobotomy, electro-convulsive therapy) to today’s mood-altering drugs (lithium, Prozac, etc.).
It’s this that sets the use of drug treatments in psychiatry apart from most other fields of medicine. If we take a commonly used drug, say an analgesic like paracetamol, then we know with a considerable degree of accuracy what the drug does, the effect it has, how it does it and why it does it. In the case of Ritalin, which is increasingly prescribed to treat ADHD in children, we may still know all these things in terms of their physical effects on the body but nowhere near as much about how and especially why they affect the mind in a particular way – we can observe and record the effects, just not explain the why of them.
I need to digress here a touch, just to explain the difference between psychologists and psychiatrists.
Psychologists aren’t doctors (they don’t have a medical degree although some, working in the field of neuropsychology do go that route in order to qualify as surgeons), they don’t generally wear white lab coats (apart from some the experimental lot and the odd one or two who do it as an affectation) and they don’t – in fact they can’t – prescribe drugs.
Psychiatrist, on the other hand, are doctors, frequently wear white lab coats (it’s mandatory) and can prescribe drugs.
There is, as a result, quite a degree of professional rivalry akin to that you’ll often find between doctors and dentists (and from some strange reason at Manchester University, in particular, doctors and engineers – no I did get it either) much of which relates to this whole business of having access to the medicines cabinet. Psychologists are firmly of the belief that psychiatrists are far too inclined to reach for the pad of prescriptions rather than tackle problems properly – they’re also firmly of the belief that the majority of psychiatrists don’t enter the profession burning with a desire to cure the ills of human mind, but because they’re too crap at doctoring to become surgeons and too lazy and anti-social for General Practice. As far as psychologists are concerned, psychiatry is to doctors what philosophy and theology are to prospective university students – a means of getting on if your grades or too poor to qualify you do anything more useful.
That being said, I’m sure psychiatrists take a similar dim view of psychologists, although I’ve never encountered one with the courage to speak up and say so – I fully expect what they think of us is near enough what they think of complementary therapists, homeopathy and other assorted unproven therapies.
I point all this out really to make the point that psychology/psychiatry is a hell of a long way from being the kind of empirical discipline that the public are often les to believe it is – most of it is educated guesswork and bit of common sense and experience (hopefully) wrapped up in a whole load of made up words with enough syllable to sound impressive and the make the speaker appear to know what they’re talking about.
It’s frequently impossible to tell whether visiting a psychologist with your problems has any real effect or whether its all just one massive placebo for the mind – talking over your problems doesn’t actually solve them it just makes you feel a bit better for having talked them over with someone.
One of my all-time favourite stories about RD Laing illustrates this point perfectly.
Laing, while practicing as psychologist, was visited for a regular consultation by a patient with depression.
On this particular occasion, the patient seemed particularly down, so rather than do the whole ‘get on the couch and tell me your problems’ routine, Laing just decided to chat to them in general, talk about mundane things like the weather, the football results over the weekend. Just the normal kinds of things that people talk about socially.
About an hour later, Laing notices that the time allotted to the session is over. At no point have he and his patient talked about the patients problems or done anything which might be considered therapeutic – they’ve just talked. By now, however, the patient’s mood has picked up considerably and he and Laing have been swapping jokes and just generally enjoying a social chat.
So, Laing breaks into the conversation to point out that the sessions over, only for the patient to reply by pointing out that they hadn’t actually talked over any of his problems.
The bit of this story I particularly like is what comes next.
Laing’s reply to this was simply to point out to the patient how much he’d obviously cheered up since he’d arrived and that, because of that, he saw no real point in talking about the patient’s problems as it would only get the guy down.
How wonderful is that? You’re happy now so why spoil it?
I’m not going to say outright that psychology is complete con but I will happily argue, as someone trained in it, that its nowhere near what the public are led to think it is.
Take schizophrenia for example – what exactly is it?
Well, this is how it’s described by Wikipedia, which is as good a description as any you’ll find in textbook:
“Schizophrenia is a severe mental illness characterized by persistent defects in the perception or expression of reality. A person experiencing untreated schizophrenia typically demonstrates grossly disorganized thinking, and may also experience delusions or auditory hallucinations. Although the illness primarily affects cognition, it can also contribute to chronic problems with behaviour or emotions. Due to the many possible combinations of symptoms, it is difficult to say whether it is in fact a single psychiatric disorder; and Eugen Bleuler deliberately called the disease “the schizophrenias,” (plural) when he coined the present name.