Mollon, P. Clinical Psychology Forum. [Division of Clinical Psychology. British Psychological Society] 174. June 2007. 13-16. [Summary:
The writings of those who claim to debunk pseudoscience may themselves
be unscientific and can be used oppressively in debates within clinical
psychology and the NHS.]
Recent years have seen the emergence of a
niche academic genre of ‘pseudoscience debunking’. This features the
writings of clinical (often American) psychologists, who see themselves
as mounting a campaign to rid clinical psychology, and the therapy world
generally, of assumptions, theories, and techniques that this group
regard as lacking in scientific validity (e.g. Lilienfeld, Lynn, &
Lohr, 2003). I offer some comments on this book and upon two papers
recently cited within one NHS Trust in an attempt to restrict the range
of psychological therapies available. Throughout the profession’s
history, there have been psychologists who attempt to establish their
territory and authority, defining what is and what is not allowed within
the field, and what methods of enquiry and critical thought are
permitted. For example, Hans Eysenck, the original ‘debunker’, writing
in 1949 about training in clinical psychology, declared that "therapy is
something essentially alien to clinical psychology … we must be careful
not to let social need interfere with scientific requirements” [p 173].
Unfortunately, the writings within this new genre of debunkers are
themselves often lacking in a genuinely scientific outlook. These become
potentially problematic when used to buttress arguments about what
kinds of therapy should, or should not, be allowed within the NHS in
Britain.
Alleged criteria for pseudoscience
In
the opening chapter of their edited collection, Lilienfeld, Lynn &
Lohr (2003) state: "One of the major goals of this book is to
distinguish scientific from pseudoscientific claims in clinical
psychology. To accomplish this goal, however, we must first delineate
the principal differences between scientific and pseudoscientific
research programs.” [p 5]. Clearly they are here stating an agenda of
delineating territory and its boundaries. They then go on to propose a
list of 10 indicators of ‘pseudoscience’. These are: An
overuse of ad hoc hypotheses designed to immunise claims from
falsification – where hypotheses are ‘pasted on’ to plug holes in the
theory; An absence of self-correction, with resulting intellectual stagnation; Evasion of peer review; Emphasis on confirmation rather than refutation; Reversed burden of proof – demanding the sceptics demonstrate that a claim is false; Absence of connectivity to other scientific disciplines; Over-reliance on testimonial and anecdotal evidence; Use of obscurantist language; Absence of boundary conditions – i.e. claims that a treatment method has a very wide range of applications; The ‘mantra of holism’ – that phenomena are not to be studied in isolation from other phenomena.
The
problem with most of these criteria is that they depend somewhat on
which pot wishes to call which kettle black. For example, with regard to
‘obscurantist language’, some of the most inelegant and jargonistic
language is found in the cognitive-behavioral literature – where facing
your fears is called ‘exposure’, refraining from an activity is called
‘response prevention’, learning to relax is called ‘stress inoculation’,
and revising your thoughts is called ‘cognitive restructuring’. Beck’s
cognitive therapy not only lacks ‘connectivity’ to psychological
findings regarding cognition and mood, but is incongruent with it
(Fancher 1995). As for ‘boundary conditions’, CBT seems to be prescribed
for almost everything these days, from chronic pain to schizophrenia.
Any novel theory or therapeutic approach, particularly of a holistic
nature, is likely to be dismissed as pseudoscience on the basis of the
above criteria. Case studies are always likely to be initial forms of
evidence – and, indeed, in many instances are the most appropriate kind
of data [Roth & Fonagy, 1996, p 16-17]. Although the principle of
falsification is important, it is not unreasonable also to cite evidence
that is consistent with the theory in question – confirmatory evidence
is surely not irrelevant (Stove 1982). Any radically new approach is
likely to display a relative lack of connection to the dominant
paradigm, but may have connections to more distant fields of scientific
enquiry. A new approach may also not yet have access to established
journals willing to consider papers that derive from an unfamiliar
paradigm. If a manuscript is sent to reviewers who are invested in a
prevailing paradigm they may be likely to reject it. Therefore it is
often the case that new approaches are presented first in the form of
books, with case histories – as with early accounts of behavior therapy
and cognitive therapy, and some of the recent therapies, such as Eye
Movement Desensitization, Thought Field Therapy, and so on. Creating a negative impression
There
are certain common styles and strategies that can be discerned in the
writings of the debunkers – one obvious feature of which is the use of
disparaging terms such as ‘pseudoscience’ and ‘junk science’, as well as
a tone of writing that can appear distinctly sneering. This distortion
of genuine scientific enquiry has been carefully explored by Perkins and
Rouanzoin (2002) in relation to EMDR – and is also discussed in Mollon
(2005). For example, Gaudiano & Herbert (2000) refer to
various new psychological therapies (such as Eye Movement
Desensitization [EMDR] and Thought Field Therapy [TFT]), stating "these
treatments are gaining widespread acceptance among mental health
practitioners despite their frankly bizarre theories and absence of
scientific support” (p 1 of internet version) – an introduction clearly
designed to evoke a negative impression in the reader. Then, referring
to EMDR, they write that this "involves a therapist waving his or her
finger in front of the patient’s eyes while the client imagines various
disturbing scenes that are thought to be related to the patient’s
problems” [p 1]. Note the subtle disparaging phrasing here: rather than
simply say that the client thinks of his or her traumatic memories, the
authors write in a way that implies some speculative theory about the
relationship of ‘disturbing scenes’ to the ‘patient’s problems’, when in
fact the disturbing scenes are the patient’s presenting problem.
In
a similar paper, Devilly (2005) engages in disdainful comments about a
number of new therapies. For example, he introduces Traumatic Incident
Reduction by describing it as "a direct conversion from Scientology”
[438] – an allusion presumably designed to create a negative emotional
impression in the reader. He cites no evidence for this claim – and it
is at odds with the TIR Association website, where its originator states
the background influences as predominantly Freud, Pavlov, Carl Rogers,
and cognitive therapy. The method is in essence to do with allowing the
client to review a traumatic incident from a position of safety and
relaxation – and it is puzzling why this should be regarded as either
unusual or controversial.
The sleight of hand style of
misrepresentation continues when Devilly refers to a randomized control
trial of Emotional Freedom Technique (a derivative of TFT). Whilst
acknowledging that the results displayed a significant treatment effect
of EFT, he then claims that "at follow-up treatment gains had dissipated
to a large extent” [438]. What the paper actually states is more or
less the precise opposite: "This immediate effect of EFT appears to be
long-lasting. This is especially clear in terms of improvement in
avoidance behavior. For BAT (the behavioural avoidance test), the
evidence was clear-cut; the follow-up showed (a) substantial improvement
compared to the pretest and (b) no evidence of dissipation relative to
the posttest. … Thus, converging evidence from four interrelated sources
leads to the same conclusion, namely that on the important behavioral
task, EFT produces an effect which lasts at least six to nine months.”
[Wells et al. 2003. p 956].
Disparagement of motives
Devilly,
like others writing in this genre, engages in extensive disparagement
of the motives and integrity of those who develop the newer therapies.
For example, in referring to Thought Field Therapy, Emotional Freedom
Techniques, and EMDR, he makes various statements about how much
trainings may cost. The implication appears to be that such methods are
essentially a means of conning practitioners and the public out of their
money. Then, in referring to what he alleges to be a kind of
manufactured sincerity, he remarks: "… it is even harder to argue with
someone who is seen as ‘gifted’ and affects ostentatious compassion
towards those in strife. Maybe they set up a ‘humanitarian’ (and tax
exempt) offshoot, such as the EMDR Humanitarian Assistance Program, or
maybe all they do is sign all correspondence with the word ‘hugs’
instead of ‘yours sincerely’, as in the case of the founder of EFT.”
[441]
Presenting theory without acknowledging it as theory.
Devilly
makes much of scientific method based on the presentation of
falsifiable hypotheses, even quoting Popper to remind the reader of this
principle. He states that the major difference between science and
pseudoscience is "that empirically supported practices build upon a
scientific theory and state the terms under which this theory could be
falsified.” [443] Devilly then goes on to present a broad social
psychological theory to answer the question "how did these interventions
obtain such a widespread following of practitioners?”. Disregarding the
more obvious and simpler hypothesis that the methods become popular
because people find that they work very well, he proposes a theory of
the "social influence strategies ... commonly used by those peddling
pseudoscience,” involving speculative hypotheses about the mental
processes of the developers and practitioners of the newer methods. An
example of Devilly’s hypothesizing is as follows. It concerns the
thought processes that might lead a psychiatrist to take a further level
of training in a particular method, having already attended an
introduction: "In effect, the target (e.g. psychiatrist) rationalizes
that they must be interested as they have already invested substantial
time and money into the practice. It is also no accident that these
trainings are held at plush, five star hotels, which convey a sense of
credibility whilst at the same time pairing a positive affect with the
technique.” [440]
He devotes more or less 4 pages to outlining
this theory – but presenting it as if it were a simple description of
social reality. Despite his own emphasis upon falsification, it is
actually difficult to see how his theory - with its many embedded
assumptions and hypotheses about motives, thought processes, and
mechanisms of defence - could be disproved. Whilst appearing cautious
and scientific at one moment, when criticizing the studies published by
practitioners of methods he does not like, at other moments Devilly
presents wildly speculative and sweeping generalizations about
large-scale social phenomena.
The kind of writing and reasoning
found in Devilly’s paper, and others of its genre, may be regarded as
journalistic rather than embodying genuine scientific enquiry. It may
create a superficially plausible impression, but is not actually helpful
in fostering a thoughtful enquiry into the inherent ambiguity and
complexity of clinical phenomena and their treatment.
Rhetorical strategies of debunking
The following rhetorical strategies seem common in the ‘debunking’ literature: A subtle misrepresentation of the target – seemingly designed to create in the reader a negative impression of the target. Comments that appear designed to disparage the motivations of the developers of the target approach. Citing
research in such a way, through subtle distortion and selective
attention to detail, as to imply that it provides scant support for the
target method. The selective citation of references so as to support the author’s narrative. Seemingly
cautious attention to scientific detail and methodology at certain
points is combined with sweeping and unsubstantiated generalizations at
other points. Presenting a theory (or theories, or sets of
hypotheses) regarding [a] the mode of action of a therapeutic method,
[b] the appeal of the method to its practitioners (including their
motives and cognitive-emotional processes), and [c] the motives and
mental processes of the developers or promoters of the method – but
without making clear that these are hypotheses or theories. A dogmatic assertion of what is and what is not to be termed ‘science’.
The
common factor running through these features is prejudice – an
aggressive assertion of ‘knowing already’ without the humbling necessity
to find out. This state of believing oneself to know already is, I
suggest, a profound obstacle to free thought and enquiry. When it is
harnessed to political and economic pressures towards degraded and
depleted versions of cognitive-behavioral therapy, under the guise of
‘evidence-based practice’, the outlook for the once vibrant and unruly
creativity of clinical psychology could be bleak indeed.
References Devilly,
G.J. 2005. Power therapies and possible threats to the science of
psychology and psychiatry. Australian and New Zealand Journal of
Psychiatry. 39 [6] 437-445.
Eysenck, H.J. 1949. Training in clinical psychology. An English point of view. American Psychologist. 4. 173-177.
Fancher, R. 1995. Cultures of Healing. Correcting the Image of American Mental Health Care. New York. Freeman.
Gaudiano,
B.A., & Herbert, J.D. 2000. Can we really tap our problems away? A
critical analysis of thought field therapy. Skeptical Inquirer.
July/August.
http://www.csicop.org/si/2000-07/thought-field-therapy.html Lilienfeld, S.O., Lynn, S.J., & Lohur, J. 2003. Science and Pseudoscience in Clinical Psychology. New York. Guilford.
Mollon, P. 2005. EMDR and the Energy Therapies. Psychoanalytic Perspectives. London. Karnac.
Perkins,
B.R., & Rouanzoin, C.C. (2002) A critical evaluation of current
views regarding eye movement desensitization and reprocessing (EMDR);
clarifying points of confusion. Journal of Clinical Psychology. 58. [1].
77-97.
Roth, A., & Fonagy, P. 1996. What Works for Whom? London. Guilford.
Stove, O.C. 1982. Popper and After. Four Modern Irrationalists. New York. Pergamon Press. Wells,
S., Polglase, K., Andrews, H.B., Carrington, P.,& Baker, A.H. 2003.
Evaluation of a meridian based intervention, emotional freedom
techniques (EFT) for reducing specific phobias of small animals. Journal
of Clinical Psychology. 59. 943-966.
Phil Mollon PhD. Psychoanalyst and Psychotherapist, Head of Psychology and Psychotherapy Services, Mental Health Unit, Lister Hospital, Stevenage, Herts. SG1 4AB |