While the conflict between religion and faith is not a new one, in the field of psychotherapy skepticism is as essential as it is in medicine. Theories of psychotherapy in their infancy or even still in gestation can be presented to the public as if they were already proven true. People depend on the "experts" to have the training to know the proven from the experimental and advise them competently. They have to assume that we are giving them the best available help and advice. Yet perhaps their lives and certainly their well-being depend on what we do to help them.
It's good that new theories and practices arise. Even when the new theories have not yet been tested, or are based on the wildest of suppositions, we have to start somewhere. When we try out new ideas that have promise, the explanations for how they work may lag by years. We can see if they appear to have any validity or if they can be modified so that they are more effective. We can test various aspects of them, keep the valid and dump the others. Then the theories can be changed to support the findings and to suggest new approaches to be tested in their turn.
As long as the people on whom we are testing out new ideas are clearly aware that they are taking part in an experimental treatment AND that they have other alternatives that are not experimental, there is nothing wrong with trying the new ideas out. They should have a right to try an untested or experimental treatment if they are fully informed. Out of experiment and exploration come the ideas that develop into superior modes of treatment.
However, many practitioners of experimental and un-evaluated modes of treatment don't tell their patients. They offer the "latest and best" even though there is not yet any experimental validation. Our patients believe, reasonably enough, that we are providing them the best and most effective treatments, treatments they are not themselves competent to evaluate. Providing them with untested modes of treatment without their informed consent is certainly unethical and in my opinion fraudulent.
Recently a friend who is trained and legitimately credentialed as a psychotherapist wanted to convince me that the newest treatment she had encountered was truly wonderful. She could not provide me with any experimental evidence or journaled research publications. However, her "personal experience" convinced her that "it worked". The theory behind this therapy has absolutely no construct validity. It relies on unsupported beliefs in "energy flow" and "visualization of personal space". There's no question in my mind that some (or all) of her patients experienced something positive and in some cases believed they were "cured". In her mind this and her own experience is enough to convince her that she has found something true and useful. She therefore belongs to the huge class of people who develop beliefs without corroborating evidence and is therefore a "true believer". There's nothing wrong with being a true believer as long as the belief is not presented as factual truth. Essentially her new kind of psychotherapy is a religion and is supported by faith and belief and her personal skills in using it. For some people, single events are enough to convince; personal experience trumps the accumulation of evidence tested rigorously.
Since she is practicing a psychotherapeutic "religion", logical argument has no weight with her. She thinks I need to "experience it for myself", and she believes that this should be enough to convince me. I find it impossible to explain to her why personal experience is not and can never be enough for validation of a psychotherapeutic approach. Every religion believes in unsupported techniques; whether they are spinal manipulation or rain dances or prayer. No satisfactory evidence has ever been found to support these religious practices, but they do not require support since they don't depend on evidence, but only belief. My chances of convincing my friend are about the same as for any member of any religion being swayed by logic.
Every religion works miracles. Some of the time. Every psychotherapy has successes. Some of the time. Every belief system, no matter how weird or in direct contradiction to physical fact, has adherents who will die to support it. All we skeptics have to rely on is evidence. Since everything works (some of the time) we account for the successes by citing the "placebo" effect. The placebo effect itself is a complex topic and is itself effected by a number of factors. The more convincing the "salesman" of the effect, the greater the placebo effect. I have watched many sick people being "cured" in my younger days by tent revivalists. There has turned out to be no evidence for the long-range outcomes, but I'm sure some people were cured. The ones who died had no public complaints to make.
There's an old joke whose ending involves a man saying to his wife (who has caught him with another woman) "Are you going to believe me or believe your lying eyes?" My psychotherapist friend is convinced by what she has seen. As an amateur magician, I'm glad to have a credulous audience, but I don't want credulous believers in charge of my treatment. I know better than to believe my eyes and my own experience. While personal experience can be convincing, for the helping professions it certainly should not be enough.
Friday, November 19, 2010
Thursday, November 11, 2010
Photography contests
I just read a book on how to win photography contests. It's well written, with lots of examples, maybe 200. Of all those, only one or two pass the "wall test". This test simply asks "Would I put this picture in a frame over my mantle?"
The criteria for winning a contest have almost nothing to do with the creation of art. While some of the principles are good ones ("Take pictures of what you love to see"), most of them have only to do with how to get a judge to look favorably on your particular photograph.
It has to have immediate appeal. It has to be an unusual point of view. Of course it should be technically perfect, or at the least be interesting in its imperfection. It should have as subject matter something that will appeal to the judges, who have seen every postcard photograph ever sold. It has to be composed well.
The prize-winning pictures certainly met these specifications. But were they art? Absolutely not. They were great postcards or pretty scenery or unfamiliar countries or unusual landscapes. But they were not "wall-hangers". After you look at them for 3 or 4 seconds you've seen everything you need to see. There's nothing more to look at. There's no depth or mystery or deeper meaning implied.
Then I look at some of the art that's in museums and it nearly universally recognized as "beautiful". A lot of it is simply pretty. Some is great, and that's because a deeper and more universal meaning is hinted at or implied. In Michelangelo's "Pieta" the universal sense of sadness and loss by a mother for her son, even the son of God, is poignant and powerful. However, the Rembrandt "Night Watch" is not. It's just a picture of a bunch of men who wanted their membership in a particular group recognized. We treat it as "a masterpiece" because the books all say it is great art. However, when I observed the people who came to look at it, after only a few minutes they lost interest. It was interesting and old, and that was about it. Even if I had a wall big enough to put that picture on, I wouldn't. It simply doesn't hold my interest.
I would have to agree with you if you pointed out that I simply am too obtuse or too tasteless or too uneducated to appreciate the quality of such work. How would I know that I'm simply artistically inadequate? On the other hand, how many of the readers of this blog note have copies of such great works of art on the walls of their dining rooms?
Just catching the attention of the viewer with a pretty piece of eye candy is not enough to treat the eye candy as serious art. Being an interesting photograph is not enough, or photojournalism would hang in people's living rooms. Where I struggle is with the issue of what the standards for genuine art in photography are?
The criteria for winning a contest have almost nothing to do with the creation of art. While some of the principles are good ones ("Take pictures of what you love to see"), most of them have only to do with how to get a judge to look favorably on your particular photograph.
It has to have immediate appeal. It has to be an unusual point of view. Of course it should be technically perfect, or at the least be interesting in its imperfection. It should have as subject matter something that will appeal to the judges, who have seen every postcard photograph ever sold. It has to be composed well.
The prize-winning pictures certainly met these specifications. But were they art? Absolutely not. They were great postcards or pretty scenery or unfamiliar countries or unusual landscapes. But they were not "wall-hangers". After you look at them for 3 or 4 seconds you've seen everything you need to see. There's nothing more to look at. There's no depth or mystery or deeper meaning implied.
Then I look at some of the art that's in museums and it nearly universally recognized as "beautiful". A lot of it is simply pretty. Some is great, and that's because a deeper and more universal meaning is hinted at or implied. In Michelangelo's "Pieta" the universal sense of sadness and loss by a mother for her son, even the son of God, is poignant and powerful. However, the Rembrandt "Night Watch" is not. It's just a picture of a bunch of men who wanted their membership in a particular group recognized. We treat it as "a masterpiece" because the books all say it is great art. However, when I observed the people who came to look at it, after only a few minutes they lost interest. It was interesting and old, and that was about it. Even if I had a wall big enough to put that picture on, I wouldn't. It simply doesn't hold my interest.
I would have to agree with you if you pointed out that I simply am too obtuse or too tasteless or too uneducated to appreciate the quality of such work. How would I know that I'm simply artistically inadequate? On the other hand, how many of the readers of this blog note have copies of such great works of art on the walls of their dining rooms?
Just catching the attention of the viewer with a pretty piece of eye candy is not enough to treat the eye candy as serious art. Being an interesting photograph is not enough, or photojournalism would hang in people's living rooms. Where I struggle is with the issue of what the standards for genuine art in photography are?
Friday, November 05, 2010
Covert and Slow Suicide
Suicide may be a long-term option in dealing with life impasses. Suicide doesn't always have to take the form of a sudden, dramatic event, such as shooting or hanging oneself. It can be a slow and deliberate, barely conscious plan carried out over a period of years. In this latter form it's very hard or even impossible to identify.
Here's a sample scenario: A 40-year-old woman in an impossible and abusive marriage has strong religious beliefs that make the deliberate taking of her own life intolerable. The same beliefs absolutely preclude divorce as an option. She believes she cannot bear the thought of living as she has for the rest of her life. So she begins doing things that will clearly shorten her life span, but will not kill her immediately. She smokes more heavily, eats a lot of fast food and gains weight. Her blood pressure gets fairly high. She is advised to exercise and lose weight, but she doesn't do that. Her physical condition continues to slowly deteriorate. She sleeps and naps a lot, complaining of "being tired". She drinks too much and sometimes (not often, perhaps) drives while slightly intoxicated. Her fights with her husband intensify, and she may be assaulted by him, but never follows through with a complaint. She knows he has a gun, but she does nothing to get rid of it.
She's not directly killing herself, but she knows as a fact that her life expectancy is pretty limited. If her husband doesn't kill her, her health will continue to deteriorate fairly rapidly. The stress of her life style increases the likelihood that she may die of a stroke or heart attack, or even in a car wreck. However, such a death doesn't count as a suicide either in her mind or in the collective mind of the family, her religious community and authorities. Nonetheless, her life is deliberately limited, even though she may never put this intention into words. She has found a way of acceptably solving her problem. If you asked her how long she might live, given her current life style, she would laugh and avoid the question, or answer it in a way that makes it a joke not to be taken seriously (gallows humor) or she may become defensively angry.
Another scenario: A middle-aged man hates his job, doesn't get along with his wife and fights with his grown children. He fantasizes about changing his life, moving away, even getting a divorce, but knows he will never do it. The thought of such major changes provokes a lot of anxiety. He begins to drink more, and his smoking becomes heavy, as much as 2 packs a day. He talks about trying to stop smoking, but nothing seems to work. He spends more and more hours per week at work in a fairly demanding and high-stress job. He gains a lot of weight and signs up for a gym, but never seems to have time to go there. He gets anti-depressant medication from his family doctor but seems to get little benefit from it.
We are all making choices regularly that will impact on our life span. Some choices are simply short-sighted; some choices make our lives better and others may shorten our lives. People carrying out a covert suicide, however, consistently make choices that are known to lead to an early death. They get angry or laugh it off when asked or confronted, because the whole intent is to get away with suicide without being forced to recognize the truth of what they are doing. Much of the time the decision to slowly shorten one's life is not verbalized or even a consciously thought. It's a passive way of dealing with difficult problems and is congruent with people who use passive-aggressive defenses.
While people in the covert suicide category can be treated successfully in therapy, they are not likely to be willing to deal directly with this issue, since a key part of its usefulness lies in its easy concealment/denial. They may ask for help in "getting over being depressed" and will be readily compliant with anti-depressant medication. However, they invariably misidentify their unhappiness as depression, and so anti-depressants don't work very well. What they don't want to do is to be faced with the underlying issue of a miserably unhappy and "trapped" life. The anger and denial they express when confronted is a give-away. They have found a solution for an impossible situation (as they see it) for which they cannot be blamed and which cannot be prevented.
Here's a sample scenario: A 40-year-old woman in an impossible and abusive marriage has strong religious beliefs that make the deliberate taking of her own life intolerable. The same beliefs absolutely preclude divorce as an option. She believes she cannot bear the thought of living as she has for the rest of her life. So she begins doing things that will clearly shorten her life span, but will not kill her immediately. She smokes more heavily, eats a lot of fast food and gains weight. Her blood pressure gets fairly high. She is advised to exercise and lose weight, but she doesn't do that. Her physical condition continues to slowly deteriorate. She sleeps and naps a lot, complaining of "being tired". She drinks too much and sometimes (not often, perhaps) drives while slightly intoxicated. Her fights with her husband intensify, and she may be assaulted by him, but never follows through with a complaint. She knows he has a gun, but she does nothing to get rid of it.
She's not directly killing herself, but she knows as a fact that her life expectancy is pretty limited. If her husband doesn't kill her, her health will continue to deteriorate fairly rapidly. The stress of her life style increases the likelihood that she may die of a stroke or heart attack, or even in a car wreck. However, such a death doesn't count as a suicide either in her mind or in the collective mind of the family, her religious community and authorities. Nonetheless, her life is deliberately limited, even though she may never put this intention into words. She has found a way of acceptably solving her problem. If you asked her how long she might live, given her current life style, she would laugh and avoid the question, or answer it in a way that makes it a joke not to be taken seriously (gallows humor) or she may become defensively angry.
Another scenario: A middle-aged man hates his job, doesn't get along with his wife and fights with his grown children. He fantasizes about changing his life, moving away, even getting a divorce, but knows he will never do it. The thought of such major changes provokes a lot of anxiety. He begins to drink more, and his smoking becomes heavy, as much as 2 packs a day. He talks about trying to stop smoking, but nothing seems to work. He spends more and more hours per week at work in a fairly demanding and high-stress job. He gains a lot of weight and signs up for a gym, but never seems to have time to go there. He gets anti-depressant medication from his family doctor but seems to get little benefit from it.
We are all making choices regularly that will impact on our life span. Some choices are simply short-sighted; some choices make our lives better and others may shorten our lives. People carrying out a covert suicide, however, consistently make choices that are known to lead to an early death. They get angry or laugh it off when asked or confronted, because the whole intent is to get away with suicide without being forced to recognize the truth of what they are doing. Much of the time the decision to slowly shorten one's life is not verbalized or even a consciously thought. It's a passive way of dealing with difficult problems and is congruent with people who use passive-aggressive defenses.
While people in the covert suicide category can be treated successfully in therapy, they are not likely to be willing to deal directly with this issue, since a key part of its usefulness lies in its easy concealment/denial. They may ask for help in "getting over being depressed" and will be readily compliant with anti-depressant medication. However, they invariably misidentify their unhappiness as depression, and so anti-depressants don't work very well. What they don't want to do is to be faced with the underlying issue of a miserably unhappy and "trapped" life. The anger and denial they express when confronted is a give-away. They have found a solution for an impossible situation (as they see it) for which they cannot be blamed and which cannot be prevented.
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