psych woes

I'm stuck in a clinical case presentation this morning that is not actually a clinical case. :( For those of you outside the little world of psych, this is essentially a "job talk" where a candidate presents the story of a client they worked with. Only this candidate is not a clinician, one can tell-- he's one of the new (and unfortunately growing) variety of researchers in clinical psych who think they can do legitimate research without having any anchor in real-world practice. They love boxes and, therefore, annoy the hell out of me. He's also a radical behaviorist. Those who know me know I had anything radical, pretty much, and consider myself an integrationist in terms of clinical theory. (They radical behaviorists are the same as the radical psychoanalytic folks. They only difference is that one group thinks everything goes back to conditioning; the other thinks it all goes back to sex and aggression. Both seem to view humanity as wild animals who can't control themselves.)

So this guy talks about his client for 10 minutes (a client he actually didn't see, but his grad student did), then describes his related research study for the remaining 50 minutes (which is really annoying since there's another presentation scheduled where he can talk about research). And I find myself being so negative to him, and behaviorism in general. How can we treat people like animals? How can we have a 3-week intervention and expect that to create actual change in huge dimensions like how well substance users can tolerate distress. It's ridiculous. All the developmental literature shows that the ability to tolerate distress is largely a product of temperament and early childhood experiences/attachment. But he's from YALE so he must be special, he doesn't need to read research in adjacent fields. He just reads his friends publications-- creating this circular masturbation/insulation that academia is known for.

And yet, they have this so-called clean data that shows vast improvements. And it is hard to argue against it because they set the rules implicitly. For example, the guy starts of his "clinical" presentation saying: "I could go on and on about this one person OR, I could go ahead and jump to the aggregate data that we have..." (and Hopko makes annoying chuckles of agreement with him). So right away there's no room for others' opinion. He makes you feel small, I guess. And for some reason, it never works to point out the implicit rules that they have made: that experimental control trumps external validity.

But what this means is the whole system is contrived-- with these "measures" where the clients rate how enjoyable certain activities were, how they spent their day, how much they wanted to use drugs, etc. But I don't see how these dinky forced self-report measures can relate to real life... especially since in this particular "treatment" one of the "interventions" was to have clients complete these same measures every day and learn to "separate mood from enjoyment." So I'm sitting there cutting this guy's research down to shreds in my mind: OF COURSE the clients in his group are going to show improvement on these "measures," since they've been coached by their therapist to fill them out a certain way every day for 3 weeks, whereas the other group has not yet learned to twist their reality into something to please the clinician. And don't even get me started on the notion of telling clients to separate mood and enjoyment. Of course they're going to be correlated! If you're sad because your grandma died and you go to an enjoyment park, you're not going to have that great of a time.

To make matters worse, this guy had the same personality as the other radical behaviorist in our program (Hopko)-- and the two were "buddies." This meant they were both workaholics who ignored interpersonal relationships (leading to divorce and affairs with students, among other maladies)-- the kind of people who, if I was Freudian, I would think had very small penises and felt compelled to constantly try and prove themselves to the world. (Sexual energy being sublimated into work energy.) Another word for these individuals would be narcissists: those who actually doubt themselves and have poor self esteem but appear to be grandiose in order to make up for this. (Yeah-- Freud was a clear narcissist... hence the preoccupation with penis envy, etc.)

I guess I am sick of these people running the country, and proliferating throughout academia. Then I had a talk with a fellow student about another peer, and how frustrating it was that this person's confidence was repeatedly confounded for competence. This is such an annoying phenomenon in the world. I think confidence is over-rated. I'd rather have quiet and competent person than someone always trying to boast their qualifications. It's like Zora Neale Hurston said: "Those that don't got it, can't show it. Those that got it can't hide it," or like Mary Chapin sings:
There are zealots and preachers
and readers of dreams.
The righteous yell loudest
and the saved rise to sing.

I don't know what she was trying to convey by that song, but when I hear it I think of the fact that those who walk around shouting all the time about their religion are not the ones who seem truest to it in their heart. I guess all this could be reduced to a single cliche of "babbling creeks are often shallow" (is that right)?

I guess what's frustrating is that people don't seem to see through this. A lot of folks seem to be deceived and impressed but such people. They want to associate themselves with these people, who seem smart because they've done 30 studies. But the quality of these studies is horrific, whereas some folks have done 5 studies of great quality. It's easy to do 30 studies by just tweaking one variable every time. There's no creativity, and little relevance to actual depression or substance abuse or whatever.

And unfortunately, this is the trend of our field: everything in ever-smaller boxes, so that pretty soon you won't be able to fit even 1/100th of a person in there... and so our science descends (perhaps due to the "stepchild syndrome" it can't shake) into a ridiculous exercise in endless bifurcations. Because those who master the art of amputation are rewarded.

Even as I write this (and as I sat in that talk), I was upset because I had such animosity towards this person and toward radical behaviorism. I am myself becoming polarized, and I wonder if in the future I will begin to reject all behaviorist or analytic explanations in subtle ways, because I abhor the extremes? I pray that won't happen. For now I feel okay, but I've got to get out of here soon. This place seems to interfere with my ability to do my job properly... and that's never good.

Meanwhile-- I also know that our society seems to be moving toward these extremes and boxes in other fields as well: In religion, fundamentalist ones are the only branches that are growing while the more "normal" integrationist churches shrink. In literature, it's all about language poetry OR lyric poetry (as if the two shouldn't overlap). I'm sure there are similar dichotomies in other fields; I just don't know anything about other fields.

Well, I guess my wish today is that, somehow, we may all hold on to our sanity and not get sucked into the mounting dichotomies of the world (Science vs. Religion, Palestine vs. Israel, Republican vs. Democrat, Christianity vs. Islam, Black vs. White, Gay vs. Straight, you name it...) They want us to believe we have to choose always one, always fully and without doubt and without acknowledging any positives of the other side. That seems like crap.