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Monthly Archives: March 2010

Somebody asked me the other day, “Why do you want to be a doctor of psychology?”

I thought about it for a moment, and then replied, “I can’t think of anything I’d rather devote my life to than the science of human behavior.”

“But psychology isn’t a science,” he said.  “I mean, at least not a real science like chemistry or physics.”

Though I didn’t really care if psychology was a “real science” or not, the idea did poke my interest a bit.  So when I went home, I looked up the definition of science.  According to Wikipedia, science is “any systematic knowledge-base or prescriptive practice that is capable of resulting in a correct prediction, or reliably-predictable type of outcome. In this sense, science may refer to a highly skilled technique, technology, or practice, from which a good deal of randomness in outcome has been removed.”

O.K.  Well let’s test some things out.  I must admit that physics and chemistry truly fit this definition quite well.  For example, through the scientific method, we have determined that when two hydrogen atoms bind to an oxygen atom, this results in the atomic structure for what we know as water.  No matter how many times this binding takes place, the result will be the same : water.  Thus, the systematic knowledge-based practice of chemistry has allowed us to remove all randomness of outcomes in this situation.  We can say that this practice results in a correct prediction.  When you bind two hydrogen atoms to an oxygen atom, you will get a water molecule.  Using this example, we can easily say that chemistry fits the definition of science.

What about physics?  Let’s take a scientifically derived equation from physics.  Force is equal to the mass of an object multiplied by its acceleration.  So we have an object of mass ‘x’ grams, with an acceleration of ‘y’ m/s2, which results in a force of ‘z’ Newtons.  This will occur every time, without fail, without question.  Using the above logic, we see that physics seems to fit the definition of science as well.

So my friend seems to be right about two things.  1. Chemistry is a real science.  2.  Physics is a real science.  But what about psychology?  Is psychology a “real science?”  I think I may have the answer.  In the field of psychology, clinical psychology to be specific, we use the scientific method to study human behavior.  The scientific method requires that you first start with a question.

For example, what is the most effective and reliable treatment for Post-Traumatic Stress Disorder?

Once we have a question, we formulate hypotheses.

For example, I hypothesize that the most effective and reliable treatment for PTSD will be antidepressant medication as well as brief psychodynamic intervention.  I believe that the combined treatment will be more effective than medication alone, and be more effective than brief psychodynamic intervention alone.

Once we have created our hypotheses, we now make a valiant attempt at formulating a way to test our hypotheses, with as few confounding variables as possible.

For example, we will perform a longitudinal study on a group of 300 individuals with the clinical diagnosis of PTSD.  We will normalize across the sample for socio-economic status, age, and severity of trauma.  100 subjects will be given antidepressant medication only.  100 subjects will be given brief psychodynamic intervention only.  And 100 subjects will be given medication plus brief psychodynamic intervention.  After 12 weeks, we will obtain outcome measures via self-report surveys, personality inventories, and reports from family.

Once we have designed a test, we then perform the test.  When we obtain our results, we then make a conclusion.

For example, based on statistically significant improvement in outcomes, we can conclude that brief psychodynamic intervention, combined with antidepressant medication, yields higher positive outcomes than medication alone, or treatment alone, for patients suffering from PTSD.

This is not a real study, nor are they real results.

So we see now, that clinical psychology uses the “real” scientific method in hopes to lessen variability in outcomes for people suffering from behavioral disorders.  So in this sense, we’re a real science.  But let’s examine this a bit further.  Though we use the scientific method, we can never truly eliminate variability in outcome in psychology.  Why is that?  Well, let’s go back to our chemistry example.  When dealing with water, you know that you are dealing with the ratio of two hydrogen atoms and one oxygen atom.  This is unchanging.  You can make more of it, or less of it, but its basic atomic structure is still the same.  As a result, we can make predictions about how this molecule will behave.  For example, we can study it to determine what it reacts with, whether it’s acidic or basic, what its specific heat is, etc.  With this information, we can accurately and flawlessly predict how this molecule will behave in nature.

What makes psychology different is that the object that we are studying is human behavior.  And the elements that make up our behavior, arguably, are our biological make-up, our experiences, and the evolution of humans as a species over thousands of years.  Because the biology and the tangible experiences of each human is so vastly different, there is no way to accurately remove all variability in behavior.  This is where psychology becomes beautiful, creative, dynamic.  The psychologist cannot simply follow an algorithm or a rubric as the physicist or chemist does.  What we do, is we use current scientific psychological research to empirically determine what type of treatment will be statistically most likely to be effective on a certain population.  But no person with PTSD will respond exactly the same to a treatment as another person.  This is where psychology asks its practitioners to be creative.  Ethically, in my opinion, we must apply the treatment that is the most likely to be effective, but we also have to consider culture, gender, age, socio-economic background, previous mental health concerns, ethnicity… an endlessly diverse number of variables in the human condition that will affect each person’s outcome.  So we use science, we use “real science,” and then we creatively monitor and vary treatments according to how the subject behaves.  Imagine how volatile water would be if every molecule behaved differently, even under the same conditions.  Imagine how boring humans would be if every human behaved exactly the same under the same conditions.  Maybe psychology isn’t a “real science.”  And I don’t care.  I’m not saying it is or it isn’t.  If it’s not, I’m glad it’s not.   If it is, I’m glad it is.

What I do know is that we cannot treat people, the objects of psychological science, as we do other objects of science.  And it is my opinion that the field of psychology often goes in that direction.  The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, attempts to assign a list of symptoms and labels to people who have mental disorders.  For example, according to the DSM IV, in order to have PTSD, “The person’s response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated behavior) (Criterion A2). The characteristic symptoms resulting from the exposure to the extreme trauma include persistent reexperiencing of the traumatic event (Criterion B), persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (Criterion C), and persistent symptoms of increased arousal (Criterion D). The full symptom picture must be present for more than 1 month (Criterion E), and the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion F).”  If the patient under consideration meets the criteria for diagnosis, then the practitioner has a list of effective treatments in hopes of alleviating PTSD symptoms.  One of the many problems in the DSM, in my opinion, is that you can find several anxiety disorders and even major depressive disorders that have almost identical criteria for diagnosis.  Thus, we find in the field that the reliability, or the ability of one practitioner to make the same diagnosis as another, is extremely poor.  The same patient, having discussed the same symptoms with multiple practitioners, could easily receive 4 or 5 different diagnoses, and thus receive different treatments.  This categorical approach to behavior is flawed, and takes away from the fluid process that psychological treatment should entail.

So, why do I want to be a doctor of psychology, you ask?  Well, I can’t think of anything I’d rather devote my life to than the science of human behavior.  It’s a fluid science, a creative science, a dynamic science.  It’s not categorical.  We can’t place humans in categories.  We behave on a continuous scale.  We don’t behave the same in nature, as water does.  We are as diverse as we are vast.  And, as a doctor of psychology, I will not treat humans as categories, nor will I endorse statistical manuals that promote that.  I don’t know the direction that the field will go.  But I know that soon, I’ll have a say in it.  And that’s why I want to be a doctor of psychology.