It has been dubbed the “bible” of psychiatry, and indeed the Diagnostic and Statistical Manual of Mental Disorders
(DSM) is taken by many as exactly that. Every new version of this publication, prepared by the American Psychiatric Association, is considered to contain the latest and more advanced criteria for the classification and diagnosis of mental disorders.
Acceptance has not been unanimous, though. For many of its critics, the DSM has been too unreliable, far too prescriptive and yet quite vague, very much geared towards the compartmentalization of human behaviour, very much conforming to the wishes of the big Pharmaceutical companies –in short: very problematic.
The news, then, that after more than sixty years of near hegemony –at least in the U.S.– the DSM is pushed aside by the US National Institute of Mental Health (NIMH), cannot but be welcome. A research framework is being introduced for collecting data for a new understanding of mental disorders, a "new nosology", away from DSM.
Is there, at last, room for optimism? Are we finally about to enter an era of scientific psychiatry which will (hopefully) settle all disagreements and clear out all ambiguities for good?
was about a new technique, whereby researchers are said to be able to reconstruct words, based on the brain waves of patients thinking of those words
. I was reminded of an anecdote about Lacan
, one of the most important post-Freudian psychoanalysts.
In 1975, during a lecture tour in the United States, Jacques Lacan spoke at MIT before an audience of mathematicians, linguists, and philosophers. Noam Chomsky, the already famous by then American linguist philosopher and activist, attending the lecture, asked Lacan a question on thought.
Lacan's reply was possibly not what Chomsky expected:
“We think we think with our brains”, Lacan said. “Personally, I think with my feet. That's the only way I really come into contact with anything, solid. I do occasionally think with my forehead, when I bang into something. But I've seen enough electroencephalograms to know there's not the slightest trace of a thought in the brain.”
I was reading something on the BBC today, regarding the “decoding” by science of people’s “internal voices”. The
I wrote about a scientific paper that claimed that “most published research findings are false”. I identified the three slightly different conceptions of truth that the abstract of that paper was alluding to, and suggested, as a work hypothesis, that we differentiate between “real truth” and “scientific truth”.
I ended that post rather abruptly and at a somewhat provocative point. I claimed that science does not have anything to do with reality
I acknowledged, however, that this would need to be clarified.
This is what I shall attempt to do today: to clarify.
So science “does not have anything to do with reality”.
How did we get to this conclusion? What does it mean?
The other day I came across a very intriguing research paper, bearing a very provocative title: “Why Most Published Research Findings are False
”. Published in 2005, this paper was written by John P.A. Ioannidis, a medical professor specializing in epidemiology. His claim is simple (I quote from the abstract of the paper): The probability that a research claim is true may depend on study power and bias, the number of other studies on the same question, and, importantly, the ratio of true to no relationships among the relationships probed in each scientific field. In this framework, a research finding is less likely to be true when the studies conducted in a field are smaller; when effect sizes are smaller; when there is a greater number and lesser preselection of tested relationships; where there is greater flexibility in designs, definitions, outcomes, and analytical modes; when there is greater financial and other interest and prejudice; and when more teams are involved in a scientific field in chase of statistical significance.
Now, as you might imagine, a scientific paper with such a subject matter would be sure to attract a lot of attention, both positive and negative, and that was indeed the case. But I do not intend to participate in the debate, and this is not the reason I am bringing up this paper here.
I am more interested in the concept of truth, especially in the way it is employed in papers such as Ioannidis’, i.e. in current scientific research.
In my previous post
I commented upon two experiments that attempted to address the question of free will from the point of view of modern neuroscience. I ended my post by suggesting a thought experiment to the reader. If a scientist informed you that he or she knows with scientific certainty the numbers you are going to play in the lottery, what would you do?
My guess was that very possibly you would avoid playing those numbers, if for no other reason, just to prove this arrogant scientist wrong!
The point of this thought experiment was to show that, at the level that our actual decisions are being taken, we are the sole masters in the house, and, crucially, that discussions about our “free will” and about all what science can, or cannot, claim in regards to it are a bit confused.
In a famous experiment of the 80s, neuroscientists claimed that they managed to show that what we, humans, call “free will” simply does not exist. The setting of their experiment was rather simple. A number of volunteers were wired with electrodes and their brain activity was monitored. Then they were asked to choose whether they would flex their fingers or their wrists. They were instructed to first report when they had made their choice and then actually flex their fingers or their wrists.
The neuroscientists running the experiment identified a consistent pattern in the recorded brain activity. Signals were appearing a split second before the volunteers were able to report that they had made their choice. A split second is not much, you would think, but when a scientist is able to show that a result in an experiment cannot be attributed to chance, then this scientist might want to interpret it.
This those scientists did. They explained this pattern of brain activity, observed just before an actual choice was made, as evidence that “unconscious neural processes” determined the volunteers’ actions before they were ever aware of making a decision. They gave it the name “readiness potential”.
This is a question I often get from people when they first meet me. "You are a psychoanalyst", they say. "Right..." And then, after a moment of hesitation: "Excuse my ignorance, but I am always confused. A psychoanalyst. What does it mean? You are a doctor, aren't you? Are you a psychiatrist? A psychologist? No? So, what are you? What's the difference?"
You see, all those Greek words, made up by people who were not Greeks at a time when creating "new" Greek words was fashionable, are more or less opaque for whomever does not have much familiarity with the so called Psi world. They are compound terms, sharing the first bit, "psych-" (which comes from Psyche, i.e. Soul.)
So, we have:
- Psychiatrist < Psychiatry < psyche + iatreia, ‘cure’.
- Psychologist < Psychology < psyche + logos, 'discourse, study'
- Psychotherapist < Psychotherapy < psyche + therapeia, 'nursing, cure'
- Psychoanalyst < Psychoanalysis < psyche + analysis, 'separation into components, close examination'
All this is very interesting, but did not answer the question. What's the difference?
There was a very interesting article on the New Scientist website, about the question of consciousness. The author, Ray Tallis, argues
that we have failed to explain how consciousness equates to neural activity inside the skull because the task is self-contradictory
Tallis, a Professor of geriatric medicine at the University of Manchester, and Fellow of the Academy of Medical Sciences, challenges the "orthodoxy", held by most neuroscientists and philosophers of the mind
, that very soon scientists will be able to explain the mystery of human consciousness in terms of the activity of the brain. He stresses, however, that his argument is not about technical limitations; rather it is about the deep philosophical confusion embedded in the assumption that if you can correlate neural activity with consciousness, then you have demonstrated they are one and the same thing, and that a physical science such as neurophysiology is able to show what consciousness truly is
This is the sort of things you see in films or read in novels –"Johnny Took his Gun" by Dalton Trumbo or "The Patient" by Georges Simenon are but two of the examples that spring to mind– but the report that circulates all media since yesterday is very real. A paralysed Belgian man who doctors thought was in coma for 23 years was conscious all along. It was only recently that a scan showed that his brain was "almost entirely" functioning. You can read the BBC report here
I cannot begin to grasp what it must have been this experience for this poor man, but I can very vaguely imagine. A recent book and film used the metaphor of a diving bell. You are inside your body as if you are inside a diving bell. It's alright when you can control your diving bell. You swim around and interact with all other beings in diving bells you encounter. Suddenly something happens and you loose control of the diving bell. Your life as such is not threatened; but you can't communicate any more, you can't interact. You are trapped inside.
You must have heard it by now. Contrary to current belief, antidepressants work much faster what previously thought, in fact within hours of taking the drug. This is, according to BBC, what Oxford University researchers found. " Although patients may not notice the effects until months into the therapy, the team say they work subconsciously", writes
BBC Health reporter Michelle Roberts.
I have to say that I found this reference to subconscious work intriguing, given that of all Freudian concepts, the concept of the Unconscious mind is the one that is contested the most, both "scientifically" and philosophically (you can read some comments on the subject here
). But this is not the reason I am posting this. What I was more interested in learning was how did they do it exactly, how did the researchers manage to observe the possible "subconscious" effects of a treatment?
I read, for example, lead researcher Psychiatrist Dr Catherine Harmer quoted as saying the following: "We found the antidepressants target the negative thoughts before the patient is aware of any change in feeling subjectively." Does this really mean that the researchers were able to measure changes in the negative thoughts of patients objectively
the patients themselves knew of any changes?