We have reached a crucial point in our investigation. We have seen that Randomized Control Trials are not really suitable for testing the effectiveness of psychotherapy and psychoanalysis. We have also seen that when focusing on psychoanalysis our standard methodologies for collecting evidence do no justice to it. So, what do we do?
First we need to understand (and accept) that the approach of a psychoanalyst is fundamentally different to the approach of the clinician; it's not better or worse, it's different.
(In fact it's because of this difference that many feel inclined to argue that psychoanalysis is not a health profession for all intents and purposes of the Health Professions Council. But that's another story.)
The analyst cannot know in advance. He can only formulate a hypothesis and begin working on the basis of this hypothesis. He will be observing very carefully all material the young woman is bringing to the sessions, and will be adjusting his hypothesis, he will reject it if necessary and formulate another.
The only confirmation that an analyst can have, his evidence if you will, lies in the material the analysand brings –and not in any pre-constructed and pre-given gauges that he could apply at will. I think that this is the main problem we face: we are trying to find objective, "scientific" measurements for something which is inherently subjective. This is not possible.
What I have just written might sound strange, and perhaps unacceptable when considering the "factual" character of certain “hard” sciences, like, for instance, physics or chemistry, or psychiatry for that matter.
But not all “hard” sciences have this character.
In a previous post I likened the work of psychoanalysis to that of an antibiotic, stressing the fact that psychoanalysis does not deal with symptoms directly. If I may use another comparison now, I would say that from all sciences psychoanalytic theory is akin to cosmology.
Let’s see why.
A cosmologist studies and tries to understand the universe. He (or she) has theories that talk about big bang, gravity, inflation, acceleration of inflation, background radiation, Hubble's constant, Einstein's cosmological constant, dark matter, dark energy, Higgs bosons etc. He (or she) has partial differential equations describing all phenomena, has big tables with calculations and observation data, has computer programmes that do simulations.
But the universe our cosmologist is studying, is only one of a kind, the one we live in. In contrast to what happens with all other hard sciences, a cosmologist has only one item to study. In other words, the cosmologist studies an individual, not a species, or a genus, or a family etc.
He constructs models that account for his current observations, but if he wants to test these models he can only make assumptions and try to collect more observations –he cannot design “cosmological” experiments.
Granted, he can attempt employ results of other experiments such the ones which will be conducted at CERN (especially the ones regarding the Higgs boson), but in doing so he will be taking a leap of faith.
There is no reason whatsoever to be convinced that the same laws that apply on Earth, or even in our galaxy, apply for the whole of the universe –let alone a proof. It’s just a hypothesis, and we may choose to believe it, but it's a belief that --sadly--cannot be tested.
In other words, cosmology does not meet Karl Popper's falsification criterion, and therefore, according to Popper, should not be considered a science proper.
You know, I am not playing with ideas here; that’s an actual debate.
So… what do we do then?