PSYCHOANALYSIS AND SCIENTISM: A DIALOGUE WITH MAREK SINASON

            In a recent blog “Symington on Psychoanalysis and Intellectual Disability” I criticised a hypotheses of Neville Symington on the cause of low IQ in people with intellectual disability. I argued that Symington’s hypothesis did not stand up to critical scrutiny and that he should take into account facts from developmental psychology and neuroscience to help him develop a superior account. Marek Sinason a neuroscientist disagreed with my criticism. Our debate got very heated and both of us felt that the other had inadvertently misrepresented the views of the other. At the end of our dialogue Marek suggested that I re-read his criticisms and this will demonstrate that I was misreading him. So I decided that in this blog I would try to revisit our discussion and to see whether we can clarify what our beliefs actually are and perhaps find some common ground.

To some degree our dispute is unusual. I am a philosopher who supports philosophical naturalism. So a large part of my time is spent defending attempts to naturalise epistemology and to naturalise metaphysics. Another area of research I am deeply involved in is attempting to explain: intentionality, consciousness, and language naturalistically. Marek on the other hand is a scientist who thinks that science has scopes and limits and it should not be extended beyond those limits. He argues that areas like folk psychology, psychotherapeutic dialogue, and literature have their own evidence and their practices are not diminished by not being reduced to physics and chemistry.

Marek’s position did not centre primarily on issues of scientism. His first criticism of my view was that the interdisciplinary research was not always beneficial. He gave some examples where interdisciplinary research would not necessarily be beneficial:

“ While many professions may benefit from learning of the fruits of others it is another thing to imply they are deficient without them. For example, geography teachers may benefit from learning about neuroscience, child development, programming, criminal law, Shakespeare…yet they may be very good teachers without the benefits of this additional expertise.

As a thought experiment, I find it useful to consider what are the realms of knowledge of other disciplines you would consider important for an adult mathematician to know about to not consider them deficient or worse, to consider the products of mathematics redundant?”

My reply was that I wasn’t arguing for interdisciplinary research in all areas and I agreed with his geography teacher example. I see no reason why a geography teacher necessarily needs to be an expert on any of the above topics. However in the case of psychoanalysis since they are making developmental claims and claims about the mind/brain they obviously have a duty to know the relevant neuroscience and developmental psychology. Our dispute on this issue went back and forth for a while. I continued claiming that as psychoanalysis is an empirical scientific discipline then its practitioners should know relevant facts that cast doubt on the truth of key claims they make. Here Marek disagreed with my characterisation of psychoanalysis as a science and pointed out that not all analysts agreed with this claim:

 “While there may be psychoanalysts who think the interdisciplinary work with neuroscience is worthy of a new discipline Neuropsychoanalysis. Others, such as Wilfred Bion, who served in a Tank Commander before studying medicine and then psychoanalysis did not consider those without this experience or interest were deficient.”

It was here that our dispute became interesting and a lot more heated. I argued that psychoanalysts are making claims about developmental issues and these issues are in fact scientific claims whether analysts acknowledge this or not. I further argued that such psychoanalysts are not doing their jobs if they do not modify their theories as we learn new scientific facts about the world.

Marek’s reply to me was that my argument presupposed that I knew what the objective truth on all these developmental psychology matters was. In other words that I was naively assuming that there was one true theory of child development and that Symington was ignoring this one true theory:

“Is Spelke’s wrong or right about intellectual differences between men and women? What is the empirical truth? What would you like ALL psychoanalysts and ALL psychologists to think on this matter?”

To this I replied that I did not have to be able to solve every question in contemporary psychology in order to judge that Symington had made a claim that was simply incorrect. I argued that Symington’s theory had absolutely no empirical evidence to support it and hence there was no reason to believe it was true. Marek’s claim about disputes within current developmental psychology struck me as beside the point. So, for example, there are current disputes within medicine on various subjects but nobody thinks that this means that we cannot know that current research has more to support it than the ideas of Galen. Or that because contemporary cosmologists disagree about the nature of string theory then we have no reason to think their theories are superior to Thales’s cosmology.

When looking back to our above debate I noted that Marek never answered my above question. So I repeat it here. I would like him to answer the following questions: (1) Does he think that there is a fact of the matter as to whether Symington’s claim about the causes of low IQ  being the result of a psychic turning away from reality is true? (2) If he thinks there is a fact of the matter what is the evidence that we could bring to bear on it? (3) If he thinks there is no fact of the matter does he think the same thing holds true of physics. Does he think that there is no fact of the matter as to whether say the cosmology proposed by Stephen Hawking is more correct that the cosmology proposed by Thales?

I think that part of our dispute may have arisen from me thinking that his argument that the fact that there are debates within contemporary developmental psychology means that we cannot judge the truth or falsity of Symington’s theory. It was for this reason that I called Marek a postmodernist. I think now I may have misinterpreted his views so if he answers my above three questions this will help me understand his point of view on the matter. If I misunderstood his position I apologise. Obviously I would have good reason to oppose the introduction of “anything goes” postmodernism into psychology, in the same way I would  oppose it being introduced into medicine,  because such an introduction would cause a lot of vulnerable people to be put in harm’s way. However given that I cannot say for certain that Marek supports postmodernist views I should not have argued so aggressively in our discussion. I should note that buying into the metaphysics of ‘facts of the matter’ and correspondence theories of truth are not the only way to deal avoid the terrors of post-modernism, personally I prefer Quinean holism (with the idea that Coherence leads to Correspondence) splashed with pragmatism. However perhaps a discussion of this point should wait till Marek answers my three questions above.

I don’t want to continue to go back and forth on the same points. I concede that Marek is not denying that evidence is important in judging psychoanalytic theory. He is merely trying to propose that interdisciplinary research is not necessary always a good thing. I agree with this to this to some degree but think that with psychoanalysis research from neuroscience and developmental psychology is relevant. This is not to dismiss the importance of intersubjective dialogue between the analyst and analysand. The majority of cases of psychoanalysis and psychotherapy in general involve emotional and existential crises. So, for example, a person may develop trust issues because of his early relationship with his primary care giver. These trust issues may result in the person being isolated and feeling depressed. Working through these issues with an analyst can probably be done without any medication and be facilitated by an emphatic analyst. However there are other cases where analysts will hold beliefs that medication is a bad thing and that all depression is the result of some childhood trauma. In this case a person who suffers from purely endogenous depression will present himself to the analyst be advised that medication is a bad thing and proceed to spend 150 a week on therapy looking for a cure that never comes. Surely this type of case can be avoided by analysts having some biological training.  Having this training doesn’t mean that the analyst is acting as a rival to the doctor offering alternative diagnoses, rather it is just a way of educating analysts so they can be aware of patients who they may not be able to help without medical intervention. Nurses, are for example trained in basic psychology, biology, etc not so they can offer alternative diagnosis to doctors but so they can manage their patients care as best as possible and contact specialists as needed. I see no reason why psychoanalysts shouldn’t have similar training.

I acknowledge Marek’s point that interdisciplinary research is often full of people making naive comments that seem silly from the point of view of people who are experts in the relevant fields. I am not proposing witch hunts on people who make naive mistakes. It is impossible to be an expert on everything so howlers are always going to happen. Within linguistics experts in syntax often make claims about phonology that experts in phonology would consider outdated or naive. My point about Symington was that his theory was false and that this could have consequences for patient care so I think he could do with modifying his theory. I still think that I am correct on this point. If Marek disagrees with me I would be interested in his reasons for thinking that Symington’s hypothesis is correct.

I mentioned that analysts who are ignorant of biology could end up causing harm to their patients. I think the history of Hysteria (now known as conversion disorder) bears this out. Hysteria is a case where people have some of the following symptoms: Feeling Unwell, Lipothymias, Vague diffuse states of fatigue, angry outbursts. (Spasms, and Paralysis are normally only found in women not men), but multiple conversion pains are common in men, as well as fear of heart disease, digestive disturbances, poorly defined neurodigestive disorders (Dor p, 97). In hysteria patients typically present symptoms which they think represent a particular disease however their symptoms actually only correspond to their own inexact idea of their body. So a patient may present with heart trouble and be complaining about they think their heart is as opposed to where the heart actually is. When they are informed about this fact their symptoms are moved to the appropriate bodily position. It is for this reason that it is assumed to be psychosomatic.

Throughout history psychoanalysts have treated people with supposed hysteria when in fact such patients were suffering from the early stages of a neurological disorder like MS. Now if a patient presents himself to an analyst with what seems to be hysteria then the analyst needs to be mindful that what seems to be hysteria could be real neurological disorder. Neurologists sometimes have difficulties diagnosing disorders like MS, MMD, or Parkinsons in their early stages. Some psychoanalytic schools have no close ties with biology so they may not be in any position to recognise when a person’s symptoms are indicating a biological as opposed to a psychological disorder. So a patient could spend a long time and a lot of money in analysis until such time as their actual disorder overwhelms them. I think that with hysteria an analyst has a responsibility (which should be legally enforced) to work with a multi-disciplinary team. In fairness most analysts are very honest and responsible people who will insist that the patient submit himself for vigorous medical tests while undergoing analysis. However I don’t think this should be left to the individual analyst but should be a matter of health board and government decision. I am not sure if this counts as scientism in Marek’s book but it seems to be just good sense to me.

Near the end of our discussion Marek made a point which I think needs to be discussed further:

“To the extent we have communicated at all, that was by virtue of the (incomplete) powers of dialogic exploration. This facility of human relations affords many things including the explorations and evaluations of ideas and formulas that may or may not have any value or applicability in this Universe at any time, or at least not right now. We did not have recourse to construct a testable hypothesis and collect statistical data to interpret before replying to each other. When speaking with individuals rather than standard deviations, there are things that can be explored that may or may not generalise beyond the confines of that dialogue…yet a dialogue may still be, powerful, moving, funny or a waste of time.
I do not feel the need to ridicule or undermine the power of dialogue or other forms of human relations in order to appreciate the value and limits of modern science. If you were to sit through a lecture on the science of humour you might agree.”

I agree with Marek on this point to some degree. When communicating with each other were not constructing testable hypothesises explicitly and statistical data to interpret each other; not at the personal level anyway. At the sub-personal level we were noticing statistical patterns in what was being said to us, we were also our background knowledge to help us construct our arguments and trying to form pictures of each other’s cognitive models, theoretical commitments etc. Most of this was of course done unconsciously. A scientist could of course try to rationally precisely what was going on, however if they ignored that we are intentional agents engaged in process of trying to communicate with each other they would miss a lot. If a scientist focused entirely on say the physics and bio-physics of the situation they would have real pattern in our environment i.e. our intentional communication. So I agree that at this stage of our development the best way to interpret each other’s behaviour is through adopting the intentional stance.  This is the intersubjective level of discourse you speak of and I agree it is very important. It may be the case that eventually some form of eliminative materialism is vindicated and we can predict and control our sociological environment by adopting design level or physical level explanations of human behaviour, however I don’t think that we are anywhere near that level of explanation. So for now our best explanation is intentional explanations in terms of propositional attitude ascription. So if my friend tells me he will meet me at the St Patricks day parade at 2 o clock I will be able to accurately predict his behaviour ceteris paribus. This will not be a scientific explanation just a bland use of folk psychology that is good enough for most purposes. Freud suggests enriching our folk-psychology by attributing to people propositional attitude level explanations which we are unconscious but which influence our behaviour. I think that this does give us some kind of useful predictive and explanatory power. And I agree with Marek that employing this approach in intersubjective communication between analyst and analysand has real explanatory power and it is not power that is best explained in-terms of physics level descriptions. Not at our present level of development anyway.