Psychology's Ghosts: The Crisis in the Profession and the Way Back

Too many mental-health professionals are blind to context, believes Steven Schwartz

June 14, 2012

In the first scene of Hitchcock Loves Bikinis (which you can find on YouTube), a young mum is happily playing with her baby. Next comes a close-up shot of Alfred Hitchcock, the late movie director, smiling. Clearly, he is a man whose heart is warmed by this sweet glimpse of maternal love. In the next scene, we see a bikini-clad woman sunbathing followed by exactly the same shot of Hitchcock smiling. Instead of a benign grandfatherly figure, this time we see a lecherous old man. The moral of the story is simple: context is everything.

Psychologist David Rosenhan's famous 1973 escapade, in which people presented themselves to psychiatry clinics pretending to hear voices, made much the same point. Most of Rosenhan's "pseudo-patients" were diagnosed as schizophrenic and hospitalised. Once in the psychiatric ward, everything the pseudo-patients did was interpreted as a sign of their "illness". For example, nurses described a patient who kept a diary as indulging in "pathological writing behaviour".

Given that Hitchcock has been dead for years and Rosenhan's prank is almost 40 years old, readers might think that modern psychologists would be alert to the importance of context. Alas, they are not. In Psychology's Ghosts, Jerome Kagan's trenchant analysis of modern psychology's shortcomings, psychological concepts such as fear, well-being and happiness are shown to be "contextually naked". Psychologists, who should know better, act as if these concepts mean the same thing across cultures, age groups and nationalities.

In addition to ignoring context, Kagan, himself a distinguished Harvard psychologist, identifies other problems in modern psychology: a failure to distinguish among different evidence-gathering procedures; making inferences based on single, often unreliable, measures; defining mental illnesses by self-reported symptoms and treating them with non-specific drugs and therapies. The common theme is a tendency to oversimplify human behaviour by ignoring the differences between people, places and situations.

Kagan deftly shows how ignoring contextual and individual differences restricts the generality, reliability and validity of psychological research. For example, he chastises experimental psychologists who assume that the US college student volunteers who participate in psychology experiments adequately represent all people on earth.

Similarly, Kagan criticises "happiness" researchers for assuming that all people mean the same thing when they say they are "happy". A minute's thought shows that Kagan must be right. Sadists are happy hurting others while masochists derive pleasure from pain. Both claim to be happy; they just hold diametrically opposite ideas about what happiness means.

Kagan is particularly critical of the way in which mental illnesses are diagnosed and treated. He is worried about the scientism, medicalisation and questionable ethics that pervade the field. Kagan admits that he is not the first to voice these concerns. Thomas Szasz made the same points in his book, The Myth of Mental Illness: Foundations of a Theory of Personal Conduct, published in 1961.

Kagan sounds most like Szasz when he decries the overuse of psychoactive drugs. He prefers a therapeutic approach focused on helping people adapt to the slings and arrows of life. Disappointingly, Kagan does not cite Szasz, which poignantly reinforces George Santayana's famous quip that those who do not remember the past are condemned to repeat it.

Curiously, for someone acutely concerned with social context, Kagan can be rather parochial. For example, he attributes psychiatry's universal obsession with diagnostic labels to the demands of US health insurance companies. Psychiatrists who work in the quasi-socialist NHS or in fee-for-service environments such as Hong Kong prioritise diagnosis just as much as their US colleagues, despite not having to deal with insurance companies.

In the course of the book, Kagan indulges himself in numerous digressions featuring broad generalisations (Americans feel despondent because of air pollution), peculiar opinions (the Japanese targeted Pearl Harbor because they felt slighted by Americans) and sheer impenetrability ("Buddhist scholars celebrate a lifestyle that celebrates dilute emotional bonds... "). Close editing would have helped enormously. It would also have curbed Kagan's habit of padding out his sentences with long lists of nouns ("worry, sadness, guilt, shame, frustration, and anger"; "painting, play, novel, memoir, or poem").

It is worth persevering, however, because Kagan is not just a critic. He also offers a way forward, showing how psychologists can increase reliability by using multiple data sources and how they could make their ethical choices transparent. Most important of all, this book reminds readers of a basic and central truth: that human behaviour cannot be understood apart from its historical, social and biological context.

Psychology's Ghosts: The Crisis in the Profession and the Way Back

By Jerome Kagan

Yale University Press 320pp, £25.00 and £38.40

ISBN 9780300178685 and 9780300184914 (e-book)

Published 30 May 2012

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