Wednesday, February 18, 2015

House of Cards, by Robyn Dawes

Book cover House of Cards - Psychology and Psychotherapy Built on Myth is a very good book that needs more recognition. It describes and really criticizes the lack of scientific method in psychology and debunks the myth of the experienced psychologist as well as many others that are now taken for granted in the field. Unfortunately the book is also very detailed, filled with expositions, repetitions of concepts and statistical information on the studies that prove the author's point, so it is rather difficult to read; it is certainly not a book you take to help you relax. Every psychologist in the world should read it, though, as well as any aspiring students or people considering going to therapy.

To make it clear, this is not an anti-psychology book. It continuously says that therapy helps. What it also says is that the amount of training and experience of the therapist is statistically irrelevant. That irritates the author tremendously, as he is a psychologist himself and desires that his chosen scientific field evolve and ... well... become a real science. Robyn Dawes unfortunately died in 2010, at the ripe age of 74. During his life he studied human irrationality, intuitive expertise and statistical applications in medicine and psychology. No wonder that in House of Cards, he is ranting against the practice of psychology as it is today.

A few concepts in the book are very interesting and quite frightening. After WW2, a lot of people came traumatized and needed mental attention. At the time, a psychologist needed to be a psychiatrist as well, having gone through the university and studied medicine; they were all doctors, with a Ph.D. degree. So what they did in the US was to create another type of degree, called Psy.D, letting people without medical training enter the field, with only minimal instruction. This created the myth of the intuitive expert who can tell things about people because he has experience, having little else. Dawes proceeds to mercilessly debunk this myth.

In order to do that, he uses - what else - the scientific method. He gathers data as objectively as possible and then tries to find correlations. One correlation that is not found is one between amount of experience (or indeed, formal training) and positive results. One that is, though, is that therapy does help. We just don't know (or better said, we don't know how to quantify) why. One obvious reason would be that, in order to come to therapy, people need to accept they have a problem and then make the first step in solving it: showing up. This alone shows that the person is already actively pursuing healing, a major step into healing themselves. He also analyses diagnosis, often using standardized tests that presumably can help a specialist determine mental issues and their type. However, presented only with test results, the experts don't really get to any useful conclusion.

Dawes is not stopping at psychology, even if that is his main focus. In one chapter he speaks of studies that have proven that doing a thing for a long time doesn't necessarily teach you anything, especially if there is no immediate feedback on whether what you did was good or bad. This also applies to some types of medical diagnosis. And yes, those people went through school - that has the main purpose to promote people who can get through it much more than to provide a comprehensive body of knowledge - and graduated, but when faced with ambiguous symptoms, they pretty much randomly guess what the patient is afflicted by. Think about that when you go to just one doctor and he tells you that he knows what you have because he's experienced.

Anyway, as I said, the book is difficult to read, it is more like a scientific paper and, as much as I wanted to finish it, I realize that I am not an aspiring psychologist, nor am I planning to go to therapy soon. Also, since I have people close to me interested in the field, it wouldn't help to talk to them about how they don't use the scientific method and they are not real doctors ;). Joke aside, this book is invaluable for anyone in the field. Not for me, though, and so I decided to indefinitely postpone reading it to the end.