Last year I reviewed Tomasz Witkowski and Maciej Zatonski’s book Psychology Gone Wrong where they pointed out that many of psychology’s accepted beliefs and therapies were not based on good evidence. Now Witkowski has written a new book, to be published later this year, Psychology Led Astray: Cargo Cult in Science and Therapy, that is certain to ruffle a lot of feathers. He compares psychology to cargo cults. He says, “the cargo cult phenomenon is virtually absent in physics, chemistry, and mathematics, yet it runs rampant in both psychology and sociology.” He uncovers cargo cult practices in psychology, unmasking therapies that are devoid of science, dangerous, and even cruel, especially those directed at children.
Richard Feynman was the first to compare the contemporary social sciences, including psychology, to a cargo cult. For those not familiar, the term “cargo cult” originates with the natives in Melanesia, who were awestruck by the planes that landed on their islands during WWII bringing all kinds of supplies. They had no understanding of what airplanes were or where they came from. Magical thinking led them to create bamboo replicas of planes and control towers in the superstitious belief that it would attract planes and bring them material goods. Similarly, many psychology researchers have been imitating the methods of science without really understanding how science is supposed to work. They go through the motions, but their research designs are so poorly thought out and the methodology so poor that their results are meaningless. And then they use those meaningless results to guide therapy. They have been led astray, have deceived themselves, and have harmed patients.
Witkowski’s book starts with a brilliant discussion of how the human mind works and how it evolved thinking processes that frequently lead to errors. Next he provides a thorough discussion of cargo cults, with far more detail than I have read elsewhere. It’s fascinating stuff, especially about the huge variety of cargo cults (at least 55) and the ones that have persisted into the 21st century because of deliberate deception, self-deception, and confusion of reality and beliefs.
Is psychology a science or a deception?
If psychologists were good scientists and psychotherapies based on evidence were effective, we would expect psychology to have had more of an impact on the world by now. We would expect to see an improvement in statistics regarding mental health and crime, fewer people suffering from depression, fewer suicides, etc. In reality we find that as the number of psychotherapists rises, the number of patients rises, and the mental health statistics get worse.
John Holt did not have much doubt in this regard:
The person whose main lifework is helping others needs and must have others who need his help. The helper feeds and thrives on helplessness, creates the helplessness he needs.
Are we involved in an act of profound deception where we bear responsibility for the upkeep of thousands of scientists who engage themselves in utterly idle efforts?
There are 500 kinds of psychotherapy; few disappear. The most successful are integrated with popular beliefs and traditions. Cargo cult prophets discourage empirical validation. Freud said “the wealth of reliable observations on which these assertions rest makes them independent of experimental verification.” Witkowski explains why people believe in ineffective treatments and why “American clinical psychologists put more trust in their own clinical experience supported by reports of their colleagues than in the scientific evidence”
To recommend a method whose consequences include the systematic and daily experience of suffering, one must possess an overwhelming certainty that the positive effects of the therapy are sufficient to counterbalance its negative ones. Unfortunately, pseudoscientific psychologists do! They have strong convictions just like the majority of cargo cult priests do. Convictions built without a foundation, resting on the pillars of mere opinion, enhanced with thin anecdotal evidence; there is precious little empirical proof to be found.
Why is this so common? He covers a long list of factors that contribute to the blossoming of psychobusiness. Anything can be called therapy today. We have color therapy, sand play therapy, nature walk therapy, and laughing therapy. If parents buy a dog, does that mean their child is getting dog therapy?
He provides numerous examples of prominent cargo cult therapies that have become well established and are rarely questioned. He suggests they should become the subject of investigations by ethnographers whose field of interest encompasses analysis of cults, myths, rites, superstitions, and other man-made constructs.
Adult Children of Alcoholics
Adult children of alcoholics (ACoA) is a recently coined diagnostic category with a laundry list of symptoms that are used to support the diagnosis. The concept has been expanded to include dysfunctional families, including most of the population.
The approach acclaimed by the ACoA movement and affiliated therapists is a peculiar brew of common sense, half-truths and common observations on psychology, metaphors, false assertions and harmful recommendations.
People waste their lives exploring imaginary problems or things that will not necessarily lead to solving their real problems. Harms include labels and social stigma, belief that we are not responsible, and digging up dirt from the past.
Psychotherapy for cancer?
The Simonton “mind over matter” method of psycho-oncology is alleged to double survival rates in cancer patients. It’s basically a marketing lie based on faulty research. Contrary to common belief, there is no association between emotions, stress, and cancer rates. Scientists have failed to identify any link between positive attitudes, emotional states, and cancer survival. In some properly-done studies we can even observe the opposite effect; workplace stress is associated with a reduced risk of breast cancer! Encouraging patients to think positively is not only an extra burden imposed on them in a difficult situation, but also deprives them of vital social support.
As the American Cancer Society concluded:
After careful study of the literature and other information available to it, the American Cancer Society does not have evidence that treatment with O. Carl Simonton’s psychotherapy method results in objective benefit in the treatment of cancer in human beings.
Cognitive-behavioral therapy, encompassing training in relaxation, stress-management and problem-solving techniques, has been shown to produce better mood, reduce psychological suffering, and improve perception of quality of life in cancer patients. But it doesn’t prolong their survival.
The disaster industry
Critical incident psychological debriefing is another example of cargo cult psychology. A Cochrane review concluded:
There is no current evidence that psychological debriefing is a useful treatment of posttraumatic stress disorder after traumatic incidents. Compulsory debriefing of victims of trauma should cease.
The helpers felt better. Sometimes the patients felt worse.
The current WHO recommendations on psychological debriefing say:
Psychological debriefing should not be used for people exposed recently to a traumatic event as an intervention to reduce the risk of posttraumatic stress, anxiety or depressive symptoms. Strength of recommendation: STRONG.
Child abuse and related nonsense
The Doman-Delacato Method is intended to treat brain damage in children and to increase the intellectual potential of non-impaired children. They claim that
our individual genetic potential is that of Leonardo, Shakespeare, Mozart, Michelangelo, Edison, and Einstein. … Our individual potential race is not that of our parents or grandparents. … All intelligence is a product of the environment.
They make fantastic claims like having taught one-year-old old brain injured children to read. They use ridiculous treatments requiring a tremendous time investment, with patterning, masking, hanging the child upside down, vitamins, diet, etc. They have built a worldwide empire. Witkowski’s critique is devastating.
Educational kinesiology (Paul Dennison and Brain Gym®) has been funded by government and is used in 87 countries. Ben Goldacre calls it “a scientific explanatory framework that is barkingly out to lunch.”
Attachment therapy and holding therapy has led to child torture and numerous deaths.
Studies use unreliable measures of problems and treatment results. They rely on subjective reports from parents and on questionnaires that have not been validated. These methods continue to be used because of unprincipled profit-motivated people, ignorance, or inability to admit they were wrong.
The list goes on
There is no end to psychological pseudoscience and pseudotherapies. A few of the other topics Witkowski covers (some covered here on SBM):
- Facilitated communication
- Neurolinguistic programming
- Dolphin assisted therapy
- The Vojta method of rehabilitation by “priming”
- The Tomatis method of auditory integration
- Sensory integration therapy
- Imaging as the new phrenology
- Dr. Amen’s SPECT scans
- Prefrontal lobotomies (an all-too-rare example of a cargo cult therapy that was finally rejected).
A suggested remedy
Baker and his colleagues have recommended changes in the existing accreditation system within the APA. They would stigmatize unscientific training programs, as well as those practitioners who use methods that are scientifically unproven. They justify this call with similar changes that have been successfully put into practice in medicine.
They say all therapies that are not empirically confirmed should be classified as an “experimental therapy,” and patients should be recognized as “medical subjects.” They suggested that using problematic therapeutic interventions such as the “facilitated communication method” in the case of autistic children should be treated as a criminal act.
I would propose the term “therapies in the phase of uncontrolled experiments on humans” as an alternative.
Guidelines for patients
When deciding to undergo therapy, one should remember that we are choosing from at least a few hundred schools and modalities, many of which are in conflict with one another. Only a handful of them can boast empirically proven effectiveness.
Patients should ask these questions:
- Is there evidence for the treatment?
- Is there a way to get redress if the treatment causes harm?
- Is the therapist a member of a professional society with a code of ethics or a code of good practices?
- Is there a system of supervision of therapists?
- What will happen if you lose the ability to pay or if you move away?
- Does your therapist record the course of therapy in a manner enabling him to transfer you as a patient to another specialist?
- Does your therapist follow precise procedures and standards of operation so that the new therapist will be able to determine what has been done and what still needs to be addressed?
- Did your therapist define the purpose of the therapy, and is he able to determine when the goals will be achieved? Or, rather, does he treat the whole process as a creative act, in which you are the medium, and nobody apart from him is able to “complete the masterpiece”?”
- Does your therapist have liability insurance?
- Are your therapist’s belief systems compatible with your own – atheist, Catholic?
Conclusion: It’s not all doom and gloom
It’s not all doom and gloom. The book ends on a positive note, with a letter to Richard Feynman chastising him for calling the whole field a cargo cult. Witkowsi draws Feynman’s attention to examples of good science in psychology that have had demonstrable benefits for society, for instance the studies on reaction time in response to different configurations of brake lights that led to laws requiring a third brake light on vehicles, dramatically reducing the number of rear-end collisions, injuries, and repair costs.
There are some errors in the book: AIDS is lumped with untreatable diseases, and the chapter on statistics is poor, with a misleading explanation of p values. But on the whole, there is a lot of valuable information here. Even if you don’t agree with calling these travesties of science cargo cults, it will make you wonder which other generally-accepted psychological principles and therapies are based on good science. This book is the second part of a trilogy; I look forward to volume 3.
This article was originally published in the Science-Based Medicine Blog.