Cartoon man with pills 521.
(photo credit: The Dallas Morning News/MCT)
Almost three centuries ago, Voltaire declared that doctors “prescribe medicines
of which they know little, to cure diseases of which they know less, with human
beings of whom they know nothing.”
The same critique, according to Jerome
Kagan, an emeritus professor at Harvard University, where he co-directed the
Mind/Brain Behavior Inter-Faculty Initiative, can be applied to
psychologists. The discipline has declined from a position of prominence,
Kagan suggests, because psychologists rarely question the concepts and
analytical methods that shape their work.
In Psychology’s Ghosts, Kagan
mounts a bold, blistering and bracing root-and-branch critique of the current
methods of experimentalists and clinicians.
Although biologists have long
recognized that responses can result from more than one set of conditions,
researchers in psychology, he argues, continue to base their conclusions on
single variables rather than patterns, relying on statistical techniques
(including regression analysis and co-variance) to control for – and sometimes
exclude – conditions that may well be “essential to the causal sequence.” They
do not often enough consider the immediate setting “in which measurements of
brain, behavior or verbal replies are gathered,” concludes
According to the author, assuming that concepts such as fear,
self-regulation, well-being, security and happiness are “contextually naked,”
moreover, psychologists often underestimate the influence of social class and
Kagan is especially tough on psychologists’ identification and
treatment of mental illnesses. He claims that a majority of psychiatrists, and
many psychologists, assume, without adequate empirical evidence, that mental
disorders, including anxiety and depression, are analogous to malaria or
diabetes in that they reflect abnormal brain profiles produced by chemical
imbalances or defective genes.
In recent years, they have replaced the
broad concept of madness with a host of illnesses (schizophrenia, bipolarity,
autism, ADHD), differentiated by “presenting symptoms,” largely because
insurance companies demand a standard diagnostic label.
depression lasting a month or two, provoked by illness, job loss or the death of
a loved one, Kagan reminds us, are normal reactions and not mental disorders.
Nagg, a character in Samuel Beckett’s play Endgame, noted, “You’re on Earth.
There’s no cure for that.”
Equally important, clinicians who classify
their patients as suffering from a disease invariably treat them with
drugs. These days about half of Americans with a mental-health problem
are treated with a pill; only 2 percent get psychotherapy; and clinicians appear
to have increasingly less confidence in the therapeutic value of changing the
individual’s life circumstances.
Kagan insists that no currently
prescribed drug for any mental illness “is a magic bullet.” Acting like a blow
on the head, drugs treat symptoms and often have side effects. For patients with
moderate levels of depression and anxiety, placebos are just as
Acknowledging that some drugs can be helpful for some
patients, and that the baby should not be thrown out with the bathwater, Kagan
nonetheless concludes that we do not know why a drug works when it does. He adds
that because, in part, of the corrupting alliance between the pharmaceutical
industry, physicians and therapists, drugs are now vastly
Kagan paints with a broad brush. Many of his
colleagues will, no doubt, find his characterizations of their discipline to be
unfair and inaccurate. They may notice, as well, that Kagan himself is not
immune from presenting some of his intuitions as established facts.
claims, for example, that Americans are in “a despondent mood” because air
pollution, anger, cheating, crime, debt and divorce dominate the headlines; that
competitive pressure makes students less willing to offer help to classmates;
that John Wilkes Booth may have felt he had a right to assassinate Abraham
Lincoln because he belonged to a celebrated family of actors; and that the
Japanese attacked the United States in 1941 because they felt they were a
superior race, entitled to revenge for being treated as inferiors by
Nonetheless, with its detailed reassessments of
well-entrenched principles (including John Bowlby’s theory that the quality of
the attachment between infant and mother has a profound and enduring impact on
every child’s future), Psychology’s Ghosts should command the interest of anyone
interested in the field.
Although he is comfortable analyzing the role of
endophenotypes (inherited features that predict symptoms) and with sophisticated
statistical methods, Kagan is a rarity: a humanistic-social scientist, willing
to challenge his fellow psychologists to read history; account for cultural (and
individual) differences; know that “not everything that counts can be counted,
and that not everything that can be counted, counts”; and that “ethical
intrusions seep into investigations of personality and pathology.”
impressive of all, he is able to take as his mantra J.B.S. Haldane’s observation
that “the universe is not only queerer than we suppose, but queerer than we can
suppose,” without being at all deterred from returning to the lab in hot pursuit
of the rejuvenation that accompanies “the re-injection of more or less directly
The writer is the Thomas and Dorothy Litwin Professor
of American Studies at Cornell University.