May 22, 2024

Wednesday Open Comments

Monday’s newsletter wandered in the vicinity of psychotherapy and its legitimacy. Such is life, it seems. Just when you think you’ve earned your place, others come along to question the basis of your existence.

The questioning was two-fold: whether there is a scientific basis for psychotherapy in general, and whether it makes any sense to apply its practices to youngsters who don’t have complete individual autonomy outside the family yet. I had personal experience with the latter, which created a large foundation for finding psychotherapy applied to children potentially far worse than no therapy at all.

Most of you reported having experiences with psychotherapy that you found helpful in various ways. You found the treatment methods, which differed as widely as the reasons for seeking treatment, to be as helpful as promised. That in itself is grounds enough for the field’s legitimacy: It has a proven track record of helping people, whether or not it is based on thorough and affirming scientific research.

From my reading of science reporter Gary Taubes, who has done a comprehensive job documenting the history of parts of medical science, it is clear that the bits of medicine we would like to believe have a basis in rigorous scientific research and validation in fact have no such basis at all. Much of medical practice is based on a lot of tradition going back generations and millennia. A lot of the practice thus has more to do with hand-me-down traditions passed along as standards of care rather than developed in clinical labs from scratch. The scientific rationales are tacked on as afterthoughts.

The scientifically based elements are more commonly found in the modern elements of pharmaceuticals and surgical interventions.

It’s entirely possible that some treatment has not been proven good or effective by rigorous scientific trial—and yet that it is effective. There is a lot we still don’t understand about the universe, including the details of our own biology and our own minds. The benchmark should be whether a particular course of treatment works for you as an individual patient in the context of your own life. We still rely on a lot of things that we don’t fully understand, even though we may have elaborate academic theories that pretend our comprehension is complete.

It all comes down to the internet nostrum of YMMV. If psychotherapy works for you, or some medical intervention helps you defeat some ailment, then that particular therapy can be considered perfect, or at least good enough. The scientific validation is not the ultimate yardstick at the individual level.