Você ja se fez essa pergunta: EU SOU FELIZ REALMENTE?
As vezes por uma briga,a raiva toma conta da nossa alma e perdermos a alegria.
As vezes por uma decepção,achamos que não existe mais chances,e deixamos nos levar pela dor,sofrimento.
As vezes por não ser amado e não amar você deixa a amizade o companheirismo de lado
e se perde na solidão....
As vezes por estar passando por um problema e que voce não ter mais solução,você perde o otimismo a alegria de viver e ser feliz e se entrega de vez ao sofrimento e a tristeza!
As vezes por coisas como essas agente perde a oportunidade de ser feliz e fazer alguem feliz!
Então quando você brigar em vez de perder a alegria....se entregue ao reconciliamento.
Quando você sofrer uma decepção,em vez de achar que não tem mais chance lute por ela!
Quando você não for amado,em vez de se perder na solidão...procure sair dela e achar o amor!
E quando enfrentar um problema em vez de se entregar ao sofrimento e ao pessimismo..levante a cabeça e veja quantas coisas boas a vida tem para te oferecer e simplesmente viva e seja feliz,
não deixando de lado as responsabilidades e nem o deveres..!
e ai será que você responde a minha pergunta....VOCÊ É REALMENTE FELIZ?
rsrs abraços!
Friday, January 21, 2011
A arte de ser Feliz
Esta é mais uma oportunidade que você
tem para ser feliz.
Seja seu próprio motor de ignição.
O dia de hoje jamais voltará.
Não o desperdice, pois você nasceu
para ser feliz!
Enumere as boas coisas que você
tem na vida.
Ao tomar consciência do seu valor,
você será capaz de ir em frente com
muita força, coragem e confiança!
Trace objetivos para cada dia.
Você conquistará seu arco-íris,
um dia de cada vez.
Seja paciente.
Não se queixe do seu trabalho,
do tédio, da rotina,pois é o seu
trabalho que o mantém alerta,
em constante desenvolvimento pessoal e profissional,
além disso o ajuda a manter a dignidade.
Acredite, seu valor está em você mesmo.
Não se deixe vencer, não seja igual, seja diferente.
Se nos deixarmos vencer, não haverá surpresas,
nem alegrias.
Conscientize-se que a verdadeira felicidade
está dentro de você.
A felicidade não é ter ou alcançar,
mas sim dar.
Estenda sua mão. Compartilhe.
Sorria. Abrace.
A felicidade é um perfume que você
não pode passar nos outros
sem que o cheiro fique um pouco
em suas mãos.
O importante de você ter uma atitude
positiva diante da vida,
ter o desejo de mostrar o que tem
de melhor,
é que isso produz maravilhosos
efeitos colaterais.
Não só cria um espaço feliz para o
que estão ao seu redor,
como também encoraja outras pessoas
a serem mais positivas.
O tempo para ser feliz é agora.
O lugar para ser feliz é aqui!
Thursday, January 20, 2011
Retract That Seroxat?
Should a dodgy paper on antidepressants be retracted? And what's scientific retraction for, anyway?
Read all about it in a new article in the BMJ: Rules of Retraction. It's about the efforts of two academics, Jon Jureidini and Leemon McHenry. Their mission - so far unsuccesful - is to get this 2001 paper retracted: Efficacy of paroxetine in the treatment of adolescent major depression.
Jureidini is a member of Healthy Skepticism, a fantastic Australian organization that Neuroskeptic readers have encountered before. They've got lots of detail on the ill-fated "Study 329", including internal drug company documents, here.
So what's the story? Study 329 was a placebo-controlled trial of the SSRI paroxetine (Paxil, Seroxat) in 275 depressed adolescents. The paper concluded: that "Paroxetine is generally well tolerated and effective for major depression in adolescents." It was published in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP).
There's two issues here: whether paroxetine worked, and whether it was safe. On safety, the paper concluded that "Paroxetine was generally well tolerated...and most adverse effects were not serious." Technically true, but only because there were so many mild side effects.
In fact, 11 patients on paroxetine reported serious adverse events, including suicidal ideation or behaviour, and 7 were hospitalized. Just 2 patients in the placebo group had such events. Yet we are reassured that "Of the 11, only headache (1 patient) was considered by the treating investigator to be related to paroxetine treatment."
The drug company argue that it didn't become clear that paroxetine caused suicidal ideation in adolescents until after the paper was published. In 2002, British authorities reviewed the evidence and said that paroxetine should not be given in this age group.
That's as maybe; the fact remains that in this paper there was a strongly raised risk. However, in fairness, all that data was there in the paper, for readers to draw their own conclusions from. The paper downplays it, but the numbers are there.
*
The efficacy question is where the allegations of dodgy practices are most convincing. The paper concludes that paroxetine worked, while imipramine, an older antidepressant, didn't.
Jureidini and McHenry say that paroxetine only worked on a few of the outcomes - ways of measuring depression and how much the patients improved. On most of the outcomes, it didn't work, but the paper focusses on the ones where it did. According to the BMJ
On neither of these measures did paroxetine work better than placebo at the p=0.05 significance level. It did work if you defined 'responded' to mean only a final HAMD of 8 or below, but this was not how it was defined in the protocol. In fact, the Methods section of the paper follows the protocol faithfully. Yet in the Results section, the authors still say that:
Finally, there were also issues of ghostwriting. I've never been that concerned by this in itself. If the science is bad, it's bad whoever wrote it. Still, it's hardly a good thing.
Does any of this matter? In one sense, no. Authorities have told doctors not to use paroxetine in adolescents with depression since 2002 (in the UK) and 2003 (in the USA). So retracting this paper wouldn't change much in the real world of treatment.
But in another sense, the stakes are enormous. If this paper were retracted, it would set a precedent and send a message: this kind of p-value fishing to get positive results, is grounds for retraction.
This would be huge, because this kind of fishing is sadly very common. Retracting this paper would be saying: selective outcome reporting is a form of misconduct. So this debate is really not about Seroxat, but about science.
There are no Senates or Supreme Courts in science. However, journal editors are in a unique position to help change this. They're just about the only people (grant awarders being the others) who have the power to actually impose sanctions on scientists. They have no official power. But they have clout.
Were the JAACAP to retract this paper, which they've so far said they have no plans to do, it would go some way to making these practices unacceptable. And I think no-one can seriously disagree that they should be unacceptable, and that science and medicine would be much better off if they were. Do we want more papers like this, or do we want fewer?
So I think the question of whether to retract or not boils down to whether it's OK to punish some people "to make an example of them", even though we know of plenty of others who have done the same, or worse, and won't be punished.
My feeling is: no, it's not very fair, but we're talking about multi-billion pound companies and a list of authors whose high-flying careers are not going to crash and burn just because one paper from 10 years ago gets pulled. If this were some poor 24 year old's PhD thesis, it would be different, but these are grown-ups who can handle themselves.
So I say: retract.
Newman, M. (2010). The rules of retraction BMJ, 341 (dec07 4) DOI: 10.1136/bmj.c6985
Keller MB, et al. (2001). Efficacy of paroxetine in the treatment of adolescent major depression: a randomized, controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 40 (7), 762-72 PMID: 11437014
Read all about it in a new article in the BMJ: Rules of Retraction. It's about the efforts of two academics, Jon Jureidini and Leemon McHenry. Their mission - so far unsuccesful - is to get this 2001 paper retracted: Efficacy of paroxetine in the treatment of adolescent major depression.
Jureidini is a member of Healthy Skepticism, a fantastic Australian organization that Neuroskeptic readers have encountered before. They've got lots of detail on the ill-fated "Study 329", including internal drug company documents, here.
So what's the story? Study 329 was a placebo-controlled trial of the SSRI paroxetine (Paxil, Seroxat) in 275 depressed adolescents. The paper concluded: that "Paroxetine is generally well tolerated and effective for major depression in adolescents." It was published in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP).
There's two issues here: whether paroxetine worked, and whether it was safe. On safety, the paper concluded that "Paroxetine was generally well tolerated...and most adverse effects were not serious." Technically true, but only because there were so many mild side effects.
In fact, 11 patients on paroxetine reported serious adverse events, including suicidal ideation or behaviour, and 7 were hospitalized. Just 2 patients in the placebo group had such events. Yet we are reassured that "Of the 11, only headache (1 patient) was considered by the treating investigator to be related to paroxetine treatment."
The drug company argue that it didn't become clear that paroxetine caused suicidal ideation in adolescents until after the paper was published. In 2002, British authorities reviewed the evidence and said that paroxetine should not be given in this age group.
That's as maybe; the fact remains that in this paper there was a strongly raised risk. However, in fairness, all that data was there in the paper, for readers to draw their own conclusions from. The paper downplays it, but the numbers are there.
*
The efficacy question is where the allegations of dodgy practices are most convincing. The paper concludes that paroxetine worked, while imipramine, an older antidepressant, didn't.
Jureidini and McHenry say that paroxetine only worked on a few of the outcomes - ways of measuring depression and how much the patients improved. On most of the outcomes, it didn't work, but the paper focusses on the ones where it did. According to the BMJ
Here's the worst example. In the original protocol, two "primary" endpoints were specified: the change in the total Hamilton Scale (HAMD) score, and % of patients who 'responded', defined as either an improvement of more than 50% of their starting HAMD score or a final HAMD of 8 or below.Study 329’s results showed that paroxetine was no more effective than the placebo according to measurements of eight outcomes specified by Martin Keller, professor of psychiatry at Brown University, when he first drew up the trial.
Two of these were primary outcomes...the drug also showed no significant effect for the initial six secondary outcome measures. [it] only produced a positive result when four new secondary outcome measures, which were introduced following the initial data analysis, were used... Fifteen other new secondary outcome measures failed to throw up positive results.
On neither of these measures did paroxetine work better than placebo at the p=0.05 significance level. It did work if you defined 'responded' to mean only a final HAMD of 8 or below, but this was not how it was defined in the protocol. In fact, the Methods section of the paper follows the protocol faithfully. Yet in the Results section, the authors still say that:
Of the depression-related variables, paroxetine separated statistically from placebo at endpoint among four of the parameters: response (i.e., primary outcome measure)...It may seem like a subtle point. But it's absolutely crucial. Paroxetine just did not work on either pre-defined primary outcome measure, and the paper says that it did.
Finally, there were also issues of ghostwriting. I've never been that concerned by this in itself. If the science is bad, it's bad whoever wrote it. Still, it's hardly a good thing.
*
Does any of this matter? In one sense, no. Authorities have told doctors not to use paroxetine in adolescents with depression since 2002 (in the UK) and 2003 (in the USA). So retracting this paper wouldn't change much in the real world of treatment.
But in another sense, the stakes are enormous. If this paper were retracted, it would set a precedent and send a message: this kind of p-value fishing to get positive results, is grounds for retraction.
This would be huge, because this kind of fishing is sadly very common. Retracting this paper would be saying: selective outcome reporting is a form of misconduct. So this debate is really not about Seroxat, but about science.
There are no Senates or Supreme Courts in science. However, journal editors are in a unique position to help change this. They're just about the only people (grant awarders being the others) who have the power to actually impose sanctions on scientists. They have no official power. But they have clout.
Were the JAACAP to retract this paper, which they've so far said they have no plans to do, it would go some way to making these practices unacceptable. And I think no-one can seriously disagree that they should be unacceptable, and that science and medicine would be much better off if they were. Do we want more papers like this, or do we want fewer?
So I think the question of whether to retract or not boils down to whether it's OK to punish some people "to make an example of them", even though we know of plenty of others who have done the same, or worse, and won't be punished.
My feeling is: no, it's not very fair, but we're talking about multi-billion pound companies and a list of authors whose high-flying careers are not going to crash and burn just because one paper from 10 years ago gets pulled. If this were some poor 24 year old's PhD thesis, it would be different, but these are grown-ups who can handle themselves.
So I say: retract.
Newman, M. (2010). The rules of retraction BMJ, 341 (dec07 4) DOI: 10.1136/bmj.c6985Keller MB, et al. (2001). Efficacy of paroxetine in the treatment of adolescent major depression: a randomized, controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 40 (7), 762-72 PMID: 11437014
Retract That Seroxat?
Should a dodgy paper on antidepressants be retracted? And what's scientific retraction for, anyway?
Read all about it in a new article in the BMJ: Rules of Retraction. It's about the efforts of two academics, Jon Jureidini and Leemon McHenry. Their mission - so far unsuccesful - is to get this 2001 paper retracted: Efficacy of paroxetine in the treatment of adolescent major depression.
Jureidini is a member of Healthy Skepticism, a fantastic Australian organization that Neuroskeptic readers have encountered before. They've got lots of detail on the ill-fated "Study 329", including internal drug company documents, here.
So what's the story? Study 329 was a placebo-controlled trial of the SSRI paroxetine (Paxil, Seroxat) in 275 depressed adolescents. The paper concluded: that "Paroxetine is generally well tolerated and effective for major depression in adolescents." It was published in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP).
There's two issues here: whether paroxetine worked, and whether it was safe. On safety, the paper concluded that "Paroxetine was generally well tolerated...and most adverse effects were not serious." Technically true, but only because there were so many mild side effects.
In fact, 11 patients on paroxetine reported serious adverse events, including suicidal ideation or behaviour, and 7 were hospitalized. Just 2 patients in the placebo group had such events. Yet we are reassured that "Of the 11, only headache (1 patient) was considered by the treating investigator to be related to paroxetine treatment."
The drug company argue that it didn't become clear that paroxetine caused suicidal ideation in adolescents until after the paper was published. In 2002, British authorities reviewed the evidence and said that paroxetine should not be given in this age group.
That's as maybe; the fact remains that in this paper there was a strongly raised risk. However, in fairness, all that data was there in the paper, for readers to draw their own conclusions from. The paper downplays it, but the numbers are there.
*
The efficacy question is where the allegations of dodgy practices are most convincing. The paper concludes that paroxetine worked, while imipramine, an older antidepressant, didn't.
Jureidini and McHenry say that paroxetine only worked on a few of the outcomes - ways of measuring depression and how much the patients improved. On most of the outcomes, it didn't work, but the paper focusses on the ones where it did. According to the BMJ
On neither of these measures did paroxetine work better than placebo at the p=0.05 significance level. It did work if you defined 'responded' to mean only a final HAMD of 8 or below, but this was not how it was defined in the protocol. In fact, the Methods section of the paper follows the protocol faithfully. Yet in the Results section, the authors still say that:
Finally, there were also issues of ghostwriting. I've never been that concerned by this in itself. If the science is bad, it's bad whoever wrote it. Still, it's hardly a good thing.
Does any of this matter? In one sense, no. Authorities have told doctors not to use paroxetine in adolescents with depression since 2002 (in the UK) and 2003 (in the USA). So retracting this paper wouldn't change much in the real world of treatment.
But in another sense, the stakes are enormous. If this paper were retracted, it would set a precedent and send a message: this kind of p-value fishing to get positive results, is grounds for retraction.
This would be huge, because this kind of fishing is sadly very common. Retracting this paper would be saying: selective outcome reporting is a form of misconduct. So this debate is really not about Seroxat, but about science.
There are no Senates or Supreme Courts in science. However, journal editors are in a unique position to help change this. They're just about the only people (grant awarders being the others) who have the power to actually impose sanctions on scientists. They have no official power. But they have clout.
Were the JAACAP to retract this paper, which they've so far said they have no plans to do, it would go some way to making these practices unacceptable. And I think no-one can seriously disagree that they should be unacceptable, and that science and medicine would be much better off if they were. Do we want more papers like this, or do we want fewer?
So I think the question of whether to retract or not boils down to whether it's OK to punish some people "to make an example of them", even though we know of plenty of others who have done the same, or worse, and won't be punished.
My feeling is: no, it's not very fair, but we're talking about multi-billion pound companies and a list of authors whose high-flying careers are not going to crash and burn just because one paper from 10 years ago gets pulled. If this were some poor 24 year old's PhD thesis, it would be different, but these are grown-ups who can handle themselves.
So I say: retract.
Newman, M. (2010). The rules of retraction BMJ, 341 (dec07 4) DOI: 10.1136/bmj.c6985
Keller MB, et al. (2001). Efficacy of paroxetine in the treatment of adolescent major depression: a randomized, controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 40 (7), 762-72 PMID: 11437014
Read all about it in a new article in the BMJ: Rules of Retraction. It's about the efforts of two academics, Jon Jureidini and Leemon McHenry. Their mission - so far unsuccesful - is to get this 2001 paper retracted: Efficacy of paroxetine in the treatment of adolescent major depression.
Jureidini is a member of Healthy Skepticism, a fantastic Australian organization that Neuroskeptic readers have encountered before. They've got lots of detail on the ill-fated "Study 329", including internal drug company documents, here.
So what's the story? Study 329 was a placebo-controlled trial of the SSRI paroxetine (Paxil, Seroxat) in 275 depressed adolescents. The paper concluded: that "Paroxetine is generally well tolerated and effective for major depression in adolescents." It was published in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP).
There's two issues here: whether paroxetine worked, and whether it was safe. On safety, the paper concluded that "Paroxetine was generally well tolerated...and most adverse effects were not serious." Technically true, but only because there were so many mild side effects.
In fact, 11 patients on paroxetine reported serious adverse events, including suicidal ideation or behaviour, and 7 were hospitalized. Just 2 patients in the placebo group had such events. Yet we are reassured that "Of the 11, only headache (1 patient) was considered by the treating investigator to be related to paroxetine treatment."
The drug company argue that it didn't become clear that paroxetine caused suicidal ideation in adolescents until after the paper was published. In 2002, British authorities reviewed the evidence and said that paroxetine should not be given in this age group.
That's as maybe; the fact remains that in this paper there was a strongly raised risk. However, in fairness, all that data was there in the paper, for readers to draw their own conclusions from. The paper downplays it, but the numbers are there.
*
The efficacy question is where the allegations of dodgy practices are most convincing. The paper concludes that paroxetine worked, while imipramine, an older antidepressant, didn't.
Jureidini and McHenry say that paroxetine only worked on a few of the outcomes - ways of measuring depression and how much the patients improved. On most of the outcomes, it didn't work, but the paper focusses on the ones where it did. According to the BMJ
Here's the worst example. In the original protocol, two "primary" endpoints were specified: the change in the total Hamilton Scale (HAMD) score, and % of patients who 'responded', defined as either an improvement of more than 50% of their starting HAMD score or a final HAMD of 8 or below.Study 329’s results showed that paroxetine was no more effective than the placebo according to measurements of eight outcomes specified by Martin Keller, professor of psychiatry at Brown University, when he first drew up the trial.
Two of these were primary outcomes...the drug also showed no significant effect for the initial six secondary outcome measures. [it] only produced a positive result when four new secondary outcome measures, which were introduced following the initial data analysis, were used... Fifteen other new secondary outcome measures failed to throw up positive results.
On neither of these measures did paroxetine work better than placebo at the p=0.05 significance level. It did work if you defined 'responded' to mean only a final HAMD of 8 or below, but this was not how it was defined in the protocol. In fact, the Methods section of the paper follows the protocol faithfully. Yet in the Results section, the authors still say that:
Of the depression-related variables, paroxetine separated statistically from placebo at endpoint among four of the parameters: response (i.e., primary outcome measure)...It may seem like a subtle point. But it's absolutely crucial. Paroxetine just did not work on either pre-defined primary outcome measure, and the paper says that it did.
Finally, there were also issues of ghostwriting. I've never been that concerned by this in itself. If the science is bad, it's bad whoever wrote it. Still, it's hardly a good thing.
*
Does any of this matter? In one sense, no. Authorities have told doctors not to use paroxetine in adolescents with depression since 2002 (in the UK) and 2003 (in the USA). So retracting this paper wouldn't change much in the real world of treatment.
But in another sense, the stakes are enormous. If this paper were retracted, it would set a precedent and send a message: this kind of p-value fishing to get positive results, is grounds for retraction.
This would be huge, because this kind of fishing is sadly very common. Retracting this paper would be saying: selective outcome reporting is a form of misconduct. So this debate is really not about Seroxat, but about science.
There are no Senates or Supreme Courts in science. However, journal editors are in a unique position to help change this. They're just about the only people (grant awarders being the others) who have the power to actually impose sanctions on scientists. They have no official power. But they have clout.
Were the JAACAP to retract this paper, which they've so far said they have no plans to do, it would go some way to making these practices unacceptable. And I think no-one can seriously disagree that they should be unacceptable, and that science and medicine would be much better off if they were. Do we want more papers like this, or do we want fewer?
So I think the question of whether to retract or not boils down to whether it's OK to punish some people "to make an example of them", even though we know of plenty of others who have done the same, or worse, and won't be punished.
My feeling is: no, it's not very fair, but we're talking about multi-billion pound companies and a list of authors whose high-flying careers are not going to crash and burn just because one paper from 10 years ago gets pulled. If this were some poor 24 year old's PhD thesis, it would be different, but these are grown-ups who can handle themselves.
So I say: retract.
Newman, M. (2010). The rules of retraction BMJ, 341 (dec07 4) DOI: 10.1136/bmj.c6985Keller MB, et al. (2001). Efficacy of paroxetine in the treatment of adolescent major depression: a randomized, controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 40 (7), 762-72 PMID: 11437014
Sunday, January 16, 2011
Psychoanalysis: So Bad It's Good?
Many of the best things in life are terrible.
We all know about the fun to be found in failure, as exemplified by Judge A Book By Its Cover and of course FailBlog. The whole genre of B-movie appreciation is based on the maxim of: so bad, it's good.
But could the same thing apply to psychotherapies?
Here's the argument. Freudian psychoanalysis is a bit silly. Freud had pretensions to scientific respectability, but never really achieved it, and with good reason. You can believe Freud, and if you do, it kind of make sense. But to anyone else, it's a bit weird. If psychoanalysis were a person, it would be the Pope.
By contrast, cognitive-behavioural therapy is eminently reasonable. It relies on straightforward empirical observations of the patient's symptoms, and on trying to change people's beliefs by rational arguments and real-life examples ("behavioural experiments"). CBT practitioners are always keen to do randomized controlled trials to provide hard evidence for their success. CBT is Richard Dawkins.
But what if the very irrationality of psychoanalysis is its strength? Mental illness is irrational. So's life, right? So maybe you need an irrational kind of therapy to deal with it.
This is almost the argument advanced by Robert Rowland Smith in a short piece In Defence of Psychoanalysis:
Human relationships aren't built on rational, scientific foundations. They can be based on lots of stuff, but reason and evidence ain't high on the list. Someone who agrees with you on everything, or helps you to discover things, is a colleague, but not yet a friend unless you also get along with them personally. Working too closely together on some technical problem can indeed prevent friendships forming, because you never have time to get to know each other personally.
Maybe CBT is just too sensible: too good at making therapists and patients into colleagues in the therapeutic process. It provides the therapist with a powerful tool for understanding and treating the patient's symptoms, at least on a surface level, and involving the patient in that process. But could this very rationality make a truly human relationship impossible?
I'm not convinced. For one thing, there can be no guarantee that psychoanalysis does generate a genuine relationship in any particular case. But you might say that you can never guarantee that, so that's a general problem with all such therapy.
More seriously, psychoanalysis still tries to be scientific, or at least technical, in that it makes use of a specialist vocabulary and ideas ultimately derived from Sigmund Freud. Few psychoanalysts today agree with Freud on everything, but, by definition, they agree with him on some things. That's why they're called "psychoanalysts".
But if psychoanalysis works because of the therapeutic relationship, despite, or even because, Freud was wrong about most things... why not just chat about the patient's problems with the minimum of theoretical baggage? Broadly speaking, counselling is just that. Rowland Smith makes an interesting point, but it's far from clear that it's an argument for psychoanalysis per se.
Note: A truncated version of this post briefly appeared earlier because I was a wrong-button-clicking klutz this morning. Please ignore that if you saw it.
We all know about the fun to be found in failure, as exemplified by Judge A Book By Its Cover and of course FailBlog. The whole genre of B-movie appreciation is based on the maxim of: so bad, it's good.
But could the same thing apply to psychotherapies?
Here's the argument. Freudian psychoanalysis is a bit silly. Freud had pretensions to scientific respectability, but never really achieved it, and with good reason. You can believe Freud, and if you do, it kind of make sense. But to anyone else, it's a bit weird. If psychoanalysis were a person, it would be the Pope.
By contrast, cognitive-behavioural therapy is eminently reasonable. It relies on straightforward empirical observations of the patient's symptoms, and on trying to change people's beliefs by rational arguments and real-life examples ("behavioural experiments"). CBT practitioners are always keen to do randomized controlled trials to provide hard evidence for their success. CBT is Richard Dawkins.
But what if the very irrationality of psychoanalysis is its strength? Mental illness is irrational. So's life, right? So maybe you need an irrational kind of therapy to deal with it.
This is almost the argument advanced by Robert Rowland Smith in a short piece In Defence of Psychoanalysis:
...The irony is that in becoming more “scientific”, CBT becomes less therapeutic. Now, Freud himself liked to be thought of as a scientist (he began his career in neurology, working on the spinal ganglia), but it’s the non-scientific features that make psychoanalysis the more, not the less, powerful.Rowland Smith's argument is that psychoanalysis offers a genuine therapeutic relationship complete with transference and countertransference, while CBT doesn't. He also suggests that analysis is able to offer this relationship precisely because it's unscientific.
I’m referring to the therapeutic relationship itself. Although like psychoanalysis largely a talking cure, CBT prefers to set aside the emotions in play between doctor and patient. Psychoanalysis does the reverse. To the annoyance no doubt of many a psychoanalytic patient, the very interaction between the two becomes the subject-matter of the therapy.
The respected therapist and writer Irvin Yalom, among others, argues that depression and associated forms of sadness stem from an inability to make good contact with others. Relationships are fundamental to happiness. And so a science that has the courage to include the doctor’s relationship with the patient within the treatment itself, and to work with it, is a science already modelling the solution it prescribes. What psychoanalysis loses in scientific stature, it gains in humanity.
Human relationships aren't built on rational, scientific foundations. They can be based on lots of stuff, but reason and evidence ain't high on the list. Someone who agrees with you on everything, or helps you to discover things, is a colleague, but not yet a friend unless you also get along with them personally. Working too closely together on some technical problem can indeed prevent friendships forming, because you never have time to get to know each other personally.
Maybe CBT is just too sensible: too good at making therapists and patients into colleagues in the therapeutic process. It provides the therapist with a powerful tool for understanding and treating the patient's symptoms, at least on a surface level, and involving the patient in that process. But could this very rationality make a truly human relationship impossible?
I'm not convinced. For one thing, there can be no guarantee that psychoanalysis does generate a genuine relationship in any particular case. But you might say that you can never guarantee that, so that's a general problem with all such therapy.
More seriously, psychoanalysis still tries to be scientific, or at least technical, in that it makes use of a specialist vocabulary and ideas ultimately derived from Sigmund Freud. Few psychoanalysts today agree with Freud on everything, but, by definition, they agree with him on some things. That's why they're called "psychoanalysts".
But if psychoanalysis works because of the therapeutic relationship, despite, or even because, Freud was wrong about most things... why not just chat about the patient's problems with the minimum of theoretical baggage? Broadly speaking, counselling is just that. Rowland Smith makes an interesting point, but it's far from clear that it's an argument for psychoanalysis per se.
Note: A truncated version of this post briefly appeared earlier because I was a wrong-button-clicking klutz this morning. Please ignore that if you saw it.
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