The evidence-based revolution in psychology.
A revolution is taking place in the world of human psychology. Before the revolution, psychology relied on untested, sometimes untestable assumptions about an abstraction called the mind, and science had no important role. After the revolution, there will be a new science where psychology now stands.
In a recent Scientific American article entitled “Faulty Circuits”, Thomas Insel, director of the National Institutes of Mental Health (NIMH), describes recent efforts to bring an evidence-based, scientific perspective to the diagnosis and treatment of psychological ailments. Insel says, “From the scientific standpoint, it is difficult to find a precedent in medicine for what is beginning to happen in psychiatry. The intellectual basis of this field is shifting from one discipline, based on subjective ‘mental’ phenomena, to another, neuroscience. Indeed, today’s developing science-based understanding of mental illness very likely will revolutionize prevention and treatment and bring real and lasting relief to millions of people worldwide.”
We’re witnessing a fundamental change — a sweeping reëvaluation of psychology’s content, interpretation and methods. Until recently clinical psychologists have attempted to diagnose and treat what are called “mental illnesses”, which by definition are behaviors that originate in psychological abnormalities or “mental states”, and are therefore addressable using psychological methods. But in recent decades, strong evidence has begun to suggest that what we call mental illnesses are actually symptoms of physical illnesses, and any meaningful diagnoses and treatments will require an understanding of the physical conditions that produce those symptoms.
Psychologists have recently begun to experience great pressure to abandon subjective clinical evaluations and treatments in favor of evidence-based methods — methods that require objective criteria to establish a diagnosis or choose a treatment. But many psychologists have objected to these pressures, arguing that such a change would expose them to the risk of malpractice lawsuits. Of course, they are right — if a mental illness can be objectively diagnosed and effectively treated, then the possibility of a clinical failure would exist for the first time. (Under the present system, because there’s no objective measure of success, there’s no measure of failure, and no one can be held to account.)
But there is a much more compelling reason for clinical psychologists to resist evidence-based methods, and it’s a reason many do not fully appreciate — the possibility exists that there are no mental illnesses, at least as that term was once defined:
Mental illness (old definition): An abnormal, debilitating condition originating solely in the mind, reliably diagnosable using psychological methods, and successfully treatable using psychological techniques.
Most modern definitions of “mental illness” don’t agree with the above traditional one — many now include the possibility that some mental illnesses have causes and remedies apart from psychological ones, but to date the implications of that fact haven’t significantly changed clinical practice.
In this article I will show that, until now, psychology has operated under an assumption for which there was and is little evidence, and that we are in the midst of a complete change in the understanding of mental illness. I will show that the end result of the present revolution will be the abandonment of psychology and its replacement with a new branch of medicine with objective diagnoses and treatments. The bad news is that — yes! — the new practitioners might get sued for clinical misbehaviors. The good news it that this will become true only because there will be objective diagnoses and treatments that actually work.
I predict that the present revolution will succeed for the best of reasons — the ascendancy of reason over belief — and twenty years from now an evidence-based medical discipline will have replaced psychology. The latter will continue to exist but will be ranked alongside astrology.
I have one more prediction: all the conditions we now believe to be mental illnesses will either be reclassified as physical illnesses with mental symptoms, or will be recognized as behaviors not meriting the label “mental illness.” In short, what we now think of as mental illness as defined above, will be exposed as a myth.