I went shopping in town. Just off the high street there’s an advertisement — treatments for various things, including depression. But these are not ‘conventional’ treatments, they’re ‘alternative’.
The advertisement is in a centre for Chinese medicine, and the treatment on offer for depression is acupuncture. How can sticking needles in various parts of your body treat depression? What a daft idea!
But…how can eating various chemicals treat depression? That’s pretty daft too.
And…what about spending hours talking to some bloke about your thoughts? Is that not just as daft?
It’s difficult to know what to believe.
There are typically three possible reasons for believing something.
You might believe something because someone knowledgeable or powerful tells you to. This kind of belief depends on the authority of the person who tells you what to believe.
Or you might believe something because it seems sensible. This kind of belief depends on your personal mental model of how things are.
Or you might believe something because you tried it and you found out what happened. This kind of belief is scientific.
To complicate matters further, there are three kinds of science. Those three reasons
for believing things are well known, but the three kinds of science are not well known, and I’ll describe them in more detail.
Science began as a way to validate mental models of how things are. That is, if you are trying to make sense of things, and you are not sure about one particular aspect of your mental model, you can do an experiment to find out the answer.
Or, if two of you are trying to make sense of things, and you have different theories, you can do an experiment to find out which theory makes more sense.
I’ll call this kind of science hard science.
The tricky part of hard science is that an experiment can only be used to knock down a faulty theory. A theory is valid if it makes sense. A theory is invalid if experiments show it to be false.
The whole point of hard science is to find out what makes sense.
So originally there were only two reasons for believing things — authority and science. Science was founded on mental models of how things are, with experiments used to resolve any uncertainties and disputes. Science, hard science, was in direct opposition to authority.
When science became popular it was only the easy part — the experiments — that was popular. The hard part — making a mental model of how things are — was too hard. So a kind of science appeared in which making sense no longer had any value.
I’ll call this kind of science soft science.
In soft science, an experiment proves something. Whatever the experiment proves is true. It doesn’t matter whether the thing makes any sense or not, it must be true because an experiment proved it.
Equally, it doesn’t matter if two experiments prove that conflicting or opposite things are true. Soft science does not require the overall picture to make any sense. There is no overall picture. There is just a collection of truths.
This is the kind of science that we see reported in the news media. Today a research study showed that…whatever. It doesn’t matter if a research study yesterday or tomorrow shows something else, or the exact opposite.
The tricky part of soft science is that in the end it doesn’t help you to work out what to believe. Different experiments would have you believe different things all at the same time. Soft science gives you no way to decide.
So soft science makes you fall back on authority to choose between conflicting beliefs, all of which have been proved true by experiment. Soft science is in direct alliance with authority.
I was drafting this post, and in the draft there were just two kinds of science, hard and soft, when I came across this funny, rambling, and ultimately surprising and important TED talk by Nobel Prize winning biochemist Kary Mullis: Celebrating the scientific experiment
In it he describes two kinds of science, but they are not the same as my two. His first kind of science is what I am calling hard science. He has an idea. Then he uses experiment to test the idea. It’s all about his mental model of how things are. It’s not about truth. It’s about what works, what makes sense.
His second kind of science is completely fake. It’s when powerful people — authority — falsify experiments in order to make their authority seem more convincing. So this third kind of science goes even beyond soft science.
In soft science, the experiments are genuine and the results are true, but they might make no sense. In fake science, the experiments are faked and the results are phoney. If the results seem to make sense, you’ve been hoodwinked. Both soft science and fake science force you to rely on authority to decide what to believe.
So it turns out there are really only two reasons for believing things: common sense or authority. Common sense is backed by hard science. Authority is backed by soft science and fake science.
Returning to treatments for depression, acupuncture is in the weakest position. It is only backed by authority and soft science. There is a lot of theory behind it, but there is no common-sense reason to believe the theory. Many experiments have proved that it works, but many experiments have proved that it doesn’t, and soft science like that never helps you to decide what to believe.
Drug treatments are in a stronger position, but only slightly. There is common-sense reason to believe that eating certain substances affects mood, because it is our everyday experience with substances like sugar and alcohol. There is also a complex theory about mood based on the action of neurotransmitters in the brain, which antidepressant drugs influence. There is experimental evidence that proves drug treatments work.
But the experimental proof is soft science. In the usual way with soft science, other experiments prove conflicting things. Some experiments designed to validate the theory of neurotransmitters have indicated that the theory is wrong. Hard science does not support the model.
Talking therapies other than CBT are in a similar position to drug treatments. There is common-sense reason to believe that talking to other people affects mood, because that is our everyday experience. But neither common sense nor hard science supports the theoretical basis for most forms of psychotherapy. There’s plenty of soft science that proves one thing or another, and that’s the usual inconclusive result.
What distinguishes CBT is that the underlying theory makes sense. The theory is to do with the way thoughts, feelings and pattern-recognition (schemas) interact, and these are things that we all have everyday experience of. In practice, if you are a patient having CBT, all of the things you talk about and do as part of your therapy make sense. That’s the whole point of CBT. It’s hard science applied to emotional difficulties.
The authoritarian view of CBT is that it’s ‘evidence based’, supported by research that proves it works — soft science. A variety of treatments claiming to be CBT, but without the same theoretical basis, have jumped on the bandwagon, all with research proving they work too. This authoritarian view demeans CBT, making it seem no better than the rest. The authorities have a difficult time explaining why they recommend drug treatments despite the evidence against them, and why they don’t recommend acupuncture despite the evidence for it.
So if you’re shopping for a way to treat depression you have many choices — acupuncture, drugs, talking therapies, and probably others. Almost all of your choices come down to reliance on some authority telling you what to believe, except CBT. CBT comes down to reliance on your own common sense understanding of yourself.