A recent article in the New York Times had the provocative title of “If you could add one book to the high school curriculum, what would it be?” The reporters (Concepcion de Leon, Lovia Gyarkye, and Tas Tobe) asked a number of well-known authors (whose works, I’m sad to say, I was largely unfamiliar with) to recommend a title. I was equally embarrassed to find that I had read only two of the books they recommended, even though one was by a psychologist: Stanley Milgram’s Obedience to Authority. I guess I have a lot of summer reading to do, and here it’s already September.
Even though I didn’t know anything about most of the books recommended, it was interesting to read these eminent authors’ rationales for recommending a book. Pretty much everything you’d want to see was on the list—a desire to teach enduring precepts (the Bible, the Epic of Gilgamesh), or to present a framework for understanding social problems (Milgram, Albert Murray’s The Omni-Americans, Nicola Yoon’s The Sun is also a Star, Heilbroner’s The Worldly Philosophers). All of the important authors who were surveyed sought to provide a frame for conceptualizing and maybe even solving major social problems. After all, who doesn’t at heart view themselves as a pedagogue, able to impart only the best lessons to the young, transmitting whatever small wisdom life has taught us to another generation, in the hopes that they will both be spared the hardship and pain of our unpleasant lessons and be inspired to do better than we have been able to? Needless to say, the Times reporters somehow overlooked me on their lists of go-to authors to find what classic volume I would recommend. At least this leaves me free to opine, for whatever it’s worth.
Hands down, the book I’d like to see high school students read is Richard Holmes’ The Age of Wonder, a brilliant history of the “second” scientific revolution in the early 19th century, the so-called era of Romantic Science. As Holmes noted in his introduction to this remarkable book, this was an era where the scientific revolution of the 17th century became democratized, where techniques of rigorous analysis, measurement, and experimentation became coupled with a metaphysical sense of the infinite, when scientists expressed themselves via poetry and poets expounded scientific precepts. Unlike in modern society, where walls between the “hard” sciences, social sciences, and literature and arts are increasingly rigid, Coleridge, Keats, Byron and Blake shared an intellectual curiosity regarding science, and often expressed this curiosity in verse, as did the scientists, though they were probably more successful at writing equations than iambic pentameter. Historically, the modern emphasis on the key experimental criterion of reproducibility can arguably be traced to experiments with nitrous oxide and other gases by Humphrey Davies, Joseph Priestley and others during this period, and the chemical revolution of the 19th century was the foundation, and remains a core pillar, of much of modern psychopharmacology. Although Holmes doesn’t make this particular link, it is not too much of a stretch to see that many of the foundations of modern clinical psychology were rooted in the Romantic Scientific revolution. Romantic scientists, for example, carried out systematic studies of the mind-altering properties of nitrous oxide. Although its role in anesthesia was observed, for a number of reasons it did not become a component of surgical practice for many decades. But the notion of repeated experimentation (even at great risk to the experimenter, as Davies inhaled many of the gases he manufactured, including carbon monoxide), careful observation of inner responses and reproducible results stuck, and became a part of the modern scientific method.
Around this time, we also began to explore the psyche systematically, rather in the narrative descriptions that had predominated before then. Modern concepts of psychosis, depression, and mania were carefully and systematically based on close observation and the reporting of case series. One rainy day several decades ago in a medical library I came across what I think is the first published description of postpartum depression in America, written at the height of Romantic Science in 1828. Leaving aside the joy of opening a book 150 years old and how sensing that book enriched the experience—the typeface, the archaic language, the heft and the smell of that old volume lending immediacy to my learning—it was clear that the author had on the basis of a careful case series deduced that puerperal mania, as it was then known, was a recognizable clinical phenomenon that had both physiological and psychological components. In a wonderful juxtaposition for me, Paul Meehl’s classic 1973 article “Why I no longer attend case conferences,” was a current reading assignment in the internship program where I was on faculty. Meehl’s dismissal of case conferences is eloquent and powerfully reasoned, in spite of its somewhat cranky title. His analysis stood in contrast to the rich, clinically based descriptions of the 19th century article I had just read. Now to be fair, Meehl wasn’t dismissing the power of clinical observation, and he certainly had a few choice words for misapplied standardized tests. His contempt was reserved for the way that observational data was construed, and the fallacious reasoning often employed to explain a patient’s behavior or shove her or him into a specific diagnostic box.
We are a profession of clinician scientists. We are schooled in science, our best therapeutic techniques are rooted in science, and we impart science to our students and, more importantly—even more so if we do it right—our patients. We teach our patients to be curious about themselves, not overwhelmed by their flaws or misperceptions. But most of us, I suspect, are like the Romantic scientists of the 19th century. The structured, logical processes we employ are charged with a sense of curiosity and wonder regarding the infinite and often unexpected variety of human experience. Although CBT is the therapeutic coin of the realm in most current empirical research, I imagine that whatever our avowed theoretical orientation, we all use a combination of humanistic techniques that tap into that sense of wonder (unconditional positive regard, accurate empathy, and reflective listening) to help our patients gain the courage to undertake a dispassionate analysis of their strengths and weaknesses and to identify areas for therapeutic change.
Though some theoreticians claim that intellectual roots of CBT lie in operationalizing the Stoic philosophies of two millennia ago, the functional basis of CBT is dispassionate structured inquiry into the self. That is, we teach the scientific method to our patients: We work with our patients to elucidate the schemae that underlie their sadness, guilt, and anxiety. We teach them to test assumptions, and, if we do our job right, we teach them another key of the scientific method—reproducibility. We teach them to apply the same technique to each problem they uncover. We teach them to be impartial and to recognize enduring schemae that allow them to correct inaccurate assumptions about themselves or others. Most patients, in my experience, are reluctant to expose themselves to a frank examination because of the fear that they will come up wanting, that they will validate yet another deficit or incorrigible flaw. Sometimes we talk about the courage to heal. In my mind, “healing,” or resolution, is the part of the process that involves the least amount of courage. What requires most courage is the initial decision to look dispassionately on one’s shortcomings and errors of omission and commission and set a path toward remedying them. This is a lesson that all of us who act as psychotherapists have learned. The techniques of CBT and other therapies can be scientifically developed, reproducibly assessed, and efficiently imparted to patients. But courage cannot be taught, nor can the exercise of will be easily manipulated. So when all is said and done, I suspect that it is our acknowledgement and encouragement of those inner resources, rather than any specific therapeutic technique, that leads to the lasting change we hope our patients will remember us for.
Copyright © 2018 National Register of Health Service Psychologists. All Rights Reserved.