Man Without Qualities

Tuesday, January 28, 2003


Society, science and responsible people place a heavy, affirmative burden on those advocating a medical procedure to demonstrate that it is both safe and effective. And "effective" means consistently and objectively effective. It is perfectly fine for those with a certain deep religious faith to journey to Lourdes and admire the associated miracles, for example. A miracle is supposed to be something operating beyond the bounds of predicable scientific law, so it is no criticism of Lourdes to point out that it is not "scientific." The Man Without Qualities deems people who find their faith in Lourdes or other miraculous events neither weak of mind nor unintelligent. But a doctor, medical association or medical school that recognized a journey to Lourdes as a medical procedure would not easily find favor here - or in most of the medical or scientific community. The main question would be whether mere denunciation is enough, or whether an officially sanctioned tarring and feathering is appropriate.

The effects of this heavy, affirmative burden can be quite controversial. For example, chiropractory claims to be scientifically based medical procedure, and has been beating at the door of medical legitimacy for quite some - generally to be rebuffed. The Man Without Qualities lives in Los Angeles, perhaps the world capital of chiropractory, and knows many people who routinely submit themselves to its care. For the most part, I find their claims of benefits from these procedures to be more a testimony to their personal inability to locate the right brand of good masseur than to any efficacy of chiropractory. But my point here is not to condemn chiropractory. Instead, I note that chiropractory has been broadly refused acceptance as a medical procedure because its advocates have not been able to carry the required heavy, affirmative burden of demonstrating sufficient efficacy. No serious person tarries for more than a moment or two over the argument that the mere existence of a great many patients willing to testify that they were helped by chiropractory is substantial evidence of efficacy. Obviously, controlled, scientific studies are the only acceptable evidence. That is the rule.

What, then, is one to make of the curious persistence of psychoanalysis (as distinguished from other forms of psychotherapy) as an acceptable medical procedure? The body of materials documenting the lack of psychoanalytic efficacy is huge. Psychoanalysis is expensive and, worse, time consuming. The field itself harbors a truly disturbing focus on its founder, Freud, bearing a strong similarity to the focus of a religious cult on its main prophet. In this sense, psychoanalysis is at a distinct disadvantage to chiropractory.

Yet, the New York Times reports today on the survival of psychoanalysis as an apparently approved, if minority, medical procedure. Worse, the Times article all but endorses psychoanalysis as a medical procedure.

The article almost willfully avoids the basic question that is almost always thrown up at chiropractory: Where is the demonstrated ability of psychoanalysis to carry the heavy, affirmative burden on those advocating a medical procedure that it is both safe and effective?

Instead, we are given snapshots of patients willing to state they like psychoanalysis, a survey of how psychoanalysis has changed, and the ultimately preposterous conclusion that much of the tarnish that clings to psychoanalysis derives from an earlier time, when rigid neo-Freudian orthodoxy was the rule.

The Times is grossly in error. The "tarnish" that "clings" to psychoanalysis is the absence of repeated, broad, hard, clinical, scientific studies demonstrating that psychoanalysis is efficacious. Until that support is provided – and psychoanalysis has had almost a century of failure in this regard – psychoanalysis and chiropractory are medical and scientific equals.

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