There are dogmatists (and many of them) of this variety who think that they can be good mental health professionals by simply applying the truths of, say, Freud (or Prozac) to all. This article, and the 2 that will follow in future issues, are addressed to those who know that they do not know or at least want to know more.
When faced with persons who are mentally ill, we clinicians need to first determine what their problems are and then what kinds of treatments to provide. In both cases, particularly in the matter of treatment, we need to turn somewhere for guidance. How should we treat patients?
We no longer live in the era of Galen and pointing to the opinions of a wise man is insufficient (although many still do this). Many have accepted that we should turn to science, that some kind of empirical research should guide us.
If we accept this view—that science is our guide—then the first question becomes: how are we to understand science?
Science is not simple
This article and those that will follow would be unnecessary if science was simple. I would like to disabuse the reader of any simple notion of science, specifically “positivism.” This view holds that science consists of positive facts, each piled on one after another—each of which represents an absolute truth, or an independent reality—and that our business is simply to discover those truths or realities.
This is simply not the case. Science is much more complex.
For the past century, scientists and philosophers have debated this matter. A partial summary might be as follows: facts cannot be separated from theories; science involves deduction, and not just induction. In this way, no facts are observed without a preceding hypothesis.2 Sometimes, the hypothesis is not fully formulated, or even conscious: I may hold a number of assumptions that direct me to look at certain facts. In this sense, philosophers say that facts are “theory-laden.” But between fact and theory, no sharp line can be drawn.
A scientific revolution
The rise of statistics was really a revolution; it was a major change in our thinking about science. Before, even the most enlightened thinkers (such as the French Encyclopedists of the 18th century, and Auguste Comte in the 19th century) saw science as the process of developing absolutely certain knowledge through refinements of sense-observation. Statistics is based on a different concept—the notion that scientific knowledge, derived from observation using our 5 senses that are aided by technologies, is not absolute. Hence, “the basic idea behind the statistical revolution is that the real things of science are distributions of number, which can then be described by parameters. It is mathematically convenient to embed that concept into probability theory and deal with probability distributions.”3
It is thus not an option to avoid statistics, if one cares about science. And if one understands science correctly, not as a matter of absolute positive knowledge but as a much more complex probabilistic endeavor, then statistics are part and parcel of science.2 Some doctors hate statistics; but they claim to support science. They cannot have it both ways.
1. Silverman WA. Where’s the Evidence? Debates in Modern Medicine. New York: Oxford University Press; 1998.
2. Fulford K, Thornton T, Graham G. Oxford Textbook of Philosophy and Psychiatry. Oxford, UK: Oxford University Press; 2006.