by Morton Hunt
—bipolar disorders: lithium and several other medications are effective; psychosocial treatments, including CBT, increase medication adherence.
—bulimia: antidepressant drugs produce significant short-term reduction in binge eating and purging; CBT ends binge eating and purging in roughly half the patients.
—major depressive disorder: behavior therapy, CBT, and interpersonal therapy all yield substantial reductions in depression.
—OCD: SSRIs reduce or eliminate both obsessions and compulsions; CBT involving exposure and ritual prevention methods is also a first-line treatment.
—panic disorders: CBT, in vivo exposure, and coping skills acquisition have proved effective.
—social phobia: exposure-based procedures and multicomponent CBT effectively reduce or eliminate the symptoms.
—specific phobias: exposure-based procedures, especially in vivo exposure, eliminate most or all components of specific phobia disorders.
All of which is as convincing an answer to the question “But does it really work?” as anyone could ask for.
The new forms of outcome research and the moral (and financial) pressure of the evidence-based ethos are making psychotherapy, in alliance with psychopharmacology, increasingly scientific and increasingly effective. Perhaps even the specter of Wundt, were he presented with the data, might relax his dark scowl and grudgingly nod approval.
* DSM-III, the 1980 edition of the American Psychiatric Association’s bible of diagnosis, and DSM-III-R, the 1987 revision, omit “neuroses” as a diagnostic category and identify the disturbances formerly grouped under that label as separate categories of mental disorder. “Neurosis” and “neurotic” are, however, still informally used by both practitioners and the laity, and will be so used here.
* Overall data are hard to come by, because psychotherapy is not a regulated profession and many kinds of professionals practice it. Paul Crits-Christoph, director of the Center for Psychotherapy Research at the University of Pennsylvania, said in an interview for this book that a 1990 survey of 423 psychotherapists found that over two thirds identified themselves as eclectic in orientation, but that the majority of these eclectic therapists said that they most often used a psychodynamic orientation, and an additional 17 percent identified themselves as purely psychodynamic. (But as we will see, later estimates indicate that somewhat lower figures now prevail.)
* Apparently, he was not aware that in 1924 a psychologist named Mary Cover Jones had used classical conditioning techniques to cure a three-year-old boy of a phobia of furry things by pairing the appearance of a rabbit, first far off and then closer, with his enjoyment of favorite foods.
* Since 1993 it is also sometimes called “rational emotive behavior therapy,” or REBT.
* Ellis was using the patient’s own figures for the sake of argument (the number of homosexuals per hundred males is, of course, rather larger). He also has said (in a personal communication) that he was not agreeing with the patient that being a homosexual is bad but merely showing him that thinking it would be bad would not actually make him a bad person.
* Past tense, because these days Beck limits himself to research and training. The Beck Institute for Cognitive Therapy and Research that he founded in 1994 is now headed by Dr. Judith Beck, his daughter; there, she and others provide therapy and training.
EIGHTEEN
Users and Misusers
of Psychology
Knowledge Is Power
Whatever the phantom of Wilhelm Wundt might think of present-day clinical psychology, the flesh-and-blood Wundt was incensed at the sight of his science put to other disgracefully practical uses—and by some of his favorite students.
One of them, Ernst Meumann, committed what Wundt saw as apostasy, abandoning pure research in order to apply psychological principles to education. Even worse, two others hawked their knowledge to business and the public. In 1903 Walter Dill Scott, a professor at Northwestern University, published a book on the psychology of salesmanship and advertising, and in 1908 a prize pupil of Wundt’s, Hugo Münsterberg, whom William James brought over to be director of the psychology laboratory at Harvard, published a book on the psychology of courtroom testimony and in 1915 another on applications of psychology to everyday problems.
Münsterberg, although an archetypal German professor, reactionary in his social views (he vehemently maintained that woman’s place was in the home) and of formidable appearance (austere mien, pince-nez, jutting chin, a pointed guardsman’s mustache), had become a leading figure in American psychology. As such, he seems to have been ambivalent about his identity. Although he energetically promoted applied psychology in books, articles in popular magazines, and lectures before large audiences, he sought to preserve his status as a scientist by producing a number of ponderous tomes of abstruse psychological theory. He could have spared himself the effort: His applied psychology had major impact; his theoretical work, none.
Many psychologists were affronted by Münsterberg’s advocacy of applied psychology, but the public liked it. Of greater consequence, a few adventurous businessmen asked Münsterberg and his students to use their psychological knowledge to improve workers’ efficiency, make advertising more persuasive, and help select the job applicants best able to perform specific tasks.
On behalf of a telephone company, for instance, Münsterberg developed a test to identify women with the aptitudes needed for competent switchboard operation. To check up on him, the company secretly included several skilled operators among the thirty job applicants it sent him; happily for Münsterberg, the skilled operators scored at the top of the list.
Less happily, at the outset of World War I Münsterberg made a number of pro-German public statements that destroyed his prestige; when he died in 1916 the American Psychological Association, of which he had once been president, published not one word of eulogy.1
Münsterberg’s efforts to be both an applied and pure psychologist symbolizes an age-old debate about the value of knowledge. Most intellectuals have held that it is worth pursuing for its own sake, without any thought of possible utility; many if not most scientists have prided themselves on conducting research without thought of its potential business applications, and considered applied research less prestigious, more commercial, and soiled by the goals of sales and profit. But most leaders of society and most ordinary people have felt that scientific research— including psychological research—is worthwhile only if it has some practical use. This view has been particularly dominant in the pragmatic, industrial-technological society of America, with whose values it is in harmony.
Not surprisingly, therefore, as basic psychology blossomed during the past century, applied psychology soon caught on and flourished. Today it is manifest in a myriad of university departments, a number of applied psychology journals, textbooks, and several societies and annual conferences.
Moreover, the long-dominant view that research moved in one direction—from basic to applied—has recently been challenged in various ways. In 1997 Donald Stokes, a political scientist, made a convincing case in Pasteur’s Quadrant that, rather than a single straight line of development from basic to applied research, the two are different dimensions between which there is an area of multidirectional interaction; Pasteur’s great work, he pointed out, was applied, practical, and basic all at the same time.
Not long afterward, Rodney Nichols, president of the New York Academy of Sciences, proclaimed, “Revolutionary advances also come out of mission-oriented research. It is possible—indeed, often natural—to fulfill a social goal and create even richer scientific results than pure curiosity engenders.”2 A current textbook of applied cognitive psychology says, “When a product or service is especially compelling, researchers seek to derive the basic principles that made the product or service useful in the first place.”3 Significantly, a number of recent government research grants have backed the concept that applied research can lead to new basic knowledge.4
And some b
asic researchers who have switched to applied research find it intellectually (as well as economically) rewarding. Donald Norman, for years a leading figure in cognitive science, left academia for applied research in 1993 (but now holds positions in both camps); what intrigues him about applied cognitive psychology, he says, is that “technology expands the human mind, its perceptions, its interactions with the world. Consider the screwdriver: It extends your perceptual system. That’s a metaphor for all sorts of technological advances. My book, Things That Make Us Smart, is about things that are not just tools but extensions of our minds.”5
That pertains to product design, but applied psychology takes many other forms and exerts many other influences on society and everyday life. We have already seen a number of early applications of basic psychological research and theory to practical ends, among them:
—intelligence testing by the Army in the two world wars to screen out unfit draftees;
—intelligence and ability testing by many schools throughout the nation in order to group children in classes according to their ability to learn;
—the use of perception principles in the testing of candidates for pilot training by the Army Air Corps in World War II;
—the citing by the Supreme Court of psychological research findings in its momentous Brown v. Board of Education decision, and the resulting integration of public schools;
—the education of parents, through the popular media and other means, in the normal stages of child development and the kinds of parent behavior that most benefit the child at each stage;
—and, of course, all the forms of psychotherapy and their huge impact on the mental health and behavior of Americans. And on their physical health: A number of studies have shown that people who make heavy use of medical services reduce that use by as much as a third after mental health treatment.6
These are only a few of the ways in which psychological knowledge has been applied over the past century. In recent decades the field has burgeoned. Clinical and other applied psychologists now make up well over half the total membership of the American Psychological Association and probably at least that proportion of nonmember psychologists, and American society is profoundly influenced by their work in the following (and many other) ways:
—Each year, the plans of 1.5 million high school seniors are determined in large part by their scores on SATs (formerly known as Scholastic Aptitude Tests) and over 1 million by their scores on ACTs (American College Testing), both designed by educational psychologists; many schools do not even consider for admission those who score below some cutoff point.
—The hiring of millions of people for positions ranging from assembly-line jobs to managerial posts is governed in considerable part by their scores on tests of intelligence, aptitude, honesty, and personality traits.
—As a people, we spend billions of dollars each year to improve our performance at work, in sports, and in personal relationships through various forms of training, many based on psychological findings.
—A multibillion-dollar flood of TV and radio commercials and print-media advertisements significantly influences our tastes, purchases, everyday behavior, and voting preferences. Much of that communication uses techniques of persuasion recommended by psychological consultants (or, to call them by the disquieting term now used by some textbooks of applied psychology, “compliance professionals”).
—Countless products, appliances, gadgets, medications, food supplements, books and magazines, insurance programs—and so on and on—that we buy and use have been partly or wholly designed in accordance with psychological research about our preferences (or in many cases susceptibilities) or the preferences of particular age groups, racial groups, gender, and other criteria.
All of which raises the question: Does applied psychology use scientific knowledge to better the human condition, or misuse it for selfish goals and at considerable cost to its targets?
It does both, of course. All scientific knowledge can serve good ends or bad ones, often both at the same time. The norms and structure of each society determine which choice or mixture of choices prevails. For example, American society, by richly rewarding the healing of the ill and the postponement of death, has fostered the development of such measures as respirators and devices to maintain nutrition and hydration, but by failing to modify its traditions and laws, obliges doctors to prolong life in the terminally ill, the permanently unconscious, and the hopelessly agonized.
So, too, with psychology. Of its many applications, some improve individual and collective life while others benefit their practitioners but harm those they are used on. Knowledge, once gained, cannot be expunged from our collective consciousness, nor would we want it to be, but as a society we have not yet learned to encourage the uses of psychology and at the same time recognize and limit or even prevent its misuses.
What follows is not an overview of the broad range of applied psychology (which would require a book as thick as this one) but a series of brief sketches of a few of its beneficial and harmful influences on our lives today.
Improving the Human Use of the Human Equipment
A number of applications of psychology enable human beings to make more efficient or more salutary use of their capabilities and responses. Among them:
Health psychology: Some of these applications ameliorate or cure mental and physical illnesses linked to psychological factors. Psychotherapy,of course, is the major example. Others include diagnostic procedures and situational or social interventions. A few instances:
—The Type A Behavior Pattern (TABP), that of people who are unusually ambitious and aggressive, tense, given to rapid speech and quick action, and easily irritated and provoked to hostility, was suspected for many years to be a cause of coronary heart disease. By 1981, a number of studies offered enough evidence for the National Heart, Lung, and Blood Institute to conclude that TABP was associated with increased risk of CHD. Since then, however, further research has modified this conclusion; recent studies have found that it is the “Anger/Hostility” dimension—only a part of TAPB—that is most predictive of CHD. While TABP and its anger-hostility component seem to be an innate personality tendency, stress reduction training can mitigate it greatly. Also, the situational factors that provoke it can be minimized or avoided. Informed parents, for instance, can consciously play down their emphasis on a child’s need to achieve; they can also select schools that minimize competition. Adults with TABP can change to a less competitive work environment or even, if necessary, a less competitive career.7
—Social psychologists and epidemiologists have found a statistical connection between the disruption of social ties and networks by events like migration, divorce, or death and a number of physical and psychological illnesses. For instance, depression and a concomitant weakening of immune response are markedly more common among divorced and widowed people than married ones. The antidote recommended by psychologists is social support, which, much recent research has shown, moderates the vulnerability to stress. Accordingly, support groups of many kinds have proliferated throughout the country. There are groups for the elderly, impaired, families of substance abusers, and cancer patients (particularly women who have undergone mastectomy), and hospice programs that tend to the needs of the terminally ill and their family members.8
—The normal decline of memory in the aging is often a cause of severe distress, lowered self-esteem, depression, and withdrawal from social situations. Lately, clinics in a number of universities and other centers have been offering training in mnemonic and other associative techniques that compensate. One leading clinic has reported that after a two-week course, middle-aged and older trainees could recall the names that went with faces as well as or better than they could when young.9 Research-based methods of memory improvement are now also available in books, on the Web, and on CD-ROMs.
—Many health maintenance organizations and medical clinics use methods derived from the psychology of motivation to get patients
to take their prescribed drugs and carry out recommended activities. Among the techniques: presenting patients with indisputable evidence of benefit; providing proof that recognized authorities back the procedures; and rewarding patients, particularly those on weight-loss diets, with encouragement, approval, and chart displays of their progress.
Educational psychology: By the 1960s, psychologists and educators had amassed evidence that disadvantaged children are cognitively and culturally ill-prepared for school, and that this is why they fall farther behind other children year by year. Head Start, begun in the 1960s as part of President Johnson’s War on Poverty, was a large-scale experiment intended to offset the learning difficulties of poor children by giving them special education to supply the skills and background they need to succeed in school.
But for political reasons Head Start was launched hurriedly, without plans for properly assessing its effects. Only after the program had been running for some years did Congress ask to have it evaluated. Researchers then compared a number of first-, second-, and third-grade children who had taken part in Head Start with similar children who had not, and found, distressingly, that the Head Start students were doing no better in school than the others. The finding touched off a raging controversy. Defenders of the program said that the two groups were not really equivalent—that Head Start had attracted those who needed it most and would have done even worse without it. Attackers said the program had proven that compensatory special education had no lasting effect and that the children’s poor environment prevailed.10
The debate continued year after year, with some studies reporting success and others reporting failure, and with other programs designed by researchers rather than social activists yielding more hopeful data. By 1982, the pooled findings of eleven well-designed studies of early enrichment programs showed that children in the programs had done better than the control groups of comparable children and had scored higher on IQ tests for several years.11 Unfortunately, the gains were not permanent, and for a fundamental reason: after three decades of experience, a careful summary of the evidence yielded a mixed finding and an explanation:
