Story of Psychology - Morton Hunt [373]
Obsessive-compulsive disorder, in which certain obsessive ideas cause such persistent senseless actions as washing the hands dozens of times a day, has also been found by means of PET scans to be associated with abnormally high rates of glucose metabolism in the basal ganglia, a region of the brain between the limbic system and the cerebral cortex. By the late 1980s, clomipramine, an antidepressant, was found to sharply reduce the symptoms over a period of weeks, but it had unpleasant side effects, including sleepiness, difficulty starting urination, dry mouth, and a drop in blood pressure when rising from a seated position. Currently, therefore, the medication of choice is usually one of the SSRIs—fluvoxamine (Luvox), fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), or citalopram (Celexa). If an SSRI does not work, clomipramine is the fall-back treatment.19 (Another SSRI now coming into favor is escitalopram oxalate [Lexipro]).
Given the long-standing derogation of psychotherapy and the many assertions that it is not science but, at best, a form of magical belief and, at worst, fraud, how can we account for its vast growth and wide acceptance? Some people offer sweeping social explanations: We live in a disconnected and alienated age; we seek sources of comfort and reassurance and turn to those who offer them for pay; in a secular age, psychotherapy takes the place of religious belief and is a secular sanctuary. And so on.
But if we meet some of the practitioners, eavesdrop on their clinical sessions, and look at the accumulated evidence of outcomes, we may arrive at a more empirical and less ideological explanation of the success of the psychotherapists and of psychotherapy.
Freud’s Offspring: The Dynamic Psychotherapists
One of the few generalizations that can be made about psychotherapy today is that few generalizations can be made about it. By now it is practiced in accord with half a dozen or more major methods, of which there are hundreds of variants. At one extreme is the patient lying on the couch—now very rare—and pouring out random thoughts while the psychoanalyst murmurs mmm from time to time; at the other, an alcoholic, after taking a dose of Antabuse (disulfiram) or Temposil (citrated calcium carbimide), is served a generous whiskey-and-soda in a treatment room and soon after drinking it gasps, breaks into a sweat, complains of rapid and irregular heartbeat, dizziness, nausea, difficulty breathing, and headache, and vomits violently into a handy basin.
Nonetheless, one legitimate generalization about modern psychotherapy is that a majority of all psychotherapists use forms of dynamic therapy (also called “psychoanalytically oriented psychotherapy ”) at least part of the time.* These are based on dynamic psychology, which conceives of psychological problems as resulting from intrapsychic conflicts, unconscious motivations, and the interplay of external demands with components of the personality structure.
This conception, though psychological, had its origin, as we saw, not in psychology itself but in the chance discovery of a neurologist— Freud—that he had more success treating hysterics with “the talking cure” than with physiotherapy or hypnosis. Psychology was slow to adopt his discovery and theories; during the early decades of the twentieth century, while psychoanalysis was gaining ground among physicians and psychologists in Europe, clinical psychologists in America were still chiefly performing psychological testing and measurement. Some universities did open psychological clinics before World War I, but these were limited to the testing