June 15, 2005



this, then. The impression cyeevond to -- for example -- prospective patients would be quite different. But, fair enough. I withdraw the criticism.(2) I was aware of your intent, and I completely agreed with the conclusion, so far as I understand the field, which is from an at best only modestly-informed viewpoint. The success of behaviour therapy for OCD and phobias seems very impressive, and represents a real breakthrough as far as I understand.My criticism was not directed at the content of your post, but at the tone, which struck me as a bit egoistic. As I said, there's nothing wrong with a substantial bit of narcissism: you've got to believe you know what you're doing to do any good at all. But too much is equally bad; it can delay re-assessment of error and I hazard it can compromise some patient outcomes by fostering an inappropriate degree of dependency. But here I wander so far outside my area of competence that I freely admit the possibility -- even probability -- of being wrong. Let us just attribute my differing opinion on how a therapist might discuss his successes and failures to a matter of personal taste, and leave it at that.(3) I appreciate the problem. I myself ponder this issue when I write for a popular audience instead of for a scientific journal. But perhaps I reach the opposite conclusion. I regard it is as more important to be careful about what I imply about what is known, and not known, when I am talking to people who are not in a position to independently verify what I say, for lack of experience, access to the data, education, whatever. When I teach graduate students or talk to colleagues, I feel more free to speak carelessly, because they are sufficiently sophisticated to cross-check what I say with their own understanding. When I teach freshman or speak publically, I am very, very careful, because they can't, and my responsibility for carelessly implying things that I don't mean to imply is much higher.I realize of course this is a personal blog we are talking about, and you are making semi-personal reflections, not issuing professional advice. But, the common practice notwithstanding, a blog published on the Internet is not the same as a private diary. It's more like an op-ed column in a newspaper. If a professional would be careful writing a column in a newspaper, or an article in Newsweek, it's not unreasonable to suggest some similar caution in his blog. Perhaps a bit less, granted, given the more ephemeral and clearly personal nature of a blog. I recognize, too, that these areas of professional ethics are so new as to be fully protean. What is one's responsibility to the public reading your blog when you identify yourself as a professional (doctor, scientist, lawyer), and you reflect on aspects of the field on which you can be expected to have a professional opinion? Is a token disclaimer sufficient? I'm not at all sure. It's an interesting question. I agree reasonable men may differ.dweeb, please allow me to modify my comment post posto to interject the adjective superior before the noun phrase heart surgeon. Perhaps that removes your complaint? I've never met a truly first-class professional in any field who isn't humble about his successes, and well aware of the role of Dame Fortune. It's the second tier that tends towards arrogance.

Posted by: Utku at September 16, 2012 2:21 AM

There are two aspects of the lieknd post and this therapist as a professional that bug me. First, there is the strong strain of narcissism. Certainly a moderate dose of narcissism is necessary to be of any help at all to patients, but this guy seems to display a bit much. Blogging about recent individual professional cases seems a bit iffy in itself, a tad self-centered and unprofessional, even if, as here, presumably only the patient himself and his closest friends and family can recognize enough detail to know who the patient is. But also the tone of how he presents the case smells a bit of egoism: "Look! These other fools couldn't cope, were misguided, unscientific idiots, but I solved the problem in 4 months 'and it isn't even my area of specialty.'" I exaggerate of course, but the tone isn't far from this, IMHO.From what I know, mood disorders, phobias and other neuroses are complex and baffling things that scientifically, to use this guy's favorite word, we know at best partially, and very probably with many errors and misconceptions. Certainly the history of what has been "known" about mental illness is not encouraging about whether what we "know" now is error-free. I doubt curing them is almost as simple as curing an infection with an antibiotic, as this guy seems to imply. I think there's almost certainly significant elements of luck and mystery self-treatment by the patient in any success. Even a heart surgeon would acknowledge this in his field, and be a bit more humble about his successes, knowing them to be a bit less "my" successes than "ours" (meaning his and his patient's) and even "ours and Lady Luck's."Second, his notion of the statistics of epidemiology seems a bit primitive for someone with a PhD. I don't think he should throw around statements like "scientifically proven" so readily. He wouldn't in a journal, would be? I suspect it is unbelievably difficult and delicate to design a study that truly controls all variables when it comes to something as complex as outcomes of treatment for human neuroses. No one with any appreciation for the subtle flaws that can infect such an effort should be nearly so off-handedly confident about what has been proven, and what not. I don't say that as a mental-health professional or patient, because I've been neither, but as a straight physical scientist. Even when you discuss the statistics of molecules in a glass of water, you have to be very, very careful about designing the statistical measures and interpreting their measured value. It's very easy to be wrong about what the numbers mean. It doesn't seem to me any harder to go wrong when you study human beings instead of molecules.

Posted by: Saepul at September 17, 2012 6:51 PM

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Posted by: rwukxt at September 18, 2012 12:44 PM