To a lot of people, even to a lot of scientists, science is a subject matter. “Science” is numbers. Science is molecules. Science is ‘scientific experts,’ white coats, stethoscopes, medicine bottles, brain images. When we think about science in this way, it’s easy to get sucked into a phenomenon I called scientism. Scientism is a cultural phenomenon unique to modern culture. “Scientism” is like the child’s joke about washing a diaper. As a seven-year-old, I rolled on the ground with laughter at this one.
(pretending to scrub a diaper in the sink): “Wishy washy wishy washy wishy washy!
(Holds up the diaper to inspect) “Looks clean, feels clean. . .
(Smells the diaper) “Smells. . . (pause).
(Scrubs vigorously) “Wishy washy wishy washy wishy washy!”
The fact is that scientism isn’t a subject matter, like a class at school. When I teach research methods at my medical school, I define science as “systematic inquiry.” The question of how to treat mental disorders requires systematic scientific inquiry to painstakingly uncover the truth.
When you understand science as a subject and not a method, you start to confuse something that looks like science…sounds like science…smells like science?
But isn’t science.
I did a post-doctoral fellowship at a prestigious mental health services institute. In the 1990s, the big question for mental health researchers was the question of why so many depressed patients, especially low income patients, were not getting effective medications for depression. And the goal of a lot of the research at the institute focused on how to get more medication into these patients. At the same time, there was a lot of emerging data regarding the effectiveness of these medications that suggested that getting more poor people on antidepressants might not solve the public health crisis of depression. When it comes to treatment, both for medication and psychotherapy, evidence suggests that a lot of the healing comes from the relationship between the healer and the patient. Something like caring, empathy, support, guidance…
One of my colleagues had designed a program that used a complicated algorithm to identify depressed patients and offer them antidepressants. When I asked her about the issue of therapeutic relationship, she scoffed: “Sounds like you think that the way to treat depressed people is to be nice. But being nice is not science!”
That’s scientism in a nutshell. The fact is, if being ‘nice’ helps patients, we need a science of ‘niceness.’ What is it about empathy, warmth, and support that makes people better? How do individuals differ in terms of what they need? How do we develop effective therapeutic relationships? How do we design institutions like schools, hospitals, workplaces, so that individuals are supported and cared for? The jury is still out…
