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Excerpt
No matter how rapidly neuroscientific knowledge advances, psychiatry remains an anomaly within medicine largely because of our continued emphasis upon psychotherapy as a core intellectual challenge and clinical skill. Psychiatry's unique position can be viewed as a problem or as an opportunity to expand the intellectual basis of all medicine to study what cannot be reduced to simple, or even complex, biological processes. The gold standards for evaluating medical treatments-randomized, placebo controlled trials, measuring the impact of intervention on cells and tissues, comparison of outcomes as concrete as death or recovery-help little in the evaluation of psychotherapy. Medical treatments have definable impact on verifiable diseases; psychological treatments apply, sometimes, to "disorders." More often, psychotherapy relieves low self-esteem, self-defeating behavior, alienation, sadness, fearfulness, and the like. These qualities often are not manifestations of disease but rather exaggerated basic human responses to basic human travails. Quantitative measures of symptomatic improvement generally fail to illuminate how psychotherapy influences, not a disorder or disease process, but the suffering person and the meaning the person gives to his or her experience.
In recent years, the limitations of standard research methods have discouraged physicians from studying psychotherapy, except in its narrowest applications to syndromic disorders or in the domain of medical cost offset. Medical research into the mechanisms by which psychotherapy may influence patients has been even scarcer. Theories derived from psychoanalysis continue to attract practitioners because of their breadth and internal coherence, not because their proponents offer solid evidence that one method or type of intervention is superior to another. Those who evaluate different psychotherapies or different elements within psychotherapy have been repeatedly obliged to accept the conclusion that, with the exception of exposure for anxiety, most forms of psychotherapy have equal impact on standardized outcome measures (Lambert and Bergin, 1994). "None," to paraphrase Orwell, "are more equal than others."
Legitimate alternatives to controlled scientific investigation are needed if psychotherapy is to remain a viable clinical discipline, of proven worth to its critics. The naturalistic study of different forms of psychological healing across cultures and of different forms of psychotherapy within our own culture-for example, pastoral care, professional psychotherapy and self help-provide one such alternative (Frank and Frank, 1993). All demonstrate the universality of mental healing in human societies and provide some insight into the crucial elements of the process. Now, in Care of the Psyche: A History of Psychological Healing, Stanley Jackson demonstrates that the history of Western medicine and philosophy provides another rich vein of evidence about the efficacy and core elements of psychological treatments.
Jackson's book is remarkable as both a scholarly compendium of historical information and as a prolonged meditation on the essential elements of psychotherapy. It is uniquely cross-disciplinary. Few historians would have made his clinically sophisticated choice of topics. Clinicians, who generally learn through apprenticeship and the study of a few modern theories of healing, would be lost trying to explore the historical foundations of their knowledge. With a background that ranges from classical philosophy through 20th century medicine, Jackson covers the role of the therapeutic relationship, altered states of consciousness, confession, consolation, persuasion, emotional expression and catharsis, conditioning, and insight. His lucid, methodical and evenhanded exposition creates a compelling argument that all are legitimate elements of psychological healing. With exquisite tact, he impugns theories that emphasize any one element at the expense of others.
