Psychology as a field has been responsible for what has been the explicitly therapeutic aspect in the division of labor among different research fields. Psychology has increasingly moved closer to “neuroscience” as a field where biological aspects are central to understanding human beings. Psychology encompasses a diversity of perspectives and a lively internal debate, with researchers who are critical of mainstream psychotherapy and psychiatry.
This section will first outline some aspects of the ongoing debate regarding the state of psychotherapy and psychiatry within the field of psychology. Afterward, I will present and discuss the analyses that sociologists have conducted of psychology, psychotherapy, and psychiatry. The aim is to establish the context in which sociotherapy is needed. There are enough problems with psychotherapy and psychiatry to justify the expansion of sociotherapy as a competing and complementary research program.
Discussions within the field of psychology
A movement within research and among practitioners is evidence, based therapy (EBT); yet, at the same time, there are several issues regarding scientific rigor within the field (Cook, Schwartz & Kaslow, 2017). The replication crisis began when it proved surprisingly difficult to replicate psychological experiments (Open Science Collaboration, 2015). There has been a debate about exactly how this should be interpreted, the extent of the crisis, and whether it is actually a crisis at all. Social psychologists such as Gilbert argue that this has been blown out of proportion and that the criticism directed at social psychology, in particular, has been too harsh and partly unfounded (Gilbert et al., 2016). Experiments have been regarded as the most reliable method in psychology, yet these do not appear to meet the expected standards or be conducted at the level hoped for. At the same time, humanists and existential psychologists have criticized such experiments, arguing that they are linked to a manipulative and technical view of human beings. RCTs have been used to make the study as similar as possible to a full, scale experiment, but this also presents inherent challenges, for example, it is not possible to achieve full blinding among researchers, practitioners, and patients (Scull, 2022). The EBT movement has argued that other methods are important for gathering “evidence” of best practices, such as quasi, experiments, etc. The lack of scientific rigor has been highlighted in the creation of diagnoses for various manuals; for example, the DSM, 3 has been criticized for relying on consensus, voting, and committees (Scull, 2022). The creators of the DSM-3 have also leveled very harsh criticism at how the DSM-5 was developed (Frances, 2013).
Reductionism has been important for scientific progress, but the extent to which this reductionism has gone has been viewed as a problem by many psychologists. It is primarily biological reductionism that many psychologists have opposed, as it fails to adequately account for social factors when they are included at all. However, even more biologically oriented researchers have also criticized an overreliance on finding biological explanations, which has been a waste of resources (Insel, 2013).
Social psychologists have criticized how clinical psychology has been dominated by a biological mindset in which social aspects have been given too little consideration (Maddux & Tagney, 2010). It should be noted that social factors are present in various psychotherapies in different ways, but far too little, according to both critical psychologists and social psychologists. Alexander Haslam, a social psychologist, argues that this is the case and has conducted studies based on social identity theory that demonstrate how strongly our health is linked to the number of groups we belong to and how well we are integrated into them (Haslam et al., 201 6).
Social, psychological interventions are a rapidly growing field, meaning that much of the criticism coming from sociologists is valid when directed at practice but not at psychology as a whole. Maddux & Tagney (2010) demonstrate how this field, with social, psychological foundations for clinical interventions, is expanding. The starting point is that social psychology and clinical psychology have been viewed as two distinct fields, but that they should actually be seen as, and should be, fully integrated fields (Maddux & Tagney, 2010).
Clinical psychology has been dominated by the biomedical model, which has led to social psychology being sidelined, with the result that group therapists are often categorized as “alternative therapies.” The medical analogy of likening mental states to diseases lacks sufficient support, but could gain it in the future (Madduz & Tagney, 2010, 6). They are critical of the practice of locating diagnoses within the individual rather than situating them within a relational context (Madduz & Tagney, 2010, 6). Early attempts to integrate clinical and social psychology did not come to fruition; for example, the journal Journal of Abnormal and Social Psychology (1921) became highly theory, driven, leading to its split into two separate journals, with only a few seeking integration.
Brown and Harris developed an influential social model of depression, in which depressive episodes are understood in relation to life events, loss, long, term difficulties, and social vulnerability factors such as loneliness, a lack of close, trusting relationships, and class, and gender, related living conditions (Brown & Harris, 1978). Criticism of an overly pharmacological understanding of depression has also drawn support from research on the limited effects of antidepressants, the results of the STARD study, problems with treatment resistance, and side effects of newer antidepressant medications (Kirsch et al., 2008)
Research into the effects of various therapies and psychotropic medications is also fraught with significant challenges. Psychotherapies tend to be heavily researched and hyped when their effects appear substantial, but this is often due to researchers being overly invested, small sample sizes in studies, and generally low study quality (Moloney, 2013). Criticism has emerged from humanistic psychology that psychology and psychiatry have treated patients inappropriately by exercising too much power, underestimating the importance of humanity and empathy, and placing excessive faith in manualized techniques and processes (Moloney, 2013). In meta, analyses, CBT is shown to be effective for certain patient groups; however, in one study, the effect was reduced when unpublished studies were included, thereby eliminating publication bias (Moloney, 2013). These meta, analyses are also hampered by the fact that much of the effect disappears when the placebo effect is accounted for; at the same time, the placebo effect is sometimes difficult to accurately replicate, which reduces the extent to which it might influence the control group, who often know they are not receiving the actual therapy. We do not know exactly what the placebo effect is, but part of it seems to stem from social factors that are not taken seriously enough. A problem with research on psychotropic drugs is publication bias, ghostwriting, outright corruption, and a dependent relationship between pharmaceutical companies and researchers, who in many cases have abandoned objectivity as a goal (Scull, 2022). Some argue that the psychopharmaceutical revolution has stalled and is in crisis, with few new drugs on the horizon and less progress than initially anticipated with new “generations” of psychopharmaceuticals (Scull, 2022).
Evidence, based therapy is an eclectic paradigm that focuses on therapies with strong evidence, according to its proponents (Insel, 2013; Cook, Schwartz & Kaslow, 2017). Proponents of evidence, based therapy argue that when new research is well integrated with the expertise of experienced therapists, it is highly effective and can be cost, effective if delivered online (Cook, Schwartz & Kaslow, 2017). The problem with this paradigm lies in what “evidence, based” actually means. Several problems have arisen due to limitations in RCTs for both therapies and psychotropic medications, where it is difficult to achieve double, blind conditions. Scull points out that CBT has nevertheless helped certain patient groups, and this can be supported, while others are more critical of this effect because so many other factors, such as the therapeutic alliance, meeting with other people, or receiving attention, contribute to the placebo effect (Scull, 2022; Moloney, 2013). Bornemark argues that instead of “evidence based practice”, which is an impossible ideal to achieve and which fosters hubris among practitioners and certain advocates in research, while ideology creeps into the concept of “evidence based” (Bornemark, 2018). Bornemark argues that we should instead use the term “evidence informed,” which is somewhat more humble in acknowledging how difficult these complex issues are to address, and that “evidence, based” has an overly positivist foundation that fails to recognize that therapies have performative effects (Bornemark, 2018). “Evidence, based” thus overlooks the cultural impact of what happens, for example, when an entire community undergoes CBT, as was attempted in the United Kingdom (Moloney, 2013). Another problem with EBT is that there is no consensus on what is empirically grounded and evidence, based (Cook, Schwartz & Kaslow, 2017). For example, as has already been highlighted, there is significant debate and criticism regarding the validity and reliability of various dimensions of the diagnoses on which EBT is based, making it somewhat misleading to call it evidence, based (Scull, 2022). It is not sustainable to be in the midst of a scientific crisis while simultaneously claiming to be evidence based.
A few psychologists have problematized the inevitably political foundations of psychotherapy, psychology, and psychiatry, as well as the implicit and explicit, conscious and unconscious, expectations of how a person should be (Totton, 2006). Psychotherapy purports to be politically neutral but is permeated by liberal politics (Totton, 2000, 2006). Psychotherapy is part of the process of internalizing certain structures as fixed and reified, while at the same time requiring individuals to change themselves; there is also a process of externalizing inner psychological processes (Totton, 2006). Psychotherapy is linked at a “deep level” to the modern self and the politics of the modern self, primarily through the process of responsabilization (Rose, 1989 in Totton, 2006, xvii).