The APA Guidelines

Science or ‘Dedicated follower of fashion[1] ’?

Posted Apr 22, 2019

Many eminent scientists think that science is a guide to action, which is true in a sense: Science guides action in the way that a steering wheel guides a car. But the wheel by itself provides no destination and the car will not go anywhere without an engine.  Without moral values to motivate action and set a goal, scientific facts point nowhere. 

As David Hume explained several centuries ago: “It is not contrary to reason to prefer the destruction of the whole world to the scratching of my finger. It is not contrary to reason for me to chuse my total ruin, to prevent the least uneasiness of an Indian or person wholly unknown to me.” Action requires motive; the facts of science by themselves provide no motive.

What should this separation between moral values and the facts of science mean for American Psychological Association policy?  A difficulty is that the APA comprises both scientists and practitioners. For the scientists, freedom of speech and inquiry are prerequisites. The APA should certainly advocate for those and for the highest research standards. See for example posts on the irreproducibility crisis, some more soothing (the APA site) than others (the National Association of Scholars site) than others.  Whether the APA should also push for more financial support for psychological science is less clear. But now science lives in the world of competitive politics and I suppose even scientific associations must fight their corner.

APA policy for practitioners — psychotherapists, counselors and the like — is much more problematic.  Therapy is intended to change people; it involves action hence motive and values. A practitioner wants to make his or her patient better. But just what is better? For conventional medicine this is rarely a problem; no one has any difficulty distinguishing a sick person from a well one.  In psychology, well and ill are often not so clearly distinguishable. Homosexuality was once classified as a disorder requiring remedy, but now is just a sexual orientation. Transgender is currently undergoing a similar transformation: “‘Gender identity disorder’ is the umbrella term used in the 10th edition of the International Classification of Diseases (ICD; WHO, 1992) although it is expected that the 11th edition will adopt the new term “gender incongruence” and remove this from the mental disorders chapter…” says the UK Royal College of Psychiatrists in March 2018 and the APA concurs (see "Is being transgender a mental disorder?"). The question of whether a particular identity is desirable or undesirable for an individual is not a purely scientific question, yet the APA seems to have an answer.

Most recently APA has taken incoming for its GUIDELINES for Psychological Practice with Boys and Men. What has gotten it into trouble is not normalizing what was previously considered abnormal, but treating as abnormal what was previously considered normal—namely the traditional role of men and boys. These are dangerous waters, because the APA, instead of evaluating the effectiveness of therapy, is specifying its right aim. It is defining the goals of practice, not its scientific effectiveness.  It is setting goals that are moral, not scientific.

Best stay silent? Or, if recommend you must, do so in “if-then” form.  Rather than fashionable, if data-free, charges about “male privilege and power” (followed without embarrassment by a long list of the ways in which males are actually worse-off than females: lifespan, accidents and health, suicide and incarceration rates, drug addiction and homelessness, academic success, etc., etc.), perhaps the APA should restrict itself to evaluating the effectiveness of different practices. In other words, limit itself to statements like "treatments X, Y and Z have been found effective."

If this proposal seems too tricky to implement, perhaps the APA should simply keep silent on these matters, cut its PR budget, and let individual therapists make their own choices. “Whereof one cannot speak thereof one must be silent[2].” 

REFERENCES

[1] The Kinks, 1966

[2] Wittgenstein, Tractatus.