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Randomized Controlled Trials of Antidepressants: Clinically and Scientifically Irrelevant
David Cohen, Florida International University and David H. Jacobs, Pyrysys Psychology Group
This contribution to the “antidepressant debate” (republished here from a 2007 article in
the now-defunct journal, Debates in Neuroscience) focuses on the validity of randomized
controlled trials. We argue that: (a) randomized controlled trials do everything possible
to methodologically stamp out high placebo response rates rather than reveal the clinical
implications, (b) assessing a psychoactive drug’s effects greatly exceeds the purpose of a
randomized controlled trial, requiring substantial investigation on normal volunteers, (c)
made-up psychiatric diagnostic categories destroy the purpose and logic of the randomized
controlled trial as a medical experiment, and (d) adverse drug reactions remain
under-studied, under-recognized, and under-appreciated, in parallel with the muting of
subjects’ voice and the reliance on surrogate measures of efficacy. The standard psychopharmacotherapy
trial has lost virtually all clinical and scientific relevance, and
needs complete revamping. The backdrop for the discussion is American biopsychiatry’s
insistence that personal difficulties must be viewed as the expression of idiopathic somatic
diseases, and the pharmaceutical industry’s dominance of the entire drug treatment
research enterprise.
Requests for reprints may be sent to either David Cohen, Ph.D., School of
Social Work, Florida International University, Miami, Florida 33199. Email: cohenda@fiu.edu.
Or David Jacobs, Ph.D., Pyrysys Psychology Group, 8950 Villa La Jolla Drive, Suite B214, La
Jolla, California 92037. Email: David.Jacobs@pyrysys.com
The Make-Believe World of Antidepressant Randomized Controlled Trials — An Afterword to Cohen and Jacobs (2010)
David H. Jacobs, Pyrysys Psychology Group and David Cohen, Florida International University
This afterword extends and refines the arguments presented in Cohen and Jacobs (2010).
The main point made by the authors is that the antidepressant randomized controlled trial
world is a make-believe world in which researchers act as if a bona fide medical experiment
is being conducted. From the assumed existence of the “disorder” and the assumed homogeneity
of the treatment groups, through the validity of rating scales and the meaning of
their scores, to the presentations of researchers’ ratings as the genuine outcome of interest
— all aspects of such trials are make-believe. The continued acceptance of randomized
controlled trials as appropriate mechanisms to ascertain the actual effects of psychoactive
drugs on human beings in distress confirms that researchers are inextricably dependent on
large-scale organizational and financial interests that require the sustained production of
make-believe results about psychoactive drugs.
Requests for reprints may be sent to either David Jacobs, Ph.D., Pyrysys Psychology Group, 8950
Villa La Jolla Drive, Suite B214, La Jolla, California 92037. Email: David.Jacobs@pyrysys.com. Or
David Cohen, Ph.D., School of Social Work, Florida International University, Miami, Florida
33199. Email: cohenda@fiu.edu
The Boundaries Still Stand: A Reply to Fisher
Kenneth Aizawa, Centenary College of Louisiana
In his recent critical notice of The Bounds of Cognition in this journal, Justin Fisher
advances a set of concerns that favor the hypothesis that, under certain circumstances,
cognitive processes span the brain, body, and world. One is that it is too much to require
that representations in cognitive process must have non-derived content. A second is
that it is possible that extended objects bear non-derived content. A third is that extended
cognition might advocate the extension of certain general categories of cognition. A
fourth is that Bounds misapplies Andy Clark and David Chalmers’ so-called “parity principle.”
The purpose of this rejoinder is to show how Fisher’s concerns can be, or have
already been, addressed.
Requests for reprints should be sent to Kenneth Aizawa, Charles T. Beaird Professor of
Philosophy, Department of Philosophy, Centenary College of Louisiana, Shreveport, Louisiana
71104. Email: ken.aizawa@gmail.com
Nothing but Neurons? Examining the Ontological Dimension of Schizophrenia in the Case of Auditory Hallucinations
Mike Ludmann, University of Duisburg–Essen
Using the example of auditory hallucinations which especially occur in the psychopathology
of schizophrenia this text tries to bridge the gap between empirical research in psychology
or psychiatry and philosophical reflection on the mind–body problem. It is a fact that the
neuronal manifestations of schizophrenia are significantly associated with psychic characteristics
of this disorder. But nevertheless, it is questionable how these dimensions of
schizophrenia are related to each other, exactly. The suggested intuitive plausible dualistic
solutions of the mind–body problem are problematic with regard to conceptual consistency
as well as to the empirically founded theories about schizophrenia. A promising approach
seems to be the monistic conception of the identity theory of mind (physicalism). A psychic
manifestation of schizophrenia and the corresponding neuronal process fuse into only
one event, which can be called psychophysical units. The perceived qualitative difference
between the phenomena which appear in the psychic and neuronal dimension cannot be
ascribed to a difference between the phenomena themselves, but to the different representation
of one and the same event in the mind of the observer. Furthermore, it can be
demonstrated that the processes of interaction between psychic and physical entities, often
being postulated within the pathogenesis of schizophrenia, can be integrated. Functionalism
holds advantages, too. Functionalist explanations make it possible to understand many
pathogenetic aspects of schizophrenia. In this way psychopathological phenomena can
be accounted for failed attempts to induce certain functional states. A reasonable research
paradigm should be raised from the connection between the principles of the identity theory
of mind and functionalism.
Requests for reprints should be sent to Mike Ludmann, Institut fur Psychologie, Universität
Duisburg–Essen, 45141 Essen, Germany. Email: mike.luedmann@uni-due.de
Methodological and Moral Muddles in Evolutionary Psychology
Stuart Silvers, Clemson University
Evolutionary psychology, the self-proclaimed scientific theory of human nature, owes
much of its controversial notoriety to reports in public media. In part this is because of
its bold claims that human psychological characteristics are adaptations to the
Pleistocene environment in which they evolved and these inherited characteristics we
exhibit now constitute our human nature. Proponents maintain that evolutionary psychology
is a scientific account of human nature that explains what this much abused
concept means. Critics counter that some evolutionary psychological hypotheses threaten
to undermine other intuitive concepts of human nature and well-being, specifically, by
emphasizing purported scientific evidence of natural inequalities based on sex, gender, or
race. They argue that this “gene machine” view entails consequences endorsing or at
least seeming to give scientific aid and comfort to politically conservative, “right-wing”
social agendas. Proponents deny that the theory has such unwelcome implications. Such
objections, they reply, stem from “left-wing” egalitarian ideologies that presuppose the
cogency of the disputed tabula rasa concept of mind intrinsic to the standard social science
model of behavior explanations. Philip Kitcher’s (1985) initial scathing analysis of sociobiology,
now called evolutionary psychology, as the science of human nature went basically
unchallenged. Bioethicist Janet Radcliffe Richards (2000) has given a detailed critique
of Kitcher’s arguments; she finds them to be “leftward-leaning,” and wanting. Here I
examine her arguments and find them wanting though not “rightward-leaning.”
Requests for
reprints should be sent to Stuart Silvers, Department of Philosophy and Religion, 126D Hardin
Hall, Clemson University, Clemson, South Carolina 29634–0528. Email: sstuart@clemson.edu
Normal Narcissism and Its Pleasures
Richard T. McClelland, Gonzaga University
Normal narcissistic functioning has to do with the regulation of a coherent set of metarepresentations
of the acting agent. That set of meta-representations has its own interior
architecture and dynamics. Normal narcissistic functioning is an adaptive form of interpsychic
processing which can be given a general account by integrating views of it drawn
from the clinical traditions of psychoanalysis, empirical psychology, and contemporary
cognitive and neurosciences. This is not to be confused with any form of organized psychopathology,
though pathological forms of narcissism are relevant to understanding
normal narcissism. Neural correlates of normal narcissism, as also the characteristic emotions
and pleasures/displeasures that accompany its operations, are also explored. It is proposed
that this allostatic regulatory system plays a prominent role in a wide range of human
behaviors. It also closes the gap between social norms governing such behaviors and the
minds of the agents performing them. This integrative interpretation of the scientific
material is offered as an exercise in “philosophy in cognitive science” and belongs to the
tradition of naturalistic philosophical accounts of the human mind.
Requests for reprints should be sent
to Richard T. McClelland, Ph.D., Philosophy Department, Gonzaga University, 502 E. Boone
Avenue, Spokane, Washington 99258. Email: mcclelland@gem.gonzaga.edu
Critical Notices
Radical Embodied Cognitive Science.
Anthony Chemero.
Cambridge, Massachusetts:
MIT Press, 2009, 244 pages, $30.00 hardcover.
Reviewed by Rick Dale, The University of Memphis
Anthony Chemero’s Radical Embodied Cognitive Science is obviously boldly entitled.
It has bold goals, and cuts across an impressive range of topics. It is filled with diverse
interweaving threads — topics of interest to the full disciplinary range of the cognitive
sciences, from psychology to philosophy. For example, any cognitive scientist interested
in a basic summary of philosophical theories of representation would find Chapter 3
invaluable, as it is one of the clearest reviews of this conceptually challenging area
that I know of. As another example, Chemero draws out the consequences of the radical
embodied approach for the philosophy of mind, a rare agenda (see also, e.g., Noë,
2005). Its inclusion of both conceptually challenging philosophical theories, along
with technically sophisticated empirical review (lots of it a review of Chemero’s own
empirical work), makes the book a cognitive science book par excellence.
Requests for reprints should be sent to Rick Dale, Ph.D., Department of Psychology, 442 Psychology
Building, The University of Memphis, Memphis, Tennessee 38152. Email: radale@memphis.edu
Book Review
The Case for Qualia. Edmond Wright (Editor). Cambridge, Massachusetts: MIT
Press, 2008, 384 pages, $38.00 paperback, $80.00 cloth. Reviewed by Stephen E. Robbins, Fidelity National Information Services
The Case for Qualia is an impressive set of nineteen essays, fascinating at the very
least for the concentrated picture it presents of the complexity with which this subject
now grows in the gardens of philosophy. The collection itself is wider than “just” the
question of qualia, holding discussions of direct versus indirect realism, representationalism
and consciousness, but all of these subjects are truly of a piece. Simultaneously,
one will not find here a concentrated or consistent thesis on qualia, but the case for
both the significance and the existence of the subject is consistently, unquestionably
supported.
Requests for reprints should be sent to Stephen E. Robbins, Ph.D., Center for Advanced Product
Engineering, Fidelity National Information Services, W126 N7449 Flint Drive, Menomonee Falls,
Wisconsin 53051. Email: Stephen.Robbins@FISglobal.com
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