Neurobabble: Comments from Dr. Mark Hubble on the Latest Fad in the World of Therapy
Rarely does a day go by without hearing about another “advance” in the neurobiology of human behavior. Suddenly, it seems, the world of psychotherapy has discovered that people have brains! And now where the unconscious, childhood, emotions, behaviors, and cognitions once where…neurons, plasticity, and magnetic resonance imagining now is. Alas, we are a field forever in search of legitimacy. My long time colleague and friend, Mark Hubble, Ph.D., sent me the following review of recent developments. I think you’ll enjoy it, along with video by comedian John Cleese on the same subject.
Mark Hubble, Ph.D.
Today, while contemplating the numerous chemical imbalances that are unhinging the minds of Americans — notwithstanding the longstanding failure of the left brain to coach the right with reason, and the right to enlighten the left with intuition — I unleashed the hidden power of my higher cortical functioning to the more pressing question of how to increase the market share for practicing therapists. As research has dismantled once and for all the belief that specific treatments exist for specific disorders, the field is left, one might say, in an altered state of consciousness. If we cannot hawk empirically supported therapies or claim any specialization that makes any real difference in treatment outcome, we are truly in a pickle. All we have is ourselves, the relationships we can offer to our clients, and the quality of their participation to make it all work. This, of course, hardly represents a propitious proposition for a business already overrun with too many therapists, receiving too few dollars.
Fortunately, the more energetic and enterprising among us, undeterred by the demise of psychotherapy as we know it, are ushering the age of neuro-mythology and the new language of neuro-babble. Seemingly accepting wholesale the belief that the brain is the final frontier, some are determined to sell us the map thereto and make more than a buck while they are at it. Thus, we see terms such as “Somatic/sensorimotor Psychotherapy,” “Interpersonal Neurobiology,” “Neurogenesis and Neuroplasticity,” “Unlocking the Emotional Brain,” “NeuroTherapy,” “Neuro Reorganization,” and so on. A moment’s look into this burgeoning literature quickly reveals the existence of an inverse relationship between the number of scientific sounding assertions and actual studies proving the claims made. Naturally, this finding is beside the point, because the purpose is to offer the public sensitive, nuanced brain-based solutions for timeless problems. Traditional theories and models, are out, psychotherapies-informed-by-neuroscience, with the aura of greater credibility, are in.
Neurology and neuroscience are worthy pursuits. To suggest, however, that the data emerging from these disciplines have reached the stage of offering explanatory mechanisms for psychotherapy, including the introduction of “new” technical interventions, is beyond the pale. Metaphor and rhetoric, though persuasive, are not the same as evidence emerging from rigorous investigations establishing and validating cause and effect, independently verified, and subject to peer review.
Without resorting to obfuscation and pseudoscience, already, we have a pretty good idea of how psychotherapy works and what can be done now to make it more effective for each and every client. From one brain to another, to apply that knowledge, is a good case of using the old noggin.
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12 Responses to “Neurobabble: Comments from Dr. Mark Hubble on the Latest Fad in the World of Therapy”
I’m glad to hear this subject being addressed. I have long been perplexed by this whole brain science thing. I know its big pharma marketing. It’s really a big deal in addictions these days and I’m not quite sure how we should be addressing it. The search for legitimacy is certainly a big part of it as you point out. I watched video clip from the HBO series called Addiction where Nora Volkow, the head of NIDA, is showing a patient his PET scans and trying to get him to engage in treatment. He’s about as impressed as a death row inmate is to see how the volt meters work that are connected to his electric chair. I used to use that brain chemistry stuff with clients and I know it must have bored them to tears. Not only that but isn’t the actual science behind this brain chemistry stuff kind of shaky anyway?
Hi Scott-
I’m not as categorically turned off by all of this. I see it as similar to how different people approach biblical texts. We can all laugh at people who think that Noah was literally 900 years old, or whatever, but there is something powerful about these mythological stories that show up in all different cultures (the baby taken from the water, the transcendence of death, virgin birth, etc.), not just in Judeo-Christian teachings. The stories are important and they can reflect something deep and eternal-feeling in the reader back to himself/herself, and this (I’m guessing) gives people a taste of God, spirit, connection with a universal or “oceanic” feeling, etc.
And since stories are powerful healing tools, I see some utility in putting together various pieces of the scientific mosaic into a cohesive story to effect a psychological change. Using modern props of science can make stories more compelling to clients and help effect change. I’m careful to think of these as “strategies” rather than “truths” (AA orthodoxy about “disease” is one such example). I am definitely NOT saying it’s okay to make a mockery of science or to lie. But all of science is couched in interpretation and selective use of evidence to tell a story. We selectively attend to some of the evidence and not to others. This may be frustrating, but it’s inescapable with wretched little human scientists. I rail against it in two situations: (1) it’s done very badly, clumsily, ignorantly, or dishonestly; and (2) it’s used to control discourse, seize power, or delegitimize alternative choices.
I don’t believe in astrology, but I’m going to have a big problem with attempts to destroy its use as a meaning-making system (to be replaced by enneagrams, the Myers-Briggs, or the Exner system perhaps?). As you say, we do know generally what works in therapy, and there is a wealth of coherent stories derivable from scientific inquiry about brain function, attunement, attachment, trauma, “integration,” the HPA axis, etc. (as one category of brain/psych research). I say it’s very important work and we should mock simple-minded, rapacious, and clumsy uses of the information, not the endeavor as a whole. There are people creating and using the information in good ways. One of those ways is to use the info as an explanatory system of how therapy works (e.g., to increase engagement, to provide a structure of meaning, an imagined path for change, etc.). I recommend a read of Allan Schore’s mindblowing “Affect Regulation and the Origin of the Self.” It’s very dense, but it isn’t neurobabble.
-Jason
Mark,
Although I appreciate your reminder to not abandon what ‘we’ know because of the explosion of all of the ‘neuro’ stuff. Let me say I think it too soon to abandon what is emerging because of what we know and to hold lightly our own beliefs and knowledges. I have been working in this field for over 30 years and my practice continues to evolve and shift. I have benefitted both personally and professionally by the ‘recent’ (though truly ancient) re-discoveries about this thing we call ‘mind’ and it’s influence on the brain (I have my own mindfulness meditation practice, now 15 years young and this has transformed my life more than any other single engagement in my own counselling/psychotherapy experiences! And I am excited by seeing psychotherapy and neuroscience come together, Boorstein, Germer, Siegel, R., Siegel, D., Bein, Kornfield, Surrey, Hanson, R. etc.). Let us not be blind to the cultural context of our work and how much our western culture excludes many people; this, I believe, applies to our practices of psychotherapy. There is a whole population of people who are now engaging in counselling and psychotherapy because THEY now believe it will make a difference; and, believe me, they have been suffering and might otherwise have carried this suffering the rest of their lives! I don’t have any problem with that at all (the engagement, not the suffering, let me be clear on that).
Thanks for prompting me to set out my own thoughts on all this. – with care, Dawn
As always you bring a broader perspective to things and alternative ways of seeing it. I don’t mean to throw out the baby with the bath water but I hate the reductionist view, the misrepresentation of the research, the blind devotion to the medical model explanation of things, and the real fact that most clients can’t really relate to that stuff or at least it’s not what is engaging for most. My Bachelors is in biological psychology. Go figure, but I do find it provides me with an appreciation of certain biologically based factors and their relationship to the psycho-relational arts. I worked for a few years with the brain injured and organic based syndromes in a pysch hospital. It does inform what I do although it’s not often that it makes me take my eye off the ball doing psychotherapy. Even with the brain injured my job is mostly relational.
Dave-
I agree:
“I hate the reductionist view, the misrepresentation of the research, the blind devotion to the medical model explanation of things, and the real fact that most clients can’t really relate to that stuff or at least it’s not what is engaging for most. ”
Yep. It’s the devotion, the distortion, and the reductionism (it’s the NEW unified field theory!) that I’ve got a major problem with too. Thanks for casting my loose associations and ramblings in such a charitable light!
Great blog Scott (and Mark) and great discussion Jason, Dave, Dawn!
I like the idea of thinking about these ideas simply as alternative stories that we might or might not find useful with individual clients. And actually for me at least, these ideas are no more “true” than Astrology or other such ideas – for some of my clients Astrology is where we find inspiration, when trying to figure out how they can begin feeling better – for some of my clients the answer is found in the spiritual world – and for some the answer is in brain chemistry. What is important for me is to connect with whatever makes sense for my clients, and then figure out how I might be helpful to them in that context.
I am not certain but I think the term ‘neurobabble’ was first coined by David Healy. He is worth googling if you are not familiar with him – he is one of the champions in the battle against big pharma.
My hero, Wittgenstein, warned of the lure of neurological explanations; arguing that the first priority is to achieve conceptual clarity. There is a lovely quote he has about the lure of neurological reductionism that you might want to tuck away somewhere for a paper one day – ““(t)he best prophylactic against this is the thought that I don’t know whether the humans I am acquainted with actually have a nervous system” (p.1063 in Remarks on the Philosophy of Psychology, Vol 2).
Thanks for this and the video. Knowing stuff (neuro science etc) is fine but, as you remind us from your work on what works, unless we know ourselves and how to use what we know (rather than telling people what we know) therapy will not be much different from a chat over the back fence and may even be less use no matter how impressive the lingo sounds.
I suppose the tone of the piece makes for entertainment but I do not see the value in dismissing interest in the neurological dimension of psychotherapy. What does come across is defensiveness. What I find to be a bit reductionist is the interpretation of an interest in neuroscience as motivated by a desire to medicalize the profession. For an enlightened integration of psychotherapy and neuroscience I refer you to the work of Dr. Kimberly Hoppes at Mount Sinai Medical Center who has integrated mindfulness approaches in the treatment of addictions. Her work has resulted in improved outcomes for people who previously had no non-drug based method for feeling better. Dr. Hoppes actually teaches her clients about neuroplasticity and how through mindfulness and meditation practice they can effect changes in the reward pathways that have been altered by habitual drug and alcohol use. Far from being bored or unimpressed her inner city, poor clients are quite interested in knowing that they can effect these changes ( increased hope and self-efficacy ). This is nothing new, ask any Bhuddist monk. Far from undermining the psychotherapy field or medicalizing it her approach empowers the client to take charge of their neuro-biology rather than rely on psychotropic interventions that by their nature render them passive consumers.
I have read the responses to the posting with considerable interest, but will not address or attempt to summarize all points and positions tendered thus far. Rather, to amplify my earlier commentary, I submit the following reflections.
To begin, I am a scientist. As a scientist, I am interested in fact and as such, remain highly critical of any system, narrative, or discourse that would place, by intention or acts of omission, stories, pretensions, or presumptions on par or interchangeable with fact. Pseudoscience (even outright nonsense) exists. Examples include, and introduced in no special order, ESP, creationism or “intelligent design,” UFOlogy, astrology, graphology, phrenology, repressed memories, and psychoanalysis. The list is legion. These beliefs and practices, other than perhaps having value as interests for historians, hysterians and the entertainment industry, should be vigorously challenged and exposed for what they are.
In the therapy world, consumers have been blitzed by a host of competing claims, myriad forms of wishful thinking, and techniques. With hindsight, much was conceived in acts of arm chair speculation, and in the end, amounted to folly. In recent years, the popular, misnamed empirically based or substantiated treatments, having been subjected to rigorous analyses, are now revealed, at the least, as instances of enthusiasm gone astray. Using fanfare and pronouncements, akin to we-have-the-next-best-thing-to-sliced-bread, the purveyors of “empirical” treatments misinformed the public, misled payers and policy makers, running the risk of making the field look foolish, if not silly, more than it already has.
Curiously, one of our icons, once wrote, “The facts are always friendly . . . .” Carl Rogers, with those words, might as well have auditioned for the “Prophet in the Wilderness” show. Psychotherapy, worshipping at the altar of theoretic explanation, often regarded fact as an inconvenience. Hubris — the mine’s bigger and better approach to therapy, best suited for the sand box –supplanted the client and common sense. Thanks the “stars,” we know what works best for our clients and they are telling us.
Returning briefly to the neuro-informed models and therapies, in the particular case of Allan Schore’s,” Affect Regulation and the Origin of the Self, I am not familiar enough with his work or the science he cites to say or offer anything intelligent. Schore, who describes himself, “essentially I see myself as a theoretician,” is about melding developmental neuroscience and developmental psychoanalysis to create a “neuropsychoanalysis.” Neuropsychoanalysis has its share of critics. Taking a broader view, if advances in neurology and neuroscience reach the stage of providing clear instruction and direction, tested and verified over time, for realizing real gains with clients, I will be for it. Until that day arrives, I invite all to consider other words: “Seek facts and classify them and you will be the workmen of science. Conceive or accept theories and you will be their politicians” – penned by Nicholas Maurice Arthus in De l’Anaphylaxie à l’immunité, 1921. (Rogers was nineteen at the time.)
At length, where do we draw the line between a legitimate science and something somebody made up which sounds scientific, especially as it is presented to the public? Science is not an instance of Western provincialism, the property of a power elite, just one way of knowing, or linguistic contrivance. All ideas are not created equal. Choosing “make believe” or “’cause I say it is so” has real and dangerous consequences. Throughout history, we have seen the costs when nations enact their “make believes” on other peoples and states.
Notwithstanding, we should never discourage discovery and innovation. Important investigative work is being conducted not by a wretched little few, but by many men and women who champion disciplined study. Their goal is to increase our understanding of nature and use that new knowledge for the good of all. That makes imminent sense no matter what you do or where you live on this planet. In this respect, Rogers was spot-on.
When I hurt my knee last year, I appreciated the orthodpedic doctor’s promptness, politeness, kindness, patience, courtesy, interest, empathy, and ability to care and listen and reflect, etc. as well as his showing me his cool 3D model of the human knee as well as the radiology scans.
I appreciate (neuro)science for what it is (and isn’t) — one quadrant of Ken Wilber’s famous four quadrants (or views of reality).
Scott and Mark,
I’m glad to hear this subject being addressed. I have long been perplexed by this whole brain science thing. I know its big pharma marketing. It’s really a big deal in addictions these days and I’m not quite sure how we should be addressing it. The search for legitimacy is certainly a big part of it as you point out. I watched video clip from the HBO series called Addiction where Nora Volkow, the head of NIDA, is showing a patient his PET scans and trying to get him to engage in treatment. He’s about as impressed as a death row inmate is to see how the volt meters work that are connected to his electric chair. I used to use that brain chemistry stuff with clients and I know it must have bored them to tears. Not only that but isn’t the actual science behind this brain chemistry stuff kind of shaky anyway?
Dave Claud
Hi Scott-
I’m not as categorically turned off by all of this. I see it as similar to how different people approach biblical texts. We can all laugh at people who think that Noah was literally 900 years old, or whatever, but there is something powerful about these mythological stories that show up in all different cultures (the baby taken from the water, the transcendence of death, virgin birth, etc.), not just in Judeo-Christian teachings. The stories are important and they can reflect something deep and eternal-feeling in the reader back to himself/herself, and this (I’m guessing) gives people a taste of God, spirit, connection with a universal or “oceanic” feeling, etc.
And since stories are powerful healing tools, I see some utility in putting together various pieces of the scientific mosaic into a cohesive story to effect a psychological change. Using modern props of science can make stories more compelling to clients and help effect change. I’m careful to think of these as “strategies” rather than “truths” (AA orthodoxy about “disease” is one such example). I am definitely NOT saying it’s okay to make a mockery of science or to lie. But all of science is couched in interpretation and selective use of evidence to tell a story. We selectively attend to some of the evidence and not to others. This may be frustrating, but it’s inescapable with wretched little human scientists. I rail against it in two situations: (1) it’s done very badly, clumsily, ignorantly, or dishonestly; and (2) it’s used to control discourse, seize power, or delegitimize alternative choices.
I don’t believe in astrology, but I’m going to have a big problem with attempts to destroy its use as a meaning-making system (to be replaced by enneagrams, the Myers-Briggs, or the Exner system perhaps?). As you say, we do know generally what works in therapy, and there is a wealth of coherent stories derivable from scientific inquiry about brain function, attunement, attachment, trauma, “integration,” the HPA axis, etc. (as one category of brain/psych research). I say it’s very important work and we should mock simple-minded, rapacious, and clumsy uses of the information, not the endeavor as a whole. There are people creating and using the information in good ways. One of those ways is to use the info as an explanatory system of how therapy works (e.g., to increase engagement, to provide a structure of meaning, an imagined path for change, etc.). I recommend a read of Allan Schore’s mindblowing “Affect Regulation and the Origin of the Self.” It’s very dense, but it isn’t neurobabble.
-Jason
Mark,
Although I appreciate your reminder to not abandon what ‘we’ know because of the explosion of all of the ‘neuro’ stuff. Let me say I think it too soon to abandon what is emerging because of what we know and to hold lightly our own beliefs and knowledges. I have been working in this field for over 30 years and my practice continues to evolve and shift. I have benefitted both personally and professionally by the ‘recent’ (though truly ancient) re-discoveries about this thing we call ‘mind’ and it’s influence on the brain (I have my own mindfulness meditation practice, now 15 years young and this has transformed my life more than any other single engagement in my own counselling/psychotherapy experiences! And I am excited by seeing psychotherapy and neuroscience come together, Boorstein, Germer, Siegel, R., Siegel, D., Bein, Kornfield, Surrey, Hanson, R. etc.). Let us not be blind to the cultural context of our work and how much our western culture excludes many people; this, I believe, applies to our practices of psychotherapy. There is a whole population of people who are now engaging in counselling and psychotherapy because THEY now believe it will make a difference; and, believe me, they have been suffering and might otherwise have carried this suffering the rest of their lives! I don’t have any problem with that at all (the engagement, not the suffering, let me be clear on that).
Thanks for prompting me to set out my own thoughts on all this. – with care, Dawn
Jason,
As always you bring a broader perspective to things and alternative ways of seeing it. I don’t mean to throw out the baby with the bath water but I hate the reductionist view, the misrepresentation of the research, the blind devotion to the medical model explanation of things, and the real fact that most clients can’t really relate to that stuff or at least it’s not what is engaging for most. My Bachelors is in biological psychology. Go figure, but I do find it provides me with an appreciation of certain biologically based factors and their relationship to the psycho-relational arts. I worked for a few years with the brain injured and organic based syndromes in a pysch hospital. It does inform what I do although it’s not often that it makes me take my eye off the ball doing psychotherapy. Even with the brain injured my job is mostly relational.
Humbly,
Dave Claud
Dave-
I agree:
“I hate the reductionist view, the misrepresentation of the research, the blind devotion to the medical model explanation of things, and the real fact that most clients can’t really relate to that stuff or at least it’s not what is engaging for most. ”
Yep. It’s the devotion, the distortion, and the reductionism (it’s the NEW unified field theory!) that I’ve got a major problem with too. Thanks for casting my loose associations and ramblings in such a charitable light!
Great blog Scott (and Mark) and great discussion Jason, Dave, Dawn!
I like the idea of thinking about these ideas simply as alternative stories that we might or might not find useful with individual clients. And actually for me at least, these ideas are no more “true” than Astrology or other such ideas – for some of my clients Astrology is where we find inspiration, when trying to figure out how they can begin feeling better – for some of my clients the answer is found in the spiritual world – and for some the answer is in brain chemistry. What is important for me is to connect with whatever makes sense for my clients, and then figure out how I might be helpful to them in that context.
Hi all
I am not certain but I think the term ‘neurobabble’ was first coined by David Healy. He is worth googling if you are not familiar with him – he is one of the champions in the battle against big pharma.
My hero, Wittgenstein, warned of the lure of neurological explanations; arguing that the first priority is to achieve conceptual clarity. There is a lovely quote he has about the lure of neurological reductionism that you might want to tuck away somewhere for a paper one day – ““(t)he best prophylactic against this is the thought that I don’t know whether the humans I am acquainted with actually have a nervous system” (p.1063 in Remarks on the Philosophy of Psychology, Vol 2).
Ha,
Nick
Mark and Scott
Thanks for this and the video. Knowing stuff (neuro science etc) is fine but, as you remind us from your work on what works, unless we know ourselves and how to use what we know (rather than telling people what we know) therapy will not be much different from a chat over the back fence and may even be less use no matter how impressive the lingo sounds.
Ian G.
Australia
I suppose the tone of the piece makes for entertainment but I do not see the value in dismissing interest in the neurological dimension of psychotherapy. What does come across is defensiveness. What I find to be a bit reductionist is the interpretation of an interest in neuroscience as motivated by a desire to medicalize the profession. For an enlightened integration of psychotherapy and neuroscience I refer you to the work of Dr. Kimberly Hoppes at Mount Sinai Medical Center who has integrated mindfulness approaches in the treatment of addictions. Her work has resulted in improved outcomes for people who previously had no non-drug based method for feeling better. Dr. Hoppes actually teaches her clients about neuroplasticity and how through mindfulness and meditation practice they can effect changes in the reward pathways that have been altered by habitual drug and alcohol use. Far from being bored or unimpressed her inner city, poor clients are quite interested in knowing that they can effect these changes ( increased hope and self-efficacy ). This is nothing new, ask any Bhuddist monk. Far from undermining the psychotherapy field or medicalizing it her approach empowers the client to take charge of their neuro-biology rather than rely on psychotropic interventions that by their nature render them passive consumers.
I have read the responses to the posting with considerable interest, but will not address or attempt to summarize all points and positions tendered thus far. Rather, to amplify my earlier commentary, I submit the following reflections.
To begin, I am a scientist. As a scientist, I am interested in fact and as such, remain highly critical of any system, narrative, or discourse that would place, by intention or acts of omission, stories, pretensions, or presumptions on par or interchangeable with fact. Pseudoscience (even outright nonsense) exists. Examples include, and introduced in no special order, ESP, creationism or “intelligent design,” UFOlogy, astrology, graphology, phrenology, repressed memories, and psychoanalysis. The list is legion. These beliefs and practices, other than perhaps having value as interests for historians, hysterians and the entertainment industry, should be vigorously challenged and exposed for what they are.
In the therapy world, consumers have been blitzed by a host of competing claims, myriad forms of wishful thinking, and techniques. With hindsight, much was conceived in acts of arm chair speculation, and in the end, amounted to folly. In recent years, the popular, misnamed empirically based or substantiated treatments, having been subjected to rigorous analyses, are now revealed, at the least, as instances of enthusiasm gone astray. Using fanfare and pronouncements, akin to we-have-the-next-best-thing-to-sliced-bread, the purveyors of “empirical” treatments misinformed the public, misled payers and policy makers, running the risk of making the field look foolish, if not silly, more than it already has.
Curiously, one of our icons, once wrote, “The facts are always friendly . . . .” Carl Rogers, with those words, might as well have auditioned for the “Prophet in the Wilderness” show. Psychotherapy, worshipping at the altar of theoretic explanation, often regarded fact as an inconvenience. Hubris — the mine’s bigger and better approach to therapy, best suited for the sand box –supplanted the client and common sense. Thanks the “stars,” we know what works best for our clients and they are telling us.
Returning briefly to the neuro-informed models and therapies, in the particular case of Allan Schore’s,” Affect Regulation and the Origin of the Self, I am not familiar enough with his work or the science he cites to say or offer anything intelligent. Schore, who describes himself, “essentially I see myself as a theoretician,” is about melding developmental neuroscience and developmental psychoanalysis to create a “neuropsychoanalysis.” Neuropsychoanalysis has its share of critics. Taking a broader view, if advances in neurology and neuroscience reach the stage of providing clear instruction and direction, tested and verified over time, for realizing real gains with clients, I will be for it. Until that day arrives, I invite all to consider other words: “Seek facts and classify them and you will be the workmen of science. Conceive or accept theories and you will be their politicians” – penned by Nicholas Maurice Arthus in De l’Anaphylaxie à l’immunité, 1921. (Rogers was nineteen at the time.)
At length, where do we draw the line between a legitimate science and something somebody made up which sounds scientific, especially as it is presented to the public? Science is not an instance of Western provincialism, the property of a power elite, just one way of knowing, or linguistic contrivance. All ideas are not created equal. Choosing “make believe” or “’cause I say it is so” has real and dangerous consequences. Throughout history, we have seen the costs when nations enact their “make believes” on other peoples and states.
Notwithstanding, we should never discourage discovery and innovation. Important investigative work is being conducted not by a wretched little few, but by many men and women who champion disciplined study. Their goal is to increase our understanding of nature and use that new knowledge for the good of all. That makes imminent sense no matter what you do or where you live on this planet. In this respect, Rogers was spot-on.
M. A. Hubble
When I hurt my knee last year, I appreciated the orthodpedic doctor’s promptness, politeness, kindness, patience, courtesy, interest, empathy, and ability to care and listen and reflect, etc. as well as his showing me his cool 3D model of the human knee as well as the radiology scans.
I appreciate (neuro)science for what it is (and isn’t) — one quadrant of Ken Wilber’s famous four quadrants (or views of reality).
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