The Two Branches of Psychology

If you have been or are a psychology major, or you’re thinking about becoming one, you’re probably familiar with (or will become familiar with very quickly) people riding your major off as humanities, soft-science, and asking you “bro, you gunna be my counselor now?” There’s a reason psychology isn’t taken seriously, and part of it is the narrative psychology professionals have created and perpetrated. Let me explain.

Having been this major for a while now, I see two very distinct branches of psychology: the humanities side that dominates the media and is what everyone thinks of when you say you’re majoring in psychology, and the science side, which rarely ever makes the media unless the research hasn’t been peer reviewed and the researcher is money hungry.

Earlier in the year, I wrote a series called “Is Psychology a Science?” which you can read the first of at this link. We concluded there is a lot of science and that the problem is it isn’t being taken seriously, or it’s purposefully being subverted.

The Perfect Example: Gabapentin

At work, I’ve spoken with plenty of people who have been prescribed Gabapentin for anxiety or depression or as a PRN (as needed) medication. After a panic attack which I mistook for an allergic reaction to a medication, I ended up in Urgent Care and was prescribed Gabapentin “to make it through the weekend” because it’s “really great for anxiety.” I picked up the prescription (with insurance, it only cost eighty one cents, kind of how Percocet only cost me one dollar, and no, I don’t have high tier insurance) and got straight to work.

Gabapentin is FDA approved for treating Seizures and Postherapetic neuralgia (nerve pain, particularly after Shingles). It is often prescribed off-label for anxiety (usually social phobia, GAD, panic attacks, and generally worry), depression, insomnia, neuropathic pain related to fibromyalgia, regular pain, just pain, migraines, any headaches that could probably go away with aspirin or time, as a replacement for benzodiazepines (Ativan, e.t.c), as a replacement for opioids (oxycodone, e.t.c), alcohol withdrawal, benzodiazepine withdrawal, alcohol treatment (reduce drinking or sustain abstinence), bipolar disorder, any mood disorder, any perported mood dysfunction, restless leg syndrome. It can be taken as needed or daily. It belongs to its own class of drugs: the gapapentinoids. Another drug you may recognize from commercials that belongs to the gabapentoid class is Pregabalin, a.k.a Lyrica.

Anyone remember Lyrica commercials? God. Disturbing shit. I don’t watch television anymore, only streaming services, so I haven’t seen a pharmaceutical ad in a while. I don’t miss it.

What Does Research Say?

I didn’t take the Gabapentin because research told me what the doctor didn’t, or couldn’t: there is no robust evidence supporting Gabapentin for any of the off-label prescriptions above. My first indication of this came from a Vice article, which I was hesitant to read because, well, it’s Vice. So I took their investigative journalism with a grain of salt and used it to guide my database research. Here’s what I learned:

• Parke-Davis, the company that funded research and research articles for Gabapentin purposefully avoided publishing the disappointing effects of Gabapentin. They tweaked the research to appear positive. This was found out in 2009, when researchers looked more carefully at the articles more carefully.
• David Franklin, biologist, started working for Parke-Davis in 1996. He quit three months later, just after an executive “allegedly” told him: “I want you out there every day selling Neurontin. We all know Neurontin’s not growing for adjunctive therapy, besides that’s not where the money is. Pain management, now that’s money.” You can read more here.
• This was all in the past, and Parke-Davis paid 420 million in restitution for violating, in the most disgusting way, psychological and biological research. The problem is, the rhetoric that Gabapentin is a “great drug” and “works well for anxiety, depression, and your momma’s broken hip” still permeates the medical world. Particularly the psychological one. This was done purposefully.
• There is no substantial evidence for any off-label use. I searched the databases all this morning. I found one measly Meta-Analysis (review of multiple studies studying the same thing, analyzed statistically) that showed 7 studies using Gabapentin for alcohol use reduction or abstinence. It was better than placebo slightly, but “the only measure on which the analysis clearly favors the active medication is percentage of heavy drinking.” So, it didn’t stop drinking or help withdrawal, it just kind of made people drink less. Or mix the two. Which is even more dangerous.
• The only research with Gabapentin and anxiety says it’s not substantial enough to help panic attacks and that many people are most likely experiencing a placebo effect when they take it. Given that I learned that, I saw no point in trying Gabapentin: the chances it wouldn’t work for me because I don’t believe it will was too great. When I checked my college’s database, I went through over ten pages of articles and didn’t see one study geared toward Gabapentin and anxiety.

What Does This Have to do With Psychologists?

Well, the same rhetoric permeates the clinical psychology department of the world as well. That is, psychologists are more likely to trust the word of their colleague than to go read a primary research source themselves, scrutinize the methods, results, and read the confounding variables. Human beings are naturally trusting, and that is a beautiful thing. It gets us into a lot of trouble though–most likely a colleague hasn’t read the primary research either, and is simply going off what their colleague told them.

Believe it or not, this is a research topic in psychology.

I came across this analysis in my searches this morning. In summary, the researchers did a qualitative analysis of different psychologists in private practice, and their attitudes toward things like empirically supported treatments. What did they find?

• Psychologists are “interested in what works.”
• They were skeptical about using protocols described by the treatments proved to work.
• They were worried non-psychologists would use those treatments to dictate practice (which I’m having trouble seeing as bad).
• Clinicians mostly used an “eclectic framework”, meaning they drew from many sources (most of which were probably not supported by any empirical data, I’m guessing.)
• They valued: experience, peer networks, practitioner-orientated books, and continuing education that wasn’t “basic”. So, nothing that involves a Starbucks drink I guess.
• If resources for learning empirically supported treatments became easier to access, they would be interested in implementing them into their practice.
• Money, time, and training are all aspects which have been preventing psychologists from actually implementing researched practices into their treatment. 68% cited this as a major issue preventing them from adhering their practice to researched methods. 14% said it was because they just didn’t believe in the efficacy of the treatment and 5% said it was because that treatment wouldn’t fit a cliental population. Again, that is a belief, not a fact.
• Only 19% of psychologists surveyed around the nation (United States) used psychological research papers as their primary source of research information. What the fuck are they reading? The Key To Beating Anxiety by some random self-published author on Amazon?

The analysis is much longer than what I’ve listed here, and gets deep into some real topics anyone considering going into clinical or counseling psychology should pay attention to. The message to take away here is that attitudes and beliefs are driving how we are being treated both in the psychological world and the medical field. Physicians fall prey to the “word-of-mouth” about drugs in the same way psychologists fall prey to the “word-of-mouth” about treatments. This is why I write these articles: it’s up to the consumers to play an active role in what they are putting into their body, how, and why. It’s also up to the consumers to be informed in treatments, ideas, and beliefs.

Otherwise, you’re giving your life up to someone who may not know what they’re talking about any better than you do.

Lastly, let’s get something straight: I’m thankful for every medical professional I’ve ever come in contact with, because they’ve all taught me something for better or for worse. I’m thankful for the front-line workers who have spent the last 8 or 9 months using insanely inventive strategies to try and keep their worse Covid patients alive. Doctors are reading researched evidence because the links to research are suddenly in the media, and researchers are putting out what works and what doesn’t, as they should always be. This scramble to beat Covid has stirred probably the most ethical (and probably also the most unethical) research that’s been done in a while.

It suddenly makes sense to do things right when your life is at stake.

The point is, stay informed, stay healthy, and read.

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