Psych's Future.....Bleak?

[beezley]

Here is another non-match topic. So I am sitting in the surgeon's lounge (doing my surg rotation) the other day and this doc (pathologist, our surgeon's lounge is like the physician's coffee shop) is giving me crap about going into psych. "It's a dead field....it is going to be swallowed up by neurology.......many psych programs aren't even around anymore they are going to neuropsych......you won't make any money". Blah blah blah.

I told him that I disagree with him on all fronts. I think it is the opposite of a dead field, the money will be fine thank you. Then he congratulated me on not taking his crap and standing up for my choice.

I guess my question is: Besides normal interspecialty bashing, why would he feel this way about psych? Is there any truth to what he is saying specifically the being swallowed up by neurology part? Is the money REALLY that much less than everything else (hour for hour)?

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[RaistlinMajere]

Then he congratulated me on not taking his crap and standing up for my choice.

My guess is that this is the reason and that he was just challenging you to see whether you had persistence and to challenge your character. Otherwise, he or she is arrogant, ignorant, and wrong--a truly dangerous combo in a surgeon.

Psych and neuro while cousins are sufficiently different that this will never happen. Many non-psychiatrists do not enjoy working with the severely mentally ill or psychotic pts. Thus, there will always be great jobs for psychiatrists. And this is a nice perk, the lifestyle/money in psych is terrific if you look at the per hour rate.

BTW, why would you ever listen to a surgeon or any other doc in a different specialty when it comes to another other specialty??? Most people think that whatever they are doing is the best option. And, surgeons are notorious for putting down all other specialties that are not surgery. I've had surgeons tell me that there was no future in emergency medicine and family medicine. Interestingly, not psych--most docs are happy that I'm going into it even if they wouldn't have chosen it for themselves.

Bottom line: you've got to do what you love. Ignore anyone else who tells you differently.

 

[RaistlinMajere]

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[Faebinder]

You know why people go into pathology right? They don't like human interaction (and really who can blame them sometimes). Psychiatry represents the extreme other side. You want this guy to be sympathatic to you wanting to go to psychiatry? Come on, you might as well ask the president to be sympathatic minimum wage liberal pro-choice anti-war gay guy.

There really oughta be rules to make all specialties play nice with each other. The problem is some of subspecialties have their nose too high up in the air.

 

[cleareyedguy]

You know why people go into pathology right? They don't like human interaction (and really who can blame them sometimes). Psychiatry represents the extreme other side.
There really oughta be rules to make all specialties play nice with each other. The problem is some of subspecialties have their nose too high up in the air.

There are plenty of psychiatrists who aren't all that good with people, as well as pathologists who like people just fine (though they may prefer to have interpersonal connections with people who aren't in therapy with them). But I do agree we should be nice.

 

[whopper]

"It's a dead field....it is going to be swallowed up by neurology.......many psych programs aren't even around anymore they are going to neuropsych......you won't make any money". Blah blah blah.

Don't know why he'd say that. There are things going around that will affect our "market" but that's going on in every field. No field is completely static. Most medical fields are dynamic due to advances & technology & changes in health care delivery.

I did get a similar thing happen 4th year as a medstudent. An attending IM doc said something to the effect of the same thing. Even went on to day psychiatry was going to be dead in a few years, among other BS things such as there's already a complete cure to mental illness. As you can see he was wrong.

At the time though, as a medstudent, I was not going to point out that attending IM doc and question him.

If anything, I think there's more demand & market oppurtunities for psychiatrists than there are for IM doctors due to the shortage of psychiatrists. I don't see any reason to think the field will be in trouble for years from a job-market perspective.

 

[Therapist4Chnge]

Coming from the clinical psychology side...if anything, I see psychiatry as a large growth area for physicians who want to enjoy a better quality of life AND be in an area in demand. Not only is there far more need than supply, when you look at the truly gifted psychiatrists, they are few and far between, which allows for more competitive people to stand out even more in the field.

Look at 'Sazi's thread about job opportunities, it seems that certain areas of psychiatry are quite lucrative (for those who worry about making enough $$), and that it all depends on your niche area.

I think the academic opportunities in regard to research are there too. I understand most people aren't as wild about that part, but I know a couple people in the area and they are really happy with their work and life balance....and still do quite well with some side work here and there.

Neurology, Psychology, and Psychiatry all have crossover areas...but each area is still distinct and there is still room for everyone. If anything, the convergence we are seeing will allow for each discipline to further define their areas of focus and provider greater service to their patients, as there will be a better understanding of how each area contributes to the overall well-being of the patient.

 

[Anasazi23]

It's hard for me to take idiotic comments like that seriously when I just now got home at 10pm after being totally swamped with new patients in the walk-in clinic today, then going to my moonlighting job and seeing hours of more new patients, having had that private company convince me to work this saturday at their new expanded facility as well because they're so overloaded with the need for a psychiatrist to see the glut of patients they have.

Holy run on sentence batman.

This isn't getting "swallowed up" by anything. Psych patients aren't going away, and psychiatrists treat them. Bottom line.

 

[Iquitos]

Here is an interesting article on this topic. If anything, it seems that the demand for psychiatry will continue to increase. All those older doc's retiring and not enough young ones to fill their shoes=increased demand.

http://ap.psychiatryonline.org/cgi/reprint/27/4/247.pdf

 

[TheWowEffect]

Here is an interesting article on this topic. If anything, it seems that the demand for psychiatry will continue to increase. All those older doc's retiring and not enough young ones to fill their shoes=increased demand.

http://ap.psychiatryonline.org/cgi/reprint/27/4/247.pdf

You are absolutely right, Sir! It's a buyer's market for psychiatry jobs these days.

 

[Iquitos]

I think I'm sold on psychiatry. I initially went into med school debating on IM or psych. Psychiatry seems to be an overall better fit for me and it doesn't hurt that there is a huge demand for psychiatrists upon graduation. I'm set on psych right now unless the clinical years change my mind.

 

[Iquitos]

Here is another non-match topic. So I am sitting in the surgeon's lounge (doing my surg rotation) the other day and this doc (pathologist, our surgeon's lounge is like the physician's coffee shop) is giving me crap about going into psych. "It's a dead field....it is going to be swallowed up by neurology.......many psych programs aren't even around anymore they are going to neuropsych......you won't make any money". Blah blah blah.

I told him that I disagree with him on all fronts. I think it is the opposite of a dead field, the money will be fine thank you. Then he congratulated me on not taking his crap and standing up for my choice.

I guess my question is: Besides normal interspecialty bashing, why would he feel this way about psych? Is there any truth to what he is saying specifically the being swallowed up by neurology part? Is the money REALLY that much less than everything else (hour for hour)?

Not to start a flame war, but I'm not sure why a pathologist had the nerve to say that. Just hop on over to the path forum and you will see numerous threads about how the outlook for pathologists can be extremely bleak especially if you are set on working in a large city. Supposedly there is also a flood of specialists in the field because many residents go on to fellowships to help make themselves look more marketable. Not to mention the maga-path labs that are driving small private path groups out of business. I know a pathologist that retired ealy due to one of these maga-labs taking over his hospital.

 

[toby jones]

There seems to be a tension between the view that mental disorders are neurological disorders at base and the view that psychiatry is independent from (and not reducible to) neurology.

But on the other hand, there also seems to be a tension between the view that mental disorders aren't neurological at base and the view that psychiatry is a branch of medicine.

Dear oh dear, what is a field to do?????

I think that behavioral symptom clusters (the natural kinds for psychiatry) won't turn out to map onto (be type-identical to) neurological states. Just like how being able to cook a good curry won't turn out to map onto (be type-identical to) neurological states. Just like how speaking English won't turn out to be type identical to neurological states. Reduction to neurology is thus implausible.

But it doesn't follow from that that we don't have a legitimate science.

Foundationalism: The physical facts determine the chemical facts and the chemical facts determine the biological facts and the biological facts determine the psychological facts and the psychological facts determine the actions (while the biological facts determine the behaviors). (But not the other way around - so no type-identity - no reduction)

I wonder if foundationalist surgeons worry about whether future chemists or physicists will be able to perform interventions such that intervening on biological structures will dissolve as a field. Can you just see a physicist with a proton gun trying to effect physical changes to physical particles that equate to a coronary bypass??? Doesn't that seem... Silly?

I also think that that the failure of type identity / reduction doesn't matter for psychiatry's status as a speciality within medicine, however. It doesn't matter to the scientific status of economics that money isn't type-type identical to chemical or physical types. It doesn't matter to surgery that the basic physical facts entail the basic biological facts. I don't see why it should matter to the scientific status of psychiatry that mental disorders aren't type-type identical to neurological types. Of course foundationalism is true - but that doesn't have any implications whatsoever for what the best interventions are going to be.

There are different causal generalizations available to each 'level'. The causal generalizations at one level (e.g., behavioural) are very unlikely indeed to map precisely to the causal generalizations at a lower level (e.g., neurological). Ultimately psychiatry cares about intervening on behaviour / action (including verbal behaviour / action). No reason to think that neurology will trump psychology will trump sociology with respect to effective interventions...

So... How do we define 'medical' science compared with 'non-medical' science? Medicine has been interested in problematic behaviors for as long as it has been interested in problematic states of organs / parts of organs. Psychiatric symptoms were considered part of medicine for as long as medicine has existed. It is all about providing the best treatment (medicine being an applied field). I see no compelling reason to change that...

 

[toby jones]

(The following is a fairly technical 'by the way' kind of remark).

The most plausible formulation of foundationalism is to say that the global physical facts entail the global chemical facts and so on. So... (as a manner of speaking) on day one God fixed the physical facts. And then he rested because there was no more work to do. It wasn't that on day one he fixed the physical facts and then on day two he fixed the chemical facts and then on day three he fixed the biological facts and so on).

But foundationalism has been questioned in the following way:

The global psychological facts are fixed by the global biological facts.
The global biological facts are fixed by the global chemical facts.
The global chemical facts are fixed by the global physical facts. (Foundationalism)

(Arguably)
The global physical facts are fixed by acts of observation / global psychological facts
Which brings us back to mind.
(Anti-Foundationalism)

 

[HCE]

(The following is a fairly technical 'by the way' kind of remark).

The most plausible formulation of foundationalism is to say that the global physical facts entail the global chemical facts and so on. So... (as a manner of speaking) on day one God fixed the physical facts. And then he rested because there was no more work to do. It wasn't that on day one he fixed the physical facts and then on day two he fixed the chemical facts and then on day three he fixed the biological facts and so on).

But foundationalism has been questioned in the following way:

The global psychological facts are fixed by the global biological facts.
The global biological facts are fixed by the global chemical facts.
The global chemical facts are fixed by the global physical facts. (Foundationalism)

(Arguably)
The global physical facts are fixed by acts of observation / global psychological facts
Which brings us back to mind.
(Anti-Foundationalism)

huh?

 

[billypilgrim37]

huh?

I think that's Toby's way of saying she believes in magic?

 

[toby jones]

Lol, sorry about that. It is my way of saying that the general rule in science seems to be that the properties / processes / entities posited by one 'level' simply don't map well (type-type identify / reduce) to the properties / processes / entities posited by another 'level'. (Smoothest example of reduction would be chemical kinds and their physical underpinnings but there are problems even there). That seems to be the general rule in science rather than the exception. If behavioral symptom clusters (kinds for psychiatry) turned out not to map well (type-type identify / reduce) to neuroscientific kinds then this wouldn't be terribly surprising.

Most people are foundationalists in the sense that they think that once you have fixed the physical facts (together with a 'stop' clause to rule out ectoplasm and immortal souls and the like) that you have thereby fixed the chemical facts and the biological facts and the psychological facts and so on.

But the current state of physics... IF it turns out that an act of observation is required in order to collapse the wave function (a very big if) AND IF it turns out that an act of observation is best characterized as psychological (an even bigger if) THEN it would be the case that facts about observers / acts of observation would be required in order to fix the facts of physics. That isn't 'magic' that is one interpretation (fairly radical to be sure) about the current state of physics...

 

[HCE]

Lol, sorry about that. It is my way of saying that the general rule in science seems to be that the properties / processes / entities posited by one 'level' simply don't map well (type-type identify / reduce) to the properties / processes / entities posited by another 'level'. (Smoothest example of reduction would be chemical kinds and their physical underpinnings but there are problems even there). That seems to be the general rule in science rather than the exception. If behavioral symptom clusters (kinds for psychiatry) turned out not to map well (type-type identify / reduce) to neuroscientific kinds then this wouldn't be terribly surprising.

Most people are foundationalists in the sense that they think that once you have fixed the physical facts (together with a 'stop' clause to rule out ectoplasm and immortal souls and the like) that you have thereby fixed the chemical facts and the biological facts and the psychological facts and so on.

But the current state of physics... IF it turns out that an act of observation is required in order to collapse the wave function (a very big if) AND IF it turns out that an act of observation is best characterized as psychological (an even bigger if) THEN it would be the case that facts about observers / acts of observation would be required in order to fix the facts of physics. That isn't 'magic' that is one interpretation (fairly radical to be sure) about the current state of physics...

Thanks for the clarification...I think. Let me get another pot of coffee under my belt, and I let you know if I have any follow-up questions.

 

[toby jones]

I'm sorry I'm not very good at explaining what I'm trying to get at sometimes. That really is a fault of mine. Explaining things simply is much harder than explaining things by incomprehensibly raving. Most times less is more... But less requires so much more time (in the way of editing and thinking up simpler model analogies that hold in the relevant respects)... I apologize.

 

[solumanculver]

There seems to be a tension between the view that mental disorders are neurological disorders at base and the view that psychiatry is independent from (and not reducible to) neurology.

What do you mean by neurology here, Toby? Neurology is a branch of clinical medicine that does not encompass psychiatric disorders. Do you mean reducible to neurobiology? I don't think that psychiatry is supposed to be independant from neuroscience, it's an application of neuroscience.

I think that behavioral symptom clusters (the natural kinds for psychiatry) won't turn out to map onto (be type-identical to) neurological states.

Why is type-identity required? I think all that's required is supervenience.

Foundationalism: The physical facts determine the chemical facts and the chemical facts determine the biological facts and the biological facts determine the psychological facts and the psychological facts determine the actions (while the biological facts determine the behaviors). (But not the other way around - so no type-identity - no reduction)

Is this just saying that everything supervenes on physics?

I wonder if foundationalist surgeons worry about whether future chemists or physicists will be able to perform interventions such that intervening on biological structures will dissolve as a field. Can you just see a physicist with a proton gun trying to effect physical changes to physical particles that equate to a coronary bypass??? Doesn't that seem... Silly?

What analogy are you making here? Something between psychotherapy and psychopharmacology?

I don't see why it should matter to the scientific status of psychiatry that mental disorders aren't type-type identical to neurological types. Of course foundationalism is true - but that doesn't have any implications whatsoever for what the best interventions are going to be.

I think that your arguments always circle around this idea that ultimately pharmacological intervention is not as good as behavioral intervention. You can show that pharmacological intervention is not better than behavioral intervention a priori just because pharmacology is a more fundamental explanatory level, but that's not the viewpoint of most people here.

Ultimately psychiatry cares about intervening on behaviour / action (including verbal behaviour / action). No reason to think that neurology will trump psychology will trump sociology with respect to effective interventions...

Well there are reasons to think that intervening on the chemical level will be more effective than intervening on the social level... not every pathway in the brain can be modulated by environmental stimulus. Parkinson's disease, for instance, can't be cured with therapy... And neither can schizophrenia. Whatever schizophrenia is in the brain, that thing can't be cured by environmental stimulus or talk-therapy, but it can be treated by altering the chemical neurotransmitters directly.

Medicine has been interested in problematic behaviors for as long as it has been interested in problematic states of organs / parts of organs. Psychiatric symptoms were considered part of medicine for as long as medicine has existed. It is all about providing the best treatment (medicine being an applied field). I see no compelling reason to change that...

That's true, but you're trying to use that to argue the opposite, that psychotherapeutic intervention is "better", and that does not follow.

 

[RRoguish]

(The following is a fairly technical 'by the way' kind of remark).

The most plausible formulation of foundationalism is to say that the global physical facts entail the global chemical facts and so on. So... (as a manner of speaking) on day one God fixed the physical facts. And then he rested because there was no more work to do. It wasn't that on day one he fixed the physical facts and then on day two he fixed the chemical facts and then on day three he fixed the biological facts and so on).

But foundationalism has been questioned in the following way:

The global psychological facts are fixed by the global biological facts.
The global biological facts are fixed by the global chemical facts.
The global chemical facts are fixed by the global physical facts. (Foundationalism)

(Arguably)
The global physical facts are fixed by acts of observation / global psychological facts
Which brings us back to mind.
(Anti-Foundationalism)

Brilliant! This is why circles are my favorite shape.

 

[HCE]

I'm sorry I'm not very good at explaining what I'm trying to get at sometimes. That really is a fault of mine. Explaining things simply is much harder than explaining things by incomprehensibly raving. Most times less is more... But less requires so much more time (in the way of editing and thinking up simpler model analogies that hold in the relevant respects)... I apologize.

Hey, no need to apologize. I went back and read the post in a much more alert state, and I actually thought it was quite insightful.

 

[DocPsychosis]

(The following is a fairly technical 'by the way' kind of remark).

...

(Arguably)
The global physical facts are fixed by acts of observation / global psychological facts
Which brings us back to mind.
(Anti-Foundationalism)

Aha! But the people arguing reductionism/foundationalism are the same people saying that the physical facts are in fact fixed (objectivism, perhaps), not dependent on observation (relativism, idealism, quantum physics, or whatever). So at the end of the day they plug their ears and say "nuh-huh" and the whole thing is moot.

 

[toby jones]

Argument One: the psychiatric facts are determined by the neurological facts. So once we know more about the neurological causes of behavior psychiatry will vanish as a distinct field.

Argument Two: the neurological facts are determined by the physical facts. So once we know more about the physical causes of neurology then neurology will vanish as a distinct field.

People seem to be worried that maybe... With neurological advances... Psychiatry might vanish as a distinct field. You can appeal to epilepsy and general pareisis (caused by syphilis) as cases where psychiatry 'delegated out' once the causes were understood.

But are people similarly worried that maybe... With advances in physics... Neurology might vanish as a distinct field? That physicists will effect the equivalent of removal of seizure foci by way of a proton gun? Or that surgeons more generally will be out of work because physicists will effect the equivalent of a coronary bypass by way of a proton gun? Of course they aren't.

So... The main issue that people seem to have with psychiatry (that it is neurology at the end of the day) doesn't seem to carry over to issues that people have with neurology (that it is physics at the end of the day) or with surgery (that surgery, too, is physics at the end of the day).

Why worry more about psychiatry's independence from lower level sciences than worry about neurology's independence from lower level sciences, or surgery's independence from lower level sciences?

Don't get me wrong - people do worry more about psychiatry... But I fail to see why that is justified...

(Though the kind of justification I'm proposing may be unwelcome because it promises psychiatry independence from neurology at the potential cost of making psychiatry not overly obsessed on focusing on neurology - the way it is at present (especially within the bio-medical model) ).

 

[DocPsychosis]

You're right, it is a tight rope to walk between disregarding and being subsumed by neuroscience. And of course I agree with your point in general; from a practical and functional standpoint it is silly to suggest that neurology could engulf psychiatry, for the reasons you mentioned.

But from a purely philosophical point of view, according to some people (not me), there is nothing that happens anywhere that can't be explained by physics, or even more basically, mathematics. Though reductionists of that magnitude scare the crap out of me.

 

[solumanculver]

Argument One: the psychiatric facts are determined by the neurological facts. So once we know more about the neurological causes of behavior psychiatry will vanish as a distinct field.

This doesn't follow, Toby. Just because psychiatry is reducible to neuroscience doesn't mean that psychiatry isn't a distinct field. Everything is reducible to physics, and in a sense every natural science is a subfield of physics, but that doesn't mean that we should scrap biology and rely on physicists to make our seedless watermelons.

People seem to be worried that maybe... With neurological advances... Psychiatry might vanish as a distinct field. You can appeal to epilepsy and general pareisis (caused by syphilis) as cases where psychiatry 'delegated out' once the causes were understood.

What does this mean "disappear as a distinct field"? Psychiatry is just the treatment of a mental disorders. If you mean to say that as neuroscience progresses neurologists will be able to treat all psychiatric disorders (supposing they wanted to), then those neurologists that specialize in these disorders would be psychiatrists, whether they use the word or not. Psychiatry can't disappear as a field unless mental illness disappears, which probably won't happen... but if it did then we should be pretty happy about it.

(Though the kind of justification I'm proposing may be unwelcome because it promises psychiatry independence from neurology at the potential cost of making psychiatry not overly obsessed on focusing on neurology - the way it is at present (especially within the bio-medical model) ).

Toby, you're misusing the terms "neurology" and "neuroscience" here in a way that makes it hard to understand what you mean. Psychiatry and Neurology are both medical applications of neuroscience, and they are only different because of the way that we carve up different disorders into clinical specialties. Diseases that are now considered "psychiatric" could be considered "neurologic" in the future, and vice versa, those are man-made categories. As for neuroscience, I don't think that there is any conceivable way that psychiatry can be made independant of neuroscience. Neuroscience encompasses everything about the nervous system, which obviously includes everything about the brain, and that subsection of the brain that controls behavior. Unless behavior is not determined by the brain then psychiatry can't be independent from neuroscience by the very definition of neuroscience.

 

[solumanculver]

But from a purely philosophical point of view, according to some people (not me), there is nothing that happens anywhere that can't be explained by physics, or even more basically, mathematics. Though reductionists of that magnitude scare the crap out of me.

Hi, I don't think that anything in the world can be explained by mathematics per se, but every physical thing can be explained by physics. Why does that scare you?

 

[colleezfascia]

Here is another non-match topic. So I am sitting in the surgeon's lounge (doing my surg rotation) the other day and this doc (pathologist, our surgeon's lounge is like the physician's coffee shop) is giving me crap about going into psych. "It's a dead field....it is going to be swallowed up by neurology.......many psych programs aren't even around anymore they are going to neuropsych......you won't make any money". Blah blah blah.

I told him that I disagree with him on all fronts. I think it is the opposite of a dead field, the money will be fine thank you. Then he congratulated me on not taking his crap and standing up for my choice.

I guess my question is: Besides normal interspecialty bashing, why would he feel this way about psych? Is there any truth to what he is saying specifically the being swallowed up by neurology part? Is the money REALLY that much less than everything else (hour for hour)?

Funny this should happen to you.

When I was doing my OB/GYN rotation, I was told by a physician that SURGERY is a dying field because it will one day be taken over by highly-trained techs.

All nonsense. Take everything with a grain of salt.

 

[DocPsychosis]

Hi, I don't think that anything in the world can be explained by mathematics per se, but every physical thing can be explained by physics. Why does that scare you?

I suspect I didn't word myself well previously. I feel like I'm walking a tight rope here, so I hope I don't sound like I'm contradicting myself. It's not that physics doesn't somehow account for all perceivable phenomena; if you break it down step by step, that's inescapable. [run-on alert ->] But suggesting that, because "psychology is neurology, which is biology, which is chemistry", ad nauseam, then math and physics are the only real explanations for anything, is misleading and unproductive. For example, just because my borderline personality disorder is contained somewhere in my cortical neurons, doesn't mean there's not a better explanation in sociology and psychology.

Make sense? On a general level, I'm agreeing with toby jones.

 

[solumanculver]

I suspect I didn't word myself well previously. I feel like I'm walking a tight rope here, so I hope I don't sound like I'm contradicting myself. It's not that physics doesn't somehow account for all perceivable phenomena; if you break it down step by step, that's inescapable.

Yeah, that clarifies things.

For example, just because my borderline personality disorder is contained somewhere in my cortical neurons, doesn't mean there's not a better explanation in sociology and psychology.

Make sense? On a general level, I'm agreeing with toby jones.

Well I think that there are a few ways to take that.

There are many different explanatory levels that we can use to describe a phenomenon. When we combust gasoline, for instance, we can think about the oxidation in terms of a schroedinger wave equation, we can think about it in terms of statistical mechanics, we can think about the organic chemistry, we can think about the engineering of the combustion chamber... there are a lot of different ways to approach this, depending on what aspect of the combustion that we're interested in. What counts as a "better explanation" depends on what we're planning on doing.

For a psychotherapist, the "better explanation" for a mental illness will be the one that hovers at the psychological level. For a social worker it is the one that hovers at the sociological level. If you're planning on prescribing psychotropic medication, you have to focus on the level of neuroscience.

On the other hand, I think that what Toby Jones keeps getting at is something different, and much more ideological. It seems like Toby wants to say that specific disorders have canonical levels of explanation, like there is no sense in considering the neuroscience of PTSD, because it is 'psychological'. I think that Toby's rhetorical goal is to convince us that it doesn't make sense to treat mental illness medically, and that we need to shift our focus to psychotherapy. I just don't think that you can make this kind of argument based on philosophical notions of supervenience, you need data reflecting the relative successes and failures of psychopharmacology and psychotherapy...