In the first scene of “Hitchcock Loves Bikinis”, a young mum is playing happily with her baby. Next comes a close-up shot of Alfred Hitchcock, the late movie director, smiling. Clearly, he is a man whose heart is warmed by this sweet glimpse of maternal love. In the next scene, we see a bikini-clad woman sunbathing followed by exactly the same shot of Hitchcock smiling. Instead of a benign grandfatherly figure, this time we see a lecherous old man. The moral of the story is simple: context is everything.
Mr. Kagan’s effort, “Psychology’s Ghosts,” consists of his assessment of four problems in psychological theory and clinical practice. The first problem is laid out in the chapter “Missing Contexts”: the fact that many researchers fail to consider that their measurements of brains, behaviour and self-reported experience are profoundly influenced by their subjects’ culture, time and experience, as well as by the situation in which the research is conducted. In his second essay, “Happiness Ascendant”, Mr. Kagan virtually demolishes the popular academic effort to measure “subjective well-being”, let alone to measure and compare the level of happiness of entire nations. No psychologist, he observes, would accept as reliable your own answer to the question: “How good is your memory?” Whether your answer is “great” or “terrible”, you have no way of knowing whether your memory of good or bad memories is accurate. But psychologists, Mr. Kagan argues, are willing to accept people’s answers to how happy they are as if “it is an accurate measure of a psychological state whose definition remains fuzzy.”
In the third and fourth essays, “Who Is Mentally Ill?” and “Helping the Mentally Ill”, Mr. Kagan turns to the intransigent problems of psychiatric diagnosis and treatment. The Diagnostic and Statistical Manual of Mental Disorders (DSM) “regards every intense bout of sadness or worry, no matter what their origin, as a possible sign of mental disorder.” Mr. Kagan laments. But “most of these illness categories are analogous to complaints of headaches or cramps. Physicians can decide on the best treatment for a headache only after they have determined its cause. The symptom alone is an insufficient guide.”
Nonetheless, the DSM is primarily a collection of symptoms, overlooking the context in which a symptom such as anxiety or low sexual desire occurs and what it means to an individual. It might mean nothing at all. What it means to an American might mean nothing to a Japanese. The same one-size-fits-all approach plagues treatment: “Most drugs can be likened to a blow on the head,” Mr. Kagan observes, they are blunt instruments, not precisely-tailored remedies. Psychotherapy depends largely on the clients’ belief that it will be helpful, which is why all therapies help some people and some people are not helped by any. No experience affects everyone equally — including natural disasters, abuse, having a cruel parent, losing a job or having an illicit affair — though many therapists wish us to believe the opposite