2013. Vol.4, No.6A1, 34-38
Published Online June 2013 in SciRes (
Copyright © 2013 SciRes.
Psychology’s Borrowings from Medical Methodology:
Analog Comparisons
Pascal Henri Keller, Marion Haza
Department of Psychology, EA4050, C APS, Poitiers University, Poitiers, France
Received March 19th, 2013; revised April 23rd, 2013; accepted May 21st, 2013
Copyright © 2013 Pascal Henri Keller, Marion Haza. This is an open access article distributed under the Crea-
tive Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any me-
dium, provided the origi nal work is properly cited.
Medical advances force practitioners to work in an increasingly standardized manner with their patients.
Quantitative health psychology attempts to follow a similar path by adopting, for the same patients,
methods that are equally systematized. In this article, the origin of such an attempt will first be positioned
historically. The clinical method will then be used to establish that, while patients tend to accept the cons-
traints imposed by the medical technique, they usually resist those resulting from quantitative psychology.
Based on clinical observations, we will present several ways in which such resistance may manifest itself.
This article aims to further the understanding of qualitative health in psychology.
Keywords: Clinical Approach; Analogous Methods; Critical Health Psychology; Medical Research
Historically, psychology was “born” out of medicine (Keller,
P.H., EHPS Symposium, 2010, Cluj Napoca, Romania). The
founder of scientific psychology in France, Théodule Ribot, de-
manded from the first psychologists that they first have a de-
gree in medicine. Today, while the experimental method re-
mains entirely suitable and efficient when it comes to studying
biological matter in medicine, it seems an inefficient way of
examining “the raison d’être of a phenomenon” (Lambrichs,
1993). This is because such a question raises the problem of
“sense”, which the social sciences, and psychology in particular,
explore in their research. However, psychology is still influ-
enced by its origins, and all the more so when its research takes
place in contact with medicine (Keller-Senon, 2007). Indeed,
“health psychology” considered for a long time that its “bio-
psycho-social” model (Bruchon-Schweitzer, 2001) enabled it to
present figures as reliable as those obtained, in their domain, by
its medical partners. The concept of “stress”, both objectifiable
and quantifiable, represented the peak of such an approach,
integrating psychological models with the medical ones. The
research conducted since the 2000s by “critical health psychol-
ogy” (Santiago-Delefosse & Chamberlain, 2008) moves away
from the purely quantitative approach of health psychology,
with “qualitative” data and in-depth analysis, taking into ac-
count and incorporating the discourse of the ill person.
Despite the attacks it sometimes faces (Lee, 2006), critical
health psychology pursues its researches, considering itself as
“an approach more than a theory” (Hook, 2004). For instance,
Hook reckons that one of the basic concerns of critical psy-
chology is aimed at “self-evident assumptions”. He points out
that these assumptions, carried on by health psychology, and
related to reality, human nature and knowledge, are only gener-
ated by “a certain group, according to a way of doing, and with
an eye to some interests” (Hook, 2004: p. 16).
Most of the time, health psychology is confined to copying
medical practices in an attempt to find its rightful place in the
form of a “biopsychosocial” (BPS) model. On the other hand,
the perspective maintained by Santiago-Delefosse proposed to
go beyond a notion of the ill human being as a juxtaposition of
BPS variables. It refers to a theoretical approach that is clearly
psychological and no longer anchored in a biomedical defini-
tion: the Embodied-Socio-Psy chological (ESP) perspective (S an -
tiago-Delefos se, 2011).
Other psychological approaches, such as the narrative ap-
proach, that neglects strictly quantitative aspects, begin to study
closely oral exchanges between practitioners and patients, and
even achieve to raise the interest of the medical world to a psy-
chology different from health psychology (Davidsen & Revent-
low, 2011)
The purpose of this article is not so much to highlight the
impasse reached by “non-critical” health psychology as to shed
light on some of its epistemological aspects. Even if the disci-
pline is sometimes lucid as to the limits of its main “bio-psy-
cho-social” model, it is interesting to analyze the logic of rea-
soning that led it to take the path it did. The logic of its reason-
ing is partly based on what psychology (Secrétan, 1992; Ri-
coeur, 1975) and literature call “analogy”, We will therefore
refer to clinical psychology work on analogical mental func-
tioning in medicine (Ducousso-Lacaze & Keller, 1995; Keller
& Ducousso-Lacaze, 2004), as well as to some other work on
analogy (Laflaquière & Ducousso-Lacaze, 2003).
Analogous Method
A subject commonly studied in its own right in philosophy,
linguistics and cognitive psychology, reasoning has not been
studied so much in clinical situations. It is nevertheless a mode
of thinking that comes easily to speakers when interviewed.
Analogy is a linguistic process that, in a general way, is in-
volved in communication between humans. Analogy articulates,
through language, “an effective, legitimate and thought-out re-
semblance between dissimilar terms” (Secrétan, 1984). This
definition contains the two terms that form the basis of the in-
terest from a psychic dynamics point of view: resemb lance and
dissimilarity. The second of these has often been ignored. In
principle and according to this definition, analogical reasoning
therefore consists in bringing together (purely through thought)
notions, data or facts that, in the first place, are completely
unrelated. In terms of reasoning structure, analogy can be ex-
pressed in the following form: A/B = C/D (“A is to B what C is
to D”). If somebody formulates an analogy to an interlocutor,
he or she does so mainly so as to be better understood by the
other. The structure makes it possible to bring together two
domains that, without it, would have no reason whatsoever to
be associated with each other. This is the way in which every-
one uses analogy, without always measuring its real impact on
the thinking of other people. When resorting to it, nobody
thinks of stating that his/her reasoning is based on an analogy.
In fact, when a speaker uses analogical reasoning, he or she has
an intention to enhance his/her interlocutor’s understanding of a
point and uses a particular linguistic means of achieving his/
her goals i.e. putting together two universes that had until then
been separate.
Generally speaking, and particularly in medicine, using ana-
logy presupposes a certain lucidity as to the point and the limits
of one’s intention, as well as the pertinence of the wording
For psychologists in medicine, it is particularly appropriate
to take an interest in analogy. Often, in order to have their eru-
dite discourse on the psycho-corporal identity of their patients
accepted, medical practitioners use analogy, without necessarily
always understanding the effect of this reasoning on the patient,
an effect that can sometimes be intrusive.
This is what we can see in the following case: a doctor
speaks to an adolescent who has just been diagnosed with dia-
betes. After announcing this diagnosis, the doctor states that
diabetes is “a lifelong illness,” and that the treatment consists in
injecting oneself everyday with insulin, adding that “the daily
injections are no more serious than brushing your teeth.” The
analogy proposed by the doctor therefore simply consists in
relating the dental hygiene of the adolescent to the daily care he
needs to take of his diabetes. The young patient does not say
anything at the time but, some years later, he will confide to a
psychologist that, “in all his life, he had never heard more vio-
lent words” (Keller, 2007). The intended effect—to make the
young man understand that his diabetes treatment has to be-
come something familiar—is based on the analogy between
brushing one’s teeth and injecting oneself with insulin (the
brushing of the teeth 1) is to general hygiene 2) what insulin
injection 3) is to diabetes 4)). But what is considered as “famil-
iar” for the doctor is not the same for the young patient. In this
case, the use of analogy provokes the opposite of the intended
effect: after this announcement and, the young patient will ne-
glect his treatment for several years, sometimes risking coma.
What is more, social discourse does not escape such improper
use of analogy. It is therefore not unusual to find formulations
such as: “Unemployment, a cancer on society”. The structure of
the analogy in this statement can be expressed as follows:
“Unemployment 1) is to society 2) what cancer 3) is to the body
4)”. In other words: there is the same connection between un-
employment and society as there is between the human body
and cancer. The essay ist Susan Sontag (in Illness as a metaphor)
considers that analogies between cancer and social disasters
(war, delinquency, drugs, unemployment, etc.) actually create
additional suffering for the patients afflicted by this illness. She
considers that the use of this analogy shows ignorance regard-
ing cancer and a lack of respect towards the patients (Sontag,
To sum up, analogy can be considered as a “relevant me-
thod”, efficient and useful if it enables us to deepen our reflec-
tion, destructive on the contrary if it inhibits it. To avoid slip-
ups, let us describe how it is used in three steps, necessary for
appropriate use: first, the speaker must announce the analogy,
that is, prepare the interlocutor and conditioning him/her to
think on the basis of the analogical reasoning proposed. He/she
understands that the analogy is going to put together two uni-
verses that, until then, were completely unrelated for him/her.
The aim is that the patient should then implement this reason-
ing his/her own way, and not to impose it on him/her. The sec-
ond step enables us to validate the reasons for bringing the two
elements together by “work on similarity” (Keller & Ducousso-
Lacaze, 2004). The shared reflection at this stage is about iden-
tifying the points of similarity between the two domains put
together by analogy. Lastly, the third and most important step
addresses the distance that separates the two domains put to-
gether by the analogical formulation. Named “work on dissimi-
larity” (Keller & Ducousso-Lacaze, 2004), this stage consists in
re-establishing a distance between the elements that have just
been brought together. This step is crucial, particularly in me-
dicine, since it limits the risks of misunderstandings between
the interlocutors. It provides a reminder that, after being brought
together, the two universes then separate, with, on one hand,
medical knowledge based on science, and on the other hand lay
knowledge, based on the history and subjectivity of the patient.
Methodological Inputs Borrowed to Medicine
This presentation of analogy might be enough to consider
that, for medicine, the qualitative approach in psychology is
more appropriate than the quantitative one. By giving priority
to the patient’s words, critical health psychology highlights his/
her history and subjective life, as well as his/her participation in
the evolution of his/her physical suffering, in the context of an
organic illness. In contrast, by giving priority to figures based
on pre-established questionnaires or scales, health psychology
has little reason to be interested in analogy. However, use of
analogical reasoning here is aimed less at comparing these two
schools of psychological thought than at thinking about the
situation of research in medicine when it concerns the psycho-
logical life of patients.
As early as 2006, M. Santiago proposed to bring an end to
the “turbulence” provoked, in psychological research, by the
confrontation between the “positive-neo-positive” paradigm and
the “subjective-constructive” paradigm (Santiago-Delefosse,
2006). Analogical reasoning might help us better understand
where the opposition stands between these two conceptions of
psychology, both of which are at work in the medical field.
We propose an analogy, from the point of view of the re-
search approach, between medicine on one side and health
psychology on the other: “In clinical research, the body is to
medicine what the mind is to psychology.” However simplistic
it may be, this formulation does at least define the object of
research in these two disciplines. As mentioned before, ana-
Copyright © 2013 SciRes. 35
logical reasoning may be misleading if used without been men-
tioned (Keller, 2007), but introducing it at the beginning of the
demonstration enables the reader (or the listener) to clearly
identify its interest, without ever losing sight of its limits. In a
clinical research situation, all practitioners-researchers are con-
fronted with rules. Physicians and psychologists have long been
mixed up, as is the case in the Declaration of Helsinki, which,
since 1964, has set out the ethical principles applicable to
medical research involving human subjects. In France, in 1988,
the “Huriet-Sérusclat” law defined the conditions for the pro-
tection of people involved in biomedical research. We never-
theless had to wait almost 20 more years for psychological re-
search to be explicitly mentioned in these texts, and even then
only in relation to the information given to the patient: “The
objective of a psychological research project, as well as its me-
thodology and duration, may be explained in a short prelimi-
nary brief as long as the research is being carried out on healthy
volunteers and does not pose any foreseeable serious risk.
Complete information on the research is given when it is over
to the persons who participated in it” (Public Health Code.
Biomedical research, article L1122-1, 2006). In other words,
until this date, from a legal point of view, the psychologists-
researchers in this domain could put psychology on the same
level as medicine, which was mixed up with it. This is also
what the definitions established by psychologists working in
contact with medicine show, as evidenced by this excerpt from
a psychological work. “(Health) psychology can be defined as
the study of health and illness, focusing on the importance and
the role of the interdependence of psychological, social and
biological factors in the maintaining of health or the onset and
evolution of illnesses;” and, later on, “in the case of cancer,
existing studies highlight several psychological characteristics
linked to the emergence and evolution of these pathologies”
(Fisher & Tarquino, 2006). In the reflection on analogy be-
tween medicine and psychology, the step on “work on similar-
ity” therefore implies that, generally speaking, some elements
would be common to the two disciplines: pathologies (infec-
tious diseases, cancer, heart disorders, etc.), objectives (illness
prevention, health study, therapeutic action, etc.), notions (di-
agnosis, aetiology, risk factors, epidemic, prevention, etc.), me-
thods (“objective” data sampling, “objective” statisticcal analy-
sis, presentation of “objective” scientific results, etc.), and, last
but not least, interlocutors (patients, patients’ families, medical
staff, etc.).
Over the last ten years or so, authorities have realized that, in
research, psychology belongs to a non-medical sector: “social
sciences.” They increasingly tend to call this field “behavioural
sciences” (Caverni, 1998). In this context, psychological re-
search carried out in medicine has progressively been divided
up into quantitative research on one hand and qualitative re-
search on the other. In other words, while biomedicine retains
and sometimes reinforces-its experimental procedures, psycho-
logy is loosening its methodological system. There are now two
options. The first, we know, is a system based on the experi-
mental method borrowed from medicine (mainly based on the
manipulation of variables), with the collection of data, mainly
figures. The second calls upon qualitative methods, of a “dia-
logical, dialectical, phenomenological, interactional, hermeneu-
tic” type (Santiago-Delofosse, 2006). For now, let us note that
in biomedical research, the dissimilarities between medicine
and psychology are mainly due to this partition of psychology
into two distinct sets. A first point of dissimilarity between
medicine and psychology is therefore established: medicine re-
mains a full-fledged discipline, united around EBM (“Evidence
Based Medicine”), whereas psychology is in broad outline split
in two (qualitative psychology and quantitative psychology).
De facto, we are witnessing a pushing away of works coming
from the “qualitative” school of psychology, where psycho-
logical works have to stay within the medical research frame-
work defined by the Declaration of Helsinki. In this framework,
only the research protocols satisfying the methodological re-
quirements imposed by biomedicine can be examined: verifi-
able procedures, validated tools, figures, repeatable results.
(Cousson-Gélie, 2011).
It is on that very point that a second point of dissimilarity can
be established. Indeed, the quantitative approach to psychology
bases its scientific claims on its similarity to the medical tem-
plate that is still used as a reference. However, a close review of
its research tools and results in fact reveals the difference be-
tween these two disciplines and sheds light on the characteris-
tics of their dissimilarity.
Dissimilarities between Quantitative
Psychology and Medicine
As if they were becoming aware of these dissimilarities, but
without clearly stating it, some European countries (France,
2003; Belgium, 2006; Switzerland, 2009; etc.), have begun to
propose regulations specific to social sciences research in gen-
eral, and psychology in particular. In 2006, the WHO even
organized an international conference in Denmark, based on the
acknowledgement of an “epidemic of psychosocial distress and
mental ill health in Europe”.
As we saw earlier, psychology and medicine sometimes,
within this legislative framework of international research
(Declaration of Helsinki, Hurriet Lax), use a common vocabu-
lary. If the research protocols submitted to research ethics com-
mittees show this community of words, paying particular atten-
tion to the meaning of these words enables us to reveal the dis-
similarities between the two disciplines. It can be easily spotted,
either when medicine has recourse to the terms usually used by
psychology, or when psychology uses words from medicine.
Furthermore, most medical protocols report a problem facing
specialists in a specific body pathology, the researchers’ aim
being to resolve this problem. A hypothesis is then proposed, as
well as the method to be used to confirm it. The judgment crite-
ria; that will be used to determine if the research fulfills its
objectives or not are then listed. Lastly, the risks are described,
making it possible to consider the cost/benefit ratio of the re-
search for the patient. In ophthalmology for example, in order
to improve the treatment of cataracts, glaucoma or myopia, the
researchers have to stick to the procedure and report, at each
step, all the data necessary to validate it. The result is the im-
provement of the patient’s sight, which is accurately measured.
These strict and precise protocols, unlike those involving psy-
chology, more often than not yield unambiguous results. An-
other dissimilarity concerns placebos (Geirso & Keller, 2009).
Medical methodology uses this subterfuge (administering a pro-
duct that is inert from a pha rmacological point of view in order
to compare its effects to those of the product being trialled) in
order to neutralize the psychological impact of a prescription.
There is probably no better way to show how medicine differs,
in research, from psychology. We can illustrate this with the
example of a research project, “Relationship between adiposity,
Copyright © 2013 SciRes.
emotional status and eating behaviour in obese women: the role
of inflammation”, that tries to scientifically merge psychology
and medicine. Conducted among around a hundred women,
before or after they underwent surgery to have a gastric band
fitted, the project aimed to establish a link between, on one
hand, their body and biological state (overweight, inflammation,
etc.), and, on the other hand, some aspects of their psychologi-
cal state (neuroticism, anxiety, depression, etc.). In this method,
the tools used to collect the biological markers (blood test and
fat samples) and the tools used to measure the “psychological”
indicators (questionnaires, scales, automatized tests) are pre-
sented side by side. This presentation therefore assumes and
equivalence between all the collected data, biological or psy-
chological. This research gives priority to the resemblance be-
tween medical and psychological procedures. However, we can
still note at least two characteristic dissimilarities: firstly, the
biological data have a material existence and can be directly
observed and measured (in our example: interleukin, adipokin,
etc.); secondly, the psychological data are intangible (answers
to questions) and are indirectly observed or deduced (here, “so-
cial support,” “quality of life,” “depression,” etc.). In addition,
the biological data are manually collected by the medical staff
with no intervention whatsoever from the patient (syringe, dos-
ing devices, etc.); on the contrary, psychological data are ob-
tained through tools designed in a specific culture, and their
content necessarily depends on the will of the patient to submit
to them.
In biology, a “chimaera” is a hybrid organism, composed of
cells of two distinct genetic origins. By analogy, can we say
that health psychology is a chimeric discipline? The fact re-
mains that still today, medicine seems to keep its distances
from such psychology. Several reasons can explain such mis-
trust. On one hand, health psychology uses tools that sometim e s
reveal the contradiction between the practitioners and the pa-
tients’ judgment on the interest and the beneficial effects of a
medical treatment (Macquart-Moulin, Viens, Bouscary et al.,
1997). On the other hand, if some medical acts entail a complex
psychological dimension, where the relational aspect is deter-
mining, it is hard to implement the involvement of psycholo-
gists alongside practitioners, whatever the reason. In that re-
spect, the reasoning used in both disciplines often applies to
objects of different nature: biologic for some, psychological for
the others. And yet, in most cases, the distinction between the
reality of the body and the imagination of the psyche is essen-
tial, espec ially to the patient (Terry , Gareth, Braun, & Virginia,
2013). Nevertheless, sometimes the interested professionals
don’t take into account this difference, however fundamental in
the relationship with the patient. Finally, among the source of
lack of understanding or misunderstanding between medicine
and psychology specialists, we can highlight that practitioner’s
training, especially in Europe, only includes a few hours of psy-
chology. This gap maintains a problematic distance between the
two disciplines, a distance that health psychology persistently
tries to reduce. If psychology has to play a part alongside medi-
cine, it would rather be achieved by a diversification at the
theoretic-clinical level than by trying to mimic the unique prin-
ciple of evidence-based medicine. This is how critical health
psychology currently multiplies its efforts, for example by pro-
posing to diversify research methods instead of unifying them
(Dures et al., 2011). By distancing themselves from the dogma
of cognitive psychology, some authors also question the idea
that conscious and rational information would enable an evolu-
tion of representations in medicine. These authors call on other
areas of relevance in order to improve the situation of people
who request medical expertise (Santiago- Delefosse, 2012).
Regarding the hesitation it raises among its medical partners,
psychology would therefore be well-advised to ponder on at
least two levels. On one hand, quantitative health psychology
could give up on mimicking medicine, enabling for the elabora-
tion of specific tools, more centered on the patient’s feelings.
And, on the other hand, by turning for instance to the study of
the “placebo relationship” from the hypothesis of the uncon-
scious, critical health psychology could renew the interest in the
speech of all partners involved in care.
Today, the Declaration of Helsinki on biomedical research is
evolving and now puts in the notion of “research involving
human subjects1”. As a consequence of such an evolution of the
regulations on medical research, psychology research projects
will have to be approved by a Committee for the Protection of
the People (CPP) before being set up2. Isn’t this the opportunity
for psychology to have the plurality of its researches acknow-
ledged and to prove its relevance in the health field?
The auteurs thanks Pr Marie Santiago-Delefosse, University
of Lausanne (Ch), Institute of Psychology, CeRPSa and the
organizers of the 25th Conference of the European Health Psy-
chology Society.
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