This week on MIA Radio, we interview Professor Jim van Os. Professor van Os is Chairman of the Division of Neuroscience at Utrecht University Medical Centre, Utrecht, The Netherlands, and Visiting Professor of Psychiatric Epidemiology at King’s College, Institute of Psychiatry in London. He trained in psychiatry in Casablanca, Bordeaux and the Institute of Psychiatry at the Maudsley Royal Hospital in London.
We last spoke with Jim for the podcast in August 2017 and this time we focus on a recent paper written by Jim and co-authors that was published in the journal World Psychiatry in January 2019. The paper is entitled ‘The diagnosis evidence-based group-level symptom-reduction model as organizing principle for mental health care. Time for change?‘ Jim says that, arguably, ‘love is the most powerful evidence-based treatment in mental health’ and his paper envisions a future for mental health that moves away from symptoms and diagnoses and towards peer support and lived experience.
In this episode we discuss:
- What the diagnosis evidence-based group-level symptom-reduction model is and how it currently informs mainstream mental healthcare.
- How mental health funding and mental health professional partners work together to monitor and assess the effects of current evidence-based interventions.
- How this curative medical model is attractive, but often fails to work for patients.
- That the focus on biological, brain-based diseases and symptoms conflicts with the experience of people who are attempting to develop a narrative view of their difficulties and suffering.
- That the paper is an attempt to start a discussion about building a synthesis between the diagnosis, symptom-based medical world and the lived experience of individual people.
- How the creation of specific and discrete diagnoses has reinforced the symptom-led approach to mental health and has also necessitated the stratification of doctors into silos of expertise.
- How Jim favors a spectrum-based approach over a fixed diagnosis and that an example is autism spectrum disorder as described in DSM V.
- The limitations of using ‘target symptom reduction’ as an outcome measure for mental health.
- That symptom reduction can be beneficial in the short-term but is not a good long-term measure of recovery.
- That the paper attempts to make clear how important individual experiences are and the need to be sensitive to the existential domain, saying “restoration of health is not the goal, it is the means to enable a person to find and pursue meaningful goals, accordingly, the person’s existential values become central”.
- That the evidence suggests that any treatment effect or improvement is often down to meaningful interaction rather than the specific expertise of the treating professional.
- That, in many countries, we still see a huge gulf between mental healthcare and social care which remain separate and remote from each other and that this separation is not how the person experiences their world.
- The importance of including lived experience in the evidence base, particularly because randomized controlled trials, considered the gold standard of evidence, are often not conclusive in the field of mental health.
- That, in mental health, evidence shows that 30% to 40% of the response is down to placebo and the expectation of being helped.
- That the desire is to make the existential domain the primary lens through which to view human experience and to respond to mental or emotional suffering.
- That, arguably, ‘love is the most powerful evidence-based treatment in mental health’.
Relevant links:
Tedx: Maastricht, Connecting to Madness
thanks professor van Os and james….
what a problem we have here …
dealing with causes and treatments that work..
without doing harm…this love thing is easy to say
but hard to do….respect and kindness sound
good to me…I like it when my therapist listens
to me and doesn’t judge or distort what is said…
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Nothing new here, despite the flowery packaging. All this positivity is still based on “studies” conducted within the “professional helper” framework, and couched in “mental health” rhetoric, all of which would be swept away if this enlightened vision were to come to fruition. Love isn’t based on profit margins and is not a profession. Once again, (I’ll go back and double check to be sure) no class analysis.
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“love is the most powerful evidence-based treatment”
Since a stay in a psychiatric hospital can be damaging or unhelpful, I have wondered whether even a fetish clinic may produce better results in the short term in some cases. Of course, actual love is a different thing entirely.
Regarding monitoring mental wellbeing of society. A reduction in suicide rates does not necessarily indicate higher wellbeing. It is possible that aggressive suicide prevention simply makes suffering less visible.
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“That the paper is an attempt to start a discussion about building a synthesis between the diagnosis, symptom-based medical world and the lived experience of individual people.”
No, thank you. It’s time to end the medicalization of distress. And screw the interventions too, frankly.
Let’s have a discussion about how money drives everything in the entire world and how it is impossible to live outside of the money controlled society. Let’s talk about the effects of systemic racism and class inequality, and how that creates a system of winners and losers. Let’s talk about how many people are labeled and stigmatized when seeking help for social issues, or seeking protection from abusers. Let’s talk about our culture of toxic individualism and toxic masculinity and frankly toxic interpretations of what women can or should be doing. Let’s talk about how we can work together, not as patients and professionals, but as members of the same community, because the concept of the superhuman doctor or professional strips them of their humanity just as surely as ours is taken – see the suicide rate of professionals. We don’t need to talk about how bad experiences hurt us and reframe them so much as we need to live in a society where these horrors don’t exist. And I’m tired of hearing that that’s somehow not possible because the alternative is a world many of us don’t value and don’t want to live in. Again, check the suicide rate amidst decades of anti-suicide measures.
I’m not interested in ever putting another second’s effort into rethinking or adjusting or fixing or synthesizing the pseudoscientific medicalization of human distress.
(Although it would be really nice to see cures for the actual known causes of neuropsychiatric symptoms (using ‘symptoms’ in the correct medical sense here).)
Do I sound like a radical? Good, because it’s not a dirty word. It’s time to take the institution down, not fix it endlessly. Forgive me for not being impressed with the language and implications of some of the points presented. Thumbs down!
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Nothing left to pick at tonight so — just thought I’d bring up this concept of “neuropsychiatric” — if it’s “neuro” it’s dealing with a pathology of the nervous system, regardless of whether it involves concomitant emotional effects. So “neurological” should suffice; this is how psychiatry imposes itself on everyday language — even everyday medical terminology.
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I found this interview to be very hopeful for the future treatment of emotional distress- the idea of learning to manage your feelings and symptoms and learning how to live with your circumstances is really the key to full recovery as opposed to symptom relief. I found a few professionals who were willing to really assist me, but the others kept throwing pills in my direction. Dr. Van Os may sound radical because his voice is far outside the mainstream, but I’d put my ship in with his any day rather than trust the traditional practitioners. Thanks for a great interview.
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Some quotes about how theology damaged psyche (psychological underworld) psychosis reality, schizophrenia reality:
Let us compare: Dionysos and Orpheus went down to redeem close personal loves: Orpheus, Eurydice, Dionysos, his mother Semele. Hercules had tasks to fulfill. Aeneas and Ulysses made their descent to learn there they gained counsel from the “father” , Anchises and Teiresias. Dionysos in Aristophanes “Frogs”, went down another time in search of poetry to save the city. But Christ’s mission to the underworld was to annul it through his resurrected victory over death. Because of his mission all Christians were forever exempted from the descent. Lazarus becomes the paradigm for all humankind. We all shall rise” (James Hillman, Dream and the underworld)
One effect of this battle with the underworld was the satanizing of Thanatos. The black figure with wings, indsictinct, and even at times gentle in pagan descriptions, became “the last enemy”. and the personification of principle of evil. The underworld became throughly moralized: death became equated with sin. As is so often the psychological rule, the sin that one commits is attributed to that which one commits it upon. Projection. The moral justification for destroying an enemy is that the enemy is destructive.
The Christian image of hell was thus a projection of a hellish image in Christianism. It must have been in raging despair over the bad exchange it had made. It had lost soul, depth, underworld, and the personifications of the imagination in exchange for idealized spiritualizations in high heaven.
Now the psychological realm is for psychiatry a devil’s realm. The fear the devil indicated his nearness which also indicated one was in danger of losing Christ. So the devil was established by the fear. The devil image still haunts in our fears of the unconscious and the latent psychosis that supposedly lurks there. and we still turn to methods of Christianism – moralizing, kind feelings, communal sharing, and childlike naivete – as propitiations against our fear, instead of the classical descent into it, the nekyia into imagination.
Dreams that have their home in the underworld must, too become anti -Christian.
(James Hillman, Dream and the underworld)
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The underworld means pure psychological reality. For example life and death of Annelise Michel. She was there, in strict psychological reality, which was stolen by theological hell.
It is about rejected reality of death, the reality of schizophrenia, psychosis. It does not exists for theological psychiatry. But Anneliese Michel was real person, with real personality, with real ego in psychological Hades. She was there. And she was a hero of descent.
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Without books:
Manufacture of madness, Re -visioning psychology, Suicide and the soul, or Dream and the underworld, no one will know anything about the psychological reality.
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The want people in “hell” to kill themselves (schizophrenia, depression, autism). Ok? Because they are in naive “heaven” (apollonian ego hegemony = normalcy) This is the main aim of inquistional psychiatry, the theological negation of psychological reality. You are not partner for them, you are not a human being, you are an enemy -a patient, a hostage.
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“You are not partner [with your psychiatrist], you are not a human being, you are an enemy – a patient, a hostage.”
That’s pretty much what I realized, once I read my, hypocrite of a, psychiatrist’s medical records. That, and he was the most deluded, and likely most stupid, person I’ve ever met. Was I supposed to assume a doctor didn’t know the difference between a person’s head and their private parts? Dumber than dirt.
I agree, love is the answer. But will point out that psychiatry is basically the opposite of love. It’s about defaming innocent and trusting people with make believe diseases, then massively gas lighting and poisoning people, with drugs that create the symptoms of the made up diseases.
Then, in the end, attempting to poison the person’s child to cover up medical evidence of the abuse of that client’s child, which was just handed over, while declaring the client’s entire life to be a “credible fictional story.” I’m not certain how much more hateful, criminal, and evil psychiatrists could get. Psychiatry = hate = criminal child rape cover uppers and profiteers = satanic.
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I really appreciate the interview and the paper its based on – I work in the industry and have of course suffered myself and still do. My own suffering is entirely down be being over worked in a targets driven relentless service that is entirely focused on moving suffering people into ‘recovery’ via symptom reduction.
This is essentially a meaningless paper recovery based on the administering of two self assessment measures the PHQ9 and GAD7 two measures that tell us absolutely nothing of someones complex life context and history. Even more bonkers is the fact that these two measures are also fundamental to continued service funding and ever increasing micro management. So everyone is pressured to focus on the reduction of the scores as the goal.
Most therapies reduce the complexity of the world/context to mere ‘triggers’ for some hypothesized internal disorder and seek through insight and will power to change ‘unhelpful’ or ‘disordered’ (in reality utterly normal and expected) thoughts, beliefs, attitudes, behaviors into more ‘rational’ or balanced modes of being – ultimately services seen to be mostly about helping people simply get on with it to accept the unacceptable.
Perhaps an approach based on helping us develop what David Smail called ‘outsight’ would be better because this would help us connect with and understand how the culture through power is causing our suffering from top down from politics, economy, ideology, media, education, jobs, debt, broken communities, alienation, fear, food systems, advertising, food banks and on and on.
Mental Health Services in the UK such as IAPT are causing huge levels of staff suffering through burnout, due to targets and this production line of suffering model we currently have.
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Whether the time has not come for us to accept that psychosis is not a medical problem, even if it spontaneously arises (though this is extremely rare)
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Thank you James for another excellent contribution.
There’s loads of technical talk and big words in “Medical Papers” but the people that recover usually recover (for free) outside of the system.
“…That the focus on biological, brain-based diseases and symptoms conflicts with the experience of people who are attempting to develop a narrative view of their difficulties and suffering….”
I would say that I was just interested in getting off medication and keeping my head straight.
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