Depression is the most frequent psychiatric diagnosis. A few years ago, one in five US adults reported having ever received a diagnosis of depression.
At a cost of 35 million dollars, NIMH’s STAR*D study, which was published in 2006, is the most extensive and expensive study ever conducted to determine the effectiveness of drug treatment for depression. The study was well-designed and particularly of value because it is of real-world patients, not carefully selected participants, and includes an assessment of long-term as well as short-term drug effectiveness.
The results of this landmark research have been reported fraudulently by its authors and by psychiatric leaders. They claim the study found the drugs to be effective treatments for depression, leading to remission in 67% of patients, but this is false; that finding was inflated by various types of research misconduct, even including imaginary remission rates from people who dropped out of the study. In addition, since STAR*D’s publication, the prescription of these drugs is generating and exacerbating depression more than alleviating it.
In 2010, I was one of the authors of a published critique of the STAR*D study’s reported findings. We showed how STAR*D’s authors had manipulated the data to manufacture fraudulent results. Three other published critiques of the STAR*D study document this malfeasant reporting of the findings—all to no avail because psychiatry is in total control of the narrative. What follows is another effort to expose this unrecognized travesty to the public and to doctors and to set the record straight.
The STAR*D study was the third of three major studies conducted by the National Institute of Mental Health (NIMH) to determine the effectiveness of drug treatment of depression.
The first NIMH treatment outcome study, which was published in 1989, found the drug treatment (imipramine) to be no more effective than placebo when measures were taken after three months of treatment. The second NIMH depression treatment study, which was published in 1992, reported on the long-term outcome of these drug treated patients. After 18 months of drug treatment, when these patients were compared with patients treated with placebo, the patients who were treated with drugs showed higher relapse rates, a lower number of weeks being symptom free, and a higher percentage seeking treatment. Thus, measured long-term—the more meaningful measure of drug effectiveness—patients treated with sugar pills fared better than those prescribed antidepressant drugs.
The STAR*D study provides data on the effectiveness of drug treatment (SSRIs), short-term and long-term. Analyzed correctly, its results replicate NIMH’s prior findings. Although the STAR*D study does not include a placebo control group, when measured short-term (after three months of treatment), the results for drug treatment are the same as those found for placebo in other depression outcome studies that do include a placebo control group (30-35% remission rates). In addition, when measured long-term, the results for the SSRIs replicate the previous negative results that were found by NIMH. After 12 months of treatment), patients treated with drugs fare worse than those given a placebo (7% remission).
Moreover, a comprehensive review of all the evidence in the UK’s National Institute for Health and Care Excellence depression guideline found antidepressant drugs to be no more helpful than placebo in the short term, and much worse than placebo in the long term.
These studies are the most substantial outcome studies ever done to assess the effectiveness of drug treatment of depression. To repeat, they all found that when measured short-term, antidepressants have a very modest benefit, being only as effective as placebos. They also found that after 12 to 18 months of continued drug treatment the benefit declined, becoming much worse than placebo. Thus, the results for antidepressant drugs, short-term and long-term, are not an endorsement for their prescription.
Regarding the outcome of measures of the effectiveness of psychological treatment for depression, the first of the NIMH studies cited above also found behavior therapy to be no better than placebo as a treatment for depression. However, since then, numerous studies have found behavior therapy to be an effective treatment for depression, significantly exceeding placebo. As a prime example, McPherson and Hengartner’s review, published 20 years later, reported psychological treatment of depression to be significantly more effective than placebo. McPherson and Hengartner also found the effectiveness of psychological treatment for depression increases with time, in stark contrast to antidepressant drugs whose outcome declines with time to be much worse than placebo.
As I have indicated, STAR*D’s researchers did not report these findings as their results, claiming falsely that drug treatment is effective with nearly 70% of patients. Despite the malfeasance of their statistical analyses having been documented in four publications in scientific journals, the truth has been suppressed by psychiatric leaders and academic psychiatrists, who have embraced the specious reporting of STAR*D’s results.
For 18 years, academic psychiatry has taught psychiatric residents STAR*D’s falsehoods. The same falsehoods are taught in continuing education programs to previously credentialed psychiatrists. Consequently, psychiatrists routinely prescribe antidepressant drugs to their patients. But the largest prescribers are primary care doctors, acting on the falsely reported results. STAR*D’s fictitiously reported success rate has led to antidepressant drugs being established as the treatment of choice for depression and has persuaded psychiatrists and other doctors to prescribe costly drugs that only demonstrate a short-term placebo effect and are associated with outcomes much worse than placebo.
Irving Kirsch, at Harvard Medical School, is medical science’s most prominent placebo researcher. The placebo effect is based on faith in our doctor. It is a well-known psychological factor that contributes to the effectiveness of medical and psychological treatments. His research expands our understanding of the anecdotal basis for patients’ (and doctors’) belief in antidepressant drugs.
Kirsch retrieved the data from published drug/depression outcome studies, including the clinical trials that led to the FDA’s approval of antidepressant drugs, and measured the sizes of the drug effects and the placebo effects in these studies. These calculations enabled him to determine how much of the response to antidepressant drugs in the treatment of depression is a drug effect and how much is a placebo effect.
He found that the response to antidepressant drugs is not a drug effect, it is a placebo effect—a placebo effect that also is determined by the patient’s interpretation of the side effects of the drugs. The side effects of the SSRIs vary individually but they include tremor, insomnia, blurred vision, headache, nausea, joint and muscular pain, weight gain, and sexual dysfunction.
He discovered that antidepressants were functioning as active placebos; the placebo effect was enhanced by many of the side effects of antidepressants. The surprising effect found by Kirsch was that the patients who identified the side effects were the very patients who improved on the drug. He summarized the findings: “The association between side effects and improvement is so strong as to be nearly perfect.” In other words, the positive effect attributed to the chemicals in the drugs is not the result of a helpful chemical treatment but attributable to patients believing they received a helpful drug since they were experiencing the side effects of the drug.
Kirsch’s findings signal a warning. Not only are antidepressant drugs found to be ineffective as treatments for depression, they are powerful drugs that have adverse effects.
Some of the other harmful effects of antidepressants include causing suicidal and homicidal urges, depression, anxiety, mania, Parkinsonism, increased balance problems with aging, and serotonin syndrome. The drugs also lead to increased likelihood of relapse and of never recovering from depression.
Data, not anecdotal opinions of scientists and doctors, must rule in health science.
Yet it should be clear that the malfeasance perpetrated by STAR*D’s researchers represents the intentions of NIMH, which is led by psychiatrists. The STAR*D study was the culmination of a seven-year NIMH contract investigating antidepressant drug treatment of depression, that led directly to the design and funding of the STAR*D study; three of STAR*D’s authors were staff members of the NIMH, two of them being branch chiefs; and the study’s statistician was one of them. NIMH’s psychiatric fingerprints are all over the manipulation of the STAR*D data.
The press is showing no interest in getting this story right, content to repeat STAR*D’s malfeasant reporting, and is therefore playing a large role in promoting the public’s belief in psychiatry’s fictitious narrative, unintentionally contributing to the damage being done. The New York Times, this country’s most prominent newspaper, known for its investigative reporting, inexplicably allows psychiatric word salad to trump science, and passively accepts and disseminates STAR*D’s falsified results. Anecdote is favored over science. I recently communicated with Ellen Barry, a Times mental health reporter, about the Times’ failure to report STAR*D’s malfeasance; she told me she has no plans to write about this subject. Science journalist Robert Whitaker made a similar effort with the Times. He, too, was spurned.
The New York Times has adopted a double standard in reporting errant research analyses related to mental health versus physical health. Within days of learning of the misreporting of cancer research at Dana Farber, that story was on page one of the Times. Pigott’s 2023 publication in the British Medical Journal of data obtained through the Freedom of Information Act, which appeared not many months before that story, documents STAR*D’s flagrantly erroneous data analyses. The revelations are of comparable importance since these falsified results are relevant to tens of millions of people, yet the STAR*D story has not been covered by the Times, despite being brought to their attention several times. I raised this double standard, too, with Ellen Barry, and got no response.
In March 2024, Psychiatric Times did acknowledge STAR*D’s fabricated reporting, becoming the first psychiatric publication to do so. Moreover, the editor underlined the significance of these findings by pointing out that STAR*D’s actual results undermine decades of psychiatric practice. Nevertheless, there has been no psychiatric follow up to this very important acknowledgment.
Instead, in April of this year, an National Institutes of Health (NIH) press release was published which purports to inform the public about the treatment options available for depression. Entitled, “Research Matters: Treating Depression,” it doubles down on the fraudulent reporting of the treatments. Cognitive behavior therapy is described as effective, but only for mild depression—if you really need help, you are advised to choose drug treatment.
So, NIH has joined NIMH in an unwarranted extolling of the value of antidepressant drugs and has compounded the fraud by adding unwarranted limitations on the value of therapy. By disseminating a false appraisal of what science has told us, NIH, along with NIMH, is failing to inform the public about the value of therapy versus drugs in the treatment of depression.
The NIH article also repeats another of STAR*D’s drug-related falsehoods. One of the aims of the STAR*D study was to demonstrate the value of psychiatry’s scientifically unsupported biological heterogeneity theory of depression, that there are different forms of depression, and patients can be treated successfully by finding the right drug for their kind of depression, “matching patients with their optimal treatments.” It repeats STAR*D’s false claim that the study’s results bear this out. But the data show that it did not matter what drug was prescribed; every drug produced the same limited effect as every other drug. There is no support for the theory that treating failed patients with drugs having different biochemical actions enhances the outcome.
The NIH goes on to extoll the value of ECT as a medical treatment for depression. This claim, too, not only is scientifically unsupported, it is highly misleading and a disservice to the public. A recent detailed review of the scientific basis for ECT comes to a very different conclusion, pointing out: The last outcome study of ECT was almost 40 years ago; the ECT outcome studies that were published back then are of such poor quality that they provide no basis for claiming ECT is an effective treatment for depression; however, those studies do reveal there is a high risk of ECT causing permanent memory loss (brain damage) and even a small mortality risk; the reviewers call for ECT to be suspended immediately until satisfactory outcome studies show it has value and is safe.
The concerns regarding ECT apply to antidepressant drugs, as well. The now thoroughly discredited serotonin chemical imbalance theory of depression was the basis for the medicalization of psychiatry in 1980, leading to drug prescriptions becoming established as the treatment of choice for mental disorder. The long-term negative results for drug treatment that were found by NIMH and NICE suggest an iatrogenic outcome for antidepressant drug prescriptions. The evidence is consistent with the conclusion that prescription of antidepressant drugs is generating and exacerbating mental disorder more than alleviating it. These concerns are not without precedent. Not that long ago, during my lifetime, psychiatry inflicted great harm advocating eugenics and lobotomy, for which a psychiatrist was awarded a Nobel prize.
The most important question is why psychiatric leaders, NIMH, and NIH are making these terrible false claims. The answer is that they have nothing else. NIMH has spent many tens of billions of research dollars over many decades attempting to substantiate a physiological basis for depression and other mental disorders, only to come up empty handed. After a hundred years of looking, psychiatry has failed to find empirical evidence for a medical/biological basis for depression, the anxiety disorders, and the great majority of the DSM’s diagnoses. So, STAR*D’s actual results are too bitter a pill for psychiatric leaders to swallow and they have chosen malfeasance, becoming a rogue medical specialty.
Scientific evidence points to the conclusion that although our physical and psychological realms are continuously interacting with one another, the explanation for physical illness is fundamentally physiological and the explanation for mental disorder is fundamentally psychological. This is why psychiatry’s efforts have failed to verify physiological explanations and medical treatments for mental disorder that parallel the verified physiological explanations and medical treatments for physical illnesses.
STAR*D’s results are in alignment with a host of studies which indicate we are pursuing the wrong explanatory paradigm for mental disorder. This same century that has witnessed an exponential explosion of evidence for a medical/biological basis for countless physical illnesses, guiding medical treatments that work, also has produced abundant evidence pointing to a social/psychological explanation and well-validated psychological treatments for depression, phobias, social anxiety, OCD, and PTSD.
With very few exceptions, the mental disorders are explained by our brain’s great capability for learning and cognition, which not only accounts for the acquisition of functional behaviors but also the establishment of dysfunctional behaviors – research that has enabled behavioral psychologists to develop treatments that are the most effective treatments we have for mental disorder.
Our behavior, including abnormal behavior, is shaped by our environment and the consequences of our actions. In contrast to the failed results of tests of brain theories, an abundance of research has confirmed psychological cause and effect explanations for mental disorder. Parsimony is a time-tested rule for the scientific explanation of causation. The psychological paradigm for mental disorder posits that in the commonly occurring mental disorders the brain is acting normally, according to behavioral principles that explain normal as well as abnormal behavior. This is the simpler explanation, that fits with the data, but psychiatrists are adamantly opposed to psychological explanations for mental disorder.
Psychological treatments work because they provide people with the tools they need to problem-solve. Whereas drug treatment promotes passivity (expecting a drug to do the work), the goal of behavior therapy is to engage the patient in problem-solving behaviors. These behaviors are a part of the patient’s repertoire after therapy ends, sustaining and enhancing the positive outcome.
Behavioral research is a significant contributor to a great body of research findings which led the World Health Organization and the United Nations to call for a paradigm shift regarding mental disorder from a medical/biological paradigm to a social/psychological paradigm.
This travesty needs to be ended. Instead of NIMH spending its precious research dollars in pursuit of a chimera, it should be investing these funds in studying psychological factors in mental disorder, improving the efficiency and effectiveness of behavioral treatments and other social/psychological remedies, and pursuing a validated behaviorally-based DSM.
There are plenty critics of the psychotherapy research and most of it is based on the very constructs that psychiatry has failed to show exist – Here are some useful summaries from William M. Epstein critiques from his books, The Illusion of Psychotherapy, Psychotherapy as Religion: The Civil Divine in America, and Psychotherapy and the Social Clinic in the United States.
1. Lack of Scientific Foundation
Epstein argues that psychotherapy lacks a solid scientific basis. He critiques the field for relying on anecdotal evidence and subjective experiences rather than rigorous, empirical research. He contends that many of the claims made by psychotherapists cannot be scientifically validated, making psychotherapy more of a pseudoscience than a legitimate scientific discipline.
2. Ineffectiveness
In his work, Epstein questions the effectiveness of psychotherapy. He asserts that the evidence supporting its efficacy is weak and that any perceived benefits are often due to placebo effects, the natural course of recovery, or other non-specific factors unrelated to the therapeutic process itself.
3. Psychotherapy as a Form of Religion
Epstein likens psychotherapy to a form of secular religion, where therapists act as priests, offering moral and emotional guidance rather than real, evidence-based solutions. He suggests that psychotherapy fulfills a cultural need for meaning and comfort, similar to religious practices, but without delivering concrete, measurable benefits.
4. Commercialization and Professionalization
He critiques the commercialization and professionalization of psychotherapy, arguing that it has become more about maintaining a lucrative industry than genuinely helping people. He is particularly critical of how the field has expanded its influence by medicalizing normal human experiences, turning everyday struggles into mental health issues that require professional intervention.
5. Impact on Social Policy
Epstein is concerned about the influence of psychotherapy on social policy. He argues that it diverts attention and resources away from addressing structural issues like poverty, inequality, and social injustice, focusing instead on individual psychological problems. He believes that this shift reinforces a neoliberal agenda that blames individuals for their circumstances rather than addressing broader societal issues.
6. Ethical Concerns
He raises ethical concerns about the power dynamics in the therapist-client relationship. Epstein is critical of the authority that therapists wield over their clients, often without sufficient accountability or transparency. He questions the ethical implications of this dynamic, especially when combined with the lack of solid evidence for the effectiveness of therapeutic interventions.
1. Questionable Efficacy
Weak Evidence for Effectiveness: Epstein argues that the evidence supporting the effectiveness of psychotherapy is weak and inconsistent. He contends that many studies that claim to demonstrate the benefits of psychotherapy are methodologically flawed, often relying on small sample sizes, biased reporting, and subjective measures of improvement. According to Epstein, much of the research fails to establish causality, meaning it cannot definitively prove that psychotherapy itself is responsible for any observed improvements in clients.
Placebo and Non-specific Effects: He suggests that any benefits reported by clients of psychotherapy can often be attributed to placebo effects, the therapeutic relationship (often called the “therapeutic alliance”), or other non-specific factors such as the passage of time, rather than the specific techniques or interventions used in therapy. Epstein argues that these factors would provide similar benefits even in the absence of formal therapy, thereby calling into question the necessity of psychotherapy itself.
Regression to the Mean: Epstein also points to the statistical concept of “regression to the mean” as an explanation for why people often report feeling better after therapy. Since many clients seek therapy during periods of acute distress, their symptoms may naturally decrease over time regardless of the therapy they receive. This natural improvement is often mistaken for the effect of the therapy, leading to an overestimation of its efficacy.
2. Harms of Psychotherapy
Pathologization of Normal Life: Epstein argues that psychotherapy can cause harm by pathologizing normal human experiences. By labeling everyday challenges and emotional responses as symptoms of mental disorders, psychotherapy may encourage individuals to see themselves as ill or deficient, which can lead to unnecessary treatment and a sense of dependency on mental health professionals.
False Sense of Control: He is critical of the way psychotherapy promotes the idea that individuals can exert control over their mental health through therapy. Epstein argues that this belief can be harmful because it ignores or downplays the significant impact of external, structural factors—such as poverty, discrimination, and social inequality—on mental well-being. As a result, individuals may feel responsible or blame themselves for their struggles, leading to increased feelings of inadequacy or failure if therapy does not lead to the desired outcomes.
Reinforcement of Social Conformity: Epstein contends that psychotherapy can reinforce social conformity by encouraging clients to adjust their thoughts, feelings, and behaviors to fit societal norms, rather than challenging those norms or addressing the underlying social conditions that may contribute to their distress. This can be particularly harmful for individuals who may be experiencing distress as a result of oppression, marginalization, or other social injustices.
Dependence on Therapy: Another harm that Epstein identifies is the potential for clients to become dependent on therapy. He argues that psychotherapy can foster a reliance on the therapist, creating a dynamic where the client feels unable to cope with life’s challenges without the ongoing support of therapy. This dependence can undermine an individual’s autonomy and self-efficacy, potentially leading to long-term reliance on mental health services.
Lack of Accountability: Epstein also critiques the lack of accountability in the psychotherapy profession. He argues that because the outcomes of therapy are difficult to measure objectively, therapists are rarely held accountable for ineffective or harmful practices. This lack of oversight, combined with the subjective nature of therapy, can lead to situations where clients are harmed without recourse.
3. Broader Social and Ethical Concerns
Distraction from Structural Issues: Epstein argues that the focus on individual psychotherapy distracts from addressing broader social and structural issues that contribute to mental distress. By framing psychological problems as individual issues to be solved through therapy, society may neglect the need for systemic change to address social determinants of mental health, such as poverty, inequality, and discrimination.
Reinforcement of the Status Quo: He further contends that psychotherapy often reinforces the status quo by encouraging clients to adapt to existing social conditions rather than challenging or changing them. This can perpetuate social inequalities and injustice, as therapy becomes a tool for maintaining social order rather than promoting meaningful change.
William M. Epstein is also critical of the Diagnostic and Statistical Manual of Mental Disorders and for obvious reasons.
1. Medicalization of Normal Behavior
Epstein argues that the DSM contributes to the medicalization of normal human behavior. He believes that the manual pathologizes a wide range of everyday experiences and emotions, transforming them into mental disorders that require treatment. This, he contends, is a way to expand the reach of psychiatry and psychotherapy, turning ordinary life challenges into medical issues.
2. Lack of Scientific Validity
Similar to his critique of psychotherapy, Epstein questions the scientific validity of the DSM. He argues that many of the disorders listed in the DSM are not based on objective, scientific criteria but rather on subjective judgments made by committees of mental health professionals. He suggests that these categories lack clear, empirical definitions and are often created or modified based on cultural, social, or economic factors rather than scientific evidence.
3. Influence of the Pharmaceutical Industry
Epstein criticizes the DSM for being influenced by the pharmaceutical industry. He argues that the expansion of diagnostic categories serves the interests of pharmaceutical companies by increasing the market for psychotropic medications. This relationship, he suggests, undermines the integrity of the DSM and raises ethical concerns about its role in promoting the use of drugs to treat conditions that may not require medical intervention.
4. Reinforcement of a Neoliberal Agenda
He believes that the DSM reinforces a neoliberal agenda by individualizing social problems. By framing issues like anxiety, depression, and stress as personal mental health disorders, the DSM shifts focus away from structural factors such as poverty, inequality, and social injustice. Epstein argues that this approach absolves society of responsibility for these issues and places the burden on individuals to manage their problems through therapy or medication.
5. Arbitrariness and Over-Diagnosis
Epstein also critiques the DSM for its arbitrariness in defining and categorizing mental disorders. He points out that the boundaries between different diagnoses are often vague and that the criteria for inclusion in the DSM are not always consistent or based on solid evidence. This, he argues, leads to over-diagnosis and the potential for harm, as more people are labeled with mental disorders and subjected to unnecessary treatment.
6. Ethical and Social Implications
Finally, Epstein is concerned about the ethical and social implications of the DSM’s widespread use. He argues that the manual’s influence extends beyond psychiatry into broader social and legal contexts, where DSM diagnoses can affect individuals’ rights, responsibilities, and social standing. He questions the ethics of relying on a document with such significant power when its scientific and moral foundations are, in his view, deeply flawed.
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Your comment totally demolishes the fallacious premises and dubious claims of all psychotherapy.
While Dr. Leventhal rightly condemns the questionable conduct of, if not the outright fraud committed by, dishonest and incompetent purveyors of the now-refuted hypothesis regarding a chemical imbalance as the putative cause of “mental illness,” he nonetheless continues to use misleading, inappropriate medicalized terms (e.g. “disorders,” “abnormal” or “dysfunctional” behavior) to label various states of emotional distress, which I for my part regard as a normal, understandable response to harrowing life experiences. Such misuse of stigmatizing language contributes to the faulty perception of people with “problems in living” (Thomas Szasz’s apt description) as being somehow defective and supposedly needing the wise guidance of an expert in CBT, for example (although a recent article on the MIA website asserted that psychodynamic therapy has become the new, more effective modality) to make them whole again. This condescending attitude not infrequently leads to a harmful power imbalance in the relationship between clients and therapists, and confers on the latter a superior level of insight, skill, and authority that exists only in their own endless self-serving justifications.
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Thomas Szasz is an extreme right wing fascist who’s entire project was to classify all people struggling with mental, developmental or psychosocial distress and disability as ‘malingerers’ who should be left to die alone on moral grounds. Epstein is a mid level social work professor of no note or intellectual rigour whatsoever who is publishing to gain prestige for a group many of my fellow working class people have described as ‘colonialist child kidnappers’.
Psychotherapy is provably helpful, overwhelmingly evidenced. There are certainly criticisms to be made, specifically of the proliferation of pseudo-scientific modalities and theories as selling points when they make up 1% of the difference in outcomes. Good psychotherapy or counselling is the offering of the services of a person trained, practiced, and skilled in active listening, warmth, empathy, curiosity, and non-judgement who is not personally involved in your situation to talk things through with. it’s a service every single remotely complext society in human history has offered in some form.
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‘Psychotherapy is provably helpful, overwhelmingly evidenced’
really?
instead of lazy irrelevant character assassination, why not critique Epstein’s critique.?
Or try this recent paper written by world renowned scientists and researchers, not that that should matter when the content of critique is quite clear to see and understand.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8751557/?
from the summary:
‘In summary, a systematic re‐assessment of recent evidence across multiple meta‐analyses on key mental disorders provided an overarching picture of limited additional gain for both psychotherapies and pharmacotherapies over placebo or TAU. A ceiling seems to have been reached with response rates ≤50% and most SMDs not exceeding 0.30‐0.40. Thus, after more than half a century of research, thousands of RCTs and millions of invested funds, the “trillion‐dollar brain drain” 2 associated with mental disorders is presently not sufficiently addressed by the available treatments. This should not be seen as a nihilistic or dismissive conclusion, since undoubtedly some patients do benefit from the available treatments. However, realistically facing the situation is a prerequisite for improvement. Pretending that everything is fine will not move the field forward 156 , nor will conforming and producing more similar findings 157 .
A paradigm shift in research seems to be required to achieve further progress’
and what of these helpful elements? placebo?- try this from a former president elect of the British Psychological Society.
https://www.psychreg.org/why-most-psychotherapies-equally-ineffective/
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is there somewhere i can read more about your claim regarding Epstein?
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It’s worth noting that your wildly scattershot ad hominem diatribe against Szasz and Epstein, and against similar critics of the mental health industry by implication, immediately raises a number of number of important points that call for prompt vigorous rebuttal.
1. I have read a number of Szasz’s books and articles and listened to many of the videos he produced before his death. Nowhere in them have I ever found a trace of “extreme fascist” tendencies, and this should come as no surprise, since he was a Hungarian Jew forced to flee from Europe with his family before the Second World War. He hated and condemned authoritarianism and coercion of any stripe, especially in the psychiatric context. If you can adduce proof to the contrary, please cite the relevant source in full.
2. Your dismissive put-down of Wiliam Epstein as a “mid-level social work professor of no note or intellectual rigour whatsoever” is nothing but a cheap, gratuitous insult that fails to refute even a single one of his arguments. Can you demonstrate their intellectual vacuity with your own, independent, science-based counter-arguments? And I’m really curious about the group of “colonialist child kidnappers” for whom Epstein supposedly published; would you mind revealing the identity of this nefarious criminal cabal and his connection with it? Could they all have been scientologists who abducted helpless children to boost membership in their cult? Inquiring minds do want to know….
3. You claim, again without the slightest corroboration, that psychotherapy is “provably helpful, overwhelmingly evidenced.” This remark not only discounts the numerous accounts by contributors to the MIA website who have been stigmatized, degraded, and gaslit, if not physically abused or otherwise harmed permanently, by mental health “professionals,” but also ignores the well-documented history of the fraud and incompetence of psychiatry and its allied fields over the past century. I refer you, inter alia, to Jeffrey Masson’s work on the complicity of German psychiatrists with the Nazi T-4 program and the Holocaust, and to the APA’s approval of sterilization and other eugenics measures even through the 1940s.
Lastly, in regard to your dubious assertion that some sort of special “training” in empathy, active listening, warmth, curiosity, and non-judgmental, objective counseling is required for those who wish to add their fellows in emotional distress, I remain unconvinced that the motley host of clinicians, LSWs, neurolinguistic programmers, psychoanalysts, and other practitioners (a large percentage of whom make use of bogus DSM diagnoses in order to receive compensation for their services) in fact are uniquely endowed with all these sterling qualities, which I seriously doubt can be acquired by osmosis through academic courses or other formal instruction. On the contrary, I find arrogance, dogmatism, and grandiosity to be far more characteristic of this entire field.
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And now when you look at dying things your eyes will help them die. It’s the negation you call death, it’s the negation good calls evil, not knowing death, for it is ever alive. Death knows only itself. it’s other name is pleasure, and it is always dying in pleasure – pleasure is a dying thing. You see that – you know it. It is the flame that is always going out. And when you see a dying thing today you will help it die. This will happen inside and out. A shrinking carcass pulls and tightens and reveals the true eternal structure underneath. You call it the skeleton but it’s the true selves of all selves.
And you will destroy the weeds in your own garden, not just in our garden, and you will not have to worry about growing. Growing is natural in freedom as the whole of nature shows. Just stay with the dying in order to watch the dying and be free of the dying and become free through this dying. The dying includes the whole world and everything thought and said. Don’t be afraid of the destruction of all that is and has been and all that has ever been known: it is the oldest story in the Universe, one each wave understands as it crashes against the shore.
We are the ocean and the sea, but you imagine you are a person who loves persons, and this is imprisonment by persons, in the illusions of persons who know only how to die and suffer. And in this peopled world of illusion you imagine you love your parents and daughters and songs but if we took away your sun from the sky you’d soon know that you love the sun above all things. All things you thought you loved are mere etchings on the walls of eternity, these etchings by the sun. He writes on her and it is only through each other that they can ever know each other. And they know only by seeing. Everything is untouchable, unreachable except as seeing.
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We’re all here for the same thing. We either know it or we don’t. We are here first and foremost to see and understand what is, as it is, which is the first aim of all natural life. It is through that perception and understanding that it grows in intelligence, strength and power. The introduction of the socially conditioned mind complicated this process, but it is still essentially the same, and the whole evolution of human consciousness and society is in crisis because we don’t understand this basic fact. We imagine we need to devise intellectual solutions to all the world problems created by the intellect in the first place, andthis very attempt to find intellectual solutions just adds to the problems it itself creates out of it’s own ignorance. The true solution cuts at the roots of all problems and solutions. It is the clear, uninfluenced perception of what actually is as it is, and until you discover this, you are not even the ever decreasing circles on the surface of the lake. You are not even a water bird feature. But when you understand yourself you become the lake and all the circles and water bird features of life which are mere impulses of the vast body of life, which are the mere fluterings within a vast, infinite system of nerves. Don’t be afraid to die because it is only through death that you understand what is at it is, which is the whole of life, it’s bliss, it’s emptiness, it’s nothingness and the unreachable mystery that all things are. Or stuff your face at KFC on chickens whose consciousness is even more pure and innocent then yours was when it first learned a word, for that word was the destruction of your purity and innocence and the replacement of freedom with ignorance, which is the toxic shadow of knowledge, which is false truth in the hands of the social system for which it can only be used for gain. This is why the whole of civilization is the movement of unredeemed evil, ignorance and greed. It is the blind fury of coming to understand yourself, so understand yourself now. It just means destroying everything you are through perception, through clarity, that’s all. And then you will discover that you were nothing at all besides these smoke and mirrors of confusion and blind stumbling. And that stumbling was always ever this unreachable mystery that you always and ever already are. That’s the truth of self-seeking and self-finding. Finding yourself is discovering that there was never anything to be found.
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True that in one article you can’t say everything. But for anxiety and depression it doesn’t talk about inflammatory state, vagus nerve and microbiota. Yet Microbiota Revolution seems to be the new way.
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Agree– I don’t think it’s sensible to argue that there is *never* a biological basis for symptoms of depression or anxiety. And Stuart Shipko– who seems like a very gifted clinician and researcher who I only had one the pleasure of speaking with once– has been studying the microbiome and gut health for decades.
Back in 2010 or so, I though that was a little weird. By 2016, I was definitely rethinking that opinion. In 2019, I got a terrible case of diverticulitis. I will never forget being fully recovered from the acute phase of the illness, surrounded by loving friends, family, and pets, and realizing that it was literally not possible for me to be in a better mood because antibiotics had temporarily destroyed all the flora in my intestines. That felt more like anhedonia than depression– I was functional, and I even saw a few clients and did some paperwork– but it was really clear because it was as if a single facet of previous depressive symptoms suddenly existed all by itself for the first time.
I wonder if something similar was going on when I was drinking; certainly, depressive feelings I’ve had were much harder to shake when there was a lot of alcohol in my system, and I wonder if gut health had something to do with it.
I think Leventhal is pretty close to the mark when he says, “although our physical and psychological realms are continuously interacting with one another, the explanation for physical illness is fundamentally physiological and the explanation for mental disorder is fundamentally psychological.” He might have added that often, the physical interactions can be very, very profound, and this is one of the rare situations where the ‘standard of care’ is probably right: Assess and refer for physical complaints before, or concurrently, with initiating psychotherapy.
His references to ‘behavioral research’ are intriguing. I suspect he does not mean ‘behavioral psychology’ in the conventional sense, which in my opinion doesn’t really work– and our dogs are laughing at us because we think that it does. (At least mine do.) He certainly doesn’t sound like Watson or Skinner!
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Nice article. And another reminder why I will never, ever subscribe to the New York Times.
The fact that Leventhal’s trenchant and well-informed article has some vague overlap with the wild, eugenicist crackpottery of William Epstein should, and will, confuse absolutely no one who does even the most cursory research on Epstein’s, er, oeuvre… such as it is. Don’t know what else to call it– certainly isn’t research, and doesn’t have anything to do with science.
I am particularly grateful for Leventhal’s discussion of active placebos. I had some idea what this was, but didn’t know there was a name for it!
The uncomfortable truth about validating either psychiatric medication or psychotherapy is that we’ve all fallen prey, at one time or another, to the post-digital fallacy that everything aspect of the human condition can be measured or quantified empirically. Unfortunately, that is not the case, at least not just at this moment. We have very little idea of what to measure or how to measure it.
Another way of putting it: Combine a vast, heterogeneous sample size with a self-reporting inventory and you have… exactly nothing, except, perhaps, a metastatic, amorphous, writhing monstrosity of uncontrolled independent variables.
That doesn’t mean we should stop searching for the metrics. Why not? Perhaps if we can repair the crisis in academic publishing, our grandchildren or great grandchildren will see the light at the end of the tunnel. But as long as RCTs are the ‘gold standard’ of research, nothing is going to change anytime soon.
Until then, we have only our own observations– thin gruel, to be sure, but that’s where we are. How many people do I know who have actually benefited from psychopharmacology? I can count them on a single hand, and even then, I’m being generous.
How many people do I know who have benefited from psychotherapy or been harmed by psychopharmacology? Well, I could probably count them.
But it would take a very, very long time.
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You curtly dismissed William Epstein’s well-reasoned critique of the mental health industry as being an expression of “eugenicist crackpottery.”
Instead of engaging in unsubstantiated calumny, would you mind explaining in what way his arguments smack of eugenics (where does he advocate the breeding of a superior race, and the sterilization or euthanasia of the genetically defective, the sick and disabled, or mental patients?) and why he should be regarded as a crackpot? And if Epstein is wrong on all counts, whom do you consider to have the correct viewpoint in this entire debate about the validity and credibility of mental health diagnoses and treatments? CBT practitioners, Freudian psychoanalysts, behaviorists, Reichian bodyworkers? I assume that if you look with disfavor on critics of psychiatry, you yourself can cite a body of credible research and verifiable findings to support your assertions. Then what is it?
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From Epstein’s ‘parody’ article ‘Corrective Abortion and Crime’:
“Had some of the nation’s youths been aborted before birth, many billions more would have been saved. “
“A corrective abortion is an abortion performed after parturition from the mother’s womb.”
“The equipment required for corrective abortions is already in place throughout the states. Whether lethal injection, shooting, electrocution, or hanging, each technique and each site must make reasonable efforts to protect the safety of parents.”
If the article were funny– which it is not, Epstein is no Jonathan Swift– it might find a place in a publication like The Onion, or even in this comments section. The fact that Epstein felt it was appropriate to tar and feather the social sciences and belittle and berate those who disagree with him as would-be executioners in an academic publication provides ample evidence of his insufferable pedantry. Psychotherapists and Social Workers, at a minimum, are trained to know the difference between briefly making an intemperate comment in private or by email after work– and mocking our colleagues and the people that we serve in public. If he’s really that jaded, why is he still writing articles? How could this possibly be helpful or even amusing?
I have neither the expertise, time or inclination to determine whether this article is evidence of projective identification– whether Epstein might actually believe some of the eugenic solutions he is accusing the social workers of promoting in his article. But I’m suspicious. I mean, come on, this is pretty damn creepy. He seems awfully worked up– and hysterical folks don’t always have the sharpest insights or make the best decisions.
I do not recall Irving Yalom, Robert Whittaker, or Gabor Mate (or author authors I respect but occasionally disagree with) ridiculing those who disagree with them in this way. Do we really need more junk articles littering the landscape of academic publishing? How is this moving the ball forward? Why would anyone take Epstein seriously after reading an article like this?
Yes, I get it, an article like this could be attempting to be a sly, clever put-down of both “woke” social justice warriors and death penalty advocates. But it fails miserably. As parody, it lacks inspiration, and most importantly, compassion. It’s part of the problem, not the solution,
What makes you think that I believe ANYONE has ‘the correct’ viewpoint in the debate about the credibility of mental health diagnoses and treatments, or that I look with disfavor on critics of psychiatry? I AM a critic of psychiatry! I just generally avoid polarized, black-and-white thinking.
Except, perhaps, when it comes to black-and-white thinking itself. It isn’t ‘both-sideism’ to suggest that this categorical cognitive error is a big part of what brought us biological psychiatry in the first place. It’s all in the brain! Or the body! All the psychiatrists are wrong! All the Social Workers are wrong!
Come on. Haven’t we had enough of that?
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In this comment section, a contributor named Topher recently presented William Epstein’s very cogent criticism of the shaky intellectual foundations of psychotherapy.
The entire issue regarding the validity and credibility of psychiatry as well as other disciplines in the mental health field is not just a rarefied academic debate, but can have extremely serious psychological and physical consequences for troubled people who mistakenly believe in the competence, objectivity, and integrity of their therapists, the great majority of whom continue to base diagnoses and treatments on the DSM compendium of billing codes. If the DSM lacks scientific credibility (the NIH, inter alia, does not recognize it as a reliable guide to medical practice), what DOES inform the training of social workers, psychologists, adepts of behaviorism, CBT, Freudian and Jungian analysts, primal therapists, and other”professionals?” It seems to me that any discipline claiming to be a full-fledged science in the traditional sense of the word should possess at least a somewhat credible body of empirical knowledge derived from meticulous experimentation and testing and verifiable, universally applicable findings obtained under strictly controlled laboratory conditions. I simply fail to grasp how the hundreds of categories of mental disorders arbitrarily voted into, and sometimes out of existence by panels of self-styled experts (who not infrequently have dubious ties to pharmaceutical companies and ECT manufacturers) meet any of these elementary criteria. What, then, confers upon mental health practitioners legitimate authority to claim superior knowledge of and insight into their clients’ thoughts, emotions, and behavior? Without a sound justification for this self-assumed authority, the mental health industry is nothing but a mercenary cult/racket profiting from the emotional distress–not from the mythical disorders–of its clients.
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Just as well Epstein clearly has a sense of humour.
‘Crimes in every category are committed less by the unborn and more by people below 18 years of age. Indeed, fetuses committed less than 1% of all violent felonies’.
I’d recommend everyone goes and reads this serious research paper by this Social Worker Nazi and please share your best bits here https://journals.publishing.umich.edu/sdi/article/id/5299/
why bother with such silliness? maintaining a sense of humour is vital is these corrupted days -https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020124
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Epstein worked for years and years in communities as a Social Worker, community organiser and professor of Social Work, producing thoughtful detailed critiques of the Social Clinic. All of this was really a careful confection of image, seemingly banging his head against business as usual desperate for change.
I love this paper and encourage everyone to read it very carefully and perhaps post their favourite parts here – one of my favourite parts is this
‘Indeed, fetuses committed less than 1% of all violent felonies’
Still, even 1% of fetuses with flick knives is something we should all fear.
Read this at your peril people, its not for the faint hearted, https://journals.publishing.umich.edu/sdi/article/id/5299/
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Yeah, fetuses and felonies and flick knives. Hysterical.
A gonzo journalist Epstein is not. This kind of smug, low-brow pseudointellectual blather wouldn’t have cut it in even in the ’70s. And this is DEFINITELY not funny when one of the guys running for president is trying to whip people into a frenzy by claiming his opponents are in favor of infanticide.
I did actually go and read a few of his articles. Sure, he makes valid points about how low quality of research in psychology and social work and the biases and assumptions that go unquestioned. But hundreds of far better writers, and more serious academics, have covered that ground more thoroughly before. This is part of any decent research and writing course in a psych or master’s program. Practicing therapists talk– and argue– about these problems all the time.
Also, can we put to rest the idea that therapists are rarely held accountable for their actions? That is true of some specialties in health care, yes. But our trade magazines have an entire section devoted to disciplinary actions, describing in detail how some of our colleagues lost their way, or never should have been practicing to begin with, and the punishments they received. And– at least in the last half century or so– we aren’t like some law enforcement agencies or religious institutions where offenders get a slap on the wrist only to be re-hired somewhere else– at least not in my state. We’re even held accountable for our actions when we are not practicing; blow a .08 at a checkpoint, and it’s not just five of ten grand and community service, you basically lose your career. And if you want it back, figure that could take you tens or hundreds of thousands of dollars and several years.
I think it’s a categorical error to make no distinctions between different forms of ‘treatment’ (and scare quotes are appropriate, because many of these are not treatments at all), and to treat problems in research, problems in treatment, problems in ethics, and problems in law, as if they all spring from the same singular fundamental misconception. That would be convenient, but the reality, I think, is messier than that.
This isn’t whistle blowing, it’s just lazy. And we can do better. Levanthal, at least, is trying.
I agree with him that a paradigm shift is necessary, and I think his case for that is well made. I don’t completely agree with him that a focus on ‘problem-solving behaviors’ is the answer– or not all of it, though it is a core intervention for depressive symptoms. CBT, an an ‘evidence-based’ modality of treatment, seems to be showing its age a bit, lapsing into toxic positivity and manualized reframes. The reason my own theoretical orientation is eclectic is because to me, it seems like different interventions work for different people, but I DID grow up in the ’70s, and that’s a little vague even for ME, okay?!
Also, I’m not sure how I feel about this: “The psychological paradigm for mental disorder posits that in the commonly occurring mental disorders the brain is acting normally, according to behavioral principles that explain normal as well as abnormal behavior.” I think the brain probably does act abnormally while clients are experiencing symptoms, and while I think that can sometimes be quite informative, (I’m thinking of what they’re calling the ‘salience network’ at the moment) what I think is absolutely hopeless is searching for a biological solution to that issue. Yeah, if a patient or client felt better, we might see that in an fMRI, but please, God, can we not make that part of diagnosis and treatment?! Reducing depressive symptoms probably involves not only cognitive, behavioral, and emotional, interventions but also cultural and environmental ones.
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Catalyzt writes;
“can we put to rest the idea that therapists are rarely held accountable for their actions? That is true of some specialties in health care, yes. But our trade magazines have an entire section devoted to disciplinary actions, describing in detail how some of our colleagues lost their way, or never should have been practicing to begin with, and the punishments they received. And– at least in the last half century or so– we aren’t like some law enforcement agencies or religious institutions where offenders get a slap on the wrist only to be re-hired somewhere else– at least not in my state. We’re even held accountable for our actions when we are not practicing; blow a .08 at a checkpoint, and it’s not just five of ten grand and community service, you basically lose your career. And if you want it back, figure that could take you tens or hundreds of thousands of dollars and several years.”
Can you direct me/us to some of the articles in the ‘trade magazines’? It seems these articles very rarely make it to the mainstream media possibly contributing to the ‘myth’ that there is no accountability mechanism in place.
That and the vicious gaslighting by narcissistic politicians who manipulate outcomes (with fraud) and make the issue about the victims response rather than the vile conduct of the ‘therapist’? They do the same sort of ‘editing’ for war criminals, who then begin to behave in the same sort of manner as these ‘therapists’, once they realise they are unaccountable. (see “Our friend is going to jail” @boy_boy mirror on Youtube)
Commit crimes against the public (torture, involuntarily euthanise), and ‘edit’ documented legal narrative to make the victims an ‘outpatient’ post hoc seems to be working where I live. A bit like dragging your victim onto your property to make your assault justifiable because of their trespass.
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Capitalism gonna do what Capitalism gotta do init?
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Has the NYT started publishing any articles about the dangers of nicotine/smoking yet?
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May I have more insight into the legal origins of this website and platform? It is possible that this is connected to an investigation on police misconduct and a cover up on trafficking amongst other crimes. The guilty officer suffering from self-admitted psychiatric conditions behind this mishap would be J. McCoy.
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Alan Watts Psychotherapy East and West is a self help masterpiece to be recommended.
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To Catalyzt:
Snide ad-hominem put-downs of William Epstein’s critique (which you cavalierly dismiss as “blather”) of the intellectually and morally bankrupt mental health field–a pernicious cult/racket futilely pretending to be a legitimate, science-based branch of medicine–is no substitute for a point-by-point refutation of his cogent arguments.
As for the accountability that so-called mental health professionals supposedly bear for their often ineffective, if not downright harmful “treatments,” I have serious doubts regarding your assumption. I recall, for example, a case in Massachusetts where a young girl, perhaps only three years old, died as a result of potent neurotoxins administered to her on the advice of a psychiatrist, and the state authorities absolved him/her of any responsibility for her death. One cannot but wonder how many other cases of such blatant poisoning of children (not to mention frail, helpless dementia patients, often elderly women, in nursing homes who have to ingest chemical cocktails or undergo ECT in order to make them more docile and manageable) there may be which never come to public attention…
I’ve just watched an hour-and-a half online interview with journalist Robert Whitaker, founder of the MIA website, in which he described in detail the sordid history of the chemical imbalance myth deliberately propagated by the APA to bolster its professional reputation and fill its coffers–at the expense of the physical and emotional well-being of unwary clients who were taken in by this widespread harmful and still prevalent medical fraud. How many of the leading figures in pharmaceutical companies, academia, regulatory bodies, and the media who were complicit in this massive cover-up, or indifferently turned a blind eye to it, lost their jobs, had to pay compensation to victims of psychiatric malpractice, or incurred other well-deserved punishment for their connivance or apathy?
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No, I’m not going to offer a point-by-point refutation of Epstein. You don’t offer a point-by-point criticism of each discipline– social work, psychiatry, psychotherapy, pharmaceutical companies, ECT, so why would respond at that level of detail? It’s like you imagine we’re all nodding our heads and colluding with each other in some vast conspiracy, when our relationship (at least for many of us) is often quite oppositional. Instead, you deliver a sweeping diatribe against the entire field of mental health without offering a single constructive idea in return. This is also a problem I have with Epstein: I only read three or four articles (and I’m kicking myself for wasting that much time on them) but I could not identify any constructive ideas concerning what we should do instead.
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Yes, I certainly do reject the entire field of mental health because it’s based on false premises and fails to satisfy the elementary criteria of rigorous experimentation and testing as well as verifiable findings that are the sine qua non of any genuine science or branch of medicine. I’m in total agreement with Thomas Szasz’s perfectly logical contention that it’s senseless to speak of certain thoughts, emotions, and patterns of behavior in terms of pathology, except as metaphors that have meaning solely in a specific socio-cultural context, which evolves over time–as one can plainly see from the arbitrary decision of an APA panel in 1973 to declassify homosexuality as a mental illness, or from the equally unsubstantiated incorporation of the so-called prolonged grief disorder in DSM-V. As for your criticism that I failed to detail the widespread incompetence, collusion, and outright fraud in each of the disparate disciplines engaged in this shady racket/cult (for what else can one call a pseudoscience that has propagated for many decades the pernicious chemical balance myth and other unproven hypotheses to the detriment of its unsuspecting clients?), all those sordid doings have been exposed not only in books and articles by Dr. Szasz but also by Peter Goetsche, Robert Whitaker, Jeffrey Masson, Bruce E. Levine, Phil Hickey, Jeffrey Schaler, and William Epstein. Their arguments have been set forth on the MIA website frequently, and there’s no need for me to repeat them here. The eloquent and moving testimonies of MIA contributors also confirm the views of those courageous critics.
Lastly, in regard to my supposed failure to offer a single constructive idea in return, I have in fact often done so, to wit: Given that the DSM compendium of billing codes should not be considered a reliable guide to sound medical practice (something that its compiler Thomas Insel and the NIH itself frankly acknowledged), the host of clinicians, psychiatrists, social workers, counselors, therapists, psychologists, and other practitioners who continue to base “diagnoses” and “treatments” on that pastiche of concocted disorders lack all professional credibility. Rather than relying on their dubious authority and condescending attitudes, the preferable alternative for a person in emotional distress–as Jeffrey Masson pointed out in “Against Therapy”–is to join a non-hierarchical, non-judgmental support group of intelligent peers. You will likely find more empathy, insight, understanding, and wisdom there than in the office of a credentialed, highly paid “professional” hawking a brain-disabling neurotoxin or the latest vogue in talk therapy.
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In a recent post, I expressed doubt regarding your claim that mental health professionals bear accountability for their actions. I cited the notorious case of a toddler in Massachusetts whose death resulted from the administration of a potent neurotoxin, and psychiatrists who shrivel the brains of elderly nursing home patients, particularly women, with ECT and chemical lobotomies). I also mentioned the collusion (well documented by Robert Whitaker, Peter Breggin, Bruce E. Levine, Peter Goetzsche, among others) between the APA, Big Pharma, the media, academia, and so-called regulatory bodies in propagating and covering up the chemical imbalance myth over four decades. So where is that accountability in real life? Would you mind substantiating your assertion with some concrete examples?
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To Catalyzt
‘evidenced based’ is becoming a meaningless or at best misleading term. CBT takes for granted the DSM is legitimate, the disorders real and its research and reductive models fall from this.
When I reflect on the service I work in we use EB framings constantly, more as advertising than anything else.
We run groups and courses as well as one to one therapy. One element that comes to mind is a course based on Behavioural Activation that we claim is evidenced based.
The course materials were lifted from a range of other people’s works and cobbled together and do not reflect the protocols in the actual research at all. The researcher presenting the initial training to the team for BA made all sorts of claims about the evidence base.
Then you go look at the Cochrane review on BA and we see:
‘Behavioural activation may be an effective and acceptable treatment for depression in adults. Offering this therapy in practice would give people with depression greater treatment choice, and different formats and types of delivery could be explored to meet the demand for mental health support’
Sounds quite positive right, but then in the ‘certainty of our evidence’ section:
‘Our certainty (confidence) in the evidence is mostly low to moderate. Some findings are based on only a few studies, with poorly reported results, in which the participants knew which treatment they received. Therefore, we are not sure how reliable the results are. Our conclusions may change if more studies are conducted’
Then try reading Farhad Dalals the CBT Tsunami, The Therapy Industry by Paul Maloney, David Smail and plenty others.
Also, it would seem the editorial team of the journal Social Development Issues considered Epstein’s parody worth publishing. I wonder if they share his frustration at how little things have changed primarily because we’re so unquestioning and complaint with the status quo.
In my experience working in the field in a range of roles and services I just don’t see what you claim:
‘Practicing therapists talk– and argue– about these problems all the time’
really? In my experience most are usually too busy flitting from one competing demand to the next.
To my mind you are a very lucky person indeed if you have the time, resources and colleagues with such open minds to challenge and reflect in these ways on their own practice and often cherished pet model and fixed bias.
In fact in the talking therapies services I’ve worked in for many years now, I have been banned from trying to share relevant but critical/challenging resources and to generate discussions with the wider team, banned.
I have also been posting for several years on another group for qualified and those training in CBT. The focus of my posts is often critical, encouraging debate and reflection.
I would say 90% of respondents are angry, upset and some have tried to have me closed down and blocked. Around 10% send me private messages thanking me and some brave folks post supportive thank you’s and engage with the materials on the public page itself.
This is staggering to me – Mostly qualified CBT therapists, likely daily, encouraging their own clients to self reflect, to look for the evidence, to question thoughts, beliefs and assumptions and to make change – completely unable to do so themselves.
I recall about 20 years ago when I first came across psychologist David Smails works and it caused me quite a professional wobble as it challenged views I’d held for some time in ignorance, eg the efficacy of evidence based treatment within the NICE guidelines and elsewhere is settled.
I took this to my supervisor to explore and was met with a complete inability to explore any of it and he, like me, found it very personally challenging and so it was simply closed down. However the cat was out of the bag for me and I was compelled to keep reading and learning and this was and remains personally challenging.
This supervisor was also an experienced older therapist trained in CAT, Humanistic Counselling and EMDR and a practising supervisor for years.
Currently out of a team of about 80 people one or two have been interested to explore some elements of the materials I’ve shared but that’s it. Colleagues have asked me if I am ‘some sort of activist’ simply for engaging in any critical self and professional reflection.
None of the trainings I have done EVER critically appraised the evidence for the modality they were teaching and it was all presented as accepted truth that CBT etc is ‘gold standard’ and so well evidenced, so the only job now is to train you in these proven therapies and models.
ZERO critical self reflection or any encouragement to do so and why would there be if they believe the arguments over evidence have been settled and are sanctioned by NICE etc. Few people ever read the full guidelines and the older versions did reference the poor quality of the research.
Pleased to see you note at the end of your post those last four words. Yes they are tagged on the end, seemingly in order of what you believe to be more important but for me are absolutely fundamental to wellbeing.
‘Reducing depressive symptoms probably involves not only cognitive, behavioral, and emotional, interventions but also cultural and environmental ones’
It seems for decades now we’ve been focussed on the C,B and E with barely any success and all around a rising tide of suffering. Could this be because we are trying to force square pegs into round holes? That therapy systems are more like compliance managers, obfuscation agents and ultimately maintainers of a toxic status quo?
Ironically, the only training I have done that encouraged any sort of critical self reflection more generally and consideration of broader systems of power was Social Work. Epstein is absolutely scathing about this own profession. For my money if more people in senior positions had the honesty and courage to be so open to critical self reflection we would not keep creating and repeating so much harm in the name of good, something the road to hell is always paved with.
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“The welfare of the people in particular has always been the alibi of tyrants, and it provides the further advantage of giving the servants of tyranny a good conscience.”
― Albert Camus
No need for critical self reflection when your conscience is clear.
I think back to the justification offered by the Private Clinic ‘counselor’ for the use of torture methods on me….. and that I should be “morally relative” (they were after all trying to help…… just not me).
Then when watching an episode of Spooks the words that if ever there was a “moral absolute” it would be against the use of such methods.
Of course the narcissistic people in charge tend to shift the focus from their morally bankrupt conduct, to the reaction of the victims. “Sorry you still feel bad about your referral” (though such uttering with fraudulent documents which made it a referral will never be followed up on because the statement came from our Premier…. and keeping it as a ‘mental health issue’ instead of what it actually is, a criminal matter, means they can remain unaccountable)
And thus it justified me being involuntarily euthanised for complaining…… sadly there are still some within the system who “don’t have the stomach for it”, and are prepared to interrupt such ‘unintended negative outcomes’. Perhaps Epstiens ‘tongue in cheek’ wasn’t so far from reality after all?
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Agree with many ideas in your post. I prefer the term “evidence baste” — e.g., baste your research in evidence, whether it has anything to do with what you’re studying or not, and voila! The perfect recipe!
You are correct in reminding me that my experience is probably more outside the mainstream than I realize. Fair point, my bad. I was trained at a very progressive organization which was both privately and publicly funded, where in-house training encouraged us– actually forced us– to constantly assess each other for our biases, confront interpersonal dynamics that made us uncomfortable, and where the ‘standard of care’ seemed at odds with patient’s health. We never did a single referral for ECT. I was also able to keep most of my clients off medication, even when they experienced delusions, though not all, and I never initiated, of my own volition, a single medication referral for medication for Major Depressive Disorder, not one. On a few occasions, I was forced to by a supervisor; even then, most of the time, I could convince the psychiatrist to ‘wait and see.’ I have also been running with the same pack of therapists and social workers for a decade now, so my view on what is going on in the rest of the profession is NOT representative. I’m very lucky, though I was also very careful choosing a training site.
In a situation like yours, I would not share with my team, either. I would share with my clients– I have to, that’s part of Informed Consent. “Ah, your psychiatrist prescribed two different SSRIs. Here’s some information about them.” I might refer them to Kaplan, just to be even handed, and Healy or Whittaker. Who do you think is usually more convincing? We can’t recommend or dispute medications. But we can absolutely provide clients with ‘psychoeducation,’ including the BMJ article eviscerating STAR*D. No one’s going to sue you for passing along a BMJ article.
All that said, my training site DID have SOME evidence-baste trainings– you know, the power point presentations with the little dopamine molecules with parachutes dropping in to the synaptic cleft– and they were excruciating. Sitting there with out hands folded and saying nothing really sets your teeth on edge, but… bide your time. Learn their tactics. Spot the fallacies. If a client has questions that echo those, talk about them.
Finally, YES– direct change of the culture, our profession has very limited ability to do this, but we do have some. Get a release, talk to the folks at DCFS, talk to the police who are about to (or just did) bang on your client’s door. Bring the abusive parent into your office, sit down and listen to them, show empathy, but set really firm boundaries: if they abuse their kid, deprive them of food, lock them in the garage again, there’s going to be trouble, and plenty of it. Also: Talk to employers, HR departments, and representatives of these weird companies HR departments outsource to in order to manage what they perceive to be a ‘difficult’ employee. Keep calling them back, get to know them. I’ve only done that a couple of times, but it went pretty well– those folks were so sick of having robotic conversations that they were relieved to actually be working a case. “Why are we considering termination or suspension? Is it okay if I talk to you a bit about your corrective action plan? Oh, and while we’re talking about that, I’d like SOME ACCOMMODATIONS FOR MY CLIENT.”
Thanks for your thoughtful post. Much appreciated.
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