In a new article in PLOS Mental Health, researchers Laura Batstra and Sami Timimi write that existing treatment interventions for mental health are a “dead horse,” which we continue to ride despite its uselessness and which we are determined to flog into moving faster.
“The tribal wisdom of the Dakota Indians, passed on from one generation to the next, says that when you discover that you are riding a dead horse, the best strategy is to dismount. However, in modern business, because heavy investment factors are taken into consideration, other strategies are often tried with ‘dead horses,’ including reclassifying the dead horse as ‘living-impaired’ and providing additional funding to increase the dead horse’s performance,” they write.
Batstra and Timimi write that as the proportion of people receiving mental health treatment has increased, so too has the prevalence of psychiatric conditions. Individual mental health treatments, according to their review of the scientific evidence, are ineffective for many, and may even worsen outcomes on average. As an alternative, they propose primary prevention—focusing on the societal causes of emotional distress through policy change.
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I’m not convinced that there is compelling evidence that the risk of developing mental illness is linked to social disadvantage
I grew up in a lower/lower-middle class family and now live in an upper middle class neighborhood. I can’t say I see a tremendous difference in “mental illness” in the “disadvantaged” compared to the “advantaged”.
Part of the problem is the term mental illness, a vague concept that is almost meaningless when it’s contended that 90% of people will become mentally ill. But then all those people to treat means all that money to make, so for lots of professionals it’s worth expanding the definition.
As for treatment, I can’t disagree that it’s often worthless. But I have seen psychotherapy help some people.
I know this is largely based on personal experience. But I don’t believe there’s evidence that contradicts my observations.
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“But I have seen psychotherapy help some people.”
The reason psychotherapy helps some people is because everyone needs to talk to someone from time to time, but from what I experienced, there’s not an overabundance of “therapists” who know how to listen because most of them seemed more interested in hearing themselves talk than listening to me.
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You’re right, of course, but an actually helpful therapist can be life-changing.
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True, but an actually helpful therapist is not easy to find. What’s more, no one has to actually be a therapist to help someone change their life for the better. Being a therapist does not automatically mean someone is helpful.
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I have found that to be true
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You are so right Birdsong. I wrote in a previous post that one Psychologist I worked with said to me, he was glad there was an 8 session limit, because then he “ran out of words to say”. I was shocked. My wife (also a therapist), and I, thought there should be a test for therapists to see if they could stay quiet and non-verbal for an hour. Surely the most important quality of any therapist is can they listen. (then can they understand, and then can they empathize).
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Any therapist who thinks it his/her job to “keep the conversation going” is an idiot. Silence is really important in a good, supportive conversation. It allows important things to surface!
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Thanks, David.
You and your wife are right, there ought to be a test to see how long a therapist can keep their mouth shut, but I doubt many would pass the test!
I don’t think most therapists have what it takes to truly understand or empathize with clients — which is sensitivity — not a head full of ideas invented to make themselves feel good.
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Be good to get more of these sorts of analyses out into the public domain and keep them there
The industry simply drowns out anything that challenges its credibility and continuance, as is to be expected in capitalist neoliberal order.
Be great to see an interview with William M Epstein or at least detailed reviews of this three key books The Illusion of Psychotherapy, Psychotherapy as Religion and Psychotherapy and the social clinic in the united states, soothing fictions.
We need to move on for this internalising profitable mess and start diagnosing and treating our many and growing cultural disorders causing so much distress.
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What’s the biggest “societal ill” in today’s world? Believing that answers to psychological problems are found outside the individual because there will always be someone ready to take advantage of another’s bad situation.
Do yourself a favor: put the jackasses who capitalize on others’ learned helplessness out of business, including the “experts” who make a living doing “research” like this —
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Psychotherapy is now revealed to be a “dead horse?” Actually, it never existed in real life, but solely in hypotheses put forward by self-appointed guardians of social propriety who arbitrarily attached labels to patterns of thought or behavior they regarded as disturbed, eccentric, deviant, abnormal, pathological, dysfunctional, etc. according to the mores prevalent in their own time and culture.
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You forgot to mention it’s a great way to pocket some cash if you have no idea WTF you are doing. In other words, just sit and pretend you are listening while slowly nodding your head…
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Why are more and more people being “diagnosed” with “mental illness”? Because every day more and more people buy into the lie that psychological stress means they have a “mental illness” in large part due to the ever-increasing number of imaginary “disorders” invented by the powers that be to benefit the powers that be.
But the question remains: do societal ills such as severe economic inequality, discrimination and trauma cause or greatly contribute to psychological angst? Yes, but as long as people keep waiting to be spoon-fed “policy” solutions by the so-called “experts” that are often employed by the powers that be, things will never change very much, if at all, imho.
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“It is difficult to get a man to understand something when his salary depends upon his not understanding it.”—Upton Sinclair
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“Psychiatry” is synonymous with learned stupidity.
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In the article it states, “I’m not ill, I’m hurt” which I think is so true for almost everyone who is in therapy and/or on psychiatric medications. Who hasn’t been hurt by family, school, work or society in one way or another? This should be a no-brainer. The whole person needs to be seen and heard. Their history, their environment, present situation, everything.
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“The whole person needs to be seen and heard.”
Yes, but NOT by someone “trained” to “diagnose” them as
“mentally ill”.
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I agree because diagnoses are very superficial and basically dehumanizing.
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I agree because the DSM is pile of shit.
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Agreed. And I’m a therapist.
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Since you agree with Birdsong that the DSM is a “pile of shit,” (an opinion with which I heartily concur), I’d like to know what you base your therapeutic diagnoses and treatments on. If i’m correct to assume that you accept payment for your services from your clients’ insurance companies (as some 90% of psychologists admit doing) are you still using sham DSM categories for billing purposes? I ask this because any profession that claims to be a legitimate branch of science or medicine should be grounded in verifiable criteria obtained by rigorous, universally applicable testing and experimentation, otherwise one is dealing with metaphysics or cult-like beliefs (I’m thinking here of Freudianism, Jungian mysticism, and other such speculative hypotheses colored by the prejudices of their times). So, if you reject the DSM as a valid guide, what exactly do you–or any other therapist–offer that cannot be found equally well and at presumably much less expense in a non-hierarchical, non-judgmental peer support group?
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I’ll expand on my comment. As a psychotherapist, I do not take insurance. The primary reason for this is that I don’t subscribe to the idea that people seeking my services are mentally ill and need me to get back to health. What I offer is my ability and passion for bringing a psychological, familial, social and physiological lens to their experiences and knowledge of themselves. I work with them in understanding parts of themselves as often flooding their emotional system and how to observe and gain the ability to compassionately be curious within themselves and gain more control over their responses, creating a more effective way to develop relational understanding. I give them tools to emotionally regulate and create relationships that bring them more authenticity and peace. I’m referring you to their internal relationship and external ones as well. I speak to them as whole people with conflicting feelings, vast and complicated experiences and internal beliefs developed from those experiences. I try to give them ways to connect with themselves outside of my office space, with specific tools and resources, rather than to need to see me or any other therapist to be well as they journey through life.
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I like a lot of comments here on MIA and the comments on this article are no exception. Of course I’m grateful for the great article here—I love it when experts draw our attention to the societal or systemic causes of so many individual struggles—your phrasing (and use of quotation marks) in this comment is fantastic. It succinctly sums up so much. Thank you in advance, I will likely use this phrase exactly in future discussions with “diagnosers.”
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I would have to agree. And I’ve tried explaining that I don’t diagnose people, except for a few insurance clients, and try to explain that when I say things like, “well, we might call this anxiety that has some characteristics of OCD or ADHD, though it doesn’t might the criteria, and it’s rare that someone actually does,” that doesn’t always help. The meaning of words like ‘anxiety’ has just become so loaded now, and it really wasn’t always like this! There is just this overwhelming idea that if someone is coming to see you, and you use any terminology that’s found in the DSM, you’re saying someone is defective. It’s just this ghastly idea that blots out the sun– it feels like some mysterious force has taken away my words, ripped the meaning from them, and given them something totally different.
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“- it feels like some mysterious force has taken away my words, ripped meaning from them, and given them something totally different.”
I’ll do you one better: it feels like letting someone taking a crap on my soul.
P.S. Anyone who believes in the DSM is incredibly naive, and that includes “therapists”.
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…IMHO.
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People are diagnosed because insurance and the laws governing therapy require a diagnosis be given. It is a stupid system that creates these diagnoses. As a therapist, I agree people benefit from talking with someone who is interested yet uninvolved in their lives as they have no stake in a path or decision the person may make. People benefit from that kind of ability to talk through things and consider all options. I often think about offering some kind of non-clinical option yet the only word I know now for that is coaching, which carries its own context that is not accessible or that people might find off-putting because it is so often associated with goals for work vs anything else.
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I am told that many Scientology field auditors make a good living.
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The authors make good points. But as I have asserted here many times, they have failed to identify the root cause of mental travail.
Probably a public “mental health” system based only on reducing this-life trauma would work much better than the system we have now. Yet “rich kids” also go crazy (refer to a recent public shooting in NYC).
I think it is evident to anyone who has studied the subject that we are dealing with a problem that goes deeper than the challenges of staying alive and well in this current lifetime. Work has been done in this direction that has resulted in useful treatments. No one in the academic community (almost no one) wants to acknowledge the existence of this work or attempt to validate any of it in their own clinical environments. This is unacceptable science, even though it could be considered to be predictable human behavior.
I agree with stripping the current system of all its sham treatments and medicines. And perhaps that would be enough for most people. It would be a good start. But no one should fool themselves that it would solve the problem entirely.
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Hi Larry Cox
can you please say what is the idea you have in mind. I am interested in learning. thank you
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I’m a Scientologist. That’s what I am referring to.
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Thanks for taking the time to respond. I am familiar with Scientologist and was attempted at recruitment in my teens but resisted. Now I know. Thank you.
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What are the purportedly “useful” treatments, and can you cite the credible work that you claim has been done to substantiate their efficacy?
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Here is an example where some of this technology is used in an institution that interfaces with secular society, and thus there have been some studies of its effectiveness: https://www.narconon.org/about-narconon/studies-and-reports.html
Outside of these studies and perhaps some done regarding the “purification” program, only Hubbard and his students report on the results of these therapies.
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“Work has been done in this direction that has resulted in useful treatments. No one in the academic community (almost no one) wants to acknowledge the existence of this work or attempt to validate any of it in their own clinical environments.”
Is that so? Prove it. Prove that Scientology is successful at treating people where other methods fail. I’d like to see all that data, if it is indeed openly available.
I’d also like to see proof that these verifiable methods are being wilfully ignored by academics and other experts.
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Well, Mark, you have a lot of reading and studying to do if you want “proof.”
You’d probably have to learn how to do some of the procedures yourself (they can teach you to do basic Dianetics in a weekend) and see if it works for you.
As far as academic attention goes, you can’t “prove” a negative. But I went to PLOS Mental Health (an open-access journal) and searched on “Dianetics” “Scientology” and “Narconon” and came up with no results. If you put these terms into a search engine they will of course bring up results. But will any of the results be of an academic nature?
There have been some academic studies done of Scientology as a religious philosophy. One used by the church was written by G. C. Oosthuizen (Th.D.) in 1977. Another was written by Urbano Alonso Galan (PhD, Rome) in 1996.
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I’m not arguing it doesn’t work. But if I have to be the subject of the “procedures” within the confines of Scientology, then it would seem the information on their effectiveness is neither verifiable nor readily available to outside scrutiny.
Which places them in the same category as all the other mental health practices which are often criticized here for the very same reasons.
Larry, I often get agitated by promises that “I/we have the answers to your troubles” because I’ve been experimented on like a lab rat. After nearly 20 years of extreme patience through many agonizing trials, I walked away from psychiatry much worse off than when I first entered. Desperate for some relief, I then went on a fruitless journey through alternative wellness practices and explored alternative spiritual practices to the Catholicism I was born into.
None of that stuff stands up to any real scrutiny either, and most of it is a godd*mned scam IMO. So I’m sure you can understand why people like me suspect Scientology is no different.
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We are speaking here about private therapy sessions, in this case usually with a church minister. How deep do you expect to get in investigating the “effectiveness” of any of these methods, Scientology or otherwise? I have seen academic studies on CBT and so forth, so I know some sort of evaluation is possible in these subjects. But in the end it comes down to the subjective experience of the participants, and they are all self-selected because you can’t force anyone into any kind of therapy.
Your only real alternative is to learn how to do some of these techniques yourself, advertise for patients, and see what you can do with them. I don’t see any way around that. You are never going to get a level of “proof” that is as confident as what you can do with physical objects.
Something has kept Scientology going since the 1950s. If you want to believe we are all hypnotized, be my guest. That’s what many of us believe about you! Otherwise, you will have to actually get involved with the subject and its people and find out for yourself.
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“in the end it comes down to the subjective experience of the participants, and they are all self-selected because you can’t force anyone into any kind of therapy.”
I read that as just a different way of saying “caveat emptor”, Latin for “Let the buyer beware”. Which is hardly comforting to people like me, who indeed DID do the hard work of trying to find what we thought was a reliable, relatively safe form of therapy, only to be seriously harmed.
It also misses the point entirely, not just of my statement, but of Mad In America’s mission in general. MIA exists because Robert Whitaker discovered that psychiatry did not have the massive success rates that it claimed. MIA is not only a way of disseminating information so the “buyer can beware”, but it also attempts to hold accountable those who are doing damage in the name of therapy, and to ultimately make all forms of therapy safer and more effective, or to be discarded entirely if need be.
So anyone who claims “our way is better, you just need to try it” without offering verifiable data that it is effective and has not harmed anyone would seem to be at odds with MIA’s basic mission.
Which begs the question: why would anyone waste any time here if they disagree with MIA’s basic mission and have little empathy for its readers?
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Judging by how many people are willing to accept mainstream “treatments,” I’m not sure “verifiable data that it is effective” makes much difference to most people. If you are really interested, you can find more data, such as the studies done with Narconon. But My experience has been that people who say “prove it” really aren’t interested in learning what works, but only want to make everyone wrong for trying to help others.
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Didn’t read the MAD article, read the PLOS article. I was struck by this:
<>
Bastra, one of the authors of the PLOS article, seems like a really interesting clinician; I have little doubt her heart is in the right place. But imagine if this had read:
<< One hundred and two meta-analyses, encompassing 3,782 RCTs and 650,514 vehicles, were included, covering tire problems, brake failure, failure of air bags, overheating and coolant issues, metal fatigue, errors with driver automation systems, lubrication problems, instrument failures, and neglect of maintenance…"
…would it even MATTER what the outcome measure was?
With respect to the PLOS article, does anyone really believe that there is a research design, some exotic form of statistics– you know, Science!– that can put order to the chaos of so many different study designs, different drugs, and different presenting issues? That can control for all the independent variables, publication and sample selection bias, and conflict of interest, and say anything meaningful at all?
I feel terrible for the authors. I mean, they actually seem to be honest! They actually listed all the limitations of their study at a meaningful level of detail, but somehow arrive at the conclusion that the six issues they raise– and it's trenchant, brilliant writing, these are the kinds of hard questions researchers SHOULD ask themselves– don't really matter so much. AND, just intuitively, I think they have to be on the right track; Marie, I don't think they were saying so much that social disadvantage causes mental health issues as that social disadvantage makes it harder to respond to mental health interventions, or psychotherapy is less effective for disenfranchised populations. We live in a really twisted culture, or cultures– and I agree, that's got to be the problem, or a big part of it. It always has been, but it used to change more slowly… what worked in 1965 might work in 1980, but now…
More and more, it seems my practice is about helping clients get out of their own way and develop tactics to deal with the absurd situations that our economy and society place them in through no fault of their own. And when I say, 'get out of their own way,' I mean that only because usually they've been manipulated, not because there is something wrong with them. Less and less does it seem that another theory, another manualized one-size-fits-all treatment, is going to be helpful.
It's interesting that the study period for the PLOS article started in about 2014. I think it's possible, even likely, that psychotherapy is less effective now than it was 40 years ago– though this article doesn't come close to demonstrating that, I don't think it's something that can be proved empirically. One thing that's definitely going on is that our education can't keep up with the massive cultural and social upheaval that's happened over the last half or quarter century. There's no research on sh*t like Internet addiction or the impact of social distancing for young adults– and maybe there shouldn't be. I wish there was more of a community where therapist could talk about what they're doing and what seems to work, because more study, more papers– there's just no way to keep up.
Look, mental health care is a mess, okay? That's why we're all here, probably. That's why, as a clinician, I come back here and listen to people who, mostly, I really disagree with– like Topher, who can't stop talking about Epstein, or the guy who's pushing Narconon. (For that outfit, you don't need to do much research at all, just read their Wikipedia article and check the sources.)
Because– and Topher, I meant to say this a few months ago– in the middle of flaming each other, I did start asking myself: Is the way that I, and my small circle of colleagues, do therapy really very similar to what other folks are doing? And having that question in the back of my mind, I started asking different questions of my clients who had had much more extensive contact with the mental health care system.
And I'm realizing… I wasn't quite right about that. I may have gotten trained during a heartbeat where we were taught not to pathologize people, that the DSM V doesn't make a lot of sense, that diagnoses are simply a taxonomy in mental health care– and are categorically different from physical medical diagnoses. There are probably thousands of new people getting licensed who were taught something very different, and who didn't read Healy or Whittaker, or the blog Boring Old Man.
It's scary. And this article scared me, too, though I have a lot of respect for the authors and what they are trying to do.
Stay safe out there, folks. And I'll do the same.
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“As an example of the worsening outcomes, a recent study found that 50% of the population could be considered ‘mentally ill’ by the time they are 18; over the course of a lifetime almost 90% of people will become ‘mentally ill.'”
And according to my former “mental health professionals,” all dreams are “psychosis.” Thus, since we all dream, this means 100% of people should be defamed as “mentally ill” … but in reality, this is greed inspired insanity on the part of the DSM deluded “mental health industry,” not reality.
How long will it take for us, as a society, to actually admit to the “bullshit” nature of the DSM? Oh, that’s right, Allen Frances and Thomas Insel both admitted to the “bullshit” and “invalid” nature of the DSM “disorders” in 2013 – 11 years ago.
So it’s long past time for the “mental health professionals” to flush their “bullshit” DSM “bible.” But instead, they want to “maintain the status quo,” according to an attempted thieving, computer hacking psychologist, who I adamantly and repeatedly refused to hire.
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Reading this article, one could become quite hysterical the amount of times the word “therapy” is used in order to point out what?
If it statistically correlates with less recovery, a whole spike in the problem it’s said to heal (something one might call an epidemic), then WHY is it called therapy: “Here take this, and go there, it statistically causes more of the problem, and then you’ll get more therapy for the therapy, and……..
You know, I think it’s called “brainwashing” actually.
Try: more “therapy” is not the answer and put “it” in italics.
Or simply: “More Brainwashing doesn’t make something that’s not working work,” and then somewhere add, “although there’s more of the problem needing therapy, this doesn’t mean that the ‘therapy’ that was implemented, was supposed to work, which instead caused more of the problem, not only does this point out it caused more of the problem, you can not separate this from needing more ‘therapy’ and deny there’s a causal link, while making out what statistically and scientifically correlates with more of the problem is going to fix it just because it’s called ‘therapy’ and is the mainstream approach.”
That’s ALSO brainwashing 101, make people believe they are being attacked, and then spoon feed them how to fix the problem, and you have control over them. That ISN’T therapy that’s deceiving people. No matter HOW BAD the problem has become it is NOT going to be fixed with what’s in correlation with CAUSING it. No matter HOW MUCH one has the need to BELIEVE on is doing something, and then just do what one is told to do, when this isn’t fixing the problem no matter how much one is told it will, it still WILL NOT. NOT even if the problem seems to go away temporarily. Not even when you disable the brain with “medications” CAUSE chemical imbalance, while telling people they treat them, because this promotes the idea that suppressing the expression of the problem is a cure, then science and statistics has shown the problem does not go away, but in the majority of cases gets worse. When there’s a problem that needs to be looked at regarding what DOES help it, this isn’t solved by suppressing being able to express there’s a problem. When there’s a warning signal, and you cut the wires to the warning signal, that doesn’t mean what it was manufactured to point out has gone away. And when there’s more of the problem this ISN’T solved by having more “authority” to cut the wires for more warning signals pointing out the problem, nor is it solved by only hiring people to solve the problem that are going to do only that, and will question that it’s solving the problem while it’s causing more of it.
People that don’t understand trauma, or who don’t understand that there’s a whole part of reality that can solve that trauma (so maybe it’s not trauma, it’s just a challenge), but the solution isn’t following the “rules” of said society, whether it’s economic, spiritual, political or the rest of it……… people who don’t understand and offer solutions that don’t work for those who don’t want to be deceived (whether that’s conscious or subconscious) this isn’t a solution for people actually wanting answers……
Yeah, in the article “therapy” is used 12 times it seems. And this isn’t a fill in the blank test meaning replace that blank: “therapy” with SOMETHING ELSE!
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Sorry, in my rant, I….
“nor is it solved by only hiring people to solve the problem that are going to do only that, and will question that it’s solving the problem while it’s causing more of it.” should read
nor is it solved by only hiring people to solve the problem that are going to do only that, and won’t question whether it’s solving the problem while it’s causing more of it.
I’m sorry, it’s difficult to simply keep track of all of the indoctrinated behavior….z
And, in thinking about this one line, prior: I pondered how this is like manufacturers making products that are designed, on purpose, to break down after a period of time, so you have to buy a new one, or manufactured obsolescence. I was wondering how many medications where there’s proof they treat some sort of chemical imbalance, that there was something the tests could determine was missing, and that these medications correlated with causing that chemical to again be present. I mean, there must be all sorts of chemical processes going on where one can find there’s this one thing missing, but when you introduce a medication that introduces what’s missing, the medications causes a whole series of side effects. So, I did a search with this: “medications that treat chemical imbalances but have side effects that are worse than no treatment” and what were most of the google results!? They are about psychiatric medications, which have NOT been proven to treat a chemical imbalance, but instead cause one, which is then seen as healing because it disables the mind, although in the long term things get worse, thus the spike in the problem current. And most of the hits were “promoting” this theory that hasn’t been proven, that psychiatric drugs treat chemical imbalances.
This is quite something, that when I do a search involving “chemical imbalances” one mostly gets hits that spout the same theories that have been proven to instead of treating a chemical imbalance are causing one, and more problems in the end, and is called therapy. Hit after hit after hit. And I was looking to see what kind of medications that scientifically actually can be said to treat a chemical imbalance might have side effects that cause serious problems. I mean, if there’s a chemical imbalance, there’s all sorts of ways to change one’s behavior, one’s diet, one’s responses etc. and the body itself is AMAZING and can make all sorts of changes itself, and start re-balancing itself, without the problem of a medication intruded into the process and perhaps causing more of one chemical deemed to be missing, while in the process causing all sorts of side effects that point out it’s better to do things that get the body or spirit itself to re-balance what’s going on. That kind of myopic behavior. So, I did a search for medications proven to treat chemical imbalances, not one promoted as doing such but doing the opposite and causing one, and apparently this catch phrase “chemical imbalances,” referring to “medications” that cause such rather than treating such, this has become so ingrained that……. it’s like the word “therapy,” when used. People are THAT brainwashed. THAT triggered.
The same with: “chemical imbalance,” or “chemical imbalance symptoms,” a whole splurge of hits showing how the words “chemical imbalance” have been corrupted. In fact, when people have normal emotional responses to life, responses that when given a bit of legroom might give needed perspective, or with proper help could be understood so a person has a heightened understanding of themselves, they are during these times made to believe something is going on while the “treatment” that is billed as healing: it actually scientifically and statistically proves to cause it…….
Thanks to the incredible work of Moncrieff, though, there is one hit that says the following, hit number six for me: “Patients should be informed that there is no evidence that antidepressants work by correcting a chemical imbalance, that antidepressants have mind-altering …”
“I want to help,” “Do this!” But don’t question whether that is really helping because it has an exclamation point. That DOESN’T mean it’s so critical that you can negate whether what you’re doing is really helping. I feel so sorry for ANYONE ever having to deal with a system that is making them worse while they have to act as if it’s making them better, can’t say how it’s really affecting them, can’t know it’s not really helping, can’t even question whether it’s really helping. And are made terrified of non violent normal responses to trauma, or a difficult situation the brain is trying to gain perspective on, while they are forced to believe or act like they believe that…..
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