Sunday, August 18, 2019

Comments by Tim Carey, PhD

Showing 100 of 153 comments. Show all.

  • Thanks for your further thoughts Don. Of course, you’re perfectly entitled to disagree. I disagree with your disagreement :-)!

    It’s great that you’re interested in things like consciousness and the mind. I’ve actually just finished writing a book chapter about consciousness from a PCT perspective. It’s due to be published in May next year.

    PCT is a first person perspective theory. That is, it explains behaviour and the process of living from the inside looking out not from an observer’s perspective. As such it is entirely compatible with, and accommodates, trauma-informed work and listening-based approaches. The Method of Levels is almost entirely “listening-based” and trauma-informed work is an important aspect of working effectively with Aboriginal and Torres Strait Islander Australians.

    PCT and MOL are definitely not everyone’s cup of tea. I’d love it if they were, but they’re not. That’s OK.

    Tim

  • Thanks Don. It’s a great question and, I agree, that paragraph probably did stand out a bit from the others. All of my work is based on the premise that we are designed as living control systems as described by Perceptual Control Theory (www.pctweb.org; http://www.iapct.org). I’ve developed a transdiagnostic cognitive therapy based on these ideas (Method of Levels; http://www.methodoflevels.com.au). Being controlled by other people is so damaging because we’re designed to control the things that matter to us ourselves. No-one else can do that for us because no-one else knows how it is to be another individual or what the life is that that individual would like to carve out for themselves.

    Does that help?

    Tim

  • Thanks Rebel. I think it would be great if people would listen to themselves a little more. Understanding who I am as an individual and what I need to move in the direction I want to go in is surely one of the most important things I can do. I wonder if the first step in solving some of the conflicts of the world is first resolving our own internal conflicts.

    Tim

  • It’s one of those timeless classics isn’t it?

    By the way, I also really go along with your idea stopping the dividing up we do and focus more on our individual uniqueness. I think it’s possible to recognise that we all share some common fundamental features as being part of the same species but, within it that, we are all marvellously unique.

    If we recognised that and celebrated it a little more we might be in a different place.

    Tim

  • Hi Bradford,

    Yes, the invention of the DSM (I’ve suggested elsewhere that this might stand for “Damn Smoke n Mirrors”) categories is a big part of the problem. The importance of things like current relationships and past trauma is ever so slowly being recognised but there’s a mountain to move when it comes to industry of diagnosing and medicating.

    It’s great to have a forum like this where we can communicate our ideas and perspectives on these issues and help to keep the ground swell swelling 🙂

    Tim

  • Hi Rebel,

    Little Women was a favourite in our family when I was a child too!

    I agree that anger can be a big problem for both individuals and social relationships. Ironically, in the work I do, self-control is considered to be a form of internal conflict. The reason people experience this sense of needing to control themselves is because they want to do something (maybe yell at someone) but they also don’t want to do it (they want to treat people respectfully) at the same time. When people are unconflicted and pursuing important life goals it doesn’t feel like self-control. It doesn’t feel like anything really it’s just kind of going with the flow.

    Maybe the reason that counting to 10 can be so effective is that it gives people a chance to step back (in their own minds), see the bigger picture, and remind themselves of the things that are really important to them.

    Thanks for the reference to Little Women … that was a delightful trip down memory lane :-)!

    Tim

  • Hi Bradford,

    I really like the way you’ve expressed this. The mutually interdependent, bidirectional nature of influences is really important isn’t it? All of my work is based on the idea of circular, rather than lineal, causality which very much speaks to these ideas as well. At the same time that we are influencing we are also influenced. It’s a very cool concept!

    Tim

  • Hi Ceebee1,

    Yes, I did suggest that neither of us were going to get much mileage out of continuing this conversation. We just operate in different worlds. My understanding is that blood and urine tests detect metabolites of neurotransmitters which do not have a straightforward relationship with levels of neurotransmitters in the brain.

    But these are all just details. The bottom line is that you’re happy believing that the chemical imbalance myth is not a myth and I’m firmly convinced that it is.

    There’s not a lot of room for discussion there 🙂

    Tim

  • Hi there RJGrigaitis,

    Actually, the modern day Santa Claus is the combination of a few different historical figures: https://en.wikipedia.org/wiki/Santa_Claus

    I’m not sure I made a relative comparison in terms of saying that Santa Claus “is as mythical” as the chemical imbalance. Whether one is more mythical than the other isn’t important from my perspective. They’re both mythical. That’s the point I was wanting to make.

    Tim

  • Hi Chet,

    Thanks for the extra information. We just have a very different perspective on all this. I’ve never heard of dopamine and serotonin levels charts and I have no idea how they would possibly even have established them. Even if those charts were accurate at a population level they still wouldn’t be meaningful for an individual. Think about height and weight charts. What is “normal” height? Should we give growth supplements or bone grafts to people whose height is normal (whatever that is)?

    Also, I don’t place too much (read “any”) faith in commercials about drugs or neurotransmitters. I’m sceptical of all advertisements. I think we generally accept and acknowledge that advertisements about things like shampoo and cars are probably exaggerating their claims and distorting the information somewhat to portray a glowing image. That is magnified exponentially when the topic is psychotropic medication.

    As I said in my article, 80% to 90% of the bodies’ serotonin lies _outside_ the brain. I wonder how their tests cope with that. In doing research for this article I contacted a couple of expert researchers who are involved in this area and they weren’t aware of “precise” neurotransmitter tests that were available.

    We just have different views, that’s all. I get the sense that you’re pretty happy with where you’re at. Me too 🙂

    Tim

  • Each time I read your posts Alex, I find myself smiling by the end of them. This is so similar to what I do. I call what I do “psychotherapy” or “therapy” or “psychological treatment” but it’s really facilitating the other person having a conversation with themselves about difficult issues. Nothing happens unless they want it to. Even not having “therapy” is OK. The whole focus of MOL is on present time, in fact it’s about the “right now” of what’s happening for the person as they’re talking about all this difficult stuff.

    And yes, even in the face of all the hard stuff, there’s often humour and almost a “playfulness”. I’ve also found that most people only need a small number of sessions. I think about 4 or 5 is the average people seem to come a long to see me for.

    Tim

  • Thanks Alex. Yep, interference is the key. It’s the problem with medications (or psych drugs or whatever you want to call them) too – they interfere with the bodies’ own processes. And lots of times the mental health professionals don’t even know they are interfering so they take resistance, not as a sign of how functional the person is, but how they “lack insight” so the mental health person does more of what they were doing, hence more interference, the person being “treated” tries to do more to protect themselves, and so it spirals!

    At least while we’re talking like this and bringing these issues into the light there’s a chance to change them. Those new perspectives we’ve both been talking about!

    Tim

  • Thanks Alex. I’ll check out the films. They sound really interesting.

    Yes, the way you’re using the term “control” is the way I understand it. A few years ago I came across an entire field devoted to the study of control as it occurs in living things. From this perspective, control is a process that is essential to life. In fact, control is life. In order to keep living, we need to be able to control things like our body temperature, the amount of oxygen in our blood, and so on. At another level we also need to be able to control things like the amount of trust and openness in our relationships, the extent to which we think well about ourselves etc.

    From this perspective, problems occur when this natural control process is disrupted or interfered with. It’s a big reason for me as to why mental health services fail so spectacularly most of the time. Because of the extent to which they go to control “patients”, they actually interfere with that person’s own control and set up a recipe for disaster!

    The point about therapy impacting on the therapist as well as the “therapee” is a really important point too. It’s a really humbling experience for me to be a therapist. To be entrusted with someone else’s stories is an enormous privilege. And you’re right, there’s definitely a learning and growing for therapist … if they’re open to it :-)!

    Tim

  • Hi Alex,

    I’m really enjoying reading about your journey. There is so much overlap with the work that I do, it’s uncanny. We’re using different words but I get the sense that we’re talking about the same kind of thing. The therapy I use is called the Method of Levels (MOL; http://www.methodoflevels.com.au) which is based on Perceptual Control Theory (PCT, http://www.pctweb.org). MOL is all about having people listen to their own talk so that they can become conscious of their problems in different ways and reorganise neuronally (this is the neuroplasticity bit) to arrive at new perspectives, new insights so control (you might call that balance) is restored.

    I also share the big “IF” that you describe. None of this can happen unless the person wants it to. And even when they want it to, it still can be gruelling, emotionally draining work. An important part of my work has been what I’ve called “patient-led treatment” so the person who is accessing the service is the one who makes the appointments and the one who decides how many they will have and how often they will have them. I’ve also started to develop an idea lately called “patient-perspective care” which in the services I’ve worked in would be much more helpful than “patient-centred care”. In my experience, “patients” can be at the centre of a clinicians deliberations while decisions are still made about them and for them and on them. That might be a lot harder to do if it was the perspective of the person accessing the service that had to be used to guide decision making.

    Tim

  • Thanks Stephen. I appreciate you taking the time to explain your position.

    I completely agree that the psychotropic drugs that are used as medication in the mental health industry do not treat illnesses and don’t “cure” anything. Your point about having a particular preference for the word you would choose to use is well taken.

    To be honest, I wasn’t even aware I had a preference until posting this article. I’m still not sure that I do. I think the words I use depend very much on the context. I’ve been really surprised that the focus of this article for some people has been on a particular word or term.

    To put it in context, the article has 1902 words. Of those, the word “medication” is used 5 times. Twice when it is used it is used as “psychotropic medication” and on the the other three occasions it is used it is being discussed in the context of what mental health service providers frequently try to do from the perspective of the chemical imbalance nonsense.

    I’m sorry that the use of the term “medication” seems to have offended some people but I’m probably even more disappointed that the focus on that term seems to have distracted a lot of discussions from the main point of the article. I think it would be very hard, based on the content of the article, to justify the idea that I support the notion of mental health disorders as “illnesses” or that I’m an advocate for the biomedical model of conceptualising and treating psychological distress.

    Tim

  • Hi Alex,

    Thanks loads for sharing this. What a profound and moving story. It’s a great comment on the strength and resilience of the human spirit. Your point about the chaotic environment really resonated with me. You say towards the end “If my chemicals had been out of whack” … it’s a big “if” :-)!! My interpretation would be you reacting very normally to a very abnormal environment!

    Thanks again.

    Tim

  • Hi Chet,

    The problem lies in this sentence “A person can have a dopamine level that is higher than normal (schizophrenia) or they can have dopamine levels that are lower than normal (ADHD).” We have absolutely no idea what “normal” dopamine levels are. Then to try and assume a particular amount of dopamine is “causing” a particular problem called “schizophrenia” or “ADHD” is a massive leap in flawed logic. “Schizophrenia” and “ADHD” are made up categories. They’re not illnesses or dysfunctions in the same way that breast cancer, Parkinson’s Disease, malaria, and diabetes are. So even if we knew what “normal” dopamine levels were (which we don’t) we still wouldn’t have solved the problem of the diagnostic categories.

    I definitely believe that “We humans say and do things because we derive some benefit from that activity”. From my perspective, that’s called a process of control. Problems then, arise when people aren’t able to derive the benefit they would wish for from the activities they prefer.

    Tim

  • Thanks AA. I definitely think psychiatric medications are at the top of the list in terms of wildly exaggerated benefits and grossly minimised harms but it’s a really important point you make. I really like Peter Gotzsche’s work in this area. He makes the point that all drugs can cause harm. In fact, according to him, prescription drugs are the third leading cause of death in Europe and the US behind heart disease and cancer. It’s a staggering statistic.
    I guess we all have our big ticket items. For me quotation marks aren’t one of them despite how useful they can be.

    Tim

  • Hi Chet,

    I appreciate you posting this information but, from my perspective, there’s nothing here to address. Identify people as having a particular “disorder” and then looking for things they might have in common that help to explain the disorder is exactly the reverse of the logic that is needed. Demonstrating that people experience some benefits when they take various medications does not provide any support for the chemical imbalance idea. If that were the case then headaches would be caused by a panadol deficiency and the people who report benefits from taking lithium would be experiencing a lithium deficiency.

    Like I said in my article, the chemical deficiency is created after the medications are ingested. So, in a way, you’re very correct. It is because of a chemical imbalance that Big Pharma is making billions of dollars. It’s an iatrogenic chemical imbalance caused by the chemicals.

    I think approaches that attempt to “regain control of the child” are actually part of the problem. My perspective is that people need to control the things that are important to them not be controlled by others. When children are behaving chaotically it’s often because, from their perspective, they’re in the middle of a chaotic environment.

    There are certainly lots of things to address and the longevity of the chemical imbalance fallacy is one of them.

    It would be nice if we had more common ground but, on this issue, we see things very differently.

    Tim

  • Hi Richard,

    I’m jumping in here to clarify one last point here. I was waiting until the previous comments had been restored but that doesn’t look like happening soon. In one of my last posts I wished you all the best with your revolution and you replied saying it was “dripping” with arrogance (or some other similar term. I can’t remember exactly which one it was). Here again in this post you refer to my arrogance. I wanted to post this just to emphasise that, when I sent that comment, I had no intent other than wishing you the best for you in terms of where you’d like to head. There was no arrogance “dripping” from the words when I clicked on “Post Comment”. All you got were words on a screen Richard so if there was arrogance dripping from the message that was your interpretation. But it is our inability to even agree on simple matters like that that reveals the huge gulf there is between us in how we communicate and what we communicate about. Again, that’s not written from a position of arrogance or superiority. It’s just an observation of the pattern of communication with this article. It’s for that reason that I can’t see any purpose in us continuing our conversation. That doesn’t mean I think you’re bad or inferior or unworthy it just means I think we have different priorities. I genuinely hope you’re able to bring about the change you’d like to see. I genuinely hope I’ll be able to do that as well.

    I can’t type it any more clearly than that. That’s where I’m coming from.

    Over and out.

    Tim

  • Hi Richard,

    From my perspective our conversation has been characterised by misinterpreting each other’s email. I can’t see a way to correct that so my solution is to leave things alone.

    In the most recent exchange, for example, I wrote “If there are things that are useful in this discussion you then that’s terrific. It’s gone way past being productive or useful for me.”

    To which you replied “And then you have to throw in the zinger at the end that you have better use for your time then to engage in dialogue with the likes of someone like me.”

    So my idea of respectfully allowing us both to do what we’d like to do is an insult to you with the implication that I don’t want “to engage in dialogue with the likes of someone like me.”

    I think it’s worth remembering that this whole discussion has arisen because my use of the terms “mental health”, “mental illness”, and “medication” didn’t match the way you thought I should be using those terms. Because I didn’t use quotation marks in the way that you thought I should there have been statements like “This is about unscientific and harmful language that is part of the very foundation upon which Biological Psychiatry was constructed and now reinforces and justifies all the harm carried out in its oppressive “mental health” System.”; “making comments that I believe denigrate my reputation”; “totally clueless”; “you have have found it necessary to concede Biological Psychiatry certain key aspects (use of the terms “medications,” “mental health,” and “mental illness”) within the other two thirds of their dangerous and mythical narrative”; “Every single argument you make in the above statement could also apply to the continued use of “medication,” and the use of “mental health” and “mental illness” without quotations. The overall harm done by these above terms is essentially NO LESS than the harm done by excepting and propagating the “chemical imbalance” theory for which you have correctly dissected.” and; “The maturity of our current scientific and political understanding on the use of the terms “medication” vs “psychiatric drug” (and “mental illness” and “mental health”) is such that there is absolutely no longer (if there ever was) any rational reason to make harmful CONCESSIONS in our writings by accepting the continued use of these unscientific and politically backward terms. WE DENIGRATE, AND RENDER LESS PROFOUND, OUR ANALYSES BY CONTINUING TO MAKE THESE CONCESSIONS IN OUR USE OF TERMINOLOGY. THIS DAMAGE BEING DONE WILL NOT STOP HAPPENING UNTIL WE MAKE IT STOP HAPPENING!”

    This is clearly a topic you feel very strongly about. I don’t feel as strongly about the use of quotation marks in this manner. I think you should be able to conduct the revolution in the way that you think it will be most effective and I think I should be able to do the same thing. We just have different views on this that’s all. I don’t think your view is wrong, it’s just different. From everything you’ve written I think it’s safe to conclude that you think my view (with regard to the use of quotation marks) is wrong. I don’t think there’s anything I can do about that. That’s why I’m bowing out of the conversation.

    I really do hope you get the revolution you’re after.

    Tim

  • Hi Gerard,

    Thanks for getting back to me. I find this whole discussion a bit mind-boggling really. This whole thing has arisen because I didn’t put quotations marks around three terms. I clearly just don’t see this as the priority that other people do. I think if you have a look at other articles I’ve posted on this blog you would get a sense of where I’m coming from. I think I do my fair share of questioning and criticising the disease model and, perhaps I’m kidding myself, but I don’t feel trapped in a disease model narrative. Like you, I think the BPS has made some great strides forward. I worked in the NHS in Scotland for 5 years and really liked a lot of what went on over there. I’m still a member of the BPS.

    Tim

  • Hi Alex,

    This resonates really strongly with my own approach. I base my work on a theory of control called Perceptual Control Theory (www.iapct.org; http://www.pctweb.org) and I’ve developed a therapy called the Method of Levels (www.methodoflevels.com.au) which helps people regain control of their own process. I think lack of control is at the heart of psychological distress. It is really hard to know what to believe but finding our own voice, and allowing others to have theirs, is, I think, a bit part of the solution.

    Tim

  • Really? In the context of a discussion about the language we use, you would call me “totally clueless” because I don’t share Richard’s opinion for the way terms are used. I note, also, that you didn’t put quotation marks around “totally clueless” so I’m assuming you literally mean “totally” as in “wholly, completely, entirely” and “clueless” as in “ignorant, uninformed, unaware”. So, I’m entirely uninformed and “engaging in hate speech” simply because I didn’t put quotation marks around the word “medication”. And because of this you make the assumption that “Jack Daniels is medication to you”.
    Amazing.
    Tim

  • Actually Richard, this is ALL about preferences. You have a particular recipe for advancing the revolution, I have a different one. So you will not grant me the right to pursue the revolution in the way I think it should pursued. Hmmm. That seems a lot like a mental health professional not letting a patient determine the way they would like to be treated.

    Difference doesn’t necessarily mean wrong.

    Tim

  • I would suggest you’re not victimized by a term. You might have been victimized by health professionals in mental health services but very few of them are even called “mental health somethings”. There are certainly mental health nurses, psychologists, psychiatrists, and so on. Are you of the opinion that if they weren’t called “mental health services” then you wouldn’t have been victimized?

    Tim

  • Hi Nick,

    That’s a great point. A lot of what passes for science in the mental health field is not very scientific. I completely agree that genuine reform will take time and will take many people working together. It will also take acceptance of the fact that there is not probably any one right way to proceed and criticising each other when individual approaches differ is likely to be counterproductive.

    Tim

  • Hi Richard,

    We each have our own ideas about what will help to progress things. Are you saying that if I don’t come around to your way of thinking then I’m not “truly open minded” and not using my “critical thinking skills”? Hmmm. Doesn’t that seem like the very dogmatic medical attitude that we’re trying to change? I’m not sure that we’re going to change the situation by taking the same single-minded, authoritarian approach that seems to be so pervasive at the moment in mental health services.

    Tim

  • Hi Alex,

    Thanks for taking the time to reply. I’m sure there are lots of other myths that we have – sometimes without even being aware of it. An area I’ve done a lot of work in has to do with how much psychological therapy people need. There are lots of myths here about people needing 10 sessions to get better, or 12, or some other arbitrary number. The evidence is that most people only need a small number of sessions to get to where they want to be and a small number of people need many more. My approach has been to let patients tell me how many sessions they need rather than me telling them. It’s not a common approach though and one that is regarded unfavourably by some clinicians.

    Tim

  • It’s a good point Karma. I think we could all do a whole lot better with the language that we use. It’s also an area where we will all have difference standards about what is acceptable and appropriate. “Mental health”, for example, probably isn’t the greatest term in the world but I don’t find it hugely offensive. “Mental illness”, however, is a term I almost never use except if I’m referring to a specific context where that term is used. Aboriginal and Torres Strait Islander Australians prefer to use the term “social and emotional wellbeing” and that sits pretty comfortably with me.

    For me, even having a forum where these sorts of ideas can be discussed is progress!

    Tim

  • Hi Richard,

    It’s disappointing that you don’t find my article excellent because I didn’t put quotation marks around the terms “mental health”, “mental illness”, and “medication”. I didn’t do that because that the language that is used at the moment. I don’t ordinarily put quotation marks around all made up things I discuss like mermaids, unicorns, Major Depressive Disorder, Schizophrenia, lovesickness, heartbreak, and so on. I think I used the term “mental illness” twice in the article. Once it was actually used in quotation marks and on the second occasion I used it in this context “medical explanations of mental illness”. I didn’t use quotes here because, regardless of how erroneous we think it is, that’s what medical explanations are explanations of.

    I also didn’t put quotation marks around “medication” because psychotropic medication is medication. It might be highly problematic medication but it’s still medication. I’m actually not anti-medication. I’m anti mis-information. I think the big problem is that many people are misinformed about the benefits and harms of psychotropic medication. I like to keep in mind, however, that some people take psychotropic medication and experience benefits from it and are happy to keep taking it. In my zeal to inform people about the mis-information surrounding psychotropic medication I don’t want to be disrespectful to these people who have just as much right to take psychotropic medication as other people should have not to take it.

    When I’m discussing my own perspective on mental health problems I refer to them as “psychological distress” but when I’m referring to the context in which services are delivered I generally use the term “mental health problems”.

    We’re definitely on the same page with wanting to raise the bar in terms of our scientific and political standards. In pursuit of these higher standards I do find it curious that you would withhold this otherwise “excellent” article because it doesn’t have as many quotation marks as you would prefer.

    It’s these kinds of differences that make life so interesting.

    Tim

  • Hi bpdtransformation,
    Thanks for the detailed comment you’ve provided. It’s disappointing that the ideas I presented weren’t more engaging for you but the points you’ve raised present an opportunity to clarify some of what I outlined in the paper:

    bpdtransformation:
    My viewpoint would be that viewing abuse, neglect, and trauma as producing “what is wrong with you”, would be a step in the right direction, i.e. the direction of viewing environmental stress as the primary factor in the generation of “symptoms” like hallucinations, feeling of depression, paranoia, mania, etc. The author doesn’t appear to consider that the shift could be gradual and along a spectrum; that some people, via considering more about what happened to people, might have their medical model thinking weakened before being finally eliminated. Of course there will be some hard-core medical model nuts who won’t get it no matter how its framed.

    Tim:
    OK, so you see that changing questions would be a step in the right direction. Fair enough. I think changing questions could be a step in the right direction but is not a guarantee of a shift in any direction. I can see that my writing has been unclear for you because I wasn’t really discussing how the change would occur. I was responding to the question that was posed in an email I received recently. What would happen if we started asking a different question? I’m suggesting probably nothing.

    bpdtransformation:
    On the contrary, most proponents of the medical model I’ve heard are caught up in the delusional fantasy of claiming that “poor parenting” and “family environment” do not cause psychosis, depression, or other problems. Looking at what happened could weaken this delusion on their part; why not try it? Furthermore, many, many psychiatrists ask only about immediate symptoms and never ask what happened to a person at all

    Tim:
    I guess we’ve been listening to different proponents of the medical model. Your point, however, kind of illustrates what I was trying to emphasise in this article. I think we need to move away from notions of things like “psychosis” and “depression” being caused by anything at all. Psychosis and depression are not the same as malaria and tuberculosis. They need different explanations that step away from a simple, linear cause-effect model.

    bpdtransformation:
    No, changing the question being asked can effect a change in point of view. It doesn’t always, but it is not fair to generalize that this is (always) a case of the tail wagging the dog.

    Tim:
    As you quoted, I said “Trying to change the question being asked without changing the point of view that’s generating the question is a classic case of the tail wagging the dog.” so, when it’s read this way, I still maintain that it is fair to generalise that it’s a case of the tail wagging the dog. Notice, too, that this makes no comment on the effectiveness of otherwise of the strategy. A dog can be wagged if it’s tail moves vigorously enough. I find it hard to understand the scenario where asking a question would effect a change in viewpoint. Why would the person be asking the question in the first place if their point of view was contrary to that?

    bpdtransformation:
    This is another huge generalization. Who would tell a rape victim, “The rape that happened to you is not the problem. The problem likes in the way you are handling this experience in your mind now in the hustle and bustle of your daily life.” Hopefully, the victim would tell you to screw yourself. Traumatic events are in and of themselves major stresses. Some people do overcome them immediately, and we don’t know why that is – perhaps they are more resilient or have more auxiliary supports or luck than others. And yes, how the person experiences trauma and what they do with the memory of that experience is a second important factor. It’s not either/or…. this idea about the historical event not being the problem by the author is all or nothing.

    Tim:
    It’s a bit hard to know how to respond to these comments. Suffice to say that when I work with people (including people who have been raped or experienced traumatic childhood events) from the perspective that it is their re-experiencing of the traumatic event in their day to day living that is the problem they don’t tell me to go screw myself. Generally, they seem to find it pretty helpful.

    bpdtransformation:
    Yes, but, understanding the past is also important as well as the present. Transference (the way people relate to present others as if they were people from the pastm by projecting feelings about the past onto the present) is real and important. Resolving transference distortions can often be accomplished by discussing and understanding the past, which can result in better functioning in the present. What is happening now is important too. Again, there is no need for this all or nothing position…

    Tim:
    I’m not sure what it is about the past that needs to be understood in order to assist someone in the present. I’m also not clear on how this is related to transference.

    bpdtransformation:
    What? This is so illogical! Without the river of last week, the river of today wouldn’t be here, nor would it be in its present shape/version. Both past and present matter, and asking about the past can be helpful, although that doesn’t mean getting stuck or overfocusing on the past.

    Tim:
    Definitely. That’s why I wrote things like “The past river stepping activity undoubtedly contributes to who the person is at this point in time but it is the inability to achieve things in the present moment that is paramount.” and “Past events, therefore, can be discussed in MOL but the emphasis is always on the impact of the event right now with questions such as: How is the event being remembered?; Which bits are remembered?; What happens when these experiences are replayed?; and so on.”

    bpdtransformation:
    So, to reframe the title of this article, The Questions Can Indeed Be A Problem, and Changing Those Questions Can, But Does Not Always, Effect Change 🙂

    Tim:
    Even after reading all your comments a few times, I’m happy to keep the title as is. 😉

    Tim

  • HI Travailler-vous,
    You’re right, there are many questions that RCTs are not designed to answer and, of course, the other point you raise is that RCTs won’t help you identify the someone who is allergic to the mediction because RCTs aren’t interested in ‘someones’, they’re only interested in group averages. At best, an allergic reaction might get included in a count of adverse events but that would require that it was identified in the study and judged to be an effect of the medication. And, as you finish your comment with, there’s always the question of why a particular individual decides to take a particular drug. RCTs are silent on this matter as well.
    Tim

  • Hi Trvailler-vous,
    Thanks for highlighting this. Yes, I think psychological distress is quite different from a physical cut or a broken bone. Most of our current emphasis seems to be on understanding and treating particular symptom patterns which are considered to be analogous to various physical maladies such as diabetes. My focus, however, is on the distress associated with any particular set of symptoms rather than the symptoms themselves. For any particular symptom or symptom pattern there are almost always people in the general population that experience similar things but are not bothered by them at all. From my perspective, it’s the botheration or distress that is the defining feature of what we now call mental health disorders and it’s this distress – closely associated with a person’s agency – that should be the focus of our research and treatment efforts.
    Tim

  • Hi Rick,
    Thanks for coming in on this – you’re spot on with your comments. Even when RCTs are very good the direction of inference is from the sample to the population but, of course, this is exactly the opposite direction from the direction clinicians are interested in. Clinicians want to know who they can use the results of studies to inform their work with individuals. Unfortunately, statistical inference is currently silent on that topic although conducting studies like the ones you suggest would be a start. Of course, that still wouldn’t answer the questions that are relevant in routine clinical practice such as what’s happening for clients when they are on a gallimaufry of different drugs in different combinations.
    Statistics are fantastic resources when they’re used appropriately but very blunt instruments when they’re being used for purposes for which they were not designed.
    Tim

  • Hi Jens,
    Thanks for your comments. Alternatives are definitely needed. One of my favourite books was published way back in 1991. It’s called Casting Nets and Testing Specimens. It’s written by Phil Runkel. Phil puts forward the idea that our current reliance on statistics to answer basically all questions from a quantitative perspective is a problem. The “Casting Nets” part of the title refers to statistical approaches and Phil argues that, in order to understand how people function we need to complement statistical approaches with a “Testing Specimens” attitude as well. From this perspective, a model building approach is adopted based on understanding individuals and building up common principles from the establishment of functional, rigorous models. This is the approach used by Perceptual Control Theory (www.pctweb.org). One of the interesting results from conducting research this way is the discovery that we need a different model of causality when we consider living thngs. The independent variable – dependent variable (IV-DV) methodology is a limited way of understanding behaviour. Much like the holistic paradigm you suggest, we need a model of circular rather than linear causality in order to understand accurately how living things function.
    Tim

  • Hi 9,
    The question you started with is brilliant!? That’s exactly the point isn’t it? Thanks for your insights.
    Part of the problem with sleep disorders is that the term “sleep disorder” can cover a wide range of problems. Just like a cough can indicate very different underlying problems I expect the same thing is going on with sleep disorders. As you illustrate so clearly, it’s important to understand each person and the nature of their particular problem rather than making assumptions based on inaccurate theories.
    Tim

  • Hi Steve,
    Yep, great point. Robert Whitaker has done a great job of highlighting these problems. As has David Healy. Not only do we focus almost exclusively on symptoms but we also investigate these symptoms using, mostly, self-report questionnaires.
    We need a much greater focus on the effects our treatments have on the person’s life from the person’s perspective. Are they able to socialise more, or hold down a job, or build lasting relationships, and so on. Unfortunately, these things are hard to pin down and not necessarily changeable over the few months that most RCTs last.
    Tim

  • Hi Rhonda_B17,
    Thanks for taking the time to comment. Experiences like the ones you describe are just the kinds of things I had in mind while I was writing the article.
    I’m not sure whether there are some people who aren’t able to take the ‘clean’ option but, for me, the more important issue is how people come to be living the life they’re living. I think why people are taking drugs is perhaps more important than what they’re taking. If they’re informed and are voluntarily using some form of medication because they find it helpful then that seems pretty ideal. It’s a different scenario though when people are not fully informed and have inaccurate and incorrect information about the drugs and their effects or when they’re coerced into taking the medication.
    Unfortunately there are still too many situations like the ones you’ve described.
    Tim

  • Hi Slaying,
    Psychotropic medications can be dangerous and toxic and their harms have been explained by some brilliant authors. Robert Whitaker’s book is sensational. Some of my other favourite authors are David Healy, Joanna Moncrieff, Ben Goldacre, Peter Gotzsche, and, of course, Peter Breggin.
    In my reply to Barrab I was picking up on the use of the word “really”. How do we “really” know? I’m not sure we do but I don’t think that means we can dismiss it either. I don’t really know that people are being helped by the conversations I have with them but I’m prepared to believe them when they tell me that they find them helpful or when they complete a questionnaire a particular way or when they tell me they’re socialising more or they’ve cut down on their cigarettes or they’re not as angry as they used to be.
    Perhaps I’m naive but, by and large, I tend to believe what people tell me. I may be misreading things but from the words that you’ve typed it seems as though you’re implying that people can think they feel better but they’re not really feeling better. I’m not sure I understand that distinction. Sometimes, after a hectic day at work, I have a glass or two of wine at night at home and I feel a whole lot better. Now do I just think I feel better or do I actually feel better. I don’t know and I don’t really care! When I get a headache and I take a headache tablet I think I feel better and that’s good enough for me.
    I guess the point of my article was just to say that it can be really tough to sort through problems psychologically and some people choose other ways of dealing with things. I think it’s their right to do so. People have to find their own way through the troubles that plague them. Sometimes I can help with that and sometimes other things are what they need at that time.
    Tim

  • Hi Slaying,
    Yep, I agree. Individual situations and circumstances related to psychological distress are unique and they need to be explored and examined not categorised according to a diagnostic system. There’s a great paper by E. I. Fried and R. M. Nesse (2015) called “Depression is not a consistent syndrome: An investigation of unique symptom patterns in the STAR*D study” published in the Journal of Affective Disorders. They analysed the symptom profiles of 3703 people who met the diagnostic criteria for Major Depressive Disorder. Overall, they identified 1030 unique symptom profiles so even with something as well known as depression we can’t assume what we know is going on for someone.
    I think you’re right too in that sometimes people can become more distressed as a result of treatment. It’s one of the reasons I think it’s important to let the person receiving the treatment be the best judge of how much treatment they need and how often they need it.
    Tim

  • Hi Slaying,
    There’s good and bad in every profession I guess. I’m fortunate to have known and worked with some really great psychiatrists and some of the biggest critics of biomedical psychiatry are, in fact, psychiatrists. There’s a lot clinical psychology could do to tidy up its own backyard but, as you say, psychology is more benign than psychiatry so, even when we get it wrong, it probably doesn’t have the devastating consequences that it can have when psychiatry gets it wrong.
    Tim

  • Hi Slaying,
    The love sickness metaphor isn’t central for me but it is a good way of emphasising the idea that psychological distress is fundamentally different to a physical illness. Sometimes the two can co-occur but they don’t have to. People can be physical unwell and not psychologically distressed and it can happen the other way around too.
    I definitely take your point that what is offered as help is not always experienced that way by the “helpee”. One of my fundamental principles is that help can only be defined by the helpee and not the helper. If what I’m offering isn’t experienced as help by you then it isn’t help regardless of how good my intentions are. It’s not a very common idea but one that I think is hugely important. I’m glad you raised it.
    Tim

  • Hi Travailler-vous,
    Yes, people do often confuse themselves in the conversations we have and the confusion can lead to new and helpful insights and perspectives.
    I certainly take your point about how far we have yet to go on a societal level regarding our understanding of drugs and how the brain works. I get the sense that the tide is turning – and websites like Mad in America are a big part of that – but it’s a slow process at the moment and many people still experience the full brunt of a medical approach to psychological distress.
    Tim

  • Ah, OK. Got it. Thanks! Yep, I agree – assuming we know what someone is experiencing or what’s wrong with them is a sure-fire way of shutting down the exploration of how they’re travelling. Of course, it’s fine to assume when you get it right but many times we don’t get it right and the people you describe are good examples of that.
    This is yet another problem with the area of psychiatric labels. As you point out, once someone has one of those labels, a lot of their experiences are interpreted from that perspective. I don’t subscribe to the DSM way of thinking about people’s problems so my approach is to listen and question without assuming. As people explain their situation in detail to me they’re explaining it to themselves as well and something very useful seems to happen when people say out loud the things that are bothering them and listen to what they’re describing.
    Thanks for commenting and highlighting the point about the problems with assuming – it’s one of the big barriers to effective (and therapeutic) communication I think.
    Tim

  • Hi AA,
    Where I work in remote Australia we are very limited in being able to refer on to specialists.
    I guess we just have different perspectives on how to work with people experiencing psychological distress. The people I see are all accessing the public mental health service. When they come to see me I ask them questions about the things that are bothering them. Invariably, there are things that are bothering them of a psychological nature: they don’t know who they are; they were abused in their childhood; they can’t decide where their relationship is going; and so on. These are the things we focus on.
    I guess if someone came in and wasn’t bothered or distressed about any psychological conflict or dilemma but had some unexplained pain or sleep problem we might explore options for how that could be investigated but, in my experience, people are pretty good at deciding for themselves what they need and who the best person is to see if they’re given the opportunity to express that. Where I am mental health problems still carry a lot of stigma so coming to see a psychologist isn’t something someone does lightly. I’m sure some people would much rather go to a sleep specialist and have their sleep sorted out than come to a psychologist to sort out their mind.
    This is an important conversation and probably a good indication that we still have a long way to go before we can accurately pin down the nature of someone’s difficulties.
    Tim

  • Thanks heaps Alex. The healing journey you describe is very much what MOL tries to help people create. Getting to those meta levels seems to be a key in reorganizing all those problems that are being experienced. As you say, it’s hard work to get there but the benefits are worth the effort. Thanks for sharing your experience.
    Tim

  • Hi Alex,
    You raise a really important point. Words can be used very differently depending on the intent of the person using the word. I agree, “resistance” could be used neutrally, however, I have often seen it used in a pejorative sense in that the client was somehow rejecting the help that was offered. For me, it all gets back to considering the perspective of the person we’re working with.
    Tim

  • Hi Steve,
    Thanks for your comments. Yes, I definitely agree that physiological problems should be ruled out first. I’m not medically trained though so I rely on my medical colleagues to do that and I assume that if they’re referring a person to me it’s because the physiological aspects have been sorted. Definitely scope of practice can be a real barrier to progress for both the practitioner (from an ethical point of view) and the person accessing the service.
    Tim

  • Hi again Travailler-vous,
    The reason I mention “parts” is because that is how many people I work with describe their experiences … “one part of me wants to move on but another part of me wants to sort it out with him” … one part of me has a thirst for life but another part of me has a desire for oblivion … and so on.
    Tim

  • Hi Duane,
    I wouldn’t be so grand as to represent my profession here. These are just my thoughts I’m expressing. Nevertheless, I think you raise a great point that some medical conditions do have psychological effects associated with them. I’m fortunate in where I work that I get referrals mainly from psychiatrists so I assume that physical anomalies have already been checked out.
    I really take your point about the dangers of assuming. The therapy I use (Method of Levels; http://www.methodoflevels.com.au) is based on the idea of assuming as little as possible and building a therapy around the cornerstone of “curious questioning”.
    Tim

  • Hi Alex,
    I’m really glad the article resonated with you. I love the term “radically self-responsible”. How amazing would the world be if radical self-responsibility was the norm?! I think the ideas of cause and effect are important to keep in mind. The particular story of behavior that I like (Perceptual Control Theory; http://www.pctweb.org) talks about the concept of circular causality rather than linear causality being more appropriate for living things. It’s a very cool idea.
    Tim

  • Hi barrab,
    How do I “really” know that medication helps some people some of the time. I guess I don’t “really” know that. I only know what the people with whom I work tell me and some of those people tell me that the medication has helped them. You can’t see any point in taking an antidepressant and, from my perspective, I feel the same way. Some people, however, do see a point and some people say that it helps them. It’s not the course of action I would choose but I think I need to respect that as a therapist. That’s all I was trying to communicate.
    Tim

  • Hi Someone Else,
    Just picking up on your last point … I’m not sure “schizophrenia” is a “thing” that is caused by child abuse or any other event or happening. Once we start moving beyond the label of “schizophrenia” we might get close to understanding how people arrive in the severely distressed states they end up in .
    Tim

  • Hi Travailler-vous,
    Yes, you’re absolutely right. My inspiration for the love-sickness metaphor was indeed Thomas Szasz from The Myth of Mental Illness. And, yep, I pretty much agree with the other things you’ve pointed out … I didn’t mean to communicate that it was OK to label and deceive people about the benefits of medication and I agree that medical problems can start after, rather than before, the person has taken the psychotropic medication.
    Tim

  • Hi Slaying,
    Wow! Out of my whole article you chose to focus on the love sickness metaphor. That must have really meant alot to you. I used the word “relief” rather than “spell binding” because that’s how some of the people I work with describe it. I’m sure people experiencing psychological distress didn’t come up with the “mental illness” term themselves but I’ve never heard them come up with the “spell binding” term either!
    I really didn’t mean love-sickness to be a central part of the article but I do think the agency that you mention is fundamental to living lives of value (valued from an individual perspective that is!).
    Tim

  • Hi Jonathon,
    Yes, I agree. Feeling better is often the key. And the paradox of that is that medication can help people feel better initially (well, after the two to three weeks that they start to have some effect) whereas psychological therapies can be unsettling initially. People I see can have quite a torrid time in sessions but end up feeling better afterwards. That’s where I think the trade-off between long term and short term feeling better can be important.
    Tim

  • Hi B,

    I think you’re really ‘on the money’ with these comments. Conflict goes by different names – ‘dissonance’ is one of them, ‘ambivalence’ might be another. Even concepts such as ‘willpower’ and ‘self-control’ are really issues of conflict I think. I’ve written about self-control as conflict in my Psychology Today blog. You can read it here: http://www.psychologytoday.com/blog/in-control/201412/the-difficulty-self-control-is-conflict

    One of the things I like about the ‘distress as conflict’ idea is that it doesn’t mean anyone is sick or broken or disordered. They’re just chronically conflicted. Conflict is very common. Essentially, every choice situation is a conflict so, clearly, we’re ordinarily very good at resolving internal conflicts. As you say, sometimes people don’t even resolve conflicted ideas; they just keep them in mind and focus on one rather than the other.

    At times, however, conflict can become chronic and distressing. Helping people explore and understand conflict can be very useful in enabling people to function as they would like in a world that is, often, as you put it, “in-understandable”.

    Warm regards,

    Tim

  • Hi Boans,

    You’ve highlighted the slipperiness of the slope upon which “involuntary treatment” sits. Part of my motivation in writing this article was to encourage a shift away from an “I know what’s best for you” attitude and towards an understanding of people as active, purposeful creatures who have their own ideas, dreams, and hopes about the sort of life they’d like to live.

    If we thought of “treatment” as a resource people could use to make their lives be more like the way they want them to be, then, from this perspective, it would be very hard to even construe what “involuntary treatment” might be.

    I’ve had a terrific Christmas and New Year. I hope yours has been to your liking!

    Tim