Showing 22 of 22 comments.
Something that doesn’t exist, cannot be rare – it simply doesn’t exist
Whenever I see research like this I always wonder how do you account or control for the impact of the relationship with the therapist, the support surrounding the child when not seeing the therapist and other extraneous factors that either help them along or hold them back. But research ala the medical model with it’s seductive simplicity only focuses on one active ingredient and that is the particular technique used or pill swallowed while ignoring the fact that people during the research period live in particular circumstances that have far greater and lasting impact on how they feel and make sense of things
Why is MIA interested in articles that promote disease talk and genetic predispositions? No child is at risk because the parent “had” an “anxiety disorder”. Anxious parents may certainly rear anxious children for obvious reasons and if a child at that age is anxious as a result of mistreatment and abuse at the hands of the parents, no amount of correct breathing, conflict resolution and social skills training is going to help them. This reminds of the Australian psychiatrist who was able to pre-empt psychosis in “at risk” young people and wanted to put them on “anti-psychotics”, just in case
I agree with you, but changing one’s circumstances is part of the solution. There is a place for therapy once the abuse and other adversities have started to affect people.
You have to wonder about “therapists” who prefer to deal with people at arms length in an online format. I have always thought people seek connection with others and that they want to have a real relationship that can serve as a source of comfort, a safe space from where changes can be explored and a practice ground for how they relate. I am obviously out of touch – people’s difficulties cannot be mediated through a relationship. All they need to be taught via text is that their thinking is way too negative and to breath correctly when they get “triggered” and we can be sure that they won’t “relapse”
The attractiveness of the medical model is it’s simplicity and as such it claims that we can have treatment A applied to condition B and we will have outcome C. When psychology operates in such a fashion the result is so-called empirically supported or evidence based treatments like CBT. The problem with this is we know that the most important and telling “active ingredient’ is not the approach or the technique, but the therapeutic relationship, the conditions to be targeted have a dubious existence to start off with so what is in fact being treated and most people who seek therapy don’t just want “symptom relief” as an outcome, but able to make changes, live with a purpose, feel in control again, understand themselves better, have satisfying relationships, etc.
I can only hope that psychology will one day feel that they have a right to exist as an independent science and discipline and that they don’t have to copy and pander to the pseudoscience of psychiatry
It is not surprising that if you have psychologists being trained with the medical model as backdrop, then your product will be someone who believes that they use “evidence based treatments” (usually CBT) for particular conditions (MDD, agoraphobia, GAD, etc.). Just like doctors they don’t treat people, but their “illness” and thus there is no need to consider context, how a person’s life has unfolded given his/her circumstances or what might have caused or contributed to their distress – all you have to focus on is symptom reduction and that is also the only feedback you need to elicit from them. When they “relapse” after 3 to 6 months (which is usually the case), you can blame them for not using the skills that you have taught them or that they were not overly “psychologically minded” to start off with in the first place. To these psychologists technique is everything and the relationship a mere practical coincidence. I see this particularly here in Australia and remain hopeful that one day the profession as a whole will look back and recognise that, first and foremost, people in distress need connectedness with others and that there needs to be a far greater emphasis in psychologists’ training on selecting people who have natural facilitation skills, empathy, kindness and respect as opposed to the current trend of selecting the most academically successful ones and turning them into psycho-technicians (I can’t think of another way of describing them)
Richard, the disconnect between current psychological training and a contextual understanding of distress is also very evident here in Australia because of the dominance of CBT in university curricula
Your appreciation and understanding of this issue (and others on MIA) are exceptional. I enjoy reading your comments
Childhood adversity may increase risk of suicide? Looking at the situation of Indigenous Australian children the rate of substantiated abuse (that is, a statutory protection authority believed that abuse or neglect had occurred) is 4.3 times higher compared to non-indigenous children and one needs to assume this is a gross underrepresentation of the problem as about 90% of sexual abuse alone goes unreported in these communities. Indigenous youth suicide was 80% of the total Australian suicide in 2010 and in the Kimberley region (northern part of Western Australia) there is on average one Indigenous youth suicide attempt every week
I like your analogy, Steve
“Treatment Resistant Depression” as a justification for brain shocks shows how “innovative” psychiatry can be by inventing a condition to explain away why their miracle drugs have not worked and thereby continuing to locate the problem “in” the person. As such the social factors contributing and maintaining the distress can conveniently be put in the “too hard to deal with basket”. I guess complexity has always scared psychiatrists a little bit
Differences in brain volume may be attributed to factors such as trauma, abuse and neglect, so this “mega study” proves nothing
“Physical Activity Predicts Fewer Symptoms of Depression in Children”
A loving, caring, validating and stimulating home environment would not only predict the same, but prevent feelings of sadness, loneliness and being unwanted in the first place
The moment we talk about an “alternative classification system” then we only introduce something that will continue to merely describe distress, reactions and adaptations as opposed to explaining it or making it relevant and understandable to those experiencing it
“mental disorder has something profound to teach us about the nature of being human. And it does this not by reflecting brain abnormalities, but by consisting of extreme, bizarre, usually dysfunctional and sometimes unfathomable manifestations of human agency.”
I would have said: “all human behaviour has something profound to teach us about the nature of being human and that we should avoid value judgments and the use of loaded words like extreme, bizarre, dysfunctional, disordered, etc. as these are sure to cloud and limit our understanding of others and of how they make sense of their lives.”
My apologies for the fence sitting comment as I have misunderstood your use of the word medication. A lot of people reading the blog would understand medication as those drugs (marketed by pharmaceutical companies and prescribed by doctors) that interrupt a disease process or correct some physiological abnormality. If I understand you correctly this time round you use it in the broader sense as anything that someone can derive benefit from whether this is psychiatric drugs, alcohol, crystal meth or chocolate. In that case I would suggest you use the term “remedy” just to avoid confusion with actual medication.
I think that we have made huge progress just because we have questioned and critisised the disease model and many professionals are no longer trapped in that narrative. To me the best example is the Division of Clinical Psychology (BPS) who has publicly stated the problems and limitations of the disease model – I live in hope that the Australian Psychological Society would one day wake up to that too
Good Day Tim, entertaining article, but you lost me on the medication part of psychotropic medication. We all know about the problematic side of these drugs, but please explain how people are “medicated” when using it, that is, treated for a disease? Also, if you are not anti-medication, please let us know for which diseases and disorders should medication be taken then and what are the benefits you are referring to? I don’t believe you can be a fence sitter like you are on this issue
Just wondering if any research has been done on whether particular individuals find “anti-depressants” more useful than others. For example, dependent, slightly naive and gullible types who would not readily question authority and easily slip into the passive-recipient patient role or people whose self-esteem and moods are more externally regulated (and one can reasonably assume that such issues stem from some form of abuse). If so, then doctors have under the guise of “help” taken advantage of really vulnerable people and ensured that their “mood problems” are perpetuated and thus also a steady income stream
I applaude MIA and its efforts to better educate and inform
Your story reminds me of my own experience as a clinical psychology intern at a psychiatric hospital some 25 years ago. What struck me then was how self-perpetuating and self-serving psychiatric “care” was and that in my 12 months stint saw many people return after their discharge. There was no actual involvement with the patients or preparation for life outside the hospital walls. When I encouraged a female patient to refuse the “medication” she was injected with on a regular basis as it had such severe side-effects, I was called irresponsible. And when a young man who had received more than 60 electric shocks to the brain before the age of 18, asked me whether he was a schizophrenic during an intake interview and I said to him no, you are (his name) and that it was just a label that psychiatrists use to substitute any real connection with him, I was chased out of a ward round like a rabid dog. This was fortunately towards the end of the internship and they were happy to see me go.
For a few years after that I questioned my own position which was shaky to say the least following the experiences at the hospital. Then I read Toxic Psychiatry by Peter Breggin. He eloquently stated what I intuitively knew and since then have in my own small way with my clients made sure that the psychiatric doctrine does not get promoted in any shape or form. I am also encouraged by the contributors and readers of MIA
‘We’ll keep on tweaking the medication until we get it right’
This is code for “we have no idea how these drugs work”
My personal favourite is the the distinction between “reactive” and “endogenous” depression. I remember my father being told by his doctor that he had the latter soon after his retirement (?)