TWO months ago, the British Psychological Society released a remarkable document entitled “Understanding Psychosis and Schizophrenia.” Its authors say that hearing voices and feeling paranoid are common experiences, and are often a reaction to trauma, abuse or deprivation: “Calling them symptoms of mental illness, psychosis or schizophrenia is only one way of thinking about them, with advantages and disadvantages.”
4 Dec, 14 | by BMJ Evidence based medicine (EBM) should form the foundation of effective clinical decision making; however, growing unrest—and an awful lot of criticism—suggests the evidence bit of EBM is increasingly part of the problem, and not the solution.
“Carl Heneghan jointly runs the Evidence Live conference with The BMJ and is a founder of the AllTrials campaign.”
Interesting. And does this study of “low and moderate use” invalidate all other studies?
The desire to be more like the hard sciences has distorted economics, education, political science, psychiatry and other behavioral fields. It’s led practitioners to claim more knowledge than they can possibly have. It’s devalued a certain sort of hybrid mentality that is better suited to these realms, the mentality that has one foot in the world of science and one in the liberal arts, that involves bringing multiple vantage points to human behavior.
I wish I could get in touch to ask An Observer for permission to quote the entire comment. Instead I’ll paste in some paragraphs:
But I’m not entirely happy with Mental Elf’s reflection. The most unhelpful part is the subtle (deliberate?) slide from ‘psychology vs psychiatry models’ (fairly accurate, although actually the report calls for a psychosocial model) to ‘psychologists vs psychiatrists.’ The other side of the coin from the extraordinarily aggressive responses by (some) defenders of psychiatric models was, in my view, the admirable restraint shown by the report’s authors – and from their colleagues. In fact, one of the charges levelled against them was that they were NOT responding – despite what seemed to be numerous provocations.
And let’s not forget the (inconvenient to some) fact that the report was launched and endorsed by two of the most senior psychiatrists in the country. So, I would argue that at least in relation to the recent debate, it is both untrue and unhelpful to talk about an interprofessional war. No wonder service users get upset if they are constantly told that this is what is going on. Why, then, do (some) people in responsible positions continue to promote this narrative? Well, I don’t think it’s too cynical to speculate that this serves as a convenient way of defusing challenges to entrenched positions and vested interests. Far easier to depict these uncomfortable but necessary critiques as some kind of narrow professional spat, and call for everyone to behave themselves – which is thinly disguised code for ‘Don’t dare challenge the status quo.
I have been a service user, I don’t belong in any of the warring ideological camps, and following this discussion is like watching turf wars of woo. Is it hopelessly naive of me to wish that professionals in a field called “mental health” could engage in more mentally healthy forms of communication?
So much of the time the focus is not on the client but professional standing, service requirements and power.
I have worked in and around primary care for 20 years after qualifying and during that time I have seen so many professionals lose sight of their role as a health professional and focus on their careers rather than promoting health or at least “doing no harm”.
A good doctor will focus upon the best medication for a particular presentation, the characteristics of the individual and the situation. The trouble with psychiatric medicine is that while there are symptoms there is no source and no signs for most psychiatric diagnoses. This reality makes diagnosis at best a finger in the wind task as it is reliant upon the person’s self report.
However, psychology has the same problem with formulation. How does the clinician know when they have gathered enough of the right information to make an accurate formulation, even with the wholehearted co-operation of the individual. Furthermore, how much of the past is relevant to the formulation? Even that knowledge of the past may adversely bias attention toward a particular formulation or diagnosis that is a pet issue for the professional.
In mental health, psychiatry, psychology the only expert in their lives is the person experiencing it. Surely our first and foremost question to them should be, what would your life be like if it were working better, if our intervention had been useful; if you were experiencing more of what you wanted? Rather than assuming that they wish to get rid of something, which is the traditional approach in both psychiatry and psychology. An approach that has developed from the medical model of treating illness, the removal of infection, pain and physical distress.
The sentence that I have bolded is reinforced here:
In mental health, vital question neither “What’s wrong with you?” or “What happened to you?”, but “How do you need/want yr life to change?”
— Lancet Psychiatry (@TheLancetPsych) December 1, 2014
The link is to a review by Andy Fugard, @inductivestep, and I quote him here:
Therapy, Smail argues, tries to boost the perception of clients’ power to change, when in reality it is actual power that clients often need: power over material resources, money, employment, education; personal resources such as confidence and intellect; home and family life, a love life, and an active social life (Hagan & Smail, 1997). These are areas which often cannot be influenced by talk in the clinic. So why has individual therapy grown so popular? Smail argues – and emphasises that it’s nothing to be ashamed of – that therapists rely on income to put food on the table and pay the rent, just like their clients. He illustrates with the example of Sigmund Freud (p. 3) who wrote that “My mood also depends very strongly on my earnings… I have come to know the helplessness of poverty and continually fear it”. Freud, he argues, changed his theories so as not to offend those who paid the bills, e.g., clients’ parents. Smail argues that there is a great mysticism around therapy (p. 8): “rituals of therapeutic cure… bear a strong resemblance to the spells and incantations of sorcerers”, with practitioners rarely explaining to clients how their techniques (supposedly?) work. Together these interests help sustain psychotherapy.
Our great teacher, Elvin Semrad, actively
discouraged us from reading psychiatry textbooks during our first year. (This
intellectual starvation diet may account for the fact that most of us later
became voracious readers and prolific writers.) Semrad did not want our
perceptions of reality to become obscured by the pseudocertainties of
psychiatric diagnoses. I remember asking him once: “What would you call this patient— schizophrenic or schizoaffective?” He paused and stroked his chin, apparently in deep
thought. “I think I’d call him Michael McIntyre,” he replied.