The Truth About the “Evidence” Based Therapy

Psychology as a field of study has always been in a limbo of classification and methodology. The natural sciences, such as physics and chemistry, demand a certain level of objectivity that some have argued is not possible in the study of human behaviour. This has led to a difference of opinions between psychologists in their method of study and the various schools of psychology. The clinical implementation of psychology is not spared the conflict of methods based on observable and quantifiable evidence and theoretically backed humanistic approaches.

The various counselling methods have had their own approaches to understanding and treating disorders of a psychological nature. Psychiatry, one of the most dominant fields currently is of the opinion that human psychological ailments can be traced back to a neurological and hormonal causes, for example mood disorders such as depression and bipolar syndrome are thought to be caused by hormonal imbalances and are treated with medication that regulate hormones like thyroxin. Thus their method of treatment is centred on the idea that disorders such as depression, obsessive compulsive disorder, bipolarity etc. can be treated with a variety of drugs that target the neural and hormonal system. Their method of classifying disorders is dependent on a manual of diagnosis known as the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the ICD (International Classification of Diseases) which prescribes a list of symptoms associated with various mental disorders. Psychiatry thus treats mental disorders as any other physical ailment that has a biological basis.

Why should this matter to patients?

Firstly, the method of classification of disorders in the DSM depends on obvious external symptoms that are observable and can be inferred also asked of from the patient. The problem with this method of classification is that it simply clubs together symptoms and calls them a disorder. It does not directly address the cause or actual nature of the disorder. As a result, when patients are diagnosed, they are most frequently diagnosed with multiple disorders at the same time. They would thus be diagnosed with, for example, with bipolar disorder and schizophrenia or most commonly autism and mental retardation. Also diagnoses evolve with time

Second, there is a lot more published research into psychiatry than there is in any other form psychological therapy. As a result the legitimacy of psychiatry is not solely derived from its academic rigour, validity and reliability but also because the sheer amount of research and funding it has and the money big pharmaceuticals pumps into it. This disqualifies or discourages other fields of study into psychological therapy that follow different approaches to treatment.
Thus, in the past treatments such as psychodynamic therapy that do not follow practices similar to Cognitive Behavioural Therapy (CBT) have been deemed unscientific and even unethical, regardless of the success of their treatments and disregard so called unscientific traditional routes such as healing, Buddhist healing, meditation etc.

Finally, a large portion of the funding into psychiatry and the American Psychiatric Association comes from pharmaceutical companies. I see you mentioned this here. Most psychological disorders are often treated with various kinds of medication. These medications are known to have side effects varying from patient to patient and are very often addictive. Compounding this with the fact that a patient is usually diagnosed with more than one disorder they are prescribed a long list of medications that the patient then becomes dependent on for their mental wellbeing. Often patients that go on medication are not told how long they night have to have it and are not told about all side effects in the beginning. The shrink acts like a parent and decides that its better a suicidal patient go on lithium without knowing how long they’ll have to be on it (at least a year, usually two) because the risk of suicide is very high.
Loren Mosher in his resignation letter to the American Psychiatric Association vehemently disagreed with this practice. He stated that the APA was only waging war on “drugs” because it didn’t want drugs in the market that it couldn’t profit from and instead prescribed substances that it made heavy profits from leading to the same state of substance dependence in its patients that it attempted to “cure”.

Mosher in the same letter accused the American Psychiatric Association of not being concerned with the wellbeing of their patients and instead running a business. This is an accusation that has been levied time and again against the medical field.

Some may argue that the study of psychological disorders is still nascent and that it would be some time to come before we can accurately diagnose patients; study of  genetics and its connection with mental disorders would surely shed some light and confirm these arguments, right?
This may not necessarily be the case.

A research group led by Jordan Smoller at the Massachusetts General Hospital in Boston screened genome information of over 33,000 people with five different psychological disorders looking for similarities in genetic sequences. What they discovered was that four chromosomal sites were associated with all five disorders. What does this mean? This means that if genetic characteristics is to be considered for diagnostics, the existing method needs to be reconsidered. This discovery is consistent with observations in clinics that report overlapping of disorders.

The tag “evidence based psychology” has also become nothing more than a marketing ploy, according to Jonathan Shedler, PhD. His article in Psychology Today deconstructs the methodology of the research that supports “evidence based psychology”. In these studies the control group are people who receive either no treatment or sham treatments. The advantages that emerge from these studies disappear in studies that compare results between “evidence based” and other standard practices conducted by trained professionals.

The reason these studies don’t emerge is because they’re suppressed for their unfavourable results.

In 2013, the NIMH (National Institute for the Mentally Handicapped) completely withdrew funding from DSM based research, ironically, on the grounds that the research behind the DSM lacked validity. Tom Insel, Director of the NIMH, stated that as much as the DSM is touted as a “Bible” in the field, it was nothing more than a poor excuse for a dictionary. The classifications that exist in the DSM aren’t much more than a consensus on a cluster of symptoms and even then whether the consensus ever truly existed in the first place is questionable. One consultant for DSM-III conceded to the New Yorker magazine about the amount of horsetrading that drove that supposedly “evidenced-based” edition from 1980: “There was very little systematic research, and much of the research that existed was really a hodgepodge—scattered, inconsistent, ambiguous.”
This is a serious blow to the monolithic institution surrounding the DSM. It may not lose stature any time soon but it is an important step forward in seeking more viable and fruitful alternatives.

All of this being said, alternatives do exist. Apart from the standard treatment methods there are other ways of recovery and different people have different stories. People find help and support in loved ones or in activities that they engage in, a lot of musicians, artists and authors find release and expression in their work and recover through the process of expression.

The aim of any practice that is supposed to bring about wellbeing of people should only be the benefit of their patients/customers/clients. The method is then almost irrelevant. People are allowed to choose procedures they are most comfortable with and at no point should they be exploited. The evidence and validity of a treatment is decided not only its rigour and how well it abides by established norms but also by its efficacy.

The most important thing is that we must have enough information when choosing a treatment route.

Please refer to White Swan Foundation’s website and portals in English and Kannada for information geared to the medical model. Please come to Aaina and other so called “alternate” sites for psychic health etc etc

References:

http://beyondmeds.com/2015/06/28/apex-decline-psychiatry/
http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml
https://www.psychologytoday.com/blog/psychologically-minded/201310/is-nimh-brilliant-stupid-or-both
http://www.nature.com/news/mental-health-on-the-spectrum-1.12842
http://www.moshersoteria.com/articles/resignation-from-apa/
https://www.psychologytoday.com/blog/side-effects/201305/the-nimh-withdraws-support-dsm-5
http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml


Neil likes music, food, video games, food, books and food and sometimes he studies BA Psychology at Ambedkar University.

To have your expression (photographs, paintings, poetry, videos…. anything share-able) featured on this site, please email me at mirrorworkss@gmail.com with a photograph, three line bio and relevant contact/social media information. Namaskara!

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