Bell Let’s Talk: Part 2

For last year’s Bell Let’s Talk Day I listed some reasons why we should be more open about our mental health struggles. But what happens when we do open up and seek treatment?
(Published Jan 25, 2017 in the Huffington Post)

Here is just a partial list of some of the biggest issues we might face:

Lack of scientific knowledge
The biggest issue with mental health treatment is that we simply do not have very many answers. It is especially problematic when the consumers of knowledge fall prey to the belief that an expert – by virtue of being an expert – knows everything. If we know one percent of how the brain works and an expert knows five times more than we do, the expert is still missing 95% of the information.

Lobotomies, insulin comas, and ice baths now seem barbaric but were all once touted by experts as reasonable treatments. Schizophrenia and Autism were thought to be caused by bad parenting. We now know these are biological illnesses. In retrospect these claims and treatments were abusive. Well intentioned perhaps, but abusive nonetheless.

Where are we now? We do know a lot about mental illness but we still don’t have as much knowledge as most of the general population wants to believe. And not much as some experts pretend to have.

Proliferation of pseudo-knowledge
Into this knowledge void dive all the charlatans, snake-oil salesmen, and purveyors of the latest alternative treatment. Knowledge doesn’t come from wishing it. Knowledge comes from having it. And we often don’t have it. Placebo effects remain a very powerful reality. Anything you believe in will help. A lot. But beyond these placebo effects don’t we want to know if something adds some additional benefit?

Who wouldn’t want to rid themselves of panic or depression forever with a food supplement? Proposing an alternative treatment is not the problem. I recommend many of them. If something is based on a sound logical theory or if research shows a potential benefit then it’s worth exploring. But most claims are not that hard to test. And when new alternatives are tested, most don’t measure up.

The Procrustean bed of medical diagnoses
Another important issue with mental illness is that we try to force it into a medical model. Psychiatry is not like other medical disciplines. Mental illness is an emotional state that causes distress to the person or to others. These emotional states result from a mix biological/medical conditions, personality styles, and social circumstances. There are few if any blood markers for mental illness. You can’t see it under a microscope.

Psychiatric diagnoses strive for precision by using clear and well-defined criteria. But in working with real clients we often see that no label quite fits. A diagnosis is important if specific treatments exist for specific conditions, but forcing someone into a category does little more than provide a meaningless and stigmatizing label. If the shoe fits, wear it. If it doesn’t, don’t. Trying to apply the medical model to all mental conditions is akin to trying to precisely define the sections of a cloud.

Oversimplification of medical treatments
When we pretend that all psychological distress is caused by a biochemical imbalance we perpetuate the belief that mental illness is a medical condition requiring medical treatments. All emotional states are found in the brain so technically every mental illness is a biological illness. But just because something is found in the brain does not mean the brain is ill. If I lose a loved one my brain will make me feel depressed. That doesn’t mean I’m diseased.

People can benefit from both medical and non-medical treatments, regardless of the cause.

Oversimplification of psychological treatments
One of the challenges I face when someone asks me for a referral is finding the name of someone I can trust and would see myself. Lots of people offer the service but it is difficult to do well.

Psychologists or other therapists have three main tools at their disposal. The first is more than a century of research into what makes humans tick and which treatment principles work. A good therapist should have this knowledge. Then there is what we learn from the lives of all the clients that pass through the office doors. This rich collective experience can be used to inform and educate other clients. And finally a therapist has his or her own ability to think logically and help guide people into making choices that are in their best interests. This is where it gets really tricky. What is learned from these experiences and how this is articulated for the individual client remains far more of an art than a science.

It isn’t as simple as just listening and encouraging people to express themselves. Some therapists will offer little else.

One size fits all and the latest fads
The latest megatrend in mental health treatment is mindfulness, a form of meditation. Let me start by saying that I recommend it for many clients and there is good scientific evidence that it helps many people. But like any treatment, it doesn’t work for everyone. For some people it is life transforming. Others just can’t do it.

The issue is that when something seems to help, some therapists recommend it for everyone and offer nothing else. It is easy to overstate and oversell the benefits of a treatment, be it traditional or alternative. A tool is a tool. Nothing more, nothing less. Not all tools work for all jobs.

The bottom line is that we are all in this boat together. We don’t know everything but we do know a lot. With the right amount of critical thinking we will encourage questions that force both the professional and the client to be on their toes. This will help us avoid dead ends and ruts and guide us towards better and more effective treatments for all.

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Posted in Mental health.

Posted on 24 Jan 2017

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One comment to Bell Let’s Talk: Part 2

  1. romualdo barillaro
    On Jan 24th 2017 at 19:21

    Very well said as usual.