Paul McHugh, a retired psychiatrist from Johns Hopkins, summarizes the state of modern psychiatry in a review of Shrinks, a book that tries to do the same thing. A friend whose PhD is in experimental psychology (Stanford) sometimes irritates therapists by asking “How do you do engineering when there is no physics?” McHugh makes the same point:
No formative principle or principles link the function of the brain to mental disorders, and until such is discerned, psychiatry will remain at the naming and describing level…
The end of the beginning for cardiology came when William Harvey wrote De Motu Cordis in 1628. Therein he described how the heart acted as a pump, how the blood circulated, and how the experimental method could advance human physiology. Everything in cardiology—from understanding a patient’s symptoms to discovering mechanism-based medications, right on to transplanting hearts today—rests on that foundation.
Psychiatry has no Harvey. And if DSM-5 is its “Bible,” then the “end of the beginning” for psychiatry looks decades away.
Why is psychotherapy so popular? A Harvard PhD psychologist said that “sociopaths and psychopaths love to go to therapists because part of the standard process is unconditional positive regard. They’re not going to get that from anyone whom they talk to and aren’t paying.”
What do readers think? What kinds of science would we need to enable therapists to be reliably effective? And where will that science come from? Neuropsychology? Or perhaps from the more heavily funded Artificial Intelligence folks? Are we talking about 10 years or 100 years before we see significant progress?
Separately, what success stories for psychotherapy do readers have to relate? Does anyone have personal experience with someone who went to therapy and came out as a substantially improved individual? (if drugs, such as Prozac, were involved, please limit your answer to situations in which you’ve had at least five years to observe the results (to reduce distortions from the placebo effect))
Some recent Freakonomics episodes showed cognitive behavioral therapy (CBT) was successful at reducing crime and other anti-social behavior. They performed randomized controlled trials to test the results, and found the groups given the CBT improved by significant amount. Does CBT qualify as “psychotherapy”?
From the headline for a second I thought you were referring to a giant invisible rabbit.
CBT is a type of therapy, but recent studies have found it much less effective than first thought.
The premise of CBT, and really of most therapy, is that if you are really anxious/ upset/ depressed over a problem, and you take time to think the problem through, you will realize that it wasn’t that bad and your emotions become better adjusted. But what if the problem really is that bad? Its being discovered that CBT is not that much use for people with really serious external problems. Also, CBT is basically a bandaid if the issue is some sort of physical abnormality or chemical imbalance in the brain.
My take on mental disorders is that they either have some physical cause, that will be understood as we understand the brain better, or they are perfectly rational reactions by individuals to unusual or extreme problems, but society at large doesn’t want people to react in those ways. So I agree with the implication behind this post.
LSD! By the mid-1950s, LSD research was being published in hundreds of medical and academic studies all over the world. It showed tremendous benefits in the treatment of addiction and other mental illnesses (the founder of Alcoholics Anonymous cured his alcoholism with LSD). But when the military found it had the side effect of making soldiers want to stop fighting and quit the army, LSD was quickly outlawed along with all related research.
Google “LSD therapy” or YouTube “LSD documentary”.
My experience is this:
– If you want to work on a problem or improve some aspect of yourself, then you can do it on your own, or you can go to a therapist and they can help you accelerate fixing your own mental problems.
– The therapist can also serve as a sort of mediator for evergreen marital/relationship issues, assuming both parties are open to improving. If both sides are not interested in improving, you probably end up in something like those scenes from Entourage where Ari Gold goes to therapy. What works is if the other party is “acting crazy” in your opinion, you can show up at the therapist and have the conversation in front of them and get the other party to act crazy and then you have a trained mediator there to help deal with it rather than getting into some sort of “cold war” over it.
– They can help you through tough periods. My father died suddenly a few years ago, and the therapist was helpful in getting me out of the temporary depression that it caused.
– They can be helpful in any sort of short term crisis as well, eg divorce, or even just “my kid is misbehaving at school” or even stupid stuff.
So, doing this has definitely made be a better person and made my life better since I have a better marriage as a result. Jimmy Buffet talks about how therapy has helped him in his books as well.
I think the way to think about it is in the context of what the alternatives are: let’s say you’re an intolerable asshole and everyone tells you so. You can isolate yourself, you can try to talk it through with friends, you can do a hooby that helps you forget about your problems such as flying helicopters, or ? I think therapy is the place to do that. I actually have a client that provides psychic services and I have seen some of the chat transcripts, and people are going to psychics to get advice that a therapist might otherwise dispense, I would not recommend it based on what I’ve read. 🙂
Successful treatments:
– privately write about bad experiences and your emotions towards them until feelings dissipate (few weeks?).
– move on from bad experiences (unjust, but necessary)
– replace unhappy thoughts with positive thoughts (corny, but effective).
I know a good friend who got significantly better doing some Church of Scientology stuff, including getting off a drug habit, but as near as I can tell, anecdote or not, they’re still a nutty cult. By getting better I mean she got her life completely turned around. I think the strong support group that didn’t put up with any BS was more effective than anything.
This article describes how regular electroconvulsive therapy treatment have helped Kitty Dukakis with her chronic depression. Psychiatry can probably only guess about how electrically-induced convulsions bring relief to people like Mrs. Dukakis.
http://www.politico.com/magazine/story/2015/09/dukakis-depression-treatment-campaign-213116
In the 1980s I had about five years of psychotherapy with a psychiatrist and found it very helpful. It helped me think rationally and gain self confidence and to stop worrying so much about whether or how I was a psychologically peculiar person. I’m not sure I would have gotten through graduate school without it.
Later I was diagnosed with a major mental illness. A psychiatrist diagnosed it and prescribed drugs to combat it. Except for one lapse I’ve pretty much been in remission since then.
In support groups I’ve met a lot of mentally ill people and almost all credit the drugs (usually a nuanced, evolving formula worked out with the help of a psychiatrist) with keeping them out of the hospital, jail, rehab, welfare office, morgue, etc. Not many people seem to do psychotherapy any more, but people are very grateful for what their psychiatrists do for them.
Obviously engineering (medicine) done with the help of theory is superior to that done without, and theory-free psychopharmaceutical treatment has many failures and shortcomings, but it is clear in spite of this that psychopharm has been a huge, vital benefit to a very large number of people.
Yes. Someone I know was suicidal and was treated with a combination of drugs to restore a chemical imbalance and DBT on an out-patient basis. When they first started treatment, they had to be checked in as an in-patient at a local hospital first because they were at high risk of self-harm. This was not done voluntarily.
While I ‘get’ that there is no physics equivalent for therapy, in this case DBT – taken over a period of months – helped this person develop coping mechanism. This person is much better today, and is alive (and a positive, contributing member of society) because of this help.
Mental health in the USA is a huge issue and treatment is but one part. Prevention is another – and involves everything from better city planning to maternity leave policies and mandatory minimum vacation (just a few examples).
This might help gather data (would you wear one?) : portable high-resolution EEG (electroencephalogram) brain-scanning headsets. Meet Tan Le. http://news.nationalgeographic.com/news/2013/08/130801-tan-le-portable-brain-scanning-headsets-neuroscience/
The mechanism to fool a bridge, “Don’t Collapse. Have hopes. Do the right thing.” may be fiction.
The persuasive industry (definitions?) has the most jobs under stable governements. Anyone who aren’t overtly ill needs persuasions.
Basic material needs always met yet miserable? Try psychiatry. Wait.
Social sciences, psychology or other early colonisers (artificial intelligencer?) have their headlines now and will benefit from biology while you sleep. Lest we forget: evolution and genetics. Medicine (products and services) led the charge last 10 times, “where is the fire?”.
Timing estimate? UN population division forecast manuals are published in the 1950, 1980s (in turn based on studies in the 1800s).
Some breeders believe, “7 generations” is enough to select a temperment (dogs) through breeding.
More timing estimates? Chemists did not have any tool in 1960s to identify fleeting colored substances from tuberculosis causing organism in the presence of isoniazid. Till 1980s (Youatt, Jean Beatrice. 1925-).
That’s ok. Screwdrivers can also open jam can.
Lots go to psychiatrists. Some become one. I don’t remember anyone coming back this way.
Psychiatry is one of those jobs where 90% of the professionals give the whole group a bad name.
A productive few keeps it interesting. Max Weber described such a model of academic science (~1917 ‘vocation’ lectures).
Predicting progress from history past is what ddclark may call, hallucination. A (~100 B.C.) Greek physician Asclepiades treated depression with catharsis and physical exercise; anxiety with wine and hot baths; psychosis with music; and have what Chris Hadfield (chrishadfield.ca) may recognise as a desire to explore.
A recent gathering of enthusiasts discussed what to do with what we have,
http://www.abc.net.au/tv/qanda/txt/s4303400.htm