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The Mythology of Mental Health
The greatest enemy of the truth is not the lie-deliberate, contrived, and dishonest-but the myth--persistent, pervasive, and unrealistic. John F. Kennedy
Please don't take my criticisms below to mean that therapy is not helpful. I believe in therapy. If I didn't, I would be like a priest who didn't believe in God! I only intend to caution you about the pitfalls in seeking services. There is no doubt in my mind that there are good therapists and good services out there. It is my hope that your understanding of mental health mythology helps your informed use of therapy services.
The Myth of Psychiatric Diagnosis
A word carries far-very far-deals destruction through time as the bullets go flying through space. Joseph Conrad
Sigmund Freud once said, "I have found little that is good about human beings. In my experience, most of them are trash." Surprising commentary from the founding parent of psychotherapy! But the field still finds little that is good about human beings. The only difference is that "trash" has been catalogued into hundreds of specific types in the professional digest of human disasters, the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association. Diagnosis-while providing comfort for some who are relieved to have a name for a problem-is not a factor in successful therapy and is neither reliable nor valid. Reliability means therapists can agree about what diagnosis a person has. Unfortunately, mental health diagnoses, unlike medical ones, are not reliable: agreement under the best conditions for general categories is about 66 percent; on specific categories, it is as low as 26 percent! So how useful can it be if agreement among professionals only happens 1 in 4 times? Validity, or the ability of diagnosis to do what it purports to do-namely to distinguish normal from abnormal behavior and between types of abnormal behavior so that the proper treatment is selected-simply doesn't' exist. All people do the things listed in the diagnostic manual at one time or another, so there is no way to distinguish the behavior of an individual under stressful circumstances from someone who has a "disorder." There is no biological marker-no blood test or x-ray-to show the presence or absence of the "illness." Further, because all approaches work for some people some of the time, a diagnosis provides little help in selecting the right approach. Remember the TDCRP. Knowing a person's diagnosis tells nothing about whether or not a person will benefit-there is no correlation between a person's diagnosis and the likelihood of success in therapy. Naming a problem has very little to do with solving it. So in other words, diagnosis is worthless! In addition, diagnosis can cause harmful attributions by the labeled individual, his or her family, and helping professionals. Most therapists dislike it, actively lie to protect clients from its implications, and report that it does not inform their day to day work. They only do it because it is required for payment purposes. Finally, diagnosis is culturally biased and incredibly subjective; diagnoses differentially point the finger at women and minorities-the more the person is different than his or her doctor, the more likely the person to receive more serious diagnoses and more serious drugs. Don't be fooled by the myth of psychiatric diagnosis. Diagnosing mental "disorders" has multiplied like weeds. They choke and smother alternative, hopeful ways of understanding and encouraging change and are based more on political and economic factors than science.
Resources: Kirk & Kutchins (1992). The selling of DSM. Aldine; Kutchins & Kirk (1997). Making us crazy. The Free Press; Glasser (2003). Warning: Psychiatry can be hazardous to your mental health. HarperCollins; Levine (2003) Commonsense rebellion. Continuum International.
The Myth of the Guru Therapist and Silver Bullet Cure
The savage bows down to idols of wood and stone: the civilized man to idols of flesh and blood. George Bernard Shaw
Research has led to an unarguable conclusion that is good news for both mental health professionals and clients alike: Psychotherapy is effective in helping human problems. The good news of therapy's usefulness, however, has led to the impression that therapy operates with technological precision. The illusion is that the all-knowing therapist assigns the proper diagnosis and then selects the right treatment for the particular disorder at hand. The therapist sizes up the demon that plagues the hapless client, loads the silver bullet into the psychotherapy revolver, and shoots the psychic werewolf terrorizing the client. The truth is that the therapist will offer the approach he or she was trained in or is most comfortable in delivering, regardless of the kind of problem it is or your preferences about how it should be handled.
Over the years, new schools of therapy have propagated like rabbits and arrive with the regularity of the Book-of-the-Month Club's main selection-now adding to over 400 models and techniques. Most profess to have captured the true essence of psychological dysfunction as well as the best remedies-most claim to be the true silver bullet cure for whatever ails you. However, such claims and counter claims that one approach is better than the rest have no basis in reality. In the hopes of proving their pet approaches superior, a generation of investigators ushered in the age of comparative clinical trials. Winners and losers were to be had. Thus, behavior, psychoanalytic, client-centered or humanistic, rational-emotive, cognitive, time-limited, time-unlimited, and other therapies were pitted against each other in a great battle of the brands. Nonetheless, all this sound and fury produced an unexpected bonfire of the vanities. The underlying premise of the comparative studies, that one (or more) therapies would prove superior to others, received virtually no support. Despite the Herculean efforts of legions of model worshipers, no one succeeded in declaring any religion to be the best. These findings have been creatively summarized by quoting the dodo bird from Alice's Adventures in Wonderland who said, "Everybody has won and all must have prizes," first articulated back in 1936 by the amazing Saul Rosenzweig[i]. The so called "dodo bird verdict." has proven to be the most replicated finding in the therapy literature. The dodo verdict means that because all approaches appear equal in effectiveness, there must be factors in operation that overshadow any perceived differences among approaches. If therapies work, but it has nothing to do with their bells and whistles, what are the common factors of change? Our recent best selling book for professionals, The Heart and Soul of Change, answers that question. We assembled the leading researchers in the world to review five decades of investigation and reveal its implications for practice. Chapter One talked about these factors that do make a difference-your resources, a supportive relationship, and a plan of action that fits your ideas and engenders hope. Don't be beguiled by the myth of the guru therapist and the silver bullet cure. There are endless possibilities for ideas and techniques that could prove useful to your change endeavor. There is no single silver bullet approach. Change is far more about you and the alliance you form with the therapist than his or her flashy brilliance or the brand of therapy he or she practices; tapping into your strengths and wisdom is the only silver bullet cure.
Resources: Fancher (2003). Health and suffering in America. Transaction Publishers/Rutgers; The ambitious reader may try: Duncan, Miller, & Sparks (2004).The heroic client. Jossey-Bass.
The Myth of the Magic Pill and the Biochemical Imbalance
He's the best physician who knows the worthlessness of most medicines. Benjamin Franklin
Like therapy and all approaches to human problems, medication can be useful. Some people are helped by medication and feely choose drugs as a first line of defense. In truth, I am not anti drug; rather I just object to marketing and corporate influence holding sway over public and professional opinion when both the explanation for and success of drug treatment is, at best, unconvincing-especially for children. The use of psychiatric drugs for human suffering has become our culture's conventional wisdom despite the fact that they have not been confirmed by the latest discoveries of neuroscience, nor are strongly supported by research. Mass-market advertising has succeeded in its intention to make taking antidepressants, for example, seem as normal and pervasive as swallowing aspirin. Perhaps the most impressive job of public awareness and product identification has been accomplished by the Zoloft cute little oval shaped guy-who initially mopes and frowns, while we are told about chemical imbalances, and then, starts bouncing around, cheerfully smiling, presumably after Zoloft. "Biochemical imbalance" is now an irrepressible part of the American vernacular. Paradoxically, while research has fervently pursued the illusive biological marker that will unlock the mysteries of mental illness, it has never been found! In truth there is no chemical imbalance that has been identified by science-any medical text will tell you that. There are theories about chemical imbalances, but that's it. Furthermore, little information about the long-term neurological consequences of drug therapies have surfaced-as neuroscientist Elliot Valenstein points out in his book, Blaming the Brain, the arguments supporting biochemical imbalances are not only unconvincing, but ignore the possibility that drugs create, not cure, biochemical problems because of the brain's plasticity and rapid adaptation to pharmaceuticals Despite the fact that medications like antidepressants are helpful for some, they are not helpful for others, and yet others cannot tolerate the side effects. Studies often find that they are barely better that sugar pills in alleviating depression! This doesn't make them worthless-but rather not the panacea for human problems that they are cracked up to be. It means that one should take them only after considering the possible risks and with knowledge that there are many equally or more helpful options available to consider. Nevertheless, we are left with the darling little Zoloft guy's words of wisdom. Despite the paucity of evidence, conventional belief now is that depression and other human problems are not a bundle of miseries shaped by many forces, but rather are chemical imbalances-not requiring one to get meaningful support from others or change anything. There is only one solution needed: the passive consumption of a magic pill. Of course this doesn't mean that there is anything wrong with trying drugs if you feel it is the right choice for you! Just don't buy the "chemical imbalance" tagline, monitor your results, and stop taking them, under medical care, if they don't produce a noticeable benefit. The biggest pitfall of the myth of the magic pill is that it tends to obscure other choices for addressing human suffering and the challenges of life. Finally realizing that psychiatric drug therapy is a profit-driven industry, built on a flimsy science, may be the bad tasting medicine we've needed to debunk the myth of the magic pill.
Resources: Breggin & Cohen (1999). Your drug may be your problem. Perseus;. Whitaker (2002). Mad in America. Perseus; Valenstein (1998). Blaming the brain. Free Press. Angell (2004). The truth about the drug companies. Random House.