Academics are not psychotherapists

 

There is a story in the papers this weekend about university students feeling that they are not fully supported by their universities, particularly in terms of mental health support. As per usual, given the 9k fees, students and their parents feel like high quality mental health support should be available to students.

 

However, I would ask students and their families to consider this from the other side.

 

Yes, students who are struggling, who may have a diagnosable mental health problem or who have a diagnosed mental health problem, should be supported to ensure that they have the equaivalent learning and student experience as their peers without a mental health problem.

 

But, what exactly do they expect the university to provide? Psychiatrists? Clinical psychologists? Unlimited access to psychotherapy? Academic staff to provide psychotherapy?

 

What? What do they want? The first three are the purvue of the NHS and universities will never supply services that are duplicated by the NHS.

 

The last one, academics providing psychotherapy, is ILLEGAL. “Clinical psychologist” is a protected professional title and ONLY clinical psychologists and other accredited individuals can provide formal psychotherapy. Any staff member providing psychotherapy to a distressed student is not qualified and risk formal disciplinary procedures. More seriously for the students, psychotherapy can have serious negative impacts on clients even with trained psychotherapists, and this is something many people forget. Not only can meds have deleterious side effects but so can psychotherapy, and psychotherapy provided by untrained staff is much more likely to have deleterious consequences.

 

Academics always fear students with serious mental health problems as our hands are tied and there is little that we can do for them other than to tell them to contact their GP or CMHT. We are here to provide advice about academic issues and provide an ear for students who just want to vent or talk about problems, but in reality, there is very little we can do beyond re-arranging coursework submission, etc.

 

We can, however, provide better Counselling services for students. But Counselling departments are not for diagnosing mental health problems. Student unions need to be more vocal in demanding that Counselling departments receive more adequate funding, although how likely this is with the Tory’s slashing the disabled student allowance we don’t know.

 

What I will say, though, is that if you think the support for students with mental health problems is poor, the support for staff with mental health problems is MUCH worse, and near on non-existent. Counselling services for staff have been outsourced to private providers, and realistically, counselling isn’t necessary going to be sufficient for staff with serious or complex mental health problems.

 

Also, while universities DO bend over backwards to put in adjustments for students with disabilities, including mental health problems, and the students have their own Disability Office, the adjustments and support put in place for staff with mental health problems is pretty much non-existent. Staff don’t have a Disability Office. While students may have deadlines altered due to mental health difficulties, staff requesting such adjustments are seen as being a burden. The best such staff have is their union and Occupational Health. And, OH are there to protect the university not the staff member. Getting adjustments out of OH is like pulling teeth, and this is largely due to the very unhelpful doctors who work on the service who overrule adjustments that practice nurses’ suggest. If you want adjustments you really need to push for them. And, if you are unhappy with your treatment, you have to speak to your line manager, HR, OH, or your union. There is no one-stop-shop place for staff, such as a staff disability office, unlike students, so having adjustments put in place and making your university abide by them is really up to you.

 

So, yes, we need to do more to support students, but in many case our hands are tied, and even the best service is not going to be on par with what the NHS can provide. All we can realistically do is modify academic work load. On the other hand, staff with mental health difficulties continuously get screwed over and have next to zero support in comparison to what is in place for students. Policies to support students are plentiful in university governance documentation; there is next to none for staff. Count yourself lucky.

The clown defense hypothesis

In the early 00’s I remember hearing a song by Therapy? Called “Be Happy” or something like that. Apart from being a great song it was about someone that the band knew as a kid who had been the class clown but as an adult committed suicide. I began thinking about people who put forward a personae of “the clown” as while being a clown in primary school can be useful to direct the attentions of bullies away from you, as an adult, it tends not to go down very well, being perceived of as a sign of immaturity and irresponsibility.

 

I do continue to wonder though whether being an adult clown is a defense mechanism that allows the person to hide what they really are: very unhappy. Clowns seem happy on the surface even if they also seem immature, and we may think that clowns don’t feel emotions deeply. I think, however, that they feel emotions particularly acutely and are overwhelming. To avoid appearing distressed to those they know they put on the clown mask to avoid uncomfortable questions about whether they are alright.

 

If you think this is all bullshit, think of Robin Williams. When I heard last year that he had committed suicide I was shocked but not surprised. He was probably the most well known clown and, quite frankly, it must have been exhausting keeping that up.

 

So, if you know someone who is a bit clownish, ask they how they are and don’t necessarily take “I’m fine” as true.

The Fourth Way

Given that psychiatrists have a medical degree you would be forgiven for thinking that they should be relatively smart.

However, I received an email from Psychiatric Times with this intriguing dilemna which suggests that they are either incredibly stupid or know something that the rest of us are too dumb to know:

Compared with healthy controls, the prevalence of EEG abnormalities in psychiatric patients is
A.  Significantly higher
B.  About the same
C.  Significantly lower
D.  None of the above

 

It’s (D) that I’m having a hard time getting around. I know New Labour claimed to be the third way, but has PT found a fourth?

When acceptance is misused

I’ve heard complaints from colleagues about recommending mindfulness and Acceptance and Commitment Therapy to individuals recovering from stroke, chronic pain, etc. Basically, things were some aspects of life and activities have been affected in a long-term way.

The issue is with the idea of acceptance. They say that they are uncomfortable with the idea of encouraging their patients to “accept” their level of functioning and not to strive to get better.

This is a terrible misunderstanding of acceptance.

The idea of acceptance is to be able to determine, in this context, what you are capable of, what you aren’t capable of, and setting realistic goals of what you could achieve. The alternative that is being suggested by colleagues is that it is appropriate to set unrealistic goals so as not to smash the hopes of their clients.

I don’t even think that this is ethical!

Setting unrealistic goals will only lead to failure and hopelessness and reduce desire in the future to set any goals.

If you have been impacted by such a thing as stroke, you need to be realistic. If a full recovery, in time, is realistic, then fine, but if it is not you need to have the metacognitive awareness to determine what you can and cannot do, and work within these limits. It might not be nice, it might be hard to admit that you will never reach your previous levels of function, but deluding yourself, and allowing your clinicians to delude you, into thinking you can is unrealistic and, quite frankly, unethical.

This is what happens when people “dabble” in an area and attempt to use the tools without understanding the basic theory or rationale for why they are being used. Therapies can have negative effects, especially when they are used inappropriately or by someone without training.

Graham Davey talks sense on “biomedical mental health research”

Stumbled upon this post by Prof Graham Davey of Sussex Uni and Chair of Experimental Psychopathology. You go Graham!

http://www.papersfromsidcup.com/graham-daveys-blog/experimental-psychopathology-is-it-really-necessary-to-implant-an-electrode-or-light-up-the-brain-with-a-scanner-to-do-proper-mental-health-research

Experimental Psychopathology – Is it really necessary to implant an electrode or light up the brain with a scanner to do proper Mental Health Research?

I’ve just spent a very stimulating and enlightening couple of weeks, first at the Rome Workshop in Experimental Psychopathology, and then at the University of Exeter – both times talking about experimental psychopathology. But these talks were not just about how to do experimental psychopathology, they were also about how many other researchers were simply not equipped to do experimental psychopathology, or simply had no idea about what this scientific paradigm was. And that has some very dramatic consequences for mental health funding, as well as our broader understanding of the mechanisms that contribute to mental health funding.

Let’s be quite clear about the main issue here. Most funding for mental health research goes to high profile, expensive, medically oriented research on the biological substrates of mental health problems. Why is that? Well, while psychologists learn about both biological mechanisms and psychological mechanisms, medics simply don’t learn about psychological mechanisms – in fact they tend to have no knowledge whatsoever of the inferential methodologies that allow psychologists to develop models of psychological processes – but rather sadly, there is a majority of those medics on the panels of most funding bodies for mental health research.

Is this important? Yes it is, because, I’m quite happy to assert that most common mental health problems are acquired through perfectly normal psychological mechanisms that involve attention, decision-making, learning, memory and other general cognitive processes – so the mechanisms are not in any way abnormal – only the outcomes of the process are abnormal – so why do we waste research time and taxpayers money trying to look for abnormal neurological mechanisms or medically aberrant signatures of psychopathology when they probably do not exist?

As an experimental psychologist studying learning in nonhuman animals I learnt a lot about inferential experimental methodologies that allowed us to infer cognitive processes in any organism – human or nonhuman. These are the same types of methodologies that are used to understand most human cognitive processes – such as memory, attention, decision-making and learning. What many researchers from a medical background do not grasp is that scientific method allows us to infer the nature and structure of psychological mechanisms without having to know anything about the biological underpinnings of these mechanisms. In fact, whatever medical or biological research does subsequently to psychologists elaborating these mechanisms will merely be to substantiate the infrastructure of these mechanisms – and indeed, as radical as it may seem, it will be very little more than that.

Experimental psychopathologists should have the lead on all research questions to do with the aetiology of mental health problems. Their research is cognitive, experimental, inferential, provides evidence for the causal relationships that underlie the acquisition of mental health problems, and allows the development of testable models of mental health problems – and it’s a hell of a lot cheaper than most other medically driven approaches!

I have recently been heard to say that experimental psychopathology needs a manifesto to enable it to compete with other explanatory approaches to mental health problems such as neuroscience and genetics – well, it does. We need this manifesto to prevent other disciplinary lobbies from monopolizing funding and – most importantly – from hijacking the way we explain mental health problems. Most mental health problems develop out of perfectly natural psychological processes – not medical problems. Understanding those processes in the normal, inferential way that psychologists do research will provide the basis for good mental health research.

Good to see you’ve read a book about mindfulness & you still think it is CBT

I had the misfortune today to read the reviews on Amazon for Ruby Wax’s book Sane New World.

My conclusion is that it can’t be that good if several of those who have read it STILL think mindfulness is about changing your thoughts and emotions, and using it as a coping strategy.

It is NONE of those things. THAT is CBT! The reason mindfulness works is because it does NONE of those things.

To clarify: there is nothing wrong with your thoughts or emotions or the way you think and feel. They do not need to change or be restructured. You do not need coping strategies. What you need to do is learn to live with your thoughts and feelings AND STOP AVOIDING THEM. Your problem is that you are not willing to make contact with you thoughts and feelings. You HAVE to LEARN to EXPERIENCE them. You have to LEARN TO LIVE WITH THEM. THAT is much harder than changing your thoughts.

Your thoughts and feelings are a part of you. Why would you try to suppress them and avoid them? If you do so you are denying a fundamental part of yourself and denying yourself the ability to gain satisfaction from your life.

YOU ARE NORMAL! WE ALL FEEL THE SAME THINGS AS YOU DO! THERE IS NOTHING WRONG WITH YOU!

Forgettable research in Alzheimer’s disease

None of the major news outlets could provide the info this week. I don’t even think they knew that they should be publishing it. Why let such a trivial thing get in the way of a big headline?

The journal that it was published in couldn’t even be arsed to co-ordinate publishing this study in line with the massive PR campaign. So, why should we care?

What am I talking about, dear reader?

The leading health story this week about a supposed “test” for Alzehimer’s disease.

I blogged earlier in the week about my dissatisfaction with the way the PR was handled. But my biggest grumble was that the false alarm rate for this test was never mentioned in the massive PR campaign, which I found very suss.

As the journal can’t seem to be arsed to publish the article, it was left to New Scientist, who are not exactly known for casting a critical eye over science and publish some absolute tosh that is badly flawed both experimentally and statistically, but, a hoorah for them! They actually, for once pointed out that, while the detection rate might be 87.5%, the false alarm rate was 10%.

TEN PERCENT!

Now I know why the Lancet didn’t publish the work!

With a FA rate of 10% this research is going NOWHERE!

If you don’t think that’s a big deal, think of it this way….

Think of all those people you supposedly “know” on facebook. Ten percent of them would be diagnosed with AD when they didn’t have it. Think how devastating it would be to be told that your brain is rotting and you are slowly going to turn into the living dead. Ten percent misdiagnosis is atrocious. What is even more atrocious is the false hope this has given to millions of people because the researchers had to big up their reputations, flaunt themselves in front of the media, and the media being so poorly trained in science that they overlooked the big flaw in the research.

I suppose it is ironic, given that it is AD research, that in a week’s time everyone will have forgotten about this disaster

Psychiatric Times….don’t waste your time

Badly managed websites with out of date content really annoy me.

I signed up for the newsletter from Psychiatric Times, which deposits into my email account everyday. Today was no exception. They were advertising their July edition.

However…..

I was interested in a couple of articles.

But there are no links in the newsletter to direct you to the articles.

So, I head to their webpage. Go to Journal.

What I find is that the “latest issues” hasn’t been updated since 2011.

There is a download button which implies that you are downloading the recent issue. You are not. It is a doc to pdf converter.

So, as a last resort, I copy and pasted the article titles into the search function.

These articles aren’t even published online yet.

This happened a couple of days ago when I posted about the brand spanking new Alzheimer’s “test” being published, when it isn’t even available from the journal website.

BASICALLY, don’t advertise what you can’t produce!. It makes you look disorganised. And it makes me think that you don’t value the time I wasted looking for content that you spent all your time advertising rather than putting it up on your website.

Assholes.

Where is this hallowed Alzheimer’s biomarker paper?

I was most interested today to see the top story on a new blood test for Alzheimer’s.

Over 1000 people had there blood tested and their brain scans.

We need to stop for a moment and consider that amount of money and time that must have gone into scanning over 1000 people.

The proteins together predict future Alzheimer’s with 87.5% accuracy.

The paper is published in the journal Alzheimer’s and Dementia. Which in itself is curious. If this study is so important, so methodologically robust, why wasn’t it published in the Lancet or the New England Journal?

As accuracy is not the whole story (we need to know the false alarm rate as well), I went to find this paper to read it more thoroughly.

*drum roll please*

It hasn’t been published yet.

It might have been accepted for publication, but the proofs certainly aren’t online either through the journal or the lead author’s webpage. The journal even has a section on their front page for papers in the news and it isn’t even mentioned.

With all this info, take from it what you will. But, media rule of thumb, if you are going to start crowing about your new paper in the news, it better be available for people to scrutinise.

And, if when I do get hold of it, the grand claims tooted in the media don’t stack up, you’ll be hearing about it

Those who ignore their past are doomed to repeat it, especially in neuroscience

While I was trying to get off to sleep on Monday night, I had Start the Week on, which happened to be about “The Mind”.

I put “The Mind” in inverted commas and capitals because it was the typical modern view by journalists of what they think it is. “The Mind” = “Neuroscience”.

I had to listen to neuroscientists waxing lyrical with one of the big myths of neuroscience….that it will provide clinical interventions.

Apparently, although we’ve studied brain plasticity for several decades and it has failed to produce any decent interventions, for example for stroke, we can look forward in the future to it doing so.

We just need to continue re-focusing all the grant money away from basic behavioural psychological work onto this mythical area that eats through money and machinery and never produces anything of any significance.

But, don’t worry readers, if we continue to do the latter, those interventions will eventually come. Ignore the last 100 years of research’s failures. The past is no measure of what is to come.

I’ve heard this argument before in psychiatry over the so-called magic pills for mental distress.

Listen up guys. Several tens of billions of dollars invested in psychopharmacology has yet to provide an effective treatment for any form of mental distress better than placebo and which doesn’t come with life changing side effects.

Exactly the same can be said about neuroscience.

You’re all suppose to be scientists. You’re all tackling these issues with exactly the same mindset as everyone who came before you.

Why do you think that either of these things are going to change?

You both need a paradigm shift. Otherwise, it is pouring money down the plug hole and warping science.