Posts tagged ‘Psychology’

iTherapy 2.0

Welcome to the future of reductionist psychiatry. You can now be diagnosed, labeled and treated without a doctor ever having to even look you in the eye or hear the stories that make you tick. Just click the boxes for your symptoms, fill out the questionnaire and the complexities of the human psyche can be unraveled as quickly as e-filing your taxes in the last hour of tax day. Never mind the subtle differences that define us or the experiences that got us here.

This is not some luddite rant about the technology takeover, though to some extent there is a worthwhile wariness in that discussion. I’m talking about the power of the DSM, which was never meant to be a stand-alone collection of boxes to check off in diagnosing, now essentially uploaded and online to be used in just that fashion.

From Australia’s The Age:

MENTALLY ill Australians are increasingly being diagnosed and treated online in virtual psychiatric clinics, without ever seeing a doctor.

Patients suffering from depression, anxiety and post-traumatic stress disorder are being assessed by computer and given ”e-prescriptions” for online counselling courses instead of medication or treatment sessions with a psychologist or psychiatrist…

With e-therapy, patients are clinically diagnosed after completing psychiatric reviews by answering online questions

“Assessed by computer”? It makes you wonder what we need all these psychiatrists for? Apparently all we really need are the DSM committee and a handful of tech guys to work out the interface and we’ll be well on our way to solving those pesky problems that keep cropping up and reminding us how hopelessly human we all are.

One positive point is that it presents a shift from medicine and toward some sort of counseling but I see that aspect of it as short lived. It seems likely to follow the trend of “real life” psychiatry and revert to drug based care, printing out its e-prescriptions for the latest in pharmaceuticals. Also, it makes you wonder — if these kinds of treatments are so effective, why do we need a computer to veer away from drugs? I can see computer based communication and the easy transfer of information as useful but only as a supplement to truly involved care from a living, breathing human – not a replacement. I question the quality of online counseling when compared to real counseling. Of course it’s limited to relatively minor difficulties like depression, anxiety and PTSD. They wouldn’t dare try to treat the as yet uncharted depths of serious mental illness — would they?

In Melbourne, David Austin, the co-director of the National eTherapy Centre’s Anxiety Online program, which is run from Swinburne University of Technology, said the service did not attempt to treat people with more serious conditions such as schizophrenia or bipolar disorder but there was scope for that in the future.

“Within five to 20 years we will have a proven e-therapy for most of the psychological conditions. Once you do that, you have 24-hours-a-day, seven-days-a-week low-cost access for everyone,” said Professor Austin.

Everyone. Oh good. At least they’re planning ahead. This is where the drugs are likely to come into play as most things perceived as serious mental illness are treated with drugs as a chemical problem in the brain not simply a coping, life handling or perception problem.

Patients log on anonymously to complete modules on cognitive behavioural therapy and breathing and relaxation techniques through videos, podcasts, online forums and interactive questionnaires.

Next month, courses will begin for people with eating disorders and gambling addiction.

I’m convinced computers can be of some benefit in a therapeutic setting whether it’s to impart information, the support found in many forums or supplemental counseling. The biggest problem, though isn’t in the counseling aspect of it but in the assessing. While the move to computer based diagnosis promises to extend mental health care to more people, we need to question the level of care and its potential to do more harm than good. We’re talking about diagnosing people online that we’ve never met. The internet has proven to be an unreliable way to get to know people. Something gets lost in translation between the keyboard at one end and the screen at the other. That’s why some people hide behind them, filtering and crafting their online persona and others with the best and most honest intentions just don’t come across as themselves. Many would argue that the computer isn’t even a good way to determine whether someone is dateable but somehow we think we can ascertain someone’s mental and emotional state and diagnose them which will have a huge and far reaching impact on the course of their lives.

We are all complex individuals to varying degrees. One can no more experience another’s state of mind through a computer’s screen than the fullness of a symphony through its crackling plastic speakers. I can’t imagine letting the care of someone’s mental well being hinge on that poor a translation.

June 13, 2010 at 1:07 pm

Is Health the New Sickness?

Do you plan tomorrow’s food today? Do you care more about the virtue of what you eat than the pleasure you receive from eating it? Do you feel an increased sense of self-esteem when you are eating healthy food?

You’d think answering yes to these questions would be a good thing, a sign that you’re on the right track but no — answering yes to these questions and more like them are signs that you suffer from the newest mental disorder to gain traction, orthorexia nervosa, which literally means “correct eating.” That’s right, there is now an eating disorder label for correct eating. It was inevitable. When obesity and consumption of toxic foods becomes the norm, eating correctly becomes a sickness.

While it’s not an official DSM diagnosis, it is a new label to throw into the ever growing lexicon of western pseudoscience. This one was created by a Dr. Steven Bratman in the nineties. I’m not downplaying the self destructive habits and behaviors some of us adopt but that doesn’t make them disorders, just things we shouldn’t be doing to ourselves and eating healthful foods isn’t one of them.

Whole Living had a fairly balanced take on the idea but still offered it far too much credence, saying, “Orthorexia is an eating disorder…” (emphasis mine). The article comes off as a disclaimer — as if they have to absolve themselves from contributing to a newly created disorder by promoting…health, of all things. It seems like we collectively have this sense that if a doctor somewhere calls something a disorder, we’re remiss in not warning people of its dangers without even questioning the legitimacy of the label.

That healthy eating can be pushed to extremes goes without saying. We all want to eat diets that are as natural as possible. But when that goal becomes a religion or an obsession, our efforts at finding health go very much awry: As sufferers of orthorexia can attest, fixation on dietary “righteousness” is the very opposite of healthy.

At the same time, we have to be cautious about throwing labels around, especially labels as inexact as this one. What does it mean to fixate on healthy eating?

That’s a good question considering some of the healthiest and happiest people in the word would suggest we accept no less. God help us when eating KFC’s Double Down becomes a sign of recovery.

Where does a passion for healthy food and fitness end, and psychological disturbance begin?

The answer exists, but I think it’s as hazy as the question itself. The key to eating healthily while avoiding rigidity lies in a reasonable mindset.

The article goes on to say that it’s not necessarily what you do but why you do it that may be where the problem lies and that seems very reasonable. There was a far more bizarre article in WRCB’s Eye on Health which took the trademarks of diligent and healthful eating and framed them as obsessive symptoms while repeatedly referring to orthorexia like a title behind a person’s name.

Jill Brown, Registered Dietitian says “It is a twist of an eating disorder that where a patient is so fixated on eating pure or eating clean.”

Peggy Moe, Orthorexic says “It kind of snowballed into everything that I ate had to be organic and pure and non processed…”

Jill Brown, Registered Dietitian says “It takes over and it interferes with relationships and they obsess about it. There’s a certain righteousness that goes along with it. Judgmental. They judge how others eat.”

I find it odd that Brown, in an article calling into question other people’s food choices, points a finger at “orthorexics” for judging how others eat.

Peggy Moe, Orthorexic says “I would always say, ‘You shouldn’t feed your kids any of this. You should eat organic…”

Peggy Moe, Orthorexic says “I had to drive forty minutes to the nearest grocery store that had all organic foods and I had to keep it on supply so whenever I was at someone else’s house I brought my own food.”

There’s definitely a problem here but the problem is — she’s right. Sure you can do almost anything to an unhealthy extent. For example, some would rather not eat at all than eat some of our toxic but accepted foods. Is that a choice we should  ever have to make? It shouldn’t be so hard to find organic, healthy foods on your local grocer’s shelves and they shouldn’t be priced out of the range of affordability to so many people but that’s the current situation. The major players in the food industry all stand to make a lot of money by keeping our standards low. We have antibiotics and hormones in our milk, pesticides on our produce, chemically modified fats and sweeteners that aren’t even technically food. Somehow if you acknowledge this refuse what they’re offering, you’re just not normal.

There’s a clear problem with measuring wellness by adherence to a social norm and while it’s not limited to food, this is another example of labeling the ones who won’t just go along. Currently, it’s normal to ignore all of the very unhealthy things we’ve accepted into our foods and order your family’s dinner from McDonalds at the Wal Mart cash register. Like everything it’s normal because a lot of people do it — but as Jiddu Krishnamurti said, “It is no measure of health to be well adjusted to a profoundly sick society.”

June 11, 2010 at 11:17 am 2 comments

A Two Link Mini Roundup

As some may have noticed, things come in waves around here. I’ve been very busy in recent weeks and I have not been able to post with the frequency I would like. I’m still paying attention and SB&F is not losing steam. I offer you two links that are very much worth following up on.

Pfizer: Too Big to Nail?: A giant among pharmaceutical companies, Pfizer has skirted the law in a big way on the basis of its size alone — and their friends in the FDA are happy to help. When they were found guilty of marketing a drug off label without regard for patient safety, they should have been convicted. but…

From CNN:

Promoting drugs for unapproved uses can put patients at risk by circumventing the FDA’s judgment over which products are safe and effective. For that reason, “off-label” promotion is against the law….

But when it came to prosecuting Pfizer for its fraudulent marketing, the pharmaceutical giant had a trump card: Just as the giant banks on Wall Street were deemed too big to fail, Pfizer was considered too big to nail.

Why? Because any company convicted of a major health care fraud is automatically excluded from Medicare and Medicaid. Convicting Pfizer on Bextra would prevent the company from billing federal health programs for any of its products. It would be a corporate death sentence…

So Pfizer and the feds cut a deal. Instead of charging Pfizer with a crime, prosecutors would charge a Pfizer subsidiary, Pharmacia & Upjohn Co. Inc.

The CNN Special Investigation found that the subsidiary is nothing more than a shell company whose only function is to plead guilty.

I don’t know how we’re supposed to think pharmaceutical companies are held to any measure of legal accountability when the FDA, whose function is to protect not  just public interest but patient safety, puts the viability of its friends in industry first. On the basis of the “too big to nail” argument, it seems unlikely that our beloved drug makers will ever actually be treated as criminals no matter how criminal their actions. They’ll just pay their dues to the club in the form of relatively small cash settlements and carry on with business as usual.

Oregon Governor Vetoes Prescription Privileges for Psychologists: I recently posted about psychologists’ attempt to gain prescription privileges. Recently, Oregon Governor Ted Kulongoski vetoed  the proposal in his state on the grounds that the shorter special session did not allow the time needed to thoroughly look into what was being voted upon. Given the impact such a change would inevitably have, it’s refreshing to see a politician take the slow and deliberate approach no matter how it ultimately ends up. Taking a decidedly different path than many states and our federal government, he decided against major changes decided in a short time with vague wording and too many loose ends. From Psych Central:

“I have a serious concern as to whether the special session in February provided opportunity for citizens and interested stakeholders to be adequately involved in the development of those proposed major policy changes,” Gov. Kulongoski of Oregon wrote in his veto letters.

Medical groups and even some psychologists — including Dr. John Grohol of Psych Central — opposed the bill. Gov. Kulongoski said such a change “requires more safeguards, further study and greater public input.”

And from the Oregon Politico:

Rem Nivens, spokesman for Governor Kulongoski, clarified that the Governor is supportive of the legislation which passed in February proposing a short, month long session in between regular sessions.

He added, however, that major policy changes, like the ones vetoed on Thursday, should wait to be brought up during a longer regular session. This will allow for the proper input from citizens and key players in the policy.

“The public give-and-take is critical to crafting and amending legislation by allowing all interested parties to be involved in the development of public policy,” Kulongoski stated. “I believe we must always be open and transparent when we are proposing changes to long established Oregon policy, especially in a short legislative session.”

April 11, 2010 at 10:55 am

The Last Thing We Need…

Somehow the push for psychologists to gain prescription privileges has thus far flown under my radar. As soon as I became aware of it, a host of fairly obvious thoughts ran through my head. As any return readers might have guessed, not in favor of such a move. Now that we’ve broadened the range of thought and emotion caught up in the net that is psychiatry’s drug craze, we’re moving toward increasing the number of people casting such nets. In a  culture where powerful and often deadly (but highly salable) drugs are the accepted answer to each of life’s concerns, the last thing we need is more prescribers. Needless to say, I’m not alone in these concerns and a recent article on Psych Central’s World of Psychology essentially echoes my thoughts on the matter.

If psychology wants to remain a science based upon the understanding of human behavior — both normal and abnormal — and helping those with the “abnormal” components, it would do well to avoid going down the road of prescription privileges. But perhaps it’s already too late…

It never ceases to amaze me that people can speak to a psychiatrist, present them plainly with the source of their emotional troubles, walk their doctor through their problem from onset to complete breakdown and be told they have a biological illness and given a prescription. Psychology as a profession is still in a position to offer real care for very real problems that result from life’s many stumbling blocks. The question is, is that enough?

The fundamental problem with psychologists gaining prescription privileges is the inevitable decline over time in the use of psychotherapy by those same psychologists. This is precisely what happened to psychiatry — they went from the psychotherapy providers of choice, to the medication prescribers of choice. Now it’s hard to find a psychiatrist that even offers psychotherapy…

By switching to a heavily prescription-based practice, a psychologist will be able to nearly double their salary. Can you imagine any other field where you can double your salary with an additional 2 years’ worth of training? Are proponents actually suggesting that money has little or no significant impact in helping a person make career decisions? (We only have a few decades’ worth of research to demonstrate how money does indeed influence our decision-making process.)

Back when prominent psychiatrist Loren Mosher resigned from the American Psychiatric Association (APA),  it was for just this reason. He saw his field’s practitioners getting all too cozy with drug makers — and then from cozy to dependent. It began with the blending of psychiatry and psychopharmacology in the early seventies and continued into what we see now — a field whose approach is virtually devoid of any connection between life and trauma, favoring instead to label everything a chemical imbalance with a chemical cure. It has become the goal of many psychiatrists not to pinpoint and address peoples’ actual sources of distress but, as a sales force for psychotropic drugs, to capitalize on their patients’ struggles with an endless but ever-changing and supposedly improving parade of pharmaceuticals. From his resignation letter:

After nearly three decades as a member it is with a mixture of pleasure and disappointment that I submit this letter of resignation from the American Psychiatric Association. The major reason for this action is my belief that I am actually resigning from the American Psychopharmacological Association. Luckily, the organization’s true identity requires no change in the acronym…These psychopharmacological limitations on our abilities to be complete physicians also limit our intellectual horizons. No longer do we seek to understand whole persons in their social contexts — rather we are there to realign our patients’ neurotransmitters. The problem is that it is very difficult to have a relationship with a neurotransmitter — whatever its configuration.

When you look back to the late sixties and early seventies, when psychiatrists were seeing the vast majority of psychotropic prescriptions filled by general practitioners in a trend of declining credence in psychiatry, todays push seems all too familiar. That’s when psychiatrists started to flesh out the chemical imbalance theory as an exclusive (at the time) answer and a justification of their field, positioning themselves as the sole experts on the topic of biological cause to emotional struggles. It was never backed by objective scientific discovery or even verifiably observed in study but it sold well and justified the existence of psychiatry as an institution and a higher authority on the matter than GPs. The APA and its congregants could hold up the theory disguised as fact and point out that it was they and not GPs who came up with this exclusive supposed answer.

Is that where we are with psychology? In a time where we — as patients and consumers –are conditioned to think our emotional troubles and extreme states of mind are rooted not in our environment but in our chemistry, psychologists offer little in the way of addressing the chemical cause we’ve been sold. They are sitting back watching psychiatrists sell theories and pills in a monopoly while they are increasingly regarded as new age hucksters selling psychobabble. If they are going to remain socially relevant and commercially viable, they need to market themselves as better stewards of the same keys. It would appear, by the early actions of proponents of prescription privileges, that they would do this by taking on the legitimacy offered by psychopharmacology and the balance and apparent of purity of intentions offered by addressing factors like stress,abuse and emotional damage. You can already see them holding themselves up as not having gone down the road of greed and corporate influence but if they’ve taken the high road, it’s largely because the low road has been closed off to them. Sure, there is a great number of psychologists who truly believe in and act on the ability to relate emotional discharge to environmental input but if their era sunsets, the new blood will be trained in the new paradigm and it will be a lucrative one. I’m sure we can scarcely imagine what that will do to the notion of choice in mental health care.

April 3, 2010 at 9:48 am 5 comments


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