Clinical means nothing. I can open a chiropractic clinic and create “clinical” evidence all day long. It’s still pseudo-science if the results aren’t replicable.
Studies surrounding CBT (and the field of psychology as a whole) are not replicable. They are, almost always, based on converting qualitative metrics (how you feel) and filtering them through a designed survey in order to convert these qualitative, subjective abstractions into something that resembles something quantitative and scientific. The result is a field has with a ~40% replicability rate in it’s most “prestigious” journals. So, yes, the “professionals” have PhDs and use the doctor salutation. They’re not scientists. They’re just pretending.
Want to know what you almost never see in the studies investigating the effectiveness of these “therapies”? Life outcome investigations. “Do patients doing CBT actually recover from their depression, as measured by educational attainment/employment/regaining employment?” Good luck finding a study indicating that any significant subset of “depressed” people got over their issues as a result of the CBT itself with a HARD LIFE OUTCOME as the point of investigation. It’s all subjective feelings filtered through qualitative 1 thru 10 surveys. Patients never improve. They stay on the $200/session revenue stream forever and get a lifetime prescription to go with it, often for a nebulous “condition” that is basically synonymous with descriptions of the normal human condition. “I feel anxious” gets you a script. Outside of panic attacks, it’s a normal feeling. “I have trouble focusing” gets you an amphetamine script. It’s a normal feeling. “I lack motivation and purpose” gets you an SSRI, with nary a blood test or a scan of the brain. Again, a perfectly normal part of being a human. Psychotropic intervention in this field is barbaric and pseudoscientific. If there is any justice in this world, it will be held in the same esteem as lobotomy in the future.
"Want to know what you almost never see in the studies investigating the effectiveness of these “therapies”? Life outcome investigations. “Do patients doing CBT actually recover from their depression, as measured by educational attainment/employment/regaining employment?”
That's actually exactly how they measure the efficacy of many psychological and psychiatric interventions for chronic mental health conditions, to the point of it being almost laughable, like if you managed to get a job or get better grades, that must mean you are doing better, everything else be damned. But I suppose that's the most objective metric there is.
"They stay on the $200/session revenue stream forever and get a lifetime prescription to go with it"
This is anecdotal, but every psychiatrist I've been to has attempted to titrate down the dose or remove a medication from my regimen if I've been on it a while, and observe if the improvements from those can be maintained.
Similarly, most of the therapists I have worked with proactively suggested reducing the frequency of sessions once they've observed improvement.
"often for a nebulous “condition” that is basically synonymous with descriptions of the normal human condition. “I feel anxious” gets you a script. Outside of panic attacks, it’s a normal feeling. “I have trouble focusing” gets you an amphetamine script. It’s a normal feeling. “I lack motivation and purpose” gets you an SSRI, with nary a blood test or a scan of the brain. Again, a perfectly normal part of being a human."
It's attitudes like these that contributed to me failing to seek the proper mental health treatment until later in my life, until my very real, very observable, non-nebulous conditions reached a life-threatening degree.
Something that is "normal" for some people some of the time can be disabling or life-threatening if experienced by someone most of the time. Most people experience physical pain at some points in their lives, but if you are in serious pain nearly every day, you would be right to seek treatment — and no, we don't have perfect tests for all kinds of pain either.
The fields of psychiatry and psychology have many problems, but being a pseudoscience is not one of them.
The SOP for every psychiatrist I've ever seen (and that's probably nearing 100 or so by now, over 30 years, 3 states and a dozen clinics) is to medicate until the patient is responding well, and to never ever even suggest that the patient should slow down, reduce or stop any medication. Because if the patient did so it would represent a clear and present danger and obstacle to recovery. The patient is seriously mentally ill and must take medications w, x, y and z for the rest of his life. Unless one of them creates a lot of side effects and then we'll tinker endlessly with new and different medications until he stops complaining so much of side effects, and/or he's too doped up and sleepy to care anyway.
It is absolutely preposterous for any psychiatrist to suggest that a patient titrate off drugs "to see what happens" or "just in case they've recovered". That's antithetical to their treatment methods which specify that chronic psychiatric illnesses must be treated with daily doses of medications with vague primary effects that can never be stopped.
“40% replicability” of a field doesn’t distinguish between “4 100% replicable studies + 6 0% replicable studies” and “10 40% replicable studies”, full-stops notwithstanding.
Which medication(s)? SSRIs? Have you actually looked at the pre-marketing “studies” of the most common drugs prescribed by psychs? I have.
By no stretch of any imagination are those studies replicable. And the diagnosis process is even worse —- no quantitative blood test, no scans, no nothing. Just ask the patient for verbal self-assessment, and prescribe. It’s a massive joke from start to finish.
When I was 16, I was sexually assaulted by a Pharmacy Technician who was 20 years old at the time. She knew exactly how to ply me with alcohol and contraceptives. Of course I was totally into it, but being unable to consent, it was rape (the statute of limitations ran out definitively 2 months ago.)
She was a class-A scammer. She cheated on everything. She took me to Disneyland and tried to reuse the tickets. I took her to the Prom and she tried to return the wrong dress to the rental store. Walking around town, she would walk me into lamp posts. She mocked me and ridiculed me and I kept coming back for more.
I'll never forget her profession as a Pharmacy Technician. There is no coincidence that her status as a legal drug dealer and scammer brought her into my life. Every day she dealt with leeches, IV bags, PRNs, and Scheduled drugs. Every night she handed me a wine cooler or two and put an art film on the VCR. Unfortunately my parents and teachers were powerless to intervene at that point.
Many psychiatrists I've met are apt to make a diagnosis merely on the patient's affect and demeanor. Since I have White Coat Syndrome, my affect and demeanor are always adverse in clinical settings. Since I was abused by my mother, the majority-female psychiatric clinic being very paternalistic and patronizing does not help one iota.
In the hospital the other day, the nurse asked "how are you doing" which is an essay question. I didn't feel like answering essay questions, so I just stared at her awhile. Later that day, I was diagnosed with 'catatonic schizophrenia' and earned an increased dosage of Ativan because the doctor said I didn't answer the nurse satisfactorily.
I'm still not sure what is pseudoscientific about "People with psychological problems can learn ways of coping with the problems, thereby relieving their symptoms."
> They’re not scientists. They’re just pretending.
That's harsh.
You seem to want quantitative studies to prove the efficacy of methods that treat _psychological_ problems. Depending on the disorder, researchers can often only rely on patient assessments. Whether or not someone attained education or employment would be difficult to correlate as a direct effect of any specific treatment. Methods like CBT serve to give the patient a set of tools to approach their problems, and in the real world are often combined with other treatments. They're not silver bullets, nor do they work as well for everyone, since they do require a conscious effort from the patient.
It's like with meditation; some people claim it has transformed their lives, while it has little effect on others. There's little quantitative evidence to prove its efficacy. Should we dismiss the practice entirely because of this?
It’s meant to be harsh. They’re mass-prescribing poorly understood psychoactive drugs based on unscientific assessments. They’re giving young children amphetamines for normal behavior (disliking school). They are kooks, and I have as much regards for them as I do for those that performed lobotomies.
It's pointless arguing with you, as you have no intention of considering alternative viewpoints.
I'll just say that I wouldn't dismiss an entire field of study based on wrong actions by some, or even a majority, of practitioners. Psychology and psychiatry do help many people, and it's the best we can do for many psychological issues. Can it be abused and wrongly applied? Sure. But it's not pseudoscience, and its practitioners aren't "kooks".
The mind is an abstract concept, and we don't yet have the knowledge of how it interacts with the brain, a physical entity. If we did, all psychological issues would be studied and treated by neuroscience instead. In the meantime, we need branches of research that are not as well defined as traditional "hard" sciences.
The drugs typically have inverse effects to what they're supposed to do. Antidepressants cause suicidal ideations, this is well known, but did you know that they also cause homicidal ideations? The kids at Columbine were really smart kids, but their parents started medicating them and they got a lot worse.
Charles Whitman, U Texas, 1966, was on psychoactive medications such as Dexedrine; it's no coincidence that he was compelled to murder lots of people from that tower, not because of mental defect but because of drugs he was on.
Nancy Reagan was right. "Just Say No." I listen to Nancy Reagan.
I think the OC you're replying too is far out of line and replying on emotion (personal opinion, I am too haha), but I do find frustration at CBT being used as a modality for everyone and anyone, where it actively exacerbates symptoms for a set of the population (complex trauma survivors) that looks like the target audience (mild/moderate anxiety/depression), which can create a watershed effect making the less struggling people better off and the more struggling people hurt and disillusioned with the system.
I wish there was enough coverage and recognition to have multiple pathways, or some kind of effective gated treatment going to something like CBT or over to something like Janina Fisher's empirical work practically extending IFS in a nearly universally palatable way (seriously, I'm very impressed with her work and it's among my favorites that I've ever read in the field. I keep coming away with stuff that blows my socks off. Clinically-discovered gold! :D)
