Across the globe, mental health professionals claim to be helping. Are they? They claim to make evidenced-based decisions. Do they? Can they?
If there is an evidence vacuum in mental health, what harm is done by making false claims of being evidence-based?
The mental health industry presents itself as a beacon of hope, offering solutions to every conceivable psychological problem, despite the growing body of evidence suggesting that the “profession” operates in an evidence vacuum, and may be doing more harm than good.
This article delves into the potential dangers of psychiatry and psychology, examining the lack of scientific evidence, the risks of medication, and the ethical implications of the industry’s unethical practices.
Around the world at any one time, one in four people are experiencing mental health problems. Of those, it is estimated that only one in three receive any help, even in rich, developed countries.
When they do receive “help” the side effects of the “medications” can be severe. Go online, and look at the known side effects of the most common psychiatric medications. Prepare to be shocked.
- Selective serotonin reuptake inhibitors (SSRIs). Used for depression, anxiety, obsessive-compulsive disorder (OCD), panic disorder, posttraumatic stress disorder (PTSD), and bulimia nervosa. Known and reported side effects include, nausea, headache, insomnia, sexual dysfunction, weight gain, and increased risk of bleeding. Some SSRIs have been linked to increased risk of suicide.
- Atypical antipsychotics. Used for schizophrenia, bipolar disorder, and treatment-resistant depression. Known and reported side effects include weight gain, metabolic syndrome (increased risk of diabetes and heart disease), movement disorders (e.g., tardive dyskinesia), and increased risk of blood clots.
- Benzodiazepines. Used for anxiety disorders, insomnia, and muscle spasms. Known and reported side effects include drowsiness, dizziness, impaired coordination, memory problems, addiction, and increased risk of suicide.
- Stimulants. Used for attention deficit hyperactivity disorder (ADHD). Known and reported side effects include insomnia, decreased appetite, anxiety, headache, and increased heart rate, increased risk of heart problems, increased risk of psychotic symptoms and suicide.
- Mood stabilisers. Used for bipolar disorder and epilepsy. Known and reported side effects include weight gain, tremors, kidney problems, and increased risk of birth defects, and suicide.
Life threatening medications
There are widespread reports that some “medications” have caused or are at least linked to suicidal ideation, and led to multiple suicides.
How is that possible? We just don’t know enough about the biochemical functioning of the body or brain to know what effects such “medications” could have on people. We do know this: some “medications” are so damaging that they are widely described as being a “chemical cosh”.
You may have seen some mentally troubled people looking and behaving like “zombies”, as a result of the so-called medication.
That is not to say that some medication isn’t wonderfully effective. It is – for some people. The problem is, we just don’t know for whom the medication will be helpful, and for whom it will be life-changingly harmful.
Long-term use of psychiatric medication can lead to dependence, withdrawal symptoms, and unexplained physical health changes. The “medications” used often mask underlying psychological issues, and prevent the real, and often obvious causes of the problems being addressed.
The delusion of “evidence-based practice”
The mental health professions claim to engage only in “evidence-based practice.” That phrase implies that they have a validated scientific base for their therapies. Upon even the most cursory of examinations we can see that there is a significant gap between their claims and the stark reality.
Randomised controlled studies, the gold standard for clinical research, are often difficult to conduct in mental health because of the ethical and practical challenges. As a result, there is a massive shortage of reliable evidence for almost every known mental health challenge. Anecdotes, case studies and correlational research, are the very poor substitutes that are passed off, disingenuously, as evidence. They do not constitute “evidence” in any rational use of the word.
Deeper still into the world of delusions go the claims that the professionals are objective. Nothing could be further from the truth. The diagnostic criteria used in psychiatry are subjective and often rely on self-reported symptoms. The dearth of objective biomarkers makes it all but impossible to definitively diagnose mental disorders.
With so many untruths and problems, it comes as no surprise that many individuals are misdiagnosed and become the victims of unnecessary and potentially harmful “treatments”.
Competence problems
The range of competence among mental health professionals follows a normal distribution curve. By definition 50% of mental health professionals must be below average competence. This raises serious concerns about the quality of care that many patients receive.
Even among the competent top half, the failure rate is alarmingly high: 70% (you read correctly).
This suggests that a substantial proportion of mental health professionals are unable to deliver effective treatment, even when they possess the pieces of paper which proclaim they have completed a course of study.
Ethical implications
The high failure rate in mental health “treatment” raises big ethical questions. If psychiatric and psychology professionals know that their interventions are 70% likely to be ineffective; that they will fail most of their patients, is it ethical for them to accept payment?
The problem may be worse than that. In recent studies, the IAPT (improving access to psychological therapies) system in the UK was shown to have 90% failure rate. Again, you read correctly: 90%
In a profession that proclaims itself to be ethical, one would expect such an extraordinary high failure rate to be made public, so that consumers could make an informed choice. That is not the case in the mental health “profession”.
The low standard of ethics in the mental health profession are even more troubling in light of the massive financial burden mental health “treatment” imposes on individuals and society as a whole. It means that 70% to 90% of all money spent on mental health treatments is knowingly wasted.
Is it reasonable to conclude that the lack of transparency about the failure rate and limitations of mental health professionals can be seen as a form of deception. If you speak to many people who have been subjected to the mental system, many seem to think so.
Patients are often talked in to starting therapy with (false?) high hopes, only to be disappointed by the lack of progress. This can lead to frustration, disillusionment, and even more psychological distress. In the UK alone, after repeated failures by psychiatrists, psychologists and the mental health system, many thousands take their own lives, every year.
The delusion of “non-directive” psychotherapy
Many psychiatrists, psychologists and psychotherapists claim to be ‘non-directive’, that is, the client is not, and should not be, directed by the therapist, in any way. This is probably the most widespread and most commonly held myth in mental health. Yet it is also the most patently fallacious.
Most non-directive mental health professional bodies advocate long years of training. Now we have to ask, if the therapist is never directing the client to do anything, or doing anything to the client, what skills can there be that require such training?
“Oh, very subtle, extremely complicated skills, which only a few selected people are capable of mastering.” I was once told by a supposedly leading figure.
You might, reasonably ask: “What are those special skills?” as I did.
“There’s no point in trying to explain, they’re too complicated for non-specialists to understand,” was the ‘you couldn’t make it up’ reply from the same source, who was an NHS consultant-level metal health practitioner.
The self-contradictions of “non-directiveness”
Another inadvertent self-exposé appeared in a book published by a professional organisation in this field. The author advocated non-directive therapy but then went on to say, “if the client gives you power, use it for their sake”.
A sensible piece of advice, but self-contradictory if you have advocated non-directive therapy as that author did, repeatedly. How can you use power and be non-directive?
Inconsistency in “non-directiveness”
What one non-directive therapist chooses to pick up from a client’s statements may be different from another therapist’s focus of the same client’s statements.
The factor the therapist chooses to focus on will be determined by the mood, life experiences, and a hotch-potch of other therapist-related variables.
Whatever the therapist chooses to focus on will then influence the future direction of the discussion. For example, if one therapist reflects the feeling element of a communication, the client may focus on how they feel or felt about whatever is the problem. Another therapist may decide the contextual component is more important and focus on that. A third therapist may choose to focus on the reasoning elements.
In their defence, some therapist might say: “Of course, I would pick up on and reflect, in a non-directive way all three elements that the client raised.”
That sounds reasonable, until we consider that the order of reflection contains direction, intentional or not.
Directive effects of technique variance
Even the way a particular “non-directive technique” is used to reflect will influence the future direction of the session. For instance, let’s take echoing as a technique.
Echoing reflects the client’s last few utterances word for word. What effect will echoing the last phrase have compared to echoing the last two phrases, or the last three? There is no doubt that doing so will emphasise different meanings. One phrase on its own will communicate to the client that the specific part echoed is what the therapist wishes to explore further (yes, what the therapist says to the client is interpreted by them as a statement of what the therapist considers to be worth exploring).
If the therapist echoed the last two or three phrases, the wider meaning conveyed is taken to be the important issue. How many other aspects of a every therapist’s behaviour directs their clients? Every aspect of every behaviour! Non-directive therapy is simply not possible.
More internal inconsistencies in “non-directive” counselling
Quote from a leading publication: “… a client whom one immediately and instinctively dislikes, if treated with enough empathy and respect, may gradually come to be more likeable.”
What? Firstly, one of the key premises of non-directive therapy is that therapists can suspend their judgement of people. If judgement can be suspended, why advise therapists how to react to someone they don’t like (a judgement)? Because we are all human and can’t suspend our judgement. It is simply not possible.
Secondly. If a therapist is being genuine towards the client (as all therapists should be) isn’t treating someone one dislikes with empathy and respect insincere and faking? Of course, it is.
Thirdly, non-directive therapy schools advise that one should not fake sincerity. Ehm… how then can the therapist maintain the relationship long enough for the client to ”gradually come to be more likable”?
There is no such thing as non-directive or non-judgemental therapy. It is a myth, a self-delusion and a deceit of vulnerable people. It is a myth supported by the notion that clients need protection. If clients need protection, it is from the very people who are claiming to be acting in their best interests.
Protecting yourself
Given the significant risks, ethical and other problems in the field of mental health, if you or a relative are thinking of seeking help from a psychiatrist, psychotherapist, psychologist or other mental health professional, you would be wise to consider how to protect yourself from the “professional”.
- Do your research. Before seeking treatment, research several therapists and their approaches. Good therapists will provide a free consultation period, perhaps by telephone. Look for practitioners with strong evidence-based credentials and positive reviews from former clients. However, there is a problem here. Many clients are aware that there is still much stigma associated with mental health problems, and don’t want to publish reviews of a therapist.
- Educate yourself. Learn about mental health conditions and treatment options to make informed decisions. More help is at the end of this article.
- Ask questions. Find about bout their qualifications, experience, and treatment approach. A good therapist will be open and honest about their limitations. A note of caution: many therapists have the highest possible qualifications, yet their people skills, and self-insight are horrendously bad. At the other end of the scale, there are many people who have zero qualifications in mental health, or anything else, and yet they are simply brilliant at helping others solve their mental health challenges. You may know, or have known such wonderful people. I am certainly fortunate to know several.
- Question authority. Challenge the advice of any mental health professional. They have almost no evidence for anything they advocate. Do your own research and ask critical questions.
- Judge the therapist. Any therapist should be credible; they should practice what they preach. If their mental health is in good shape, they are probably practising the techniques they will help you to adopt.
Would you seek help for obesity from an overweight therapist? Would you seek help for depression from a therapist who seems utterly devoid of joy? Would you seek help for smoking from therapist who smoked?
If they haven’t mastered what you need to master, walk away.
- Set clear goals. Clearly define your therapeutic goals. Tell your potential therapist what you want to achieve. If you are not making progress, fire them; switch therapist.
- Do your own research. Take the time to educate yourself about your condition and the different treatment options available. Knowledge empowers you to make informed choices and advocate for your well-being.
- Be wary of medication. Consider non-pharmacological approaches, such as lifestyle changes and therapy, before resorting to medication. In my view medication ought to be a last resort.
While psychiatry and psychology can be helpful for some individuals, it is important to recognise the potential harms they can and do impose on their clients. By understanding the limitations of the evidence base, the risks of medication, and the ethical implications of psychological treatments, we you make informed decisions about your mental health and protect yourself from harm.
Professor Nigel MacLennan runs the performance coaching practice PsyPerform.
