Archive | Psychotherapy RSS for this section

John Read is not fit to remain as the BPS’s representative on PHE’s Prescribed Drug Dependence/Withdrawal Review

Warning: offensive language quoted

(Draft letter to the British Psychological Society’s (BPS’s) President, and the Chair of its Clinical Psychology Division. [Added 10th December: I received so many discouraging comments about the low likelihood of a meaningful response that I did not send it.])

The review, which will soon call for evidence to be submitted, has just lost a psychiatrist with substantial links to the pharmaceutical industry. Psychologist John Read, the BPS’s representative, who made a formal complaint about Dr Baldwin earlier this year, and more recently signed an open letter calling for his removal, has stated that ‘personal abuse’ directed at Dr Baldwin was ‘nothing to do with us‘.

However, there are reasons to believe that John Read’s close professional and non-professional associates were involved in encouraging the excessive language such as ‘Pharma-whore’, that he agrees was ‘personal abuse’.

Both he and fellow psychologist Lucy Johnstone are in the ‘core project team’ of the Power Threat Meaning Framework (PTMF…link to interview with James Moore, who is mentioned below) which for many mainstream BPS clinical psychologists is more concerned to promote extreme anti-diagnosis views rather than address difficult issues around mental health interventions (including psychotherapy and drugs). Four ‘core’ PTMF authors (Read plus Mary Boyle, Peter Kinderman and David Pilgrim) signed the letter requesting Dr Baldwin’s removal.

On 19th September (six days before Dr Baldwin resigned) after a Blogger who has regularly written about ‘Pharma-whores’ described a presentation about ECT as ‘shit’, Lucy Johnstone replied ‘you are fab…Keep up the plain speaking’.

180919-shit-fab Truthman-LJ

This ‘keep it up’ Tweet was ‘liked’ by James Moore (whose Twitter icon is immediately to the right of ‘6 Likes’), a non-professional who signed the letter requesting Dr Baldwin’s removal. Mr Moore still suffers from antidepressant withdrawal, and is the lead editor of the new ‘Mad in the UK’ (MITUK) website, which promotes John Read’s activities. The lead professional on MITUK is Peter Kinderman, who has not revealed the names of other professionals in the MITUK ‘collective’: I have asked Mr Kinderman and Mr Read if the latter is part of the ‘collective’, but both declined to comment.

So this ‘Pharma-whore’ Blogger (who had also allowed another anonymous poster to comment on September 12th that Dr Baldwin was a ‘pharmaceutical rapist…worse than Hitler) was encouraged in his ‘abusive’ language by both psychologist Lucy Johnstone and non-professional James Moore, who are both John Read’s close associates.

This appears to directly contradict Mr Read’s ‘nothing to do with us’ statement.

There is further evidence that Mr Read fails to discourage, or even encourages, ‘abusive’ language more generally, against professionals and non-professionals who disagree with this group’s views.

Ms Jacqui Dillon co-edited Mr Read’s latest book, and he names her on his Twitter profile:

180925-Read-Profile

Ms Dillon is a mental health campaigner who has worked in association with John Read for many years. She has many publications, and she praised Mr Read when she received an Honorary Doctorate from the University of East London last year.

Her Twitter banner encourages the use of four-letter words in opposing critics:

1809-Dillon-Banner-cr

Ms Dillon has used dozens of four-letter words in her Tweets, many of which are hostile and attacking: she appears to believe she is doing so in justified retaliation:

180424-Dillon-F---

180727-Dillon-c---

Many Bloggers who follow John Read’s work on psychiatric drugs will have seen Ms Dillon’s Tweets. Clearly, they encourage ‘abusive’ language, and ‘personal abuse’, against opponents and critics.

As non-professionals, neither Ms Dillon nor Mr Moore can be held responsible for the general culture of how John Read and his close associates promote their views and oppose critics.

A year ago Mr Moore posted an interview with a US-based non-professional, Bob Fiddaman, a widely read Blogger and book author. For five months I have repeatedly brought a racist and misogynist Tweet by Mr Fiddaman to Mr Moore’s attention. More recently, after Mr Fiddaman again made it clear that he would not withdraw and apologise, I have asked Mr Read and Peter Kinderman to intervene. As yet they have not commented.

John Read usually adopts a benign manner on social media, but on occasion he can be unfairly sarcastic and extreme. A month ago he responded to an anonymous non-professional’s mildly critical question about ECT by comparing it to ‘lobotomy and the rotating chair’, in a manner reminiscent of extreme critics of psychiatrists, who at times allege that psychiatric treatment is deliberate torture:

As well as the PTMF group, John Read’s close associates include Dr Sami Timimi MRCPsych, fellow council member of the ‘Council for Evidence Based Psychiatry‘. I have recently raised a concern with both Peter Kinderman and John Read about Dr Timimi’s disparagement of first-person accounts by people who find benefit from their medications, as mere ‘anecdote’. All (I believe) of John Read’s close associates tend to ignore such accounts, while selectively valuing first-person accounts of people who only experience harm from psychiatric diagnosis and/or medication.

The prominent journalist who wrote an account of this disparagement made it clear that he felt Dr Timimi was unprofessional. Neither Mr Read nor Mr Kinderman have commented on this issue.

Many critics of John Read and his close associates believe that their main concern is not primarily with drug dependence and withdrawal, or even with psychotherapy, but with promoting extreme anti-diagnosis views. There is evidence that they condone or even promote deceptions which undermine mental health team working in order to achieve that. This slide from from a presentation in which Lucy Johnstone was involved has been widely commented on but has not been satisfactorily explained by John Read or his group:

180401-Strategic-Undermining-1180401-Strategic-Undermining-2

In summary, there is good evidence that John Read’s claiming the ‘personal abuse’ of Dr David Baldwin FCPsych as ‘nothing to do with us’ was false. I ask the BPS to replace him with a psychologist who has no such record, is committed to multi-disciplinary working, and has a genuine interest in seeking evidence for interventions, and their unwanted effects, both at the ordinary mental health team level and at higher policy levels.

If the BPS is unable to find a replacement at short notice, then other current PDD Review members James Davies, author of Cracked, which is highly critical of Psychiatry and its relations with the Pharmaceutical Industry, and Dr Ben Goldacre MRCPsych, author of Bad Pharma, have ample knowledge of the evidence in relation to psychiatric drug efficacy and harms.

Cosmetic surgery: an anti-capitalist issue, a feminist issue, or what?

 

The current concerns about easily-rupturing and possibly toxic PIP breast implants do not seem to be leading to much debate on: (1) Should psychotherapy for body image problems be made more available? (2) Should cosmetic surgery, in general, be more restricted?

In 2007, the BBC3 series Say No to the Knife did attempt to address this issue. It is no longer available on the BBC’s iPlayer, so I can’t check my own recollection that it was fairly superficial, offering not much more than styling and clothing tips Trinny and Susannah-style. No disrespect intended to those particular small screen goddesses, who probably never intended their message to be a universal panacea.

There were only seven episodes of Say No to the Knife, and we may never know why. Perhaps a further series would have risked drawing attention to poor NHS mental health services, which is likely to be a factor for some people seeking surgery in the UK.

Susie Orbach, well-known for her 1978 Fat is a Feminist Issue, addressed breast implants, liposuction and similar procedures in her 2009 book Bodies. Usual suspects appear: mistaken female bodily ideals, the market-driven, consumerist Western society and its commodification of emotion. Well, I respect the choice of anyone to opt out, as much as they can, from all of those things. But I know lots of people living ordinary Western lives, who wouldn’t think of having cosmetic surgery, so I somehow think there must be other causes as well.

 

Should weight-loss surgery be rolled out widely on the NHS, when effectiveness has been shown for less than 1 in 50?

 

So many adults become chronically obese, and we are now so aware of childhood obesity, that an overweight person’s history of normal weight and eating, or bulimia, or even anorexia nervosa, can be overlooked. The low cost of calories, and other “obesogenic” factors such as increased screen time and reduced exercise can also lead to therapeutic pessimism, despite nearly one-third of adults having normal weight (1).

Given the apparent failure of appetite suppressants and psychotherapy to treat obesity, a more hands-on surgical approach has gained a lot of ground (2). Reviews of bariatric surgery seem to make a well-founded case for wider use of this treatment: randomised controlled trials (RCT’s), the hallmark of proper testing, have been abundant.

But, despite well-documented cases of obesity remitting and relapsing in response to a range of interventions, sometimes with long intervals (Oprah Winfey, perhaps most famously), there has never been a single- or double-blind trial of bariatric surgery, compared with a true “placebo” which would be “sham” surgery: entering the abdomen under anaesthetic but making no further intervention.

Such genuine placebo-controlled surgical trials have been performed in many disorders where psychological factors have been felt to be significant (3). The RCT’s which give an impression of “a good evidence base” for bariatric surgery are mostly of one form of surgery compared with another, or surgery compared with a perhaps dubious non-medication-based intervention.

And anyway, according to a 2009 UK government-funded and -published meta-analysis, research into bariatric surgery has established its effectiveness for only 1 in 50 people who are at risk of health problems from being overweight: “The evidence base for the clinical effectiveness of bariatric surgery for adults with Class I [BMI30-35] or class II [BMI35-40] obesity is very limited.” (4).

Although I support bariatric surgery, and tried unsuccessfully to have it considered for one of my very obese learning disabled patients, four years ago, it appears to be at risk of being over-promoted for less severe disorders. Just like many other treatments in the history of medicine.

It is possible, in my view, that psychotherapists of all kinds (CBT, psychodynamic, 12-step-orientated) have simply not tried hard enough for a group of patients that attracts negative and even punitive public attention (5). Before proper randomised controlled trials of bariatric surgery, it must make sense to keep looking for non-surgical treatments.

 

 

(1) 31.7% of English adults were “normal weight” in 2006. The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgry for obesity: a systematic review and economic evaluation. Picot et al. Health Technol Assess 2009: 1-190, 215-357. [p3]. Available at http://www.hta.ac.uk/execsumm/summ1341.htm

(2) See my Blog piece “No” to the knife, “Yes” to Ritalin? 6th August 2010: https://drnmblog.wordpress.com/2010/08/06/%e2%80%9cno%e2%80%9d-to-the-knife-%e2%80%9cyes%e2%80%9d-to-ritalin/

(3) Laparoscopic excision of endometriosis: a randomized, placebo-controlled trial. Abbott et al. Fertil Steril 2004: p878. http://www.ncbi.nlm.nih.gov/pubmed/15482763

(4) See (1): p157. 67.1% of English adults were either “overweight” or “obese” in 2006, of which 2.2% (1.5% of the whole population) had aBMIabove 40. See (1) p3

(5) http://www.dailymail.co.uk/news/article-1298394/Call-overweight-people-fat-instead-obese-says-health-minister.html 
[includes comments from the then Royal College of General Practitioners chairman, Professor Steve Field]

Drafted by 10th June 2011; published at DrNMblog.wordpress.com on 7th October 2011

Maybe there IS a market for nuanced writing about mental health

Manufacturing Depression: the Secret History of a Modern Disease had been in my “to read” pile for a few months. I was in no hurry, assuming from the title that it was a re-hash of the “marketing by pharmaceutical vested interests” arguments of David Healy and others.

But after a patient recommended it, I had a look. The author Gary Greenberg is a psychotherapist, who has episodes of severe depression himself, possibly related to his “inexhaustible penchant for dithering”. He tells a very interesting story, especially about taking part in a double-blind, placebo-controlled trial of an antidepressant. I will not reveal the ending, but do think the book should come with a bit of a health warning because the lack of black-and-white conclusions may make some readers irritated or even depressed.

Another thing I liked about Manufacturing Depression was Greenberg’s willingness to say that pharmaceutical companies and medication prescribers are not the only vested interests in the mental health “industry”. For example: “…even though I am a psychotherapist, I don’t think the only alternative is what I sell in my office one hour at a time”. And, as what Greenberg calls a “depression doctor” myself, I agree with his view that “Depression is surely an affliction, one that at least in some cases may well have a specific, although still undiscovered, brain pathology – a disease in the usual sense of that word.”.

 

 

Quotations from Manufacturing Depression: the Secret History of a Modern Disease (2010, Bloomsbury hardback): pages 365-6, 297-8, 13

The Human Condition

 

This was the title of a talk by the philosopher and journalist Robert Rowland Smith, at London’s School of Life two days ago.

I have known Robert for a couple of years, during which he has published two books exploring how philosophy is relevant to the everyday dilemmas of modern life: Breakfast with Socrates and Driving with Plato.

The essence of the talk, I think, was that despite regular reminders throughout history of humanity’s less than fully rational nature, we still tend to overestimate our self-control. The constant development of technology not only distracts us from evidence to the contrary, but creates neurotic 
dissatisfaction which we tend to worsen by seeking relief in materialism rather than by improving our interpersonal relationships.

I’m not sure that Robert is right in seeing the Western rational “Enlightenment” as perhaps now needing some sort of counter in the form of an Endarkenment”, because I think that contemporary philosophies and psychotherapies, as well as older Romantic Western culture, offer a whole range of ways to explore what Jung called our “shadow aspects”. And some people who are stuck in over-rational ways of life are suffering from biologically-based problems such as depression (1) or autistic spectrum disorders: they may need medication or other treatments to fully take part in philosophical or psychotherapeutic discourse.

It might seem odd that medical technology is sometimes necessary to enable a less technologically-dependent life. But in my view this is just a particular case of science liberating rather than oppressing (2). Philosophy too contains many paradoxes of this kind, such as Wittgenstein’s recommendation that we should simply stop chattering about “things of which nothing can be said”: his non-silence was required first, so that therapeutic silence could follow.

 

 

(1) In general the more severe and long-lasting the depression the greater is the need for medication. But some severe depressions may respond well to psychotherapy and/or philosophy, and some mild depressions may respond only to medication.

(2) Of course, technology and science are often used oppressively, or at least with neglect, whether deliberately or by mistake. Antidepressants prescribed after a ten-minute consultation with a GP (rather than a much longer consultation with a GP, psychiatrist or clinical psychologist), including little or no discussion of psychotherapy, amounts to state-sanctioned neglect in my view.

Published at www.DrNM.org.uk on 15th April 2011; transferred to DrNMblog.wordpress.com on 7th October 2011

Using the L-word may damage your health

Psychotherapy has been in the news recently, with the announcement that a further 400 million pounds will be made available through the so-called IAPT (Improving Access to Psychological Therapies) programme.

But although the government has stated the money is “new”, a senior IAPT adviser has been sacked, apparently for saying that is “a lie” (1). Certainly, savings are to be made elsewhere in the NHS mental health budget.

Somewhat lost in the discussion has been a shift away from the idea that IAPT is just about CBT (cognitive-behavioural therapy). In theory, IAPT has for years accepted that Interpersonal Therapy (IPT), and couples therapy, are just as valid for problems such as depression and anxiety.

At a seminar on IAPT eighteen months ago, a regional manager told me that it was proving difficult to recruit therapists for these approaches. That seems to be changing, and the British Psychoanalytic Council’s recent comments appear to be positive about psychodynamic therapies gaining significant funding alongside CBT (2).

In my view that is a good thing. Since the early 1990’s, I have been sceptical of the established NHS wisdom that psychodynamic treatments had been demonstrated to be generally inferior.

 

 

(1) http://www.guardian.co.uk/society/2011/feb/02/gp-bonus-spotting-mental-illness

(2) http://www.psychoanalytic-council.org/main/index.php?page=15762&

Finding the positive in Oliver James (part II)

Oliver James (see the previous Blog piece, 4th February) is unpopular with many people and parents affected by ADD / ADHD. Not a big surprise, given his strong view that genes have been over-emphasised, and early parenting neglected, as causes of all the common mental and behavioural disorders. Also his rampant anti-Americanism (1) (it is probably significant that ADD / ADHD diagnosis and treatment, especially for adults, has largely developed in the US).

I think that he is largely wrong on those key issues, but also that his books still contain interesting and sometimes valid points. He is right, for example, to suggest that many people can gain as much “insight” from “work, sport or art”, as from psychotherapy (2).

There is no magic formula to reveal who will, or will not, be helped by psychotherapy. And James even implies that “therapy culture” could make you worse (3), although this is more of a comment on reality television than ordinary professional practice.

His linking of the Positive Psychology movement with materialism and consumerism is doubtful to say the least, because academics like Seligman have constantly stressed the primacy of interpersonal relationships for promoting happiness and preventing depression. I wonder if James was trying to make a somewhat different point about the limits of his own “Affluenza” argument: below a certain level of material provision family and social life become difficult, and psychotherapy of any kind should not collude in denying that.

As for ADD / ADHD, it is disappointing that books written in 2002 and 2007, while recognising that autism may be substantially genetic, do not accept the same might apply to other developmental conditions.

Where I agree with Oliver James most of all, in these books, is the sense that exploration of the past through psychotherapy is an uncertain process, and that objective sources such as accounts from others, or school records, should be sought wherever possible. His recommendation to “Interview your mother or father or a sibling or an adult who was close to the family when you were small” (4) sounds close to a description of the diagnostic history-taking approach used by psychiatrists and clinical psychologists.

Therefore I think it a bit of a regression when he appears to suggest, in Affluenza, that psychotherapy may reliably uncover buried memories from childhood (5). Despite a clear non-endorsement of transference-based reconstruction (6), he fails to offer any warning about the possibility of “false memories”, either overly negative or positive, being created in the psychotherapy process itself.

(1) They F*** you up (2002) paperback: p228     (2) p259     (3) p246     (4) p182

(5) Affluenza (2007) paperback: p442: “…help with directly recalling what went on in my childhood”

(6) p442: Avoid the therapist “…if they fob you off with ‘We will investigate how your past is affecting you through the way you relate to me’”

I only share James’ views about using transference as investigation: the therapeutic technique may be useful for some people, as long as the therapist does not make claims for reliable historical reconstruction.

Thanks to Andrew Lewis and Richard Sherry for comments on these two pieces.

Published at www.DrNM.org.uk on 18th February 2011; transferred to DrNMblog.wordpress.com on 9th October 2011

%d bloggers like this: