Tuesday, January 26, 2010

How to Be a Good Mental Health Consumer

Here is a response I just posted elsewhere to someone's question about how to decide on a particular therapist or mental health treatment, after the person objected that a particular website describing various treatments had not made specific recommendations:

The CEBC website is written in a way that consumers can understand, with clearly written summaries of each intervention. That is the point. Legally and professionally, I believe that they would get into trouble if they gave advice to people they had not personally assessed about recommending any one particular therapy, so what they do is provide information in a way that is understandable to people who are not mental health professionals, rather than recommend any particular intervention.

You see, evidence-based practice is not authoritarian and in my opinion, this is a good thing. Damage has been done by certain presumed authorities in the mental health profession (see Scott Lilienfeld's 2007 article in Perspectives on Psychological Science on therapies that harm, for examples and details). While some authorities on mental health practice have undoubtedly done a great deal of good for people, others, even though well intentioned, have ended up doing more harm than good because they used procedures that had not been properly tested with randomized controlled clinical trials tested for safety and efficacy. There's a very interesting series of articles about that topic in this month's American Psychologist, by the way.

Again, using the MD analogy, I would have to ask you, if someone wearing a white coat with a fully credentialed MD advised you to use a drug that had not undergone proper randomized clinical trials but had many positive client testimonials, would you do it? I realize that in the US this is regulated, but if it weren't and an MD made such a suggestion, would you follow it? While true that we do have to rely on MDs as authorities to an extent, because they have knowledge that those of us who are not MDs obviously do not have, at the same time, we can at least ask basic questions about the amount of evidence that exists for what they recommend. This holds true even moreso for the mental health profession because there is nothing in the law that would forbid a mental health professional from using a therapy that has not been properly tested with randomized clinical trials and all too often, claims are made not based on scientific evidence.

I do not give advice to people over the internet who I do not know about what specific treatments someone should choose. I do not know you. I can only recommend good sources of information so people can make informed decisions for themselves as mental health consumers and that is what the website I recommended does. It shows people what their options are.

As for a list of therapists, there are reputable professional organizations such as ABCT that provide those lists, but again, there is no foolproof way to make guarantees about professionals listed. Hence, the disclaimers. Consumers need to ask good questions of any provider. Margaret Singer in her book, Crazy Therapies had some excellent suggested questions consumers can and should ask any mental health professionals they are considering hiring as their therapist. Consumers do have the ability to ask questions and consider the answers they receive or lack thereof and other reactions of the therapist to questions.

Tuesday, January 12, 2010

Regarding My Activities During the 1970s

There is a cliche that the 1960s and 70s were turbulent times. Most of us who grew up then, I am sure, did plenty of things that would make them look pretty flaky or worse, if revealed. For some it was drug use, for others it was wild sexual escapades and for others, it was becoming involved in communes and other groups far outside of mainstream thought and lifestyle. The main difference between me and most of the others is that I have made the choice to go public about mistakes I made in my teens/early 20s in the 1970s, namely my involvement with the Church of Scientology, which I completely left and disavowed over 33 years ago in August, 1976. I could have easily chosen otherwise. I wasn't anyone prominent within the organization and had I not written my story and posted it on the internet and spoken about it at conferences and elsewhere, no one would have ever known. I had no problem with gaps on my resume, since it occurred so long ago and no one is required to report back that far for most jobs. Nevertheless, I did choose to go public because I thought that sharing my story might help others, and over the years I have received countless e-mails from people who read "My Nine Lives" saying that indeed, they did feel it was helpful to them.

I have to wonder how the many people who grew up in the 1960s and 1970s and did things they regret would feel is their activities during that period, whatever they were, were totted out before them by people who happen to be upset with something they have said or done in the present. Now, it seems that I am paying the price for my decision to go public. The price is that on numerous occasions, when I challenge people on issues that they do not seem to have a substantive response related to the issue, my 33-year old experience gets flung at me. This is an obvious ad homimen attack, but because of some of the misconceptions and false stereotypes people have of those who get involved in such groups, this gets associated with me and undoubtedly damages the reputation I have worked so hard to acquire, doing legitimate scholarly work that has culminated in numerous peer reviewed publications in respectable journals and the acquisition of my PhD.

Therefore, I would like to describe some of the false stereotypes associated with people who get involved in cultic groups such as Scientology and others. One of the most easily refutable is that such people are mentally unstable. Numerous studies have shown that this simply is not the case. The vast majority of people who get pulled into such groups are perfectly normal, in terms of mental health. Cultic groups appeal to such normal people for a variety of reasons, that can vary, according to the individual, among them:
1. A normal, healthy desire for a sense of community with people who share what are perceived as common values. Cults do not expose their odd, eccentric belief systems to new recruits. They appeal to ordinary values that many people have, such as the desire to make a difference in the world and healthy personal growth.
2. A number of ex-cultists reported to researchers that they were approached during a time of crisis in their lives, not mental illness, but rather, the sorts of crises that all or most human beings go through, such as the death of a loved one, breakup of a romantic relationship, loss of a job, etc.
3. Some people do have specific problems that they are looking for solutions for. However, again, research such as Richard J. McNally's research on people who believed they were abducted by UFOs, has shown that the percentage of people having diagnosable disorders who adopt belief systems most people would consider eccentric, is no higher than the percentage of people with diagnosable disorders in the population who have no such beliefs.
4. Studies on susceptibility to hypnosis have shown time and time again that there is no relationship between such susceptibility and mental instability or any kind of dysfunction. Such people do tend to score higher on a personality trait called "Absorption" which means that they tend to get deeply absorbed in what they are doing to the point where they can temporarily block out what is going on, in the present. This, however is not a mental illness. Far from it. Many highly creative people with no mental disorders can score highly on "absorption".
5. There is no relationship between people who get involved in cults and intelligence. Again, studies have shown time and time again, that many people who get involved are intelligent people, quite a few with college or even graduate degrees.

Yet, due to false stereotypes about ex-cultists and cultists, there is still tremendous stigma attached to having had an experience with one of those groups, even if the person managed to defy the authoritarian group and walk out. This stigma is based on ignorance and not supported by research, but that does not stop many people from having knee-jerk responses when they hear that someone has been in such a group.

Still, I hope that people will stop and think about this and question these stereotypes, next time you hear that someone has been involved with one of these groups and you feel tempted to jump to conclusions about that individual.

The tactics of my detractors is to dredge this past experience up and then associate it with my present activities that have involved exposing abusive therapies. Ironically, this is the same tactic that Scientologists use. If someone criticizes them publicly, they go into the past of the individual and dredge up anything they can find that would make the individual look bad. What they will not do is address the issues the critics are raising, which is also the case with the proponents of the therapies I have been criticizing. I suppose it's much easier for them to throw around buzzwords like "cult", "Scientology", "crank", "kook", etc., than to actually address the issues at hand. Instead, these distractions are created.