Popular Media and Commentary

1.  NY Times: The Irony of Despair, by David Brooks

It’s worth noting that the increase in suicide has correlated with the expansion of the therapy culture, and that populations with lower uses of psychotherapy, such as African-Americans, have lower suicide rates. The therapy culture encourages self-absorbed rumination on one’s personal issues rather than other-oriented action, generosity, and connection. It causes people to feel that when feeling sad one shouldn’t burden friends and family, but rather must go quietly to a paid professional and keep it under wraps. This exacerbates the sense of isolation in our culture.

Listening and being supportive is something we *all* can and ought to do for each other, our friends, partners, neighbors, communities — for free. We *all* have the ability to do our part to make this world a more compassionate and sane place to be. When we try to relegate humane support to paid workers (such as the psychotherapy industrial complex with labels and incentive structures that conflict with lasting health and flourishing), we chip away at the humanity of us all. We are all in this together, and we can do better. Let’s try to move society in this more hopeful, loving, and respectful direction.

Addendum:

For some clues on a possible causal direction, see JAMA:  
“Most suicidal adolescents (>80%) receive some form of mental health treatment. In most cases (>55%), treatment starts prior to onset of suicidal behaviors …”

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2.  TED Talk: The Secret That We Share, by Andrew Solomon

Agree that it’s incredibly valuable to be able to authentically share one’s feelings/depression/sadness/grief/lack of vitality with friends and loved ones, and we should all do our part to create a culture which fosters enough compassion and connection to make this possible.

The problem with the talk is that there are a couple of key points that do not reconcile with each other: the appalling state of the mental health industry and the recommendation to expand the use of the appalling mental health industry. The conflict is elaborated below:

Status of mental health industry:

• “The treatments we have for depression are appalling. They’re not very effective. They’re extremely costly. They come with innumerable side effects. They’re a disaster. … appalled that anyone endured such primitive science.”
• ‘I was in Rwanda working on a different project, and I happened to describe my experience to someone, and he said, … “we’ve had a lot of trouble with Western mental health workers, especially the ones who came right after the genocide.” And I said, “What kind of trouble did you have?” And he said, “Well, they would do this bizarre thing. They didn’t take people out in the sunshine where you begin to feel better. They didn’t include drumming or music to get people’s blood going. They didn’t involve the whole community. They didn’t externalize the depression as an invasive spirit [or cultural/societal factor]. Instead what they did was they took people one at a time into dingy little rooms and had them talk for an hour about bad things that had happened to them.” He said, “We had to ask them to leave the country.”‘

Speaker’s recommendation:

• We should offer this appalling “treatment” to more people.

(This recommendation seems to come on the basis of selected anecdotes. It’s important to remember that anecdotes are not sufficient evidence; that’s why we need science.)

The speaker seems to be recommending that we burn the village in order to save it.

People who are suffering deserve better, and we can do better.

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3.  NY Times: Your Submission For Most Neglected Topic, by Nicholas Kristof

I’d like to see an exploration of the ways in which people get hurt by the multi-billion dollar mental health/psychotherapy industry. As with any “treatment,” psychotherapy not only costs a great deal of time and money, but comes with the risk of side-effects and harm.

There is far too little attention paid to the victims; it’s almost as if they’re dismissed as collateral damage for the sake of some other value. The inherent structure of the therapy relationship — the one-way intimacy, one-sided vulnerability, and surrounding secrecy — lends itself to exploitation and emotional rape. As with domestic violence or priest sexual abuse, it’s a problem that people prefer to look away from and no one wants to think about or admit exists. There will continue to be more therapy victims until we’re ready to really take a look, and take action.

Addendum:

A recent study concludes that “Important information about harms is not reported systematically within this research field, suggesting that the risk of reporting bias is nontrivial in conclusions about the risk-benefit ratio of psychological treatments.”

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4.  TED Talk: Dare to Disagree, by Margaret Heffernan

The psychotherapy industry is one that is permeated with willful blindness to how it hurts people and lack of interest in dissenting voices. Most of the practices used are not supported by data from well-designed replicable randomized controlled trials, yet clients are rarely informed of this, and are unwittingly used as human experiments. Further, the structural set-up with unsupervised closed-door secrecy (perhaps subconsciously) attracts practitioners who can’t handle criticism well, and enjoy the unfettered opportunity to satisfy their needs for power/control/feeling superior and exploit clients in a more vulnerable position. By raising awareness of these issues and having the courage to blow the whistle, we can begin to help the people harmed by this industry.

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5.  Science-Based Medicine: Placebo Effects Are Not The Power of Positive Thinking, by David Gorski

Thanks for highlighting the importance of assessing expectancy and blindness, and the spuriousness of clinical trials that omit these assessments. There are no psychotherapy studies to date that include these assessments and still show that it can outperform a well-designed placebo or sham treatment. (The studies that have attempted more rigor show that psychotherapy fails to beat the placebo.) Therapy’s roots lie in the anecdotes of interested parties, and when put to the test of science, it fails.

In addition to the importance of avoiding deception in healthcare, it’s also important to avoid ripping off/cheating naive “patients” out of large sums of money (e.g., $50 – $200 per 45 minutes) for “treatments” that are no more effective than a free placebo or inexpensive alternative (e.g., talking to a friend/partner, taking a nature walk, writing in a journal, etc.)

Let’s help shine a light on the vast fraud taking place in the billion dollar psychotherapy industry.

https://trytherapyfree.wordpress.com/about/

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6.  TED Talk: What We Don’t Understand About Trust, by Onora O’Neill 

The success of the psychotherapy industry depends on obliterating the distinction between trust and trustworthiness/earned trust. It models unhealthy relationships by encouraging or even demanding “trust” with one’s most personal intimate thoughts/feelings on the basis of status and authority rather than mutual vulnerability, mutual sharing, and commitment. And when a paid/temporary display of “compassion” is involved, this can cause devastating confusion for clients — especially children — who are in effect trained to interpret signals in a manner that doesn’t align with authentic relationships, and can result in long-lasting damage to the ability to trust in cases where it is warranted on the basis of authentic mutual (not artificially bounded) connection.

For example, consider an orphan child* who gets passed around between various “therapists” over the years. How is this child to develop the ability to trust when they encounter therapists who act warm and caring while on the job, and coax them into sharing their most private selves, but then walk out the door one day never to return when the assignment is over? The next time they encounter a warm and caring person, will they abandon them, as well? How are they to be differentiated from people who do not behave in a warm, caring way, perhaps like the abandonning parents, when the outcome is the same? Children in these scenarios learn that they cannot trust warm, caring behavior (since those people abandon them too), and sadly conclude that no one is to be trusted. This confusion perpetrated by the therapy industry, in colloquial terms, is known as a “mind f*ck.” These children would be better off developing reliable instincts on who to trust and who not to trust, so that their capacity to trust — and love which depends on trust — remains in tact.

Raising awareness of the distinction between trust and trustworthiness/earned trust, and its harmful blurring in the therapy industry, may help reduce the number of victims of this systemic exploitation.

* This example may apply just as well to adults, especially those who have spent a significant amount of time in therapy.

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7.  NY Times: Ending ‘Gay Conversion’ For Good, by Jacob Victor

Thank you for helping to expose the fraud that permeates the psychotherapy industry with conversion therapy and beyond. Therapy’s roots lie in the anecdotes of interested parties, and when put to the test of science, it fails. There are no well-designed psychotherapy studies to date that show that it can outperform an active placebo or therapy-free alternative intervention (when appropriate standards of scientific testing, including systematically controlling for biases and statistical errors, is applied).

By raising awareness of Consumer Fraud Acts and the lack of evidence for the claims of the billion dollar psychotherapy industry, we can help put an end to these unethical practices that offer up snake oil to people when they’re feeling vulnerable and seeking help.

It’s great progress to see the fraud behind gay conversion therapy come to light. Let’s stand up for consumer rights and help pave the way for the other potentially harmful psychotherapies with flimsy evidence to follow suit.

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8.  The Guardian: Mental health stigma: where’s my cheesecake? by Tania Browne 

Yes!  I too would love to live in a world where friends, partners, families, acquaintances, etc. could all support each other with emotional as well as physical needs. I think a good step in that direction would be de-professionalizing such support and closing down the therapy industry. It’s not something to be paid for in contrived 45-minute doses; rather, it’s something that we should all freely give and receive for each other.   https://trytherapyfree.wordpress.com/about/

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9.  NY Times: What Does Buddhism Require? By Gary Gutting

“As I’ve worked to gain greater awareness of who I am, I’ve simultaneously gained greater awareness of my relationship and interdependence with all people. This experience may be generalizable: the more you become aware of your authentic self, so to speak, the more connected you feel with other people. An egocentric sense of self is like the teenager in rebellion against his parents, striving to be the opposite. A true sense of self stands outside this continuum of conformity vs. non-conformity, on the solid ground of authenticity. ” 

Great insight; love this conception. It also helps to show why contemporary western psychotherapy practices — with their emphasis on individualism and the lifelong teenage/egocentric separate self idea — are so much at odds with genuine compassion, authenticity, and connection.

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10.  Wall Street Journal: The Questionable Link Between Saturated Fat and Heart Disease … The dubious science behind the anti-fat crusade, by Nina Teicholz

This history of low-fat diets for heart disease has many parallels to the history of psychotherapy for brain/mental illnesses. Both were widely promoted in the 20th century by power hungry doctors (Dr. Keys and Freud) obtaining influence with powerful organizations, who in turn widely promoted their theories (with the help of money and politics) until their unproven theories started to seem like common sense. Under the influence of these unfounded theories promoted by parties with a financial/political stake in them, people made choices that caused more harm than good — they replaced healthy diets with unhealthy diets, and healthy authentic friendships with unhealthy paid therapists. We’ve damaged the quality of our diets and our relationships to one another, and consequently we’ve damaged our physical and emotional health.  

I hope that we learn from these mistakes, and don’t repeat them, and that we learn to look carefully at the evidence and act accordingly.

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11.  NY Times: Calling an Ordinary Health Problem a Disease Leads to Bigger Problems, by Aaron Carroll

This is an especially serious problem in the psychotherapy industry, in which psychotherapists are (consciously or subconsciously) incentivized to apply labels in order to keep clients, make money, and feel relevant regardless of the long-term harm it may cause.

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12.  BBC: Nostalgia: Why it is good for you, by Tom Stafford

This post about nostalgia points to one of the many reasons why psychotherapy can be so damaging to a person’s mental health and well-being. Insofar as psychotherapy pokes holes in our fond memories of the past and identifies problems in our past (e.g., problems with our childhood upbringing, problems with our family relationships, problems with the way our parents or siblings treated us, problems with our partners and friendships, etc.), it undermines perhaps our greatest resources to enjoy the present and look forward to the future.

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13.  Nature: Psychological treatments: A call for mental-health science, by Emily Holmes, et al.

Some great points here. But the “evidence base” for existing psychotherapies is overstated. The existing studies are so riddled with biases, conflicts of interest, research design flaws (e.g., failure to use active control groups that adequately control for placebo and expectation effects and demand characteristics, and lack of adequate blinding), statistical method flaws, failure to track harmful side-effects, etc. that they amount to a pile of nothing.

Until we understand how psychotherapies “work” or cause harm, we are playing dice with human lives.

Consumers deserve better. It’s great that this is coming to light.

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14.  NY Times: What the Therapist Thinks About You, by Jan Hoffman

OpenNotes is a wonderful program that should become mandatory. People deserve to know what they are paying for. OpenNotes may help to expose the pseudoscientific ideas that the psychotherapy industry depends on and the harmful effects that often go unspoken, and help to clear the way for better alternatives. Observing therapists’ reaction to OpenNotes is also a good barometer for the state of the psychotherapy industry; those who are being defensive may have good reason to prefer hiding.