I found two cool blog posts today, both by experts who tear apart Evidence Based Medicine, which I’ve shared my own disdain for here recently.
Two reasons I sneer at EBM; one has to do with the medical model of therapeutics, which tries to make an art form into a science, and that sheer, stubborn assholery has made a disaster of psychiatry. Humans don’t act like well-behaved chemical formulas. Minds aren’t brains. I am not a machine, and so on. These are the basic complaints leveled at what’s known as the mechanistic model of mental health.
Evidence Based Medicine™ is the current fad of the mechanized model. I swallow bile at every Health and Human Service committee meeting I cover, where mental health agencies appeal to the legislature for taxpayer funding by invoking EBM as a code for please give us money, we are not hippies, we’re modern and serious and on the sciency track! Sniveling hypocrites, ashamed of their own profession. Why don’t they just admit that they’re hapless, and it’s hard, and no one knows, they do their best within the limits; there are limits to what psychologists can do.
Everyone knows it’s a game. I can’t stand the pretense. I’m schizophrenic, we’re like that, we laugh at funerals, you know what I mean? Seeing people cry cracks me up, it’s funny because it’s untrue.
I frankly doubt the speakers are actually devoted to EBM or even know what the fuck they’re talking about since the phrase is so amorphous and what-EVER, something to do with research, research, and predictable outcomes concerning the research on human behavior, which last time I researched, was impossible to predict. The stupid, it burns.
The other reason I hate this shit: Out of more than 400 different psychological approaches, the one factor that effects outcome is the relationship between the patient and the treater. That’s the reported truth, in study after study, regardless of the approach, and everyone knows it.
There are three schools of applied psychology: psychoanalysis, behaviorism and humanism, and of the three the last is the only approach that revolves around the relationship between treater and client. The model of choice already exists! Humanists are true life savers for multi-disordered and difficult cases and because they are the only treaters who could handle me I for one will fight for them til they no longer appear to be a dying breed.
So I found these two posts today that made me glad to know I’m not alone in my umbrage. Spiritual Recovery links to a critical abstract at Psychiatry Online that claims the benefits of Evidence-Based Treatment do not apply to “the most seriously disabled consumers.” Damn right, and they further contend that EBT is subjective and not based on scientific evidence.
“The medical model, which is the underpinning of evidence-based practices, is described in the article by Dr. Frese and coauthors as being “highly paternalistic, emphasizing illness, weakness, and limitations rather than potential for growth.” The authors state that people who are in the greatest distress should be treated by a “paternalistic, externally reasoned approach.” This is the primary approach used in the mental health system today. When people are told they suffer from a permanent biological brain disorder, they feel they will never recover or regain control over their lives. This treatment approach has ensured that people remain hopeless, helpless patients and has made them indefinitely dependent on the mental health system.”
Is that the goal? Jesus Christ on a cupcake top.
I found this other newish blog via Furious Seasons, Clinical Psychology and Psychiatry: A Closer Look, written by an anonymous doctor who knows his stuff and is all over the reigning controversies. This post is about a study that involved therapists using EBT and therapists in community care doing whatever they do. The EBT model showed a small advantage over the control, and the doctor/blogger’s comments point to problems inherent with scientific studies on mental health treatment–
… it may all just be that therapists trained to do EBT are aware that it is supposed to be superior and just work harder since they know that they are under a microscope, so to speak. …The therapists giving the EBT are aware that there is some pressure to achieve results. I would think this makes them work harder because they feel a great sense of accountability whereas in usual practice, there may not be as great a sense of accountability on day to day basis.
I’m not saying that your typical clinician does not at all feel accountable, but that there is not as much pressure on her or him to achieve results as measured on a variety of questionnaires.
…I also wonder if therapists in community care being overwhelmed with patients (high caseloads) may have something to do with their lesser performance.
The EBT therapists generally got extra training and supervision whereas the usual care therapists were on their own. So what we can take away from this is that well-trained therapists with small caseloads and tons of supervision do better than some combination of case management and/or overloaded therapists performing treatment without supervision. Hopefully the EBT crowd will see the results for what they are instead of proudly (but wrongly) proclaiming superiority over a legitimate alternative form of treatment. I’m pretty sure that non-EBT psychotherapies administered with the same advantages EBT had in terms of training, supervision, and low caseloads would also prevail in a contest with bogus therapy.
I know this is long, so one more quick endorsement of A Closer Look, the post called The Doctor is more Important than the Pill about a study of 112 depressed patients, shows
the amount of improvement in depression scores (both self-reported on the BDI and based on the HAM-D interview) indicated greater effects for the psychiatrist than the medication or placebo itself.
And this is news. No it’s not! But it has to be said and done over and over, we just re-gain ground that we thought we covered decades ago. Why this should be true in so many realms of life is a post for a more paranoid mood, for now am off to work the next three days and will be back here Friday with an even longer post, a very cool conversation between two mad pride consumer-survivors I got permission to re-publish here in its entirety. Meanwhile stay true to your school and have a good week.