Sunday, November 30, 2014

Welcome to the Circle Jerk: My Response to the Mental Elf's Critique of Understanding Psychosis


Last week the the British Psychological Society released a very important work that I highly recommend,  Understanding psychosis and schizophrenia: why people sometimes hear voices, believe things that others find strange, or appear out of touch with reality, and what can help. The Mental Elf website posted a three-part review; here are my comments (currently "awaiting approval" now posted on that website):
and schizophrenia: why people sometimes hear voices, believe things that others find strange, or appear out of touch with reality, and what can help’. - See more at: http://www.thementalelf.net/treatment-and-prevention/medicines/antipsychotics/understanding-psychosis-and-schizophrenia-a-critique-by-laws-langford-and-huda/#comment-448951
 British Psychological Society Division of Clinical Psychology entitled ‘Understanding psychosis and schizophrenia: why people sometimes hear voices, believe things that others find strange, or appear out of touch with reality, and what can help’. - See more at: http://www.thementalelf.net/treatment-and-prevention/medicines/antipsychotics/understanding-psychosis-and-schizophrenia-a-critique-by-laws-langford-and-huda/#comment-448951

I can think of no worse disrespect to the authors of Understanding Psychosis than the haste and superficiality of thought driving this largely shallow critique. If this website wanted to have a dialogue that improved the quality of care provided to users of mental health services, this was certainly no way to get there.
Understanding Psychosis is a fine compilation of resources and valuable analysis for building and supporting the health, agency and options for service users/patients, their families, and the professionals who provide mental health services. At its center is the primacy of patient/service user agency, respect, and health.
Unlike your critique, Understanding Psychosis provides readers with tools that serve more than symptom alleviation, an important, but rather low, standard. We are more than symptoms—and the solutions on offer frequently cause horrific, life-threatening problems (mentioned only in passing here). Often referred to with that minimizing term—“side effects”—these all-too-common results of pharmaceutical intervention (tongue thrusting and jaw-gurning, mounting anxiety and akathesia, the deadened sex drive, massive weight gain, somnolence, and iatrogenic sickness) too often occupy the center of a life.
Your commentators’ remarks are disappointing in a number of ways—for both potential users of Understanding Psychosis, and because they fall far short of your vaunted scientific objectivity and high evidentiary standards. (We would all have been put right from the beginning if they’d simply written: “We don’t have any idea about most of the material in this compilation, so don’t expect more than a glancing mention of anything except the things that offend us.”)   
The question that immediately springs to mind is: Who and what was served by posting this incomplete, opinion-riddled, and error-challenged critique? As Bell notes, Langford, for example, ‘mischaracterises’ a study (oops--wrong population!) that is the foundation of his criticism. He then spends a chunk of time on his opinion about the drug-centered approach—which must be wrong, you see, because it doesn’t match his experience. (And then, to defend himself on both counts, uses a version of “Well, it *was* er, incomplete--but I had to have something so I could pile on with the other boys!”) This, Mental Elf, represents your high evidentiary standards?
Law’s criticisms of the CBT research seem to be the only one of significance; I imagine they will be useful to the authors. Note, of course, that the CBT section is a very small part of this work.
Point-scoring (and I am, of course, echoing some of @BipolarBlogger’s post on this topic) was the purpose of this critique, and only that. There was little (if any) interest in being of help to service users, other mental health professionals, and certainly not the Understanding Psychosis authors.
If that desire had been paramount, this site, for example, would also have engaged the participation of a reviewer in an allied health field to comment on the document, and certainly one or more service users. At the very least, you would have fact-checked the post.
(It has been both alarming and instructive to see the big, jostling crowd that has come to join in on this assault; it has become a veritable circle-jerk, complete with gleeful howls and crowing. When the Mental Elf, based on comments in his Twitter timeline, attempted to procure Eleanor Langdon’s contact information to draw her into this mess, I could not help but wonder why he would expect her to come and lie down in this bed he’d made. That would be crazy.)
Full disclosure: I follow and have exchanged social media messages and information with the editor and several of the Understanding Psychosis contributors. I particularly hold Jacqui Dillon, Anne Cooke, and Rufus May in high regard. I have also had one expletive-filled response from Laws to a question I asked him via Twitter.

2 comments:

  1. Angela thanks for your blog post.

    I'm a believer in the content and approach written of in the Understanding Psychosis report because I've never believed in the biomedical model of mental illness since a 17 year old girl seeing my mother in a locked psychiatric ward. My mother experienced altered mind states due to life stressors and didn't deserve the forced ECT then the lifelong depixol injection until her death at age 68 in 1998.

    I didn't believe it when they tried to pin the label on me in 2002 and managed to break free. However in my family some of us do accept the mental illness label and that the psychiatric drug treatment is helpful. They find the support of mental health professionals positive, even if the treatment wasn't always gentle or kind. I feel differently but try to respect their viewpoint.

    What bothered me about this report was that I don't think it will "convert the unbelievers", those who are firmly behind biological psychiatry, who think it's genetic rather than generational, in the brain rather than in the mind. I think it has the potential to cause greater division and entrenchment. Polarised opinions as a psychiatrist colleague described it. Them and us. The "in crowd" and those outside the circle.

    Plus it was under the British banner but no Scottish people were involved in the writing of it, on either side of the "experts by experience" fence. I felt left out because of there being no Scottish voice represented. It felt like alienation and I didn't like the feeling so tweeted about it:
    https://storify.com/ChrysMuirhead/is-it-not-the-british-psychological-society-as-in

    So in a sense I'm critical of the report yet a believer in the content. Divided. Yet rather than being divided I want to see a broad church in psychiatry and room for a variety of beliefs without us all coming to blows over our differences. Let the survivors speak out and the service users have their say. I was a runner from psychiatry while others ran to psychiatry. Force can't be the answer to differences of opinion. In my opinion.

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    1. Chrys,
      First, my deep and sincere apology for not posting and responding to this sooner. I have no excuse other than not knowing you'd commented--clearly I need to change a setting or two on this blog of mine.
      Second, thank you so much for taking the time to comment. I much appreciate hearing from you, about your experience, and that of your family.
      Like you, I don't think this report will convert the "unbelievers," but I don't think that was part of it's purpose. It is a rich document and quite ground-breaking in a number of ways and yet--like any creation--it has shortcomings. You note one--the lack of Scottish participants--and certainly there are others. I believe that the editor and contributors have learned much from this experience, and I look forward to the next edition.

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