Cutting Edge Psychology
Cutting Edge Psychology presents regular updates of reseach in psychology and the health field in general, with a particular emphasis on studies and views which relate broadly to chronic pain and closely associated topics. Readers are invited to offer their views of the topics and information presented, and to enter a dialogue if interested.
|Posted on March 25, 2015 at 12:20 AM||comments (614)|
We live in a culture which is in a state of denial about the endemic nature of trauma. Instead, we have had decades of marketing branches of big pharma telling us that emotional problems are the result of aberrant brain chemicals (which obviously require their drugs to 'balance'). Why is our culture so reluctant to acknowledge trauma? Part of must be to do with the remnants of British Victorian era stoicism (which probably resulted from upper class kids being brutalised and sent off the boarding schools at young ages- these kids ended up running society and setting the overall tone of what is 'normal'). And highly relevant to the centenary of WW1, it became apparent during the war that most men were adversely affected by mass murder in the trenches. Initially, the military and government were curious about "shell shock", however, as the numbers of victims reached into the millions, governments/military decided to shut down the discussion, fearing the risk of a massive compensation bill. They turned their backs on the psychological victims of industrialised warfare- and as a culture, we were meant to deny and suppress trauma as well. This changed in the aftermath of the Vietnam war, which coincided with larges scale social changes such as the counter-culture movement, and the womens movement- we became more open to other people's suffering, and the extent of suffering in the Vietnam vet population was undeniable (it is a fact that more American vets suicided after the Vietnam war than were killed there). As such, the study of trauma began relatively recently. Emotional/psychological/psychiatric problems do not result from aberrant brain chemicals, or dodgy genes. These are myths that have been popularised by the marketers of big pharma purely for money. People suffer from bad treatment, especially when inflicted during childhood. We want a sane world? look after the kids.
|Posted on March 25, 2015 at 12:10 AM||comments (19)|
Goping crazy is one of the main fears which people report to having. Popular culture tells us that hearing voices is an indicator of serious mental disorders. However, the evidence suggests that not even hearing voices is a sign of being crazy- most of us have this experience, most of the time. When voices are experienced as problematic and/or troublesome, then this indicates a need to tune into what it may mean, rather than just drugging it out of awareness. It will often reflect traumatic experiences which require acknowledgement and perhaps genuine therapeutic work.
|Posted on March 25, 2015 at 12:05 AM||comments (29)|
Conventional psychiatric wisdom suggests that experiences covered under the term psychosis (eg. hearing voices and other hallucinations, appearing out of touch with 'consensus reality', experiencing things in different ways, etc) result from brain disorders- genetically determined aberrations in various brain chemicals. This has been a hypothesis for many decades, and despite vigorous efforts to find either a 'mental illness gene' or any guilty neurotransmitter, even just one reliable biological marker of psychosis has remained elusive.
This inconvenient fact has not stopped psychiatry (ably assisted by the big pharma) from marketing a range of powerful 'anti-psychotic' drugs as the main treatment approach to psychosis. These drugs are more appropriately called major tranquilisers, and are effective in simply stopping the brain from functioning, depending on dosage levels. This has been effective in controlling 'positive symptoms' of psychosis (eg. agitation, acting on delusions, etc), but does nothing for the much more common 'negative symptoms' of psychosis, such as fear and anxiety, social withdrawal and isolation, loneliness, etc. In addition, the drugs have been demosntrated to cause permanent brain damage, with Parkinson-type symptoms as well as general brain dysfunction- called Tardive Dyskenesia. Unfortunately, these damaging effects are inflicted upon people (most likely to be poorer than wealthier people) due to a social need to control unsettling behaviour in others, and on the basis of hypothesis which have no support in evidence. There are also thousands of Australian primary school aged children who are placed on these drugs each year.
A recent report from the UK argues that the psychiatric model for making sense of psychosis (ie. gene and biochemical theories, and associated labels and drugs) actually gets in the way of effectively helping people who are struggling with these types of problems. What causes these problems to begin with? Trauma has been demonstrated as a major factor, but for any particular individual, the key is to sit down and ask them. That is, to treat such people as human beings. I am reminded of some other British research which showed that successful interventions with 'psychotics' followed from asking "What are we going to do with you?" in a friendly manner- and then listening to their answers.
Another corner-stone of the psychiatric treatment of psychosis is that the person should develop good 'insight'- this simply means that s/he should come to view him/herself as 'sick' and requiring psychiatric treatment. Again, the evidence suggests that no such submission to psychiatric opinion is required for a person to get better. I have worked with many people over the years who have been given just about every possible psychiatric label- only to find when i met them that they were just a human being. And being treated as a human being (rather than as a fallicious disease entity) appears to be required to get better.
read the report at:-
|Posted on October 10, 2014 at 4:55 PM||comments (24)|
This week has seen my favourite broadcaster, the Australian Broadcasting Commission (ABC), run a range of discussions and programs to coincide with mental health week. in Australia We have been inundated with the statistic that nearly 50% of the population are suffering from one form of mental illness or another. I can’t help but wonder what are the motives behind such an alarming (and alarmist) statement? Does it actually reflect reality, rather than reality bending driven by big-pharma who are seeking more and more customers? Or is it a desperate attempt for public sympathy and relevance by the ABC to withstand budgetary and ideological attacks from a hostile government? Is one in every two of us really mentally ill? Surely this statement requires some analysis.
It is just two years since the death of civil libertarian psychiatrist Thomas Szasz, and it appears that his basic message (see 'The Myth of Mental Illness') again needs restating. Psychiatry, a profession now almost entirely dependent on funds from big-pharma, has been pushing back the definitions of mental illness for decades. The latest edition of the Diagnostic & Statistical Manual (the DSM- psychiatry's ever growing list of 'mental illnesses') attracted howls of criticism long before it was published, with former contributors warning that it had been rendered useless due to its apparent desire to define an ever increasing amount of human experiences as ‘illnesses’. While the net of what is captured under the term ‘mental illness’ has been broadened to the point of absurdity, it will come as a shock for many to learn that there is still no consistent neurological basis demonstrated for even the major ‘mental illnesses’, such as schizophrenia, bi-polar disorder, major depression, etc, let alone the raft of other human experiences which are now described as illnesses. Further, there are still no proven genetic bases for what are presumed to be ‘mental illnesses’. This reality stands in stark contradiction to the claims which psychiatry has maintained for decades that ‘mental illnesses’ are brain disorders (with genetic predispositions) and are comparable to any other medical condition.
One of the essential points Szasz made is the fact that medicine already has a speciality dedicated to brain disorders, ie. neurology. If a brain basis to ‘mental illness’ is ever found, this will simply result in an addition to the list of neurological disorders and a reduction from the list of ‘mental illnesses’. As such, what are referred to as ‘mental illnesses’ by psychiatry are essentially human experiences for which no neurological basis in known.
The term ‘mental illness’ is merely a metaphor. However one wants to define the ‘mind’, whether one be a materialist or idealist, a dualist or monist, the term does not mean brain. Materialists refrain from the serious use of the term ‘mind’, and instead prefer to acknowledge only the reality of the brain. If they use the term ‘mind’ at all (as in Ian Hickey’s Brain & Mind Research Institute), they are using it metaphorically as a concession to a public which is not ready to concede the unreality of the ‘mind’- what they really mean is the brain. As opposed to psychiatrists, it is more likely to be some philosophers and psychologists who still use the term mind in any genuine manner, to refer to an aspect of the human organism and functioning not synonymous with the brain.
What is it that is 'ill' in ‘mental illness’? The ‘mind’? However the mind be conceived, it is not a physical entity. As such, ‘minds’ can only be viewed as ill or diseased in the same way that an economy or a joke can be seen as sick, ie. metaphorically. No one suggests that a joke can be made healthy via the administration of drugs, as that would be straining the metaphor beyond a workable limit. Yet, this is precisely what psychiatry (and the ABC) are doing- treating a metaphor as a literal reality. None of this is to say that many people who are called ‘mentally ill’ are not experiencing very real problems in living (although not all of them are upset by their beliefs and circumstances). I am only disputing how we are to make sense of their experience, not that their experience is real.
If the use of the term ‘mental illness’ were only a case of poor semantics, it would hardly matter. However, what follows from the use of this medical metaphor for human problems in living is both the forced incarceration and treatment (an invasion of civil liberties which is usually not permissible within criminal law), and the neurological damage which can accrue to people from the physical treatments of psychiatry. Stigma is another inevitable and damaging consequence for people whose identity has been ruined by labeling. Stigma is the inevitable consequence for a categorical way of classing human beings- you are either mentally ill or mentally healthy. The reality is that what are referred to as 'mental illnesses' are usually human responses to adverse experiences which differ only by their degree, not by kind. As long as psychiatry sticks with its categorical view, humanity is divided between the 'ill' and the 'healthy'- rather than seeing the common humanity between all of us. A dimensional approach (barely affected/moderately affected/extremely affected) has a far better chance of not resulting in stigma.
Most of us are aware of psychiatric disaster stories, such as the ‘deep sleep therapy’ of the Chelmsford Hospital in Sydney, wherein many psychiatric patients were killed (several of whom were pregnant to the chief psychiatrist). Or the primitive forms of psychosurgery in which the patient was partially murdered the by destruction of their personalities and memories, changing their sense of self. But how many people are aware of the permanent neurological damage caused by equally destructive modern approaches to psycho-surgery, or to people on anti-psychotic drugs (Tardive Dyskenesia)? Or that an ever increasing amount of Australian children are being put on these drugs each year- this includes primary school aged children. What does Patrick McGorry intend to do with those who his early psychosis detection centres identify as being susceptible to psychosis? Contemporary psychiatry offers nothing other than psychiatric drugs (not entirely true- psychiatry is still enthusiastic for ECT, which simply kills off enough brain cells so the person temporarily forgets what was depressing them).
British professor of psychiatry, David Healy is in no doubt that the skyrocketing of suicide rates in the Western world over the last 30 years is not just a random fluctuation, but has followed the radical increase in prescription of SSRI antidepressants (and he cites compelling statistics in support of his case). The list of well demonstrated brain damage from psychiatry goes on. Suffice to say that the breadth and range of well argued critiques against the widespread use of psychiatric drugs is too large to be detailed here.
The medical model requires that we talk in terms of ‘illnesses’- rather than being a reflection of psychological reality, this is merely a convention of language within the medical world. But is this sufficient reason to use the same language, or is it incumbent on psychologists to be ‘cleaner’ with our use of language, given what we know of the many serious consequences when medical language is applied to psychological phenomenon? While some psychologists have always seen themselves as vassals to psychiatry (adopting both its language as well as its world view and assumptions), most psychologists have found it difficult to both speak and think in psychiatric terms. Being social scientists as much as we are behavioural scientists, we simply know too much about social learning, the power of contexts, cultural/social/political differences, the history and philosophy of science and the sociology of illness/medicine/treatment to play dumb. How can we blindly resort to still unproven (in fact, largely discredited) theories of serotonin deficiencies when we are well aware of Seligman’s theory of Learned Helplessness of depression? How can we ignore what superficial psychiatric scrutiny of a person does to distort perception when we know of Rosenthal’s study of ‘Being Sane in Insane Places’? How can we settle for simplistic chemical imbalance theories when neuroscience is telling us how complex the brain is? How can we use psychiatric terminology when we know of studies which show that the label applied to a person’s suffering has no positive impact on the outcome of the intervention? Are we really able to maintain a silence when we read of research which demonstrates the brain damaging effects of antipsychotics, minor tranquillisers, antidepressant drugs, mood stabilisers, and ADHD drugs? How do we ignore our knowledge of the placebo effect, as it has been well demonstrated with such drugs? Can we really ignore what we know of damage to sense of self for people who have psychiatric labels applied to them, or the damage to self-efficacy for people who have been ‘saved’ by physical interventions extraneous to themselves from which they develop no life skills or valuable learnings?
These are the problematic issues which I think of whenever I hear the non-sense statistic that 50% of us suffer some form of mental illness. Yes, we know that there is suffering in the world- but clearly, not all suffering is evidence of a medical/psychiatric condition which requires chemical ‘correction’. Racism, unemployment or overemployment, sexism, abuse of children, and poverty all cause psychological suffering. We already know this. As psychologists, we need to stand confident in the wisdom of our own discipline and resist the invitations to join the great psychiatric enterprise of chemically altering an ever increasing chunk of humanity. Psychiatry is terminally joined to big-pharma. Psychology is not. Our language needs to reflect the humanities legacy of our discipline, and reject the promise of status from adopting the medical model. Disease mongering is alive and well- soon, there will be no form of human distress not considered an illness. I expect more from the ABC, which is staffed by smart people who have been able to use their critical thinking skills with a broad range of issues in the past- why not with this issue?
|Posted on September 3, 2014 at 1:45 AM||comments (26)|
ADHD is casused by out of control brain chemicals- that is why drugs are given to kids, right? Well- no, actually. Despite the stunning success of drug companies in selling this hypothesis to not just the medical profession, but also to society at large, there is scant evidence in its support. Parents and schools, often pushed to the brink of their ability to cope by difficult behaviour from children, are very eager to believe that the child is suffering from aberrant brain chemicals- the drugs often do subdue the child's behaviour, at least initially. However, the fact that drugs change behaviour does not mean that the pre-drugged behaviour was a medical or psychiatric condition, resulting from chemical imbalances in the brain. Alcohol changes behaviour, often making one more gregarious and confident- does this mean that sobriety is a psychiatric condition which is treated by the introduction of alcohol? Clearly not, but this is the dodgy logic used by the medical model when applied to children's difficult behaviour.
So, what does seem to cause such behaviour? Research recently reported from the UK, following a sample of 19,000 children over many years, has clearly demonstrated that the behaviour which attracts an ADHD label is highly correlated with poverty, the young age of mothers, and the relationship status of parents (single or together). What these results suggest is that the children of parents who are struggling to cope with their lives, perhaps due to poverty, young age or doing it on their own, are more likely to behave in erratic and difficult to manage ways. As no experiment could ever be done with this issue, which may indicate causes of 'ADHD', the best we can do is to look at the correlations. As correlation does not prove causality, is it possible that rather than these characteristics of the parents 'causing' the ADHD of their children, the behaviour of the children 'cause' the factors in their parents, ie. poverty, young age, relationship status? Although the answer is obviously a 'no', the linked research clearly shows that this is not the case. This only leaves the possibility that parental coping (influenced by factors such as poverty, age and relationship status) is the key factor in subsequent children's behaviour. The implication is obvious- ADHD is not a medical or psychiatric condition, but a social-political one, effecting those in the least resourced and powerful positions in society. Drugging such children for their challenging behaviour is simply chemically altering the consequence of social-political inequality. Children's brains are adversely effected by the drugs- there is evidence of long term harmful consequences. Is this the way a civilised society should be treating its most disadvantaged?
|Posted on September 3, 2014 at 1:10 AM||comments (42)|
In the final chapter of 'The Hidden Psychology of Pain', i discuss the importance of the psychological sense of time, and being in the present moment. When pain has become chronic, expectations of it always being there become well entrenched- this is not neurotic, but is based on one's experience up to that point in time. As with any unfavourable circumstance, we tend to build a narrative or story around the experience. It usually has three components:- our current experience (i am in pain now); our past experience (i have been in pain for two years); and a future prediction (based on past and current experience, i predict that i will be in pain tomorrow). There are many problems with this natural way of joining the past, present and future. One of the main problems, when doing this in regards to pain, is that the anticipation of pain is often worse than the experience of being in pain now. Our ability to cope with adversity in the present moment results from a combination of both the current situation (including the resources and limitations inherent to the situation) and who we are in that particular moment. Solutions to problems, to the extent that they can be found at all, result from this combination. If i have a flat tyre that needs changing, the situation itself will have resources in it (eg. a wheel brace and jack in my car) as well as limitations (my spare tyre is flat).The solution to the problem then results from a combination of the situation and me in that situation (eg. i know how to use a wheel brace and jack,or how to get help with it). Solutions to problems do not occur without 'me' (the relevant person) being in the situation. As such, when we anticipate problems, because we are guessing about a future event which is not yet happening, 'we' are not yet in the situation itself. As such, no solution to the problem is possible as a major component of a solution ('the person) is not actually yet in the situation. When seriously considering an unsolvable problem, anxiety is often experienced as we tend to feel helpless in relation to it.
It is the same with chronic pain. When we anticipate being in pain tomorrow, there is nothing we are able to do about it in terms of coping, simply because we are not yet in tomorrow in order to be able to cope with it- we can only cope now, not in some time in the future. Coping is not yet possible. As a result, we tend to dread tomorrow (if it is a bleak possibility we are thinking about). Researchers have demonstrated experimentally that the anticipation of pain is worse than the actual experience of pain. The story that we tell ourselves is very important.If our story is full of expectations about being in pain (e.g i will not enjoy my child's wedding because i will be in too much pain to actively participate), then we are adding additional layers of psychological distress. This can have the effect of exacerbating the existing pain.
While being 'mindful' is not the magic bullet to pain which its advocates suggest, there is value in cultivating an ability to simply remain with what is- not with what might/might not be. We can generally cope with 'what is'- we may not like it, but we rarely ever die or psychologically fall apart because of adversity (i am aware that this does happen sometimes, but usually not). Every moment is different from the last. Any guess we make about the next moment is just that- a guess. All scientists know that guesses, or hypotheses about the future are only ever discussed in terms of probabilities- things that may or may not happen. It is a reasonable hypothesis that if i hit this particular button on my key board, the corresponding letter will appear on the screen. But is it an absolute certainty? Any number of electrical problems could occur to stop this result from happening, so the hypothesis can only be stated with, for example, a high degree of confidence like 99%. It is the same with chronic pain. Every new moment is different. We may be convinced that the next moment will involve the same amount of pain as the last, but variations in an individual's experience of pain argues against this. The fact is that we never know what the next year, month, week, day or even moment will bring us. As long as we are convinced that it must include unmanagable pain, because thats what the last moment gave us, then we are adding to our burden of psychological distress and this is likely to have a worsening impact on our pain. This theme is discussed more in the final chapter of 'The Hidden Psychology of Pain', and research demonstrating the deleterious effects of pain anticipation is discussed in the linked article.
|Posted on September 2, 2014 at 1:40 AM||comments (17)|
How real is the 'unconscious mind'? In 'The HIdden Psychology of Pain', i state that the brain is able to perceive an eight hairy-legged object moving in our peripheral field of vision and react to it with alarm, even if we have no conscious awareness of there being a large spider near us. This phenomenon demonstrates that much of what goes on within the brain occurs at a level for which there is no knowledge- some neuroscientists suggest that as much as 98% of brain functioning is largely unconscious. It appears that our conscious awareness is merely a very handy tool, devised over many eons of evolution in order to scan the environment for danger. It can be thought of as something like the light cast by a torch on a dark night. The focus of attention will be brought into high relief, however the rest of the night's darkness will remain un-illuminated. It is clear that at any one time, we are only consciously aware of a certain amount of stimuli which is hitting our sensory apparatus and creating an impact on our brain. Conscious awareness is no doubt an extremely handy tool, and if our ancestors didnt possess it, we wouldnt be sitting here now thinking about it. But, as evident from current neuroscience, we are much more than just our conscious awareness. It is somewhat ironic that our sense of self, what to me makes me 'me', is largely derived from this pretty handy tool, even though it is only a small portion of what is going on within us.
The following article discusses some of the current research which demonstrates how unconscious much of our perception is.
|Posted on September 2, 2014 at 1:20 AM||comments (22)|
In 'The HIdden Psychology of Pain' I make a case for the relevance of early life experiences, such as trauma, and the experience of chronic pain in adulthood. Apart from being a plausible sounding theory, there is plenty of research evidence which demonstrates this link- childhood trauma is way over-represented in the chronic pain population. While the 'pain industry' (eg. medicine, physiotherpay and a range of other physical treatment approaches) state that chronic pain results from structural pathology of the body (or more honestly admit to not knowing why people experience chronic pain), the reasons for this affliction become less mysterious when the relevant research is taken into account. Childhood trauma, resulting from experiences such as sexual abuse, violence, high levels of family conflict, bullying etc, leaves a psychological 'scar' on a person which tends to reverberate throughout the person's life. Chronic pain is often an attempted solution which is unconsciously generated in order to address what is perceived to be an even greater problem- this can often be the reverberation of psychological trauma. With the aid of current research evidence, the reasons for chronic pain are not especially mysterious and puzzling. Usually, we need to only look at a person's experience of life- often, their childhood experiences, and how the residual trauma is being triggered by an aspect of their current life experience.
The following article details some of the relevant research on the association between childhood trauma and chronic pain.
|Posted on July 15, 2014 at 11:40 PM||comments (7)|
In The HIdden Psychology of Pain, i dedicate a chapter to problems relating to sleep as this is often a major side effect of chronic pain. There are many things which people can do to improve their quality of sleep, and these are detailed in the book.
But how important is it to get good sleep? Researchers in the UK have recently demonstrated the psycological harm which can accrue to people who are deprived of even one night of sleep. Subjects in the research study began to show psychological symptoms that were similar to schizophrenia after only 24 hours of sleep deprivation. As stated in my book, it appears that the psychological benefits of sleep arise from the stae of sleep which is associated with dreaming- the Rapid Eye Movement (REM) stage of sleep. Other research has demonstrated that when people are able to get all the stages of sleep other than REM sleep, they begin to suffer psychologically, even though that may have obtained enough non-REM sleep in order to still function.
Our culture is essentially REM deprived. All substances which effect the central nervous system , eg. alcohol, cannabis, sleeping tablets, anti-depressant drugs, inhibit our brain's ability to engage in REM sleep. In terms of alcohol, a person need only have as little as two standard drinks to have their REM sleep heavily curtailed. On average, Australians consume around 15 standard drinks of alcohol per week, meaning that the average Australian is inhibiting his/her capacity for REM sleep. Around one in twenty Australians are on anti-depressant drugs, some of which inhibit 100% of REM sleep, with others inhibiting less amounts. As such, it appears that most people are simply not getting enough REM sleep, so important for psychological well-being, even though they may be sleeping 'enough' hours per night. When you consider the research (see link below), this is frightening. Not many of us will be so sleep deprived that we are propelled towards psychotic-type symptoms, but it appears that many, if not most of us are REM sleep deprived enough to be causing us psychological problems.
|Posted on July 10, 2014 at 6:25 AM||comments (5)|
Memory reconsolidation is a phenomenon of neuro-plasticity, or the ability of the brain to change itself. This capacity is good news for people who suffer from all sorts of psychological problems, as it creates the possibility of erasing the cognitive and emotional aspects of such problems while leaving the autobiographical memory intact. Coherence Therapy is an example of a psychotherapeutic approach which overtly and deliberately attempts memory reconsolidation, while many other approaches, such as EMDR, Gestalt psychotherapy, Hakomi, Emotion Focused Therapy to name a few, often result in transformative change which has occurred as a result of memory reconsolidation that has been triggered by the therapy. (See my artlcle: 'Inside EMDR', under the EMDR button on the home page for a more lengthy discussion).
In order for memory reconsoldiation to be launched, the target memory or experience needs to be reactivated. Then, a form of experience which stands in stark contradiction to the reactivated experience must be presented. It was only in 2004 that neuroscientists established that memory reconsolidation was a phenomenon which could occur in humans via behavioural means- until then, research had demonstrated its possibility via chemical means. The following research, conducted on mice, is exploring the possibility of memory reconsolidation of pain memories, and pain hypersensitivity which results from exposure to painful stimuli, via chemical means. Although the research is at an early stage, and working with non-human subjects, it does show the incremental nature of scientific endevours. It is quite possible that given a few more years of research, the research may be extended to humans; and then to behavioural/psychological means of addressing chronic pain via memory reconsolidation. In the meantime, Coherence Therapy regularly achieves excellent results with the psychological/emotional issues which often 'drive' chronic pain, resulting in resolution of pain. Perhaps the eventual goal of such neuroscience research is already with us?