Later On

A blog written for those whose interests more or less match mine.

Archive for the ‘Medical’ Category

Are the Republicans giving up on killing Obamacare?

leave a comment »

Here’s why they might:

blog_obamacare_gallup_republicans

That’s from a good post by Kevin Drum that indicates that at least some Republicans think that the Obamacare fight is over, and the general public won. Worth reading.

Written by LeisureGuy

18 April 2015 at 1:01 pm

Posted in GOP, Government, Healthcare

The origin of Lufthansa’s blind spot about mental illness among pilots

leave a comment »

The NY Times has an interesting article by Nicholas Kulish and Nicola Clark about how a suicidal man was allowed to pilot a plane containing 149 people. The comments also are interesting. A few of the comments:

Henry Pinsker – Hackensack NJ

We will never understand the problem if we continue to couch discussion in terms of depression and suicide. The individual who straps on an explosive belt ends his life, but his objective is murder. His own death is collateral damage. Anger and paranoia may be important in determining which depressed person (a common problem) will commit mass murder (a rare event). These words do not appear in the article.

Carlo 47 – Italy

As defined by the Herder’s and Fichte’s original nationalist theories, Germans must defend firmly their ideas for love of national culture, otherwise they cannot fulfill the mission which history entrusted them as uncontaminated people.

Germanwings and Lufthansa will therefore never admit free-willingly their full responsibilities.

Not because they don’t know them, but simply because as Germans they cannot fail or admit to have failed by definition and national proudness.

dcl – New Jersey

This has nothing to do with ‘pilot suicide’ and I’m bewildered why the media continues to frame it in this way. 9/11 wasn’t framed as “pilot suicide” and neither should this; and if this man were a Muslim, I have no doubt the media would be talking about terrorism. At the very least, this is mass murder.

Pilots and all human beings deserve support for mental illness, but to conflate this with this mass murder is disingenuous at least and dangerous at worst. I think the motive to do so is complex and involves the desire for easy fixes. If only we had proper mental healthcare and the ability to fire anyone we wanted who had a whiff of mental illness, this wish goes, no pilot would be able to murder hundreds. In this way, by framing this as suicide rather than murder, you shrink the problem to an clinical office visit and a couple of pills and a check mark in a box.

The reality is that you are determined to murder hundreds of innocents that cannot be prevented in a psychologist’s office. Tragically, mass murder can happen anywhere in any number of scenarios.

Better communication is important but there are many depressed or otherwise ill people who are in positions of authority all the time. I think in the urge to find a simplistic ‘solution’ we will ironically cause pilot morale to plummet even more, which in turn will screen out qualified applicants, exactly what we don’t want.

C. Sparks – Nashville, TN

2 quick items:

1) In re: first photo caption— not to be obtuse, but those are not “rescuers”. They are recovery workers. Clearly, this was never a “rescue” operation.

2) What are American profilers, like Cliff Van Sant, concluding, as to mass murder v. suicide? Do the Germans have the equivalent of the BAU or New Scotland Yard, to address this, from a Germanic ethnic/cultural POV?

rude man – Phoenix

Airlines couldn’t care less about their passengers. Leave us sitting for hours stranded on the tarmac with no a/c, overflowing toilets, etc. Continually reducing seat space year after year. Canceling flights at the last minute if they’re not completely filled to sardine capacity. And now refusing to even enforce seat reservations. And you expect them to ensure our safety by spending money on medical background checks? What a laugh.

This situation will continue to deteriorate until the airlines are re-regulated, with fares controlled and high enough to enforce competition for safety, comfort and schedule adherence rather than the lowest price.

Milo – Dublin, Ireland

Pilots are like all of us, subject to flaws. It’s been well known for years that many have problems with alcohol. Long haul layover, where do you hang out? Hotel bar. It’s been brushed under the carpet because the consequences are too difficult to deal with.

The article itself begins:

When Andreas Lubitz sent an email in 2009 seeking reinstatement to Lufthansa’s flight-training program after a months-long absence, he appended what in retrospect was a clear warning signal about his fitness to fly passenger jetliners: an acknowledgment that he had suffered from severe depression.

Lufthansa put the young German back through its standard applicant-screening process and medical tests. But it did not, from everything known about the case so far, pursue any plan to assure that he was getting appropriate treatment. Nor did it impose special monitoring of his condition beyond that required for any pilot who had a flagged health issue.

Instead, Mr. Lubitz haltingly made his way through the training program and ultimately was entrusted as an Airbus A320 co-pilot for Lufthansa’s low-cost subsidiary, Germanwings. Lufthansa was so unaware of the extent of Mr. Lubitz’s psychological troubles that the company and its medical staff had no idea of the tortured drama playing out in his mind, peaking in the two or three months leading up to his final flight. Investigators told The New York Times that he visited a dozen or more doctors as he frantically sought treatment for real or imagined ailments.

In the days just after Mr. Lubitz, 27, flew himself and 149 other people into a French mountainside last month, Lufthansa’s chief executive confidently pronounced that Mr. Lubitz had been “100 percent“ fit to fly, highlighting how little the airline knew of the pilot who shook confidence in the company’s reputation for training and management rigor.

Mr. Lubitz’s journey to the moment when he found himself alone at the controls of Germanwings Flight 9525 from Barcelona to Düsseldorf on March 24 exposes a series of failures and weaknesses at Lufthansa and throughout the industry and its regulators in dealing with mental illness among pilots. And it shows how little the industry and its regulators have done to acknowledge and address the most extreme manifestation of those psychological strains: pilot suicide.

Mr. Lubitz’s increasingly troubled behavior in the period leading up to his final flight raised no alarms at the airline.

Although he had passed his standard medical exam by a flight doctor last August, he had more recent notes from specialists declaring him unfit to work that he never shared with his employer.

In the days before his final flight, he seems to have methodically plotted his own demise and that of his passengers. He researched methods of committing suicide, investigators say, and looked into cockpit security procedures. When he left for work on the morning of March 24, scheduled to fly from Düsseldorf to Barcelona and back, his iPad browser, according to one investigator, still had tabs open about two recent airline disasters. They were the mysterious disappearance last year of Malaysia Airlines Flight 370 and a Mozambique Airlines flight in 2013 in which the captain was found to have intentionally crashed in Namibia, killing himself, five other crew members and all 27 passengers.

“The airline management, the supervisors, the dispatchers — they do not see the pilots very much,” said André Droog, a former psychologist with the KLM Flight Academy in the Netherlands, who is now president of the European Association for Aviation Psychology. “It puts a lot of responsibility on the individual pilot to be responsible and self-critical and to manage their lives very well.”

Lufthansa had, at most, only a partial sense of the severity of Mr. Lubitz’s condition and how long he had been dealing with it.

Information about Mr. Lubitz’s history remains sketchy, but there is evidence that his psychological problems were well established by the time Lufthansa was training him to fly. Just days after Lufthansa’s chief executive, Carsten Spohr, vouched for Mr. Lubitz’s flightworthiness, German prosecutors disclosed that Mr. Lubitz had exhibited suicidal tendencies and been treated by psychotherapists over a long period before earning his pilot’s license. . .

Continue reading. It’s a lengthy article and worth reading.

Written by LeisureGuy

18 April 2015 at 12:57 pm

When conviction and desire override evidence: Beriberi in the Japanese Navy of the 19th century

leave a comment »

I was just reading (or, more accurately, re-reading) a passage in Timothy Wilson’s Strangers to Ourselves, that gives some insight into the Japanese military bureaucracy’s resistance to accepting a proven solution to a serious problem. Here’s the passage:

The adaptive unconscious is not governed by accuracy and accessibility alone. People’s judgments and interpretations are often guided by a quite different concern, namely the desire to view the world in the way that gives them the most pleasure—what can be called the “feel-good” criterion. Jane Eyre observed this motive in her aunt, Mrs. Reed, when she visited her on her deathbed: “I knew by her stony eye—opaque to tenderness, indissoluble to tears—that she was resolved to consider me bad to the last; because to believe me good would give her no generous pleasure: only a sense of mortification.”

One of the most enduring lessons from social psychology is that like Mrs. Reed, people go to great lengths to view the world in a way that maintains a sense of well-being. We are masterly spin doctors, rationalizers, and justifiers of threatening information. Daniel Gilbert and I have called this ability the “psychological immune system.” Just as we possess a potent physical immune system that protects us from threats to our physical well-being, so do we possess a potent psychological immune system that protects us from threats to our psychological well-being. When it comes to maintaining a sense of well-being, each of us is the ultimate spin doctor.

People who grow up in Western cultures and who have an independent view of the self tend to promote their sense of well-being by exaggerating their superiority over others. People who grow up in East Asian cultures and have a more interdependent sense of self are more likely to exaggerate their commonalities with group members. That is, people who grow up in cultures with an interdependent view of the self may be less likely to engage in tactics that promote a positive self-view, because they have less investment in the self as an entity separate from their social group. Nonetheless, nonconscious spin doctoring occurs in order to maintain a sense of well-being, though the form of the doctoring differs. What makes us feel good depends on our culture and our personalities and our level of self-esteem, but the desire to feel good, and the ability to meet this desire with nonconscious thought, are probably universal.

To what extent is the psychological immune system part of the adaptive unconscious? Sometimes we act on the “feel-good” motive quite consciously and deliberately, such as avoiding an acquaintance who is always criticizing us, or trying to convince ourselves that we failed to get a promotion not because we were unqualified, but because the boss was an insensitive ox. Given that the adaptive unconscious plays a major role in selecting, interpreting, and evaluating incoming information, though, it is no surprise that one of the rules it follows is “Select, interpret, and evaluate information in ways that make me feel good.” Furthermore, there is reason to believe that the adaptive unconscious is a better spin doctor than the conscious mind. As Freud noted, psychological defenses often work best when they operate in the back alleys of our minds, keeping us blind to the fact that any distortion is going on. If people knew that they were changing their beliefs just to make themselves feel better, the change would not be as compelling.

A key question concerns how the accuracy and “feel-good” criteria operate together, because they are often incompatible. Consider Jack, who failed to get an anticipated promotion. If accuracy were his only criterion, Jack might well conclude that he did not have the experience or ability to handle the new position. Instead, he uses the “feel-good” rule and concludes that his boss is an idiot. But is it really in his best interests to pat himself on the back and blame his boss? If he does not have the experience or ability to do the job, wouldn’t he be better off to swallow his pride and work harder?

The conflict between the need to be accurate and the desire to feel good about ourselves is one of the major battlegrounds of the self, and how this battle is waged and how it is won are central determinants of who we are and how we feel about ourselves. The best way to “win” this battle, in terms of being a healthy, well-adjusted person, is not always obvious. We must, of course, keep in touch with reality and know our own abilities well enough to engage in self-improvement. But it turns out that a dose of self-deception can be helpful as well, enabling us to maintain a positive view of ourselves and an optimistic view of the future.

You can see, in reading the account of Dr. Takaki’s struggle to get the military to accept an effective treatment for (and preventive of) beriberi, how the military establishment desperately wanted to think of itself as “modern,” being freed from the blind superstition of “folk medicine cures” (even when those cures worked). They wanted labs and microbe-caused diseases.

They show a profound misunderstanding what science is. Science does not necessarily mean laboratories. It means posing questions whose answers are obtained by observing what actually happens. It would have been easy to have one group follow the traditional diet and another a modified diet and see what happens—and that is what Dr. Takaki in fact did. But the military (the Navy, in this case) rejected the finding because the answer was not the sort of answer they wanted.

Voluntary blindness to facts and willful ignorance is always surprising. And it’s not a problem of the 19th century. For a 21st century example, see Oklahoma’s dim-witted approach to their earthquake problem: they refuse to see the answers they don’t want.

Is it possible to escape this idiotic refusal to look at the facts? I don’t think so. Institutions (business corporations, governments, bureaucracies) protect themselves—the institutional immune system—and we give great power to those institutions, so we have to accept that they will go to great lengths to ignore facts that threaten them. Another good example is the refusal to act to mitigate climate change: regardless of the magnitude of the threat, willful ignorance prevails and fights against effective action.

The story of Dr. Takaki, reported by James Simpson at War is Boring, is well worth reading. You can see the exactly analogies between the resistance to Dr. Takaki’s findings and Oklahoma’s resistance to understanding its earthquake problem and the resistance of the GOP to understanding climate change. Dr. Takaki’s story begins:

In August 1882 in Incheon Bay near Seoul, four Japanese warships were locked in a tense stand-off with two Chinese warships that had brought troops to quell a revolt on the Korean peninsula.

On paper, the Japanese flotilla outnumbered the Chinese, but the hulls of the Japanese ships hid a deadly secret. Less than half of their crews could man their stations.

The Korean peninsula erupted into conflict on July 23. A soldiers’ protest against ill treatment, unpaid wages and poor provisions turned into widespread mutiny. Ousted from power, the former regent of the king set the mutineers upon the government—and against the Japanese advisers working to modernize the Korean army.

Korean soldiers cornered the chief military adviser in his quarters and stabbed him to death. Another 3,000 mutineers attacked the Japanese Legation. The ambassador ordered his men to burn down the compound and then led his staff to a nearby harbor where they caught a ferry to Incheon.

In lashing rain, the rebels chased the Japanese all the way to the port, killing six and wounding five. The roughly two dozen survivors boarded a small boat and cast off. The next morning, the British sloop HMS Flying Fishspotted the row boat and carried the refugees to Nagasaki.

It was a humiliating blow, but the Japanese were not gone for long. The ambassador soon returned to Seoul. This time he had backup.

Four warships sailed alongside to ensure the safe arrival of the ambassador’s government schooner. As ground forces led the ambassador back to Seoul,Kongo, Nisshin, Hiei and Seiki anchored in Incheon Bay. Two Chinese ships also sailed into Incheon at the request of the Korean king.

Tensions between Japan, China and Korea were at an all-time high. Japan was East Asia’s first modern imperialist nation and its neighbors felt threatened by its new ways.

Unknown to the Chinese and Koreans, the Japanese ships were running far below fighting strength. Disease struck down 195 of Kongo’s 330 sailors. Similarly Hiei was down to a third of her regular strength, and Nisshin andKiyoteru weren’t faring much better. The sailors were lethargic, sluggish and—at worst—paralyzed.

There was no one to relieve them. The warship Fusou—designated to reinforce the mission—was in terrible shape back in Tokyo. The same disease had debilitated 180 of its 309 crew.

Sixteen per cent of all disease and injury in the Imperial Japanese Navy in 1882 stemmed from this one sickness. Beriberi. It was a great shame on the nation that one young doctor hoped to cure.

A beriberi big problem

Beriberi—kakke in Japanese—affected all levels of Japanese society, but it became especially prevalent among the urban residents of Edo, the classic name for Tokyo. The disease became known as the “Edo sickness.” Art from the period shows men in wheelchairs afflicted with beriberi.

The malady completely immobilizes its victim, as discussed by English explorer Isabella Bird in her 1880 book Unbeaten Tracks in Japan. “Its first symptoms are a loss of strength in the legs, ‘looseness in the knees,’ cramps in the calves, swelling and numbness.”

“The chronic [form] is a slow, numbing and wasting malady,” Bird continued, “which, if unchecked, results in death from paralysis and exhaustion in from six months to three years.”

At the time, the causes of the disease were unknown. It became the subject of great debate among Western medical personnel in Japan. Basil Hall Chamberlain, a preeminent Japanologist, demonstrated the lack of understanding of the disease’s causes in his 1890 Things Japanese: Being Notes on Various Subjects Connected with Japan.

“The disease springs, in the opinion of some medical authorities, not from actual malaria, as was formerly imagined, but from a climatic influence resembling malaria,” Chamberlain wrote. “Others have sought its origin in the national diet—some in rice, some in fish.”

“In favor of this latter view is to be set the consideration that the peasantry, who often cannot afford either rice or fish, and have to eat barley or millet instead, suffer much less than the townsfolk,” Chamberlain continued.

But the disease wasn’t contagious. We now know that beriberi stems from a lack of vitamin B1, which the body requires for metabolizing carbohydrates and maintaining neurological functions. Without it, a person succumbs to nerve damage and eventually death.

The source of the deficiency was the urban diet. . .

Continue reading. Read the whole thing.

Written by LeisureGuy

18 April 2015 at 12:31 pm

More good news on Obamacare

leave a comment »

Kevin Drum asks a good question: Why are Republicans so opposed to Medicare, now that it has been proven to work? Look at his post at Mother Jones:

During Obamacare’s initial open enrollment period, the uninsured rate dropped dramatically. Then it leveled out a bit when enrollment closed. So how are things going in its second year?

The latest Gallup numbers tell the story. During the first month of open enrollment, the uninsured rate dropped moderately, and then dropped sharply again during the first quarter of 2015. It’s now down to 11.9 percent:

blog_gallup_uninsured_2015_q1

This is great news, and confirms previous reports. As before, according to Gallup, the biggest drops have been among the young and those with low incomes. This represents millions of people who can now get decent medical care without fear of bankruptcy, and it’s being done at asurprisingly moderate cost. It’s just inconceivable to me why Republicans are so hellbent on ruining a program that’s showing such great results and such great promise for so many people.

Written by LeisureGuy

13 April 2015 at 5:46 pm

Posted in GOP, Government, Healthcare

Australia: If you don’t vaccinate your children, you don’t get government childcare benefits

leave a comment »

Australia has some good policies. One is the reasonably substantial fine levied on those who fail to vote—that should be implemented in the US. Another is this new policy (yet to be approved by Parliament), reported in Salon by Joanna Rothkopf:

On Sunday, Australian Prime Minister Tony Abbott announced a harsh new policy targeting anti-vaxxers: as of January 1, 2016, parents who opt out of vaccinating their children will be denied childcare-related government benefits. The measure, which could deprive families of up to $11,500 in government funds, still needs to be approved by Parliament before it can take effect.

“Parents who vaccinate their children should have confidence that they can take their children to childcare without the fear that their children will be at risk of contracting a serious or potentially life-threatening illness because of the conscientious objections of others,” Abbott said.

NPR’s Stuart Cohen reports that around 90 percent of Australian children are properly immunized, but almost 40,000 parents have claimed objections, which can be religious, medical, or even philosophical in nature.

The Sydney Morning Herald’s Stephanie Peatling reports:

Families claiming the end of year supplement for family tax benefits will also have to have their children vaccinated at all ages from the start of next year before receiving the payment…

People who have medical grounds for not vaccinating will continue to receive government payments.

But people with religious reasons will have their eligibility for government payments tightened.

They will only continue to receive childcare and family tax payments if they are affiliated with a religious group whose governing body has a formally registered objection approved by the federal government.

“The government is extremely concerned at the risk this poses to other young children and the broader community,” Abbott continued. “The choice made by families not to immunize their children is not supported by public policy or medical research nor should such action be supported by taxpayers in the form of child care payments.”

Written by LeisureGuy

13 April 2015 at 2:00 pm

The cultural roots of the anti-vaxxer movement

with one comment

Understanding is, I believe, a good thing to do. The drive to understand created philosophy, science (via natural philosophy), mathematics, and (arguably) literature, drama, and religion. Aristotle famously observed that “All men by nature desire to know,” but I think “All by nature desire to understand.” One reason arbitrary judgments are unsettling is that they cannot be understood: no rationale or reasoning is attached, and the need for understanding goes unfulfilled, leaving a kind of gasping for breath like a fish on shore.

In Religion Dispatches Michael Schulson takes a look at efforts to understand why some parents reject medical care that would have saved their children’s lives.

Collect all the evidence that vaccines cause autism and endanger children, and you will have a very, very thin file.

Collect all the evidence that there’s an appeal to believing that vaccines cause autism and endanger children, though, and you will have more than a file. You will have the work of an entire culture.

Just look around. Whole fields of marketing and spiritual counseling argue that there’s something inherently corrupt about modern society. There’s a cultural industry dedicated to encouraging us to break the rules, to “think different“; conforming to a big system is evil, rebellion is virtuous. Meanwhile, a whole library of religious traditions tell us that a better life can be found among the chosen, the saved, or the elect who obey a different set of rules from society at large.

When it comes to anti-vaxxers, critics don’t usually talk about culture or politics. Instead, they focus on the science, or on science outreach. (Collect all the writing detailing or examining the appeal of the anti-vaxxer stance, and you’d have another very thin file). But what could be more modern, and more conformist, than the government-recommended schedule of vaccines? The medical system is huge. It’s hierarchical. It’s powerful. It creates rules that apply to the entire population, and it works best when everyone participates.

Immunity is one of those elusive social goods that only works if (nearly) everyone opts in. When a population is thoroughly vaccinated, even the stray unimmunized child will be safe. No one is around to get her sick. There’s no cost for opting out, until enough people do so that the population is peppered with unvaccinated dissenters, and, bam: measles outbreak at Disneyland. It’s not just the children of anti-vaxxers who are falling sick, either. Low vaccination rates endanger kids too poor, too young, or too immunocompromised to have received the full suite of immunizations.

Today, children are falling ill from diseases that seem like relics of the 1950s. National attention is starting to pivot toward those parents who lodge conscientious objections against modern medicine. Lawmakers in North Carolina recently introduced legislation to make vaccines mandatory, with no exemption for religious objectors, such as Christian Scientists. (After backlash, the proposal’s bipartisan sponsors withdrew the legislation). Other states are following suit.

Meanwhile, the culture at large continues to idolize its principled renegades. Two recent releases—one a nonfiction book, the other a feature film—highlight our culture’s weird disconnect between semi-spiritual libertarian fantasies and the grim realities in which those rebel dreams, once enacted, can leave us mired.

‘Bad faith,’ sloppy analysis

In 2010, sixteen year-old Neal Beagley died from a bladder obstruction. Doctors can fix these kinds of blockages easily. But Beagley, a member of the Followers of Christ Church, in Oregon, had avoided medical treatment, in accordance with his church’s beliefs—and the wishes of his parents. “This is who we are,” his mother, Marci Beagley, told investigators. “This is what we do.”

Why do people like the Beagleys do what they do? That’s the question behind Bad Faith (Basic, 2015), Paul Offit’s new book about parents who seek to exempt their children from medical care on religious grounds.

A doctor, a vaccine educator, and a professor of vaccinology at the University of Pennsylvania, Offit has made his name rebutting anti-vaccination activists, most notably in his 2010 book Deadly Choices. As such, he is a practiced observer of postmodernity’s strangest class of conscientious objectors: those who, in the name of well being, exempt themselves from the most effective medical system in history.

It’s no surprise that Offit would eventually find his way to religion. Very, very few religious people avoid medicine entirely, but those who do so form a subculture large enough to merit national attention. One study mentioned in Bad Faith identified 172 deaths of children whose parents had withheld lifesaving medical treatments on religious grounds between 1975 and 1995. One of the authors of the study described the toll as “Jonestown in slow motion.”

It’s not just Christian Scientists. Small church movements around the country reject modern medicine, generally substituting some kind of faith healing. Constitutional law gives the state opportunities to intervene on behalf of children in these households. As Offit chronicles, though, states often do not.

To his credit, Offit doesn’t spin off into condemnations of religion, writ large. Instead, he digs into the New Testament, where he finds plenty of faith healings, but also plenty of calls to care for children, and nothing to imply that modern medicine would be corrupting. Ergo, religion must not be the problem, bad religion must be the problem.

Offit understands bad religion as a product of social coercion, mental illness, or clumsy interpretations of scripture. No doubt, he’s partly right: coercion happens. The line between religious fervor and mental illness is not always so easy to define. People interpret scripture in deadly ways.

Unfortunately, Offit is unable to look beyond his clumsy parceling of religion into good faith and bad faith. When it comes to religious objections to medical treatment, there are two other, more disturbing possibilities that Offit doesn’t seem equipped to even consider. The first is that there’s something legitimately frightening about the medical system for many Americans—a fear that’s absorbed into religious ideologies. Certainly, distrust of doctors can seem epidemic, and anti-vaccination activists play on fears of shadowy pharmaceutical cabals and deadly chemicals, some of which is rooted in legitimate fears.

A second possibility is that . . .

Continue reading.

Written by LeisureGuy

9 April 2015 at 9:00 am

A Tale of Two Therapies

leave a comment »

At Motherboard Steph Yin describes how therapies are judged: cost-effectiveness of studies—things cheaper to study are favored:

At the turn of the 20th century, Sigmund Freud pioneered modern psychotherapy in the form of psychoanalysis. He believed that talking to a therapist could help patients work through repressed conflicts driving pathologies such as depression, neurosis, and anxiety. But by the late 1900s, psychoanalysis had fallen from favor. Critics accused Freud of relying too heavily on what were seen as unscientific interpretations of patients’ dreams and streams of consciousness.

In the decades since, so-called neo-Freudians or post-Freudians have recast psychoanalytic principles while retaining Freud’s practice of unearthing the past to expose unconscious conflicts. But others have staked out their own ideas, arguing that psychotherapists need a better way to scientifically test their treatments. This new emphasis on experiments—what came to be called “evidence-based psychotherapy”—spawned the notion that some therapies are more scientific than others, a contention that has etched deep divides within the psychology community.

Now expanded access to mental health care under the Affordable Care Act gives the label of evidence potentially even more power. Evidence-based therapy is increasingly sold to patients on multiple fronts, said Jonathan Shedler, a psychologist and professor at the University of Colorado School of Medicine. He believes designating certain therapies as “evidence-based” can affect what type of research gets funded, how insurance companies justify spending, which treatments physicians recommend, and how the public perceives psychotherapy in general.

One concern that Shedler and others psychologists have is that over-emphasizing neat experiments of standardized treatments detracts from the ultimate goal of psychotherapy: making sure patients get the best intervention, rather than the one that lends itself to scientific research most easily. Rigid, controlled conditions tend to focus on outcomes that are easy to measure, such as symptom relief, instead of abstract benefits such as personal growth and fulfillment, said Shedler.

Some psychologists also believe that the uniform therapies studied in research are too artificial to draw conclusions about real-world therapy. “No two minutes of any human interaction are identical,” said William Stiles, a retired psychologist and professor emeritus of Miami University in Ohio. “This sort of responsiveness is essential clinically, but it wrecks the scientific logic of outcome studies.”

The main approach to claim the scientific mantle is cognitive behavioral therapy (CBT), a strain of modern psychotherapy that diverges hugely from Freud’s ideas. Since then, CBT has become an industry standard and is often the default treatment doctors recommend for conditions such as depression or anxiety disorders. Many celebrities, including J.K. Rowling and the Dalai Lama, have publicly spoken out in support of CBT.

Cognitive behavioral therapy arose from experiments done in the 1960s by Aaron Beck, a psychiatrist at the University of Pennsylvania in Philadelphia. At the time, Beck was a psychoanalyst looking to empirically study his field’s methods. He analyzed the dreams of depressed patients, expecting to find anger and hostility as predicted by Freud. But instead of validating psychoanalysis, Beck concluded that Freud’s theories did not hold. Wanting to design a more empirically testable and effective psychotherapy, Beck developed CBT.

CBT practitioners believe that faulty thinking patterns, or cognitive distortions, cause people to adopt unhealthy behaviors. Rather than looking to the past, CBT providers focus on behavioral changes that patients can make to resolve present-day problems. As a result, CBT is highly instructional: therapists work with patients to set agendas and assign homework. A CBT practitioner might treat a depressed patient by helping them create a plan for waking at a reasonable hour, making a friend at work, or going out during the week.

Meanwhile many other therapists practice a form of psychotherapy resembling Freud’s, called psychodynamic therapy. Psychodynamic therapists rely heavily on individualized relationships they develop with each patient. To treat someone with depression, a psychodynamic therapist might help the patient identify and dissect painful childhood memories. While CBT tends to be short-term, often lasting just eight to twelve sessions, psychodynamic therapies tend to be much longer, often lasting at least forty sessions or a year.

Scientific research on CBT has proliferated from its inception. “CBT evolved from academic learning theory,” said Stiles. “A lot of the early contributors were academic scientists, used to designing research and publishing, and they built a norm of data-gathering and scientific reporting into the treatment paradigm. Psychodynamic therapy grew from clinical practice and hasn’t had that ethos.”

Whereas research on psychodynamic therapy has only come into the picture in the past decade or so, thousands of studies done over the last 40 years have shown that CBT can effectively treat an impressive range of conditions, including depression,anxiety, posttraumatic stress disorder, and addiction.

But many psychodynamic proponents argue that evidence-based assessments might lead psychologists to dismiss potentially useful therapies that simply haven’t been studied enough.

“Absence of evidence doesn’t mean evidence of absence,” said Michael Thase, a psychiatrist and professor at the University of Pennsylvania. Psychologists can’t conclude a therapy doesn’t work just because it lacks supporting evidence, he cautioned. Studies show that CBT works for suicidal patients, for instance, but that doesn’t necessarily mean other therapies don’t also work—their effectiveness just hasn’t been demonstrated yet.

There’s academic incentive to study CBT over psychodynamic therapy, said Colorado’s Shedler, because studying brief therapies allows researchers to perform and publish more experiments. “It would be professional suicide to study therapies that resemble real-world therapy, which might last a year or two,” he said, and this research bias might encourage insurance companies to neglect long-term therapies. . .

Continue reading.

Written by LeisureGuy

5 April 2015 at 9:41 am

Follow

Get every new post delivered to your Inbox.

Join 1,773 other followers

%d bloggers like this: