I have decided that whatever double blind crossover placebo-controlled# trials can do for sorting out the good treatment from the bad, they're completely beyond the pale* in mental health!
My starting points are roughly these:
1. Taking major depression as an example:
a) every case has individual real-life occurrences as contributing factors: maybe being totally neglected emotionally as a child, or having a string of teenage relationships ending in "betrayal".
b) every case happens to a different brain
c) every case has a certain set of present/absent, good/bad liver enzymes
d) whatever the age, size or shape of the person, they have a different "felt response" to the same dose of a drug
e) everyone has different ways of reasoning
f) we all afford differential salience to "stimuli" such as words, happenings, situations and other people's moods.
g) if interpersonal therapy happens, each person will have a different first impression (therapist AND client), which will influence the course of the relationship;
h) therapists all have different interpretations and ways of implementing different therapies (their "style")
i)different client vs. therapist personality combinations either work or don't work in particular therapies, no matter what the therapist thinks about their own "objectivity" in the interaction.
j) clients have differing "stickability" in their regularity and timing of visits to a therapist.
k) additional contributors may/may not occur DURING treatment by any mode eg. parent dies, husband leaves etc.
l)many factors contribute to what "dose" of therapy or medication will alter core symptoms, regardless of liver enzymes etc.
m) many people on medication never get a good therapeutic effect because of recommended dosing levels, especially if they are not referred to a specialist after partial response. Specialists can observe the person while pushing the medication to the biological limit and achieve complete remission (or rule out that medication).
n) people have different "feeling criteria" of when they are "OK" again after an amount of treatment- it may be quite different to what a therapist concludes.
Anyway, having committed heresy, I'll slink away to gather some evidence!
Hi Kay
ReplyDeleteI sympathise with your under employment. Its terrible when productive and skilled human beings yearning to contribute don't find the right framework, are not given a chance, or whatever the mechanism may be. I am an emigrant to Australia from South Africa, where I had a reasonably active and acomplished career in media, but here my South African experience (seems) to be looked upon as irrelevent, so I have had to become creative in terms of supporting my addictions which include a) writing poetry and b) helping to pay my families bills. One way I'm doing that is by spreading the word about an online store called Inspired Wellbeing which sells wellnes related products, organic foodstuffs, and a range of alternative medicines at extremely reasonable prices.
As for depression, I find a combination of exercise, social contact (isolation is a terrible catalayst and exacerbator of depression), yoga, music tend to keep the beast within functional limits. Inspired Wellbeing sells things like St John's Wort, which some double blinds have found to be as effective as the Zoloft, Cybalt etc etc, but I have no prsonal experience, never having tried it.
Good luck with gathering that evidence!