Sorry to hear you’ve had a bad run; I can only add that I’m sure there is someone who can help, and I get that looking can be a real hassle in itself.
Talking about it helps, talking to professionals helps more, but you can find your way.
6 Likes
I’ve been blessed to have exactly one therapist, who I’ve been with for many years now, and who was a big part of my decision to become . . . a therapist! Glad to hear you had some great therapy experiences, it can be so positive and life changing when good. It can take such a long time to find the right one or ones.
6 Likes
I am a devoted excavator of my personal truth. I find epiphanies along the way. In general, at first an epiphany seems like it’s going to change everything. That feeling does not last. At this point in my story, the half-life of an epiphany is about 3 days.
4 Likes
My last counsellor helped immensely. I haven’t seen her in over a year but I doubt I’ll ever forget her or some of the things I learned and discovered thanks to her.
The right person at the right time can make a huge difference - sometimes it is a years-long course, sometimes it’s a single meeting. In my opinion, it is the connection that makes the most difference.
7 Likes
I’ve read a manual on treatment-resistant borderline personality disorder that had a breakdown into four quadrants that were:
- Self is good, others are bad
- Self is bad, others are good
- Others are good, others are bad
- Self is good, self is bad
Us crazy people are crazy.
I remember reading about a remarkable study for people who heard voices. They worked with an artist to design a 3D face on a computer that “looked like” their voice. Then they spoke with the face. Nearly one third of people who participated in the study, six months later, reported that their voices had stopped entirely. Like that was it, they were cured. Others reported a lessening of negative symptoms and of course a lot of people weren’t helped at all.
I wonder if the reason why new treatments help and then stop helping is because of this idea of needing to find the right treatment for you. A study showing a treatment is very promising might show a big change for 20% of people who tried it. But maybe that’s a sign that the treatment only works for about 20% of people. So the more you deploy the treatment the more you run dry the well of people it can help.
9 Likes
It certainly does seem to be the case that people aren’t getting getting more mentally healthy(or even staying even) at a population level; but that only tells you that they aren’t getting better at mental health if you can safely treat the circumstances as constant.
If the adversity of the circumstances is increasing a population whose coping techniques are improving might still only be treading water or actually declining in terms of results, depending on which thing is happening faster. The reverse could also occur, though finding an environment where psychological pressure is receding at a population level fast enough to keep steadily more brittle people at a constant level of adjustedness is probably less common in practice.
I’m not certain how one would disentangle level of environmental pressure from familiarity with coping technique(since people’s coping abilities presumably cloud their reports of how much pressure is present); but I’d suspect that there may well be some of this going on because of the number of contexts where people are judged vs. their peers in situations where loss of social status (and often good old fashioned grinding penury) are the known consequences for the ones who fall toward the bottom of the distribution.
In work or school, say, you aren’t being judged against a static target that improved coping mechanisms would allow you to hit with gradually increasing levels of wellbeing; but relative to the performance of your peers. If they are getting better at coping your performance will fall behind in relative terms(which imposes its own set of stresses); and if you and they both improving you’ll still have to use your ability to take on more pressure on order to do more in order to at least see stay where you were in relative terms.
Unless there’s something(whether it’s just custom, active pushback from unions or the like) keeping the exercise from being an open-ended judgement against peer performance without reference to some static standard of adequacy people are likely to end up with a similar outcome even if their skills improve because they are induced to take on more pressure if they can handle it.
2 Likes
That is where I was headed with this. The effect is actually bad measurement (rosy outcomes) followed by better measurement (no actual effect to be seen). It’s got nothing to do with the doctors, patients or therapies. It’s about the evaluation.
1 Like
There’s also beer.
2 Likes
And Whiskey, lest we forget.
3 Likes
- Most clinical psych is pure quackery.
– Dr Wanderfound, B.Sci (Hons) Psychology, PhD (Behavioural Neuroscience & Psychopharmacology)
1 Like
I think you’re touching on something here. A “new” or “novel” therapy isn’t going to get out of the starting gate if the first people trying it are cynical and skeptical. But as it spreads, it reaches those people.
Belief is powerful, and people are good at decieving themselves. We normally think of that as a bad thing, but sometimes it can be repurposed for good.
I have been told that I am a “bad patient” because I don’t open up easily (especially face to face) and when under stress I withdraw, but apparently that means that the reason the therapy isn’t working is because I am not trying hard enough, or don’t want to.
Hmmm… where else have I heard that line? If you aren’t getting what you think you need from God, maybe you aren’t praying hard enough or trusting him enough.
If I take a drug on schedule and it doesn’t work, we accept that the drug is not effective for me. But the immediate go-to for a lot of therapies is that the patient is at fault for not doing it right.
I mean if a therapy or a drug works for you, that’s great! It’s fantastic. But to say it’s the patient’s fault when it’s not working, especially when we know so little about the cobbled together mess of electrical circuits and chemicals we call a brain, is very cult-like to me.
4 Likes
Mark me down as another recipient of this particular childhood snake oil.
Hmm… either that book was very very well distributed, BB’s readership is positively enormous, or reading the book has a good chance of turning you into a BB denizen later in life!
(for every pedant who wants to lecture me, the above is a purely sarcastic statement, not meant to be taken seriously)
2 Likes
My guess is that many therapists and psychiatrists suck, are lazy, are experiencing extreme compassion fatigue, and don’t give 2 shits about whether or not their patients get the care they need. It’s a well-known, widespread problem. Care is only as good as the people who give it. A young friend of mine just got his masters in clinival psych, and was absolutely sickened by the way doctors and students spoke of patients like animals or test subjects or walkinh symptoms, and not people. Not only that, but we lost good psychotherapy to HMOs and drugs and talk model in the 80s. mental health care is really, really not great in this country. And that’s a euphemism.
I personally have taken DBT skills classes a few times and have seen a massive difference in how they’re taught and presented. It’s really awful and sad how little society cares about it and how some of the most marginalized members of society are ignored and disenfranchised.
You also have to have providers who are genuinely invested in helping you. Unfortunately a large number of them just aren’t, are struggling with compassion fatigue, are overworked, or all of it. 
1 Like
I recommend a book called Crazy Like Us. It doesn’t delve into this phenomenon in particular, but it could still be illuminating. Basically, clinical psychology, like economics, inevitably shapes the very things it claims to study impartially. The specific manifestations of mental illness that we categorize and treat are never t only largely products of our culture, but are directly influenced by the very act of classifying them and attempting to treat them in a particular way. Many of these mental illnesses never existed in other parts of the world until western trained psychologists showed up and started looking for them.
Essentially there is so much subjectivity, both in classifying and diagnosing mental illness and in evaluating the success or failure of treatment, that effects like this shouldn’t be surprising.
Actually, that is an incorrect definition of the Placebo Effect. The Placebo Effect is not akin to The Novelty Effect. While they can interact, they are not synonymous.
As to the novelty effect, it applied to professionals as well as patients. I worked in community mental health for 25+ years and every so often intervention philosophies were repackaged and made to sound revolutionary. At one time Psycho-Social Rehabilitation was the hot ticket out of Boston University, then later Cognitive Behaviour Therapy. There will be another one around the corner.
In terms of drug interventions, I remember the outrageous fervor about SSRI’s, Paxil in particular, and having people actually get angry at me when I suggested that it was a combination of Novelty and Placebo effects.
1 Like
This topic was automatically closed after 5 days. New replies are no longer allowed.
