When I’m not writing hard-hitting posts on heavy topics such as the merits of snow or used booksale ethics, I work in data analytics at a mental health company that provides virtual coaching and therapy services. In my role, I work closely with a team of clinical researchers with PhDs in psychology from prestigious programs.
As someone who struggles with mental health, I was extremely excited not only to help improve the lives of hundreds of thousands of people, but also learn from experts in the field. However, after 2 years of working with supposed “experts”, I have become disheartened by how much close-mindedness, conservatism, and outright dogmatism exists among academics.
Dogmatisms in mental health
Dogmatism #1: Cognitive-Based Therapy (CBT) is the best
Most experts in the mental health space trumpet how they offer the “gold-standard”, “evidence-based” care, by which they mean CBT.
CBT is the right form of treatment for some people–perhaps most–but people can benefit from other forms of treatment such as psychoanalysis, art therapy, TMS, EMDR, exercise, etc.
By championing CBT in such a manner, experts cast a stigma over other beneficial forms of treatment and deter people from seeking the help they need. A more nuanced approach would be stating that CBT is a good place to start for most people or developing some sort of framework to identify the appropriate treatment for an individual.
Dogmatism #2: mental health is about reducing negative symptoms
When companies speak of “evidence-based” care the evidence they are referring to is self-reported surveys. The predominant surveys used in practice and research focus exclusively on negative symptoms.
Decreasing negative symptoms such as anger, sadness, and anxiety are important, but talk to anyone struggling with mental health and they will tell you that increasing positive feelings is immensely important.
“What gets measured, gets managed” and in mental health that means a narrow focus on negative symptoms and a neglect of the positive aspects of life. True experts would, at a minimum, push for the use of surveys that also try to measure positive affect.
Dogmatism #3: mental health is about the mind
Although most mental health experts would acknowledge the importance of physical health, few advocate that therapists should themselves be involved in physical health.
Current dogma states that if a 500 lb patient does not think they have a problem with their weight, then a therapist should not bring it up as a likely source of some of their mental issues.
Of course, this is a nuanced topic and one must be careful not to instill shame, insecurity, and anger in their patients, but it is cowardice to act like obesity is not an issue. We allow therapists to diagnose depression, anxiety, alcoholism, bipolar, etc., but are encouraged to back off on culturally sensitive issues.
How can a therapist help with physical health? Obviously, a therapist is not best suited to help someone get fit, eat healthy, or sleep better, but they can gently push their patients towards getting help in those areas and help hold them accountable.
Why are psychologists dogmatic?
At first, I was shocked that people who have spent years formally studying mental health would be so close-minded and obviously wrong on such fundamental issues, but if you examine the psychology and incentives of psychologists, it makes more sense.
Some elements to consider:
- Psychologists are not scientists. Unlike physics, mathematics, or biology, psychology is a soft science. Psychology does not require one to study the brain directly through neuro-imaging or other biomarkers. Instead psychology predominantly relies on self-reported surveys and indirect observational data, which have enormous drawbacks (which is worthy of it’s own post, but hopefully the limitations are obvious when compared with hard science)
- Graduate school is a powerful force of indoctrination and consensus building. No matter what beliefs someone brings to graduate school, being surrounded for 5+ years by professors and peers who support the status quo is going to exert significant influence. It’s exhausting and socially detrimental to be iconoclastic and many–consciously or subconsciously–soften their stances to fit in and get ahead
- The sunk cost fallacy. It’s psychologically difficult for one who has invested so much time (and money) into something to admit that it was a mistake and they should have studied something else
- Psychologists have to pay their bills and how they do so is by selling a perception of expertise. If you are open about how flawed the “science” underpinning your degree is, you’ve decreased the value of your services.
These elements interact in an interesting way. Because psychology relies predominantly on highly-flawed self-reported and observational data, it’s easy to discredit the findings of most research as biased in some way. This helps entrench the status quo.
Additionally, psychologists have a vested financial interest in not challenging the status quo because such challenges reveal how shaky the foundations of the “science” are. If, for example, the experts were to admit that the surveys we have been using for the last few decades are significantly flawed, that would damage their credibility and have people question the validity of the field in general.
Finally, it cannot be ignored that there is likely a relationship between the degree of dogmatism in psychology and the shakiness at its foundation. Overcompensation is a natural response to mask a perceived lack of or inadequacy and this may help explain why psychologists love to hide behind terms such “evidence-based” and “scientific research” instead of saying “we asked some people”, “we think..”, or “our best guess is…”. Notice how physicists don’t feel the need to say their work is “evidence-based”, which reminds of the saying “if you have to say it, it’s probably not true”…
To some, it may not be a surprise that there is a sort of mental-health-industrial-complex that is highly self-serving, but this sort of thing is not abnormal and can be seen in the military, classic literature, and much of the field of economics. Unfortunately, these phenomena tend to arise when experts benefit more from maintaining their appearance of expertise than actually being correct.
Just like you should not get a degree in economics, I discourage you from getting a degree in psychology. If you really want to learn how the mind works, try neuroscience or deep personal observation. If you want to be a psychologist because of Freud, Jung, Rogers, Maslow, etc., just know that the greatest psychologists who ever lived would be appalled at the current narrow-minded state of psychology.
Listen, but do not defer to the judgement of psychologists. Trust your instincts. And if you have NOT experienced success in CBT, please don’t give up…there are so many other options!