Maurice Regan is a psychologist and former university professor. He lives in Pembroke.
Many news stories about personal tragedies include the suggestion that “mental health services” or even more mental health services could have prevented this alarming outcome. Sadly, many people involved in these tragedies receive these services over and over again, with no proven benefit. In this edition of My Turn, I will introduce some reasons why mental health services, no matter how good they are, still don’t work. We use “provider” here to include psychologists, psychiatrists, social workers, and mental health counselors.
Providers consistently make the “fundamental attribution error,” a well-established finding in the fields of behavioral and social psychology. When we consider the causes of behavior, we fundamentally and mistakenly attribute behavior to internal or dispositional causes rather than to external or environmental causes. For example, a depressed person lives in a depressing environment and has a depressing attitude. They do not have diseases caused by chemical imbalances. Psychotherapies that look for remote internal causes or administer drugs make this fundamental mistake, and such treatments are usually ineffective. It has long been known that encouraging people to change their environments through exercise, education, new social networks, and other productive self-care activities can help fight depression.
Behaviors that we classify as violent or psychotic respond similarly to changes in the environment. When prison and prison structures actively changed to a “direct supervision” model, suicides and other premature deaths in prison decreased not because mental health services were more available, but because the environment Not because it’s better. Health care providers typically see normal people in abnormal circumstances, not the other way around. Providers need to commit to changing the environment.
Many providers have no idea what they are talking about. As I work with others and participate in continuing education programs, I am struck by the amount of misinformation that is chronically promoted as fact. The source of information is often the provider’s formal education. Universities continue to teach, and textbooks continue to report psychological beliefs and practices that are unsupported but continue to be accepted uncritically. Here I am guilty. When I finished my course and was about to leave my university classroom, a student presenter asked me to help her move the computer and projector, and both she and her professor were confused. . After solving the problem, I looked at the screen and was surprised. She was presenting on “learning styles,” a topic that has no research support in psychology or educational research and continues to have a negative impact on children’s education.
Here are some more examples: Although cognitive behavioral therapy is currently promoted by many healthcare providers, most healthcare providers are unaware of its early development and few are implementing it properly. Efficacy is generally 40-60%, suggesting that treatment fails about half of the time. Eye movement desensitization and reprocessing (EMDR) is based on incorrect concepts about the structure of the brain, and it is no surprise that it is equivalent to a placebo that does not require eye movements.
We listen to the wrong people saying the wrong things. When I hear or read people with drug or parenting issues publicly giving advice to the rest of us, I think, “Why should I listen to you?” I often think that. These people need sympathy for the misfortunes that may befall any of us, but personal and family tragedies are conflated with psychological expertise and advice. Ironically, I know many people who drink in moderation or not at all, and who disdain other drugs. And I know many parents who have quietly raised their children to become productive adults. None of them attended the lecture. The public cannot listen to their stories and learn how they did it.
As the great American psychologist BF Skinner wrote in 1977: “We now have the methods and technology to help everyone live a fulfilling life.”
Can we now abandon our vague and erroneous concepts about mental health services, stop making the same mistakes, listen to the wrong people and heed his message?
