Friday 10 January 2014

Pulp Fiction

Doubt has been expressed by a new study about the effectiveness of CBT (cognitive behavioural therapy) in helping people with schizophrenia - see the story here.

This is not conclusive and, though I think the benefits of CBT have been exaggerated compared with in-depth therapies, I'm inclined to agree with Paul Jenkins from our English sister charity Rethink that you have got to listen to the patients who report that they have been helped.

But I suspect there is a bigger issue here which is a general prejudice against talking therapies for those who are very ill. This prejudice is shared overtly by some old fashioned clinicians ("What's the point of bothering them with a lot of words when they are out of touch with reality?"), by woolly "progressives" whose antipsychiatric position makes it too uncomfortable to face up to the need to use both medical and psychological treatments so they just steer clear (and campaign for talking treatments in primary care without mentioning those who have a more severe illness), and by doctrinaire practitioners who want patients to conform and match with their precious methodology rather than the other way round ("It's no use using my brilliant technique on these people because they are too ill to benefit from it").

This is immensely frustrating. Isn't it time to develop psychological therapies which help people with schizophrenia and other serious illnesses rather than try out existing trendy therapies and then give up if they don't work? Isn't it time to end the prejudice which says there is no point in engaging closely and methodically, one human to another, with people who are very ill? And who seriously believes that this would not work better than leaving them alone with their distress and hoping the drugs by themselves will sort them out?

Oddly I think the public would be shocked to learn that talking therapies are so scantly used for in-patients. Most of the public have a vision of mental hospitals from literature, films and telly where there may well be medication involved but there is also a busy regime of patients experiencing psychological therapy individually or in group sessions - and that, they imagine, is the main purpose and routine daily activity for a mental hospital. Similarly many members of the public believe that the primary occupation of psychiatrists is to deliver in-depth psychoanalytical therapy (probably with the patient on a couch!).

Of course it's easy for mental health insiders to sneer at the public's illusion which is largely based on pulp fiction - but isn't the public's perception as it relates to the availability of therapy (as opposed to any lurid view of how wicked mental health services might be) actually much closer to what we should want in reality?