Welcome back. Yesterday we touched on clinical arrogance a bit, and discovered that the real problem with it isn’t the arrogance of the provider, but the blockade it provides against learning new techniques and staying updated with proper research. I mentioned I had two examples, one was personal, and one was a more wide-scale issue. You can read about clinical arrogance and my psychiatrist visit here.
I want to start this section of the series off with the second example. We are still under my first bullet point from yesterday: practitioners most often rely on intuition rather than verified and reliable research.
One thing psychologists attempt to do is predict a client’s behavior. This already sounds wishy-washy. No one can predict behavior 100% as we are limited in our understanding of ourselves (more on this once we get to my second bullet point), but there are two main methods which are used: The Actuarial Method and The Clinical Method.
The Actuarial Method
With this method, data is gathered within the range of the target population. That data is then plugged into a formula or some charts or graphs, anything that quantifies the data in some way, and what this yields is a general percentage. That general percentage represents how likely someone is to behave a certain way given the observations of their behavior (or scores on an MMPI, or this or that). So, theoretically, and very simply put, if Johnny is experiencing a psychosis we can use this method to get a general idea of how he may behave and what the best treatment may be given the outcome of others who have experienced similar things.
In trying to predict the rate of degeneration in patients who had been diagnosed with neuro-degenerative diseases, this method was correct 83% of the time.
Why is this important? Well, one thing practitioners may need to predict, especially in the current mental health system and current mental health wards is this concept of “dangerousness”. You hear all the time that people particularly labeled with schizophrenia are dangerous, unpredictable, violent. You also have probably heard that the truth is people with mental health adversaries are more likely to be a victim of a crime than to commit one. So let me tell you why this stereotype continues to persist.
In 1999, a researcher, Liener (I tried to find the full paper, I couldn’t; when I do, I’ll link it) asked clinicians to rate clients’ based on their intake interviews. These clients were hallucinating. The providers were supposed to give an answer for which clients were more likely to become violent. He gave the same case studies to untrained, random high school students and requested the same service. Conclusion?
There was no difference in the predictions. That is, the high school students predicted the same level of danger as the clinicians did, and those who were seen as withdrawn were all rated as most likely to be violent. Research shows the opposite. In fact, when mass amounts of individuals locked in criminally insane wards were let out, 97.3% never got into trouble again. 2.7% wound up back in a hospital or prison.
It’s not the public’s lack of awareness, so you can chill on your lovey-dovey, let’s all unite instagram Mental Health Awareness campaigns. We don’t need as much awareness of experiences as you think–we need research. I’ve been saying this before I even started my college journey. Talked about it every May on my previous blog Mental Truths, in fact. Want to bring awareness to something? Bring awareness to the fact that none of the research is being paid attention to. That’s what needs awareness.
The Clinical Method
In this method, we gather data about the individual and use that information to attempt to predict what the individual will do. There is no real, clear-cut formula for this as far as I’m aware, it’s kind of a guess and check system. Kind of like taking psychiatric meds.
In the neuro-degenerative disease study, it was found that this method was correct 58% of the time. Diagnosis was generally accurate, but judgments and human error lead to incorrect predictions. I mean, 58% isn’t bad, that’s ore than half, but it’s no where near 83%.
And so we see the Actuarial method is quite effective when it comes to doing something human brains on their own can’t always do very well: predict things. We see in some Meta Analysis that there was either no difference in correctness between the two study methods or the actuarial worked better. Never once could the clinical method beat it’s cousin.
You can read more about both methods here.
And still, Practitioners insist that their expertise provides a better prediction. Again, this is what I like to call Clinical Arrogance. And maybe it’s not purposeful–as I said yesterday, they worked hard for their degrees and spent long hours accumulating all that knowledge in their head. Let’s not bash these individuals, a lot of them are very bright and are in the field to support people who really need it. They just can’t read. Kind of like the HumanCentIPad from South Park.
“Why won’t it read!” (22 second clip. Totally worth it.)
I think the most hilarious thing out of all of this is that a lot of pracitioners say they never use the actuarial method, and the majority of them say one reason is because they were never trained in it.
Jesus Christ.
Jesus Christ.
And remember now, we’re trying to figure out how much of a science psychology really is. This is a tough question, because so far we see that there are methods which meet the standards for the label of scientific. But they’re not being used, and when they are and the research is done properly, free from bribes by pharmaceutical companies and researchers looking for fame, the results aren’t given any attention. Can something be called a science if it neglects the only aspect of it which is a science?
I want to stop here and let this kind of sink in, because tomorrow we’re going to shoot to the top. We’re going to investigate how this trickles down and make some speculation to why.
It seems like everything is negative, but it’s not. We hear a lot of the positive in most psychology classes, at least the ones I’ve completed, and that’s great. But some of that is misinformation and that’s problematic. This isn’t about focusing on what’s wrong with the industry, this is about awareness. I think it’s great that people feel making a social media page dedicated to a “Safe Space” or whatever can help others–and for people who are super isolated, it probably is nice to see other people experience their pain. But that’s not the kind of awareness that’s going to shift the system. More people knowing the word “Schizophrenia” could indeed perpetuate stigma if you have no research to back it up.
In fact, why not raise awareness about the fact that the dopamine hypothesis is actually kind of a shoddy hypothesis? Why not find some of the studies that point toward the many holes in the chemical imbalance hypothesis? The ones that discount genes as the biggest player in mental health heritability? Where is the awareness of this?
Oh wait. No one reads.
And if someone does read, and they have articles contradicting me, please, please send them. I’m always looking for something challenging! I only ask that the articles either cite actual research so I can find the papers, or are the papers themselves.
The Philosophical Psychotic 