Posted in psychology, science, Therapy

The Two Branches of Psychology

If you have been or are a psychology major, or you’re thinking about becoming one, you’re probably familiar with (or will become familiar with very quickly) people riding your major off as humanities, soft-science, and asking you “bro, you gunna be my counselor now?” There’s a reason psychology isn’t taken seriously, and part of it is the narrative psychology professionals have created and perpetrated. Let me explain.

Having been this major for a while now, I see two very distinct branches of psychology: the humanities side that dominates the media and is what everyone thinks of when you say you’re majoring in psychology, and the science side, which rarely ever makes the media unless the research hasn’t been peer reviewed and the researcher is money hungry.

Earlier in the year, I wrote a series called “Is Psychology a Science?” which you can read the first of at this link. We concluded there is a lot of science and that the problem is it isn’t being taken seriously, or it’s purposefully being subverted.

The Perfect Example: Gabapentin

At work, I’ve spoken with plenty of people who have been prescribed Gabapentin for anxiety or depression or as a PRN (as needed) medication. After a panic attack which I mistook for an allergic reaction to a medication, I ended up in Urgent Care and was prescribed Gabapentin “to make it through the weekend” because it’s “really great for anxiety.” I picked up the prescription (with insurance, it only cost eighty one cents, kind of how Percocet only cost me one dollar, and no, I don’t have high tier insurance) and got straight to work.

Gabapentin is FDA approved for treating Seizures and Postherapetic neuralgia (nerve pain, particularly after Shingles). It is often prescribed off-label for anxiety (usually social phobia, GAD, panic attacks, and generally worry), depression, insomnia, neuropathic pain related to fibromyalgia, regular pain, just pain, migraines, any headaches that could probably go away with aspirin or time, as a replacement for benzodiazepines (Ativan, e.t.c), as a replacement for opioids (oxycodone, e.t.c), alcohol withdrawal, benzodiazepine withdrawal, alcohol treatment (reduce drinking or sustain abstinence), bipolar disorder, any mood disorder, any perported mood dysfunction, restless leg syndrome. It can be taken as needed or daily. It belongs to its own class of drugs: the gapapentinoids. Another drug you may recognize from commercials that belongs to the gabapentoid class is Pregabalin, a.k.a Lyrica.

Anyone remember Lyrica commercials? God. Disturbing shit. I don’t watch television anymore, only streaming services, so I haven’t seen a pharmaceutical ad in a while. I don’t miss it.

What Does Research Say?

I didn’t take the Gabapentin because research told me what the doctor didn’t, or couldn’t: there is no robust evidence supporting Gabapentin for any of the off-label prescriptions above. My first indication of this came from a Vice article, which I was hesitant to read because, well, it’s Vice. So I took their investigative journalism with a grain of salt and used it to guide my database research. Here’s what I learned:

  • Parke-Davis, the company that funded research and research articles for Gabapentin purposefully avoided publishing the disappointing effects of Gabapentin. They tweaked the research to appear positive. This was found out in 2009, when researchers looked more carefully at the articles more carefully.
  • David Franklin, biologist, started working for Parke-Davis in 1996. He quit three months later, just after an executive “allegedly” told him: “I want you out there every day selling Neurontin. We all know Neurontin’s not growing for adjunctive therapy, besides that’s not where the money is. Pain management, now that’s money.” You can read more here.
  • This was all in the past, and Parke-Davis paid 420 million in restitution for violating, in the most disgusting way, psychological and biological research. The problem is, the rhetoric that Gabapentin is a “great drug” and “works well for anxiety, depression, and your momma’s broken hip” still permeates the medical world. Particularly the psychological one. This was done purposefully.
  • There is no substantial evidence for any off-label use. I searched the databases all this morning. I found one measly Meta-Analysis (review of multiple studies studying the same thing, analyzed statistically) that showed 7 studies using Gabapentin for alcohol use reduction or abstinence. It was better than placebo slightly, but “the only measure on which the analysis clearly favors the active medication is percentage of heavy drinking.” So, it didn’t stop drinking or help withdrawal, it just kind of made people drink less. Or mix the two. Which is even more dangerous.
  • The only research with Gabapentin and anxiety says it’s not substantial enough to help panic attacks and that many people are most likely experiencing a placebo effect when they take it. Given that I learned that, I saw no point in trying Gabapentin: the chances it wouldn’t work for me because I don’t believe it will was too great. When I checked my college’s database, I went through over ten pages of articles and didn’t see one study geared toward Gabapentin and anxiety.

What Does This Have to do With Psychologists?

Well, the same rhetoric permeates the clinical psychology department of the world as well. That is, psychologists are more likely to trust the word of their colleague than to go read a primary research source themselves, scrutinize the methods, results, and read the confounding variables. Human beings are naturally trusting, and that is a beautiful thing. It gets us into a lot of trouble though–most likely a colleague hasn’t read the primary research either, and is simply going off what their colleague told them.

Believe it or not, this is a research topic in psychology.

I came across this analysis in my searches this morning. In summary, the researchers did a qualitative analysis of different psychologists in private practice, and their attitudes toward things like empirically supported treatments. What did they find?

  • Psychologists are “interested in what works.”
  • They were skeptical about using protocols described by the treatments proved to work.
  • They were worried non-psychologists would use those treatments to dictate practice (which I’m having trouble seeing as bad).
  • Clinicians mostly used an “eclectic framework”, meaning they drew from many sources (most of which were probably not supported by any empirical data, I’m guessing.)
  • They valued: experience, peer networks, practitioner-orientated books, and continuing education that wasn’t “basic”. So, nothing that involves a Starbucks drink I guess.
  • If resources for learning empirically supported treatments became easier to access, they would be interested in implementing them into their practice.
  • Money, time, and training are all aspects which have been preventing psychologists from actually implementing researched practices into their treatment. 68% cited this as a major issue preventing them from adhering their practice to researched methods. 14% said it was because they just didn’t believe in the efficacy of the treatment and 5% said it was because that treatment wouldn’t fit a cliental population. Again, that is a belief, not a fact.
  • Only 19% of psychologists surveyed around the nation (United States) used psychological research papers as their primary source of research information. What the fuck are they reading? The Key To Beating Anxiety by some random self-published author on Amazon?

The analysis is much longer than what I’ve listed here, and gets deep into some real topics anyone considering going into clinical or counseling psychology should pay attention to. The message to take away here is that attitudes and beliefs are driving how we are being treated both in the psychological world and the medical field. Physicians fall prey to the “word-of-mouth” about drugs in the same way psychologists fall prey to the “word-of-mouth” about treatments. This is why I write these articles: it’s up to the consumers to play an active role in what they are putting into their body, how, and why. It’s also up to the consumers to be informed in treatments, ideas, and beliefs.

Otherwise, you’re giving your life up to someone who may not know what they’re talking about any better than you do.

Lastly, let’s get something straight: I’m thankful for every medical professional I’ve ever come in contact with, because they’ve all taught me something for better or for worse. I’m thankful for the front-line workers who have spent the last 8 or 9 months using insanely inventive strategies to try and keep their worse Covid patients alive. Doctors are reading researched evidence because the links to research are suddenly in the media, and researchers are putting out what works and what doesn’t, as they should always be. This scramble to beat Covid has stirred probably the most ethical (and probably also the most unethical) research that’s been done in a while.

It suddenly makes sense to do things right when your life is at stake.

The point is, stay informed, stay healthy, and read.

Agree or disagree? Leave it in the comments below, or find me here:

Instagram: @written_in_the_photo

Twitter: @philopsychotic

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Posted in advocacy, Emotions, Freedom, Late Night Thoughts, Peer Support, psychology, Supporting Friends/Family, Uncategorized

Mental Health And African-American LIves

There was not a Mental Health Month post on Thursday for Somatic Disorders as I anticipated, not because I ran out of time but because my mind has been engrossed in other disturbing realities and going-ons in America. I will do a post on Somatic Disorders soon. But firstly, we need to discuss something.

For all the mental health websites and advocate pages on Instagram who are American-run and have not mentioned ONE DAMN THING about the riots in Louisville, Kentucky and Minneapolis, Minnesota right now, you should be ashamed of yourselves. ASHAMED.

How dare you claim to be an advocate of mental health and not bring to light the racial issues that are not only causing MORE trauma for today’s generation of colored folks, but is fueled also by the generational trauma of our ancestors.

I am a mixed race individual; my father is African American and my mother is Caucasian. I am light skinned, often mistaken for Mexican, and my mental health and physical health has been impacted by this. Doctors are less attentive. They don’t listen properly. They accuse me of drug use in the middle of my panic attacks.

For African American people in America, there is a lot of grief. There is a lot of trauma, a lot of loss, a lot of pain. We feel unsafe, unheard, tossed aside. That births anger, rage, and perpetuates violence. With the recent murders of George Floyd and Ahmaud Abery and Breonna Taylor (George and Breonna murdered by police; George was already on the ground with three cops on top of him and Breonna was IN HER HOUSE), all of these feelings and this connection we have to each other is growing stronger. Violence is happening because of the angst of hundreds of years of BULLSHIT.

So the fact that so many pages are claiming to talk about Mental Health and are avoiding this issue for political reasons I suspect makes me sick to my stomach. Until this is addressed in all facets, nothing will change. As social media has been circulating: No Justice, No Peace.

Not only does blatantly ignoring this subject aide in the problem rather than the solution, it also sends the message that those of us in the american mental health system who are dark don’t matter as much. We don’t need to talk about this collective pain we feel right now because your page can’t afford arguments in the comments.

I say affectionately, FUCK YOU.

Get off your fucking high horse.

Remember when I said I have made very frank posts on my previous blog? This is one of them.

Get off your fucking high horse and recognize that the deaths of these people, the murders of these people, affect African-American people across this nation. My anxiety, my grief, my voices, my paranoia have all doubled because of what I see happening to the people who are part of my ancestral family. I feel the same for the Native Americans who are hit the hardest with COVID-19 and receiving absolutely no help, except a box of body bags rather than PPE. Part of my family is Native to North America and their suffering has only added to my grief.

This IS a mental health topic. Racism IS a mental health topic. Not because racism is a disorder, but because how it effects people dictates their mental states. To advocate at this time for mental health without reminding followers and subscribers that people of color are collectively struggling mentally with this, to the point that VICE has to be the one magazine to offer self-care tips for African Americans, IS SELFISH.

It’s SELFISH to ignore this as a mental health topic.

I’ve been sick to my stomach all day, lost in my thoughts and my pain and watching Minnesota burn down their police station.

If we truly are all in this together, then where is your support for the black community right now? Where is your acknowledgement of our mental health in a time when we are watching ourselves get killed? Somewhere up your ass?

Good Night.

Posted in Peer Support, Supporting Friends/Family

Who Advocates For Us?

Because the internet is my happy place (not really, but I’m online a lot), I see a lot of what becomes popular as soon as it becomes popular. I don’t follow trends or imitate them, but I do observe and one thing I observe from the Pop-Mental-Health culture, as I call it, is the individuals who become Insta-famous or YouTube famous for expressing views about mental health.

I click on these advocates with a new hope. And every time I’m disappointed.

The thing about being a pop-advocate is that everything you say is really heard. And when you’re really heard and you say something controversial, you may lose your following and For some of these advocates, an online presence is their lively-hood.

I don’t think anyone advocates for the money–what money? You don’t get money for being positive about mental health. You may if you’re on YouTube with a couple million followers, but how many mental health advocates are there with that status? I do think this gives people purpose though, and combined with the drive to offer support and the hope of wellness to others, it becomes their livelihood.

What makes this an issue though, is if you’re a YouTuber with an okay following, your channel can blow up if you talk for ten minutes about how transparent you want to be with your audience and spill your mental health secrets.

It reminds me of Dave Chappelle’s recent acceptance speech when he won the Mark Twain award. Toward the end, he said something like “And one more thing–I’d like to say that I’m gay. Can’t wait to see what that does for my career here now.”

We almost fetishize this idea of being different. It’s become “a thing” now. The day we truly accept everyone is the day someone doesn’t need to come out and say they’re gay or bi or trans or anything on the spectrum. The day we truly accept everyone is the day we don’t have to feel the need to “film our panic attacks” or us talking to our hallucinations.

In the meantime, our greatest advocates have become a lot of professionals. Which is great–we need professionals. But they’re starting blogs and YouTube channels and talking about what’s good for us. As if they know.

I rarely see a primary source on their social media or their channels or their blogs. A primary source would be a mental health consumer.

I’m not against anyone advocating. In fact, I welcome everyone to stand up and say something about mental health. But to purport that you know what we need just because you have a family member who has struggled, or just because you spent 3,000 hours getting your license (for California), doesn’t make sense. You have no idea what we need.

You can ask us what we need. You can advocate for us by spreading the word that we are individuals who deserve respect and compassion and for the majority of the time are not as helpless as we’re made out to be. You can advocate for research. You can advocate for better understandings of psychosis. You can advocate for women whose anxiety is never taken seriously. You can advocate for men whose depression is never talked about. You can share your own experience. But don’t generalize any of that into “this is how to help someone.” Because you have no idea what’s helped.

Maybe medication has calmed your son down. Great! So you advocate for medication without understanding what that means. Maybe your daughter getting off medication has saved her life. Great! So you spread the word that medication is poison without understanding what that means.

So, let’s talk about what advocacy has turned into lately. I’ll list some things, and we’ll discuss the pros and cons.

What I’ve noticed is that advocacy has turned into two things:

From professionals, we get:

  1. Mental illness.
  2. They’re ill
  3. Mental illness doesn’t make you weak
  4. But you’re sick
  5. Don’t get mad at them. It’s because they’re sick.
  6. Anxiety this
  7. Depression that
  8. Anxiety this
  9. Depression that
  10. Oh, and there’s a bunch of severe ones we don’t advocate for. Because those people are REALLY sick and less common.

From the Pop-advocate world of professionals, Insta-influencers, Tweeters, Facebookers, and whoever else, we get:

  1. Today is another day. Let’s make it a good day.
  2. You can choose happiness.
  3. Here’s a video of me having a -Insert Mental Health Experience-. I just wanted to be transparent #mentalhealth #advocacy; followed by comments of “Omg this is exactly what happens to me, thank you for sharing.”
  4. You are not alone.
  5. We need to end stigma.
  6. Let’s end stigma by talking about how different we are and also saying we need to be treated like everyone else.
  7. #Shareyourstory
  8. #Mentalhealthawareness
  9. Anxiety sucks, but you’re not alone.
  10. I’m not my illness.

The good things about this is that at least there is conversation. Something is started. We have realized that a lot of people deal with anxiety and depression and this can help prevent suicide. We are making an attempt to remind people that pain can be temporary and that a lot of us struggle in the same ways–we’re relating to each other. That’s wonderful.

The bad thing? We’re still tied to this idea that we’re sick. We’re also tied to this idea that other people know what’s best for us. In some cases, this can be true. If you think someone has implanted a microchip in your head and you want to dig it out of your brain, someone stopping you is probably your best bet. But in terms of your care, your treatment, and how you want to live your life? No one knows that for you.

We also negate a lot of topics. We negate the trauma that hospitals cause and ride it off as “I needed to be there”. Perhaps you did. But that doesn’t mean coercion and force is the way to help you get better. We negate research that contradicts a lot of what’s being spread about mental health and these things we label as disorders. For example, the DSM 5 was many years late. Why?

Personality disorders. The only disorder that has been RELIABLY diagnosed (doesn’t mean it’s proven as a disorder of the mind) is Borderline Personality. It doesn’t really have any research backing as a disorder. The experiences are very real. But it’s speculated that has a lot to do with whatever trauma that person was put through, and those experiences being a result of the brain having to learn to process all of it.

The rest of the personality disorders? They’re rarely diagnosed reliably and there is no evidence backing them. And so the committee of old, bald, white men struggled in what to do about this for the DSM 5. In the end, nothing was really done. Subcategories and Axis diagnostic criteria were removed.

But does anyone hear about this? No. No one who needs to, at least. I cite my research professor as my secondary source of information. Could he be wrong? Possibly. But if he’s not, think about what that means.

I think it’s wonderful people want to share their stories. I share mine too. But advocacy is so much more than cheesy positive tweets, some random LCSW on YouTube talking about ways to help someone who is struggling, or people who think it’s cool to video tape their crisis or everyday struggle.

Advocacy is supposed to be about information and support. It’s supposed to be about relating to each other while also showing the general public that not everything they believe is accurate. Advocacy is supposed to also be about lifting each other up, and yet we’re divided in the mental health community right now.

I’ve been questioned on Instagram many times by those who consider themselves anti-psychiatry. I have an article on Mad In America called “A System Built On Fear”. I have labeled myself as anti-psychiatry in the past. I’ve shed all my labels now. I have no faith in the medical model and no faith in anti-psychiatry because neither relies on research or truth or science. Both have sprinkles of it here and there. But the medical model relies on the gullibility of the general public, and Anti-psychiatry relies on personal horror stories.

Both are valid. Neither are helping.

So who advocates for us? Right now, I get the sense it’s mostly professionals and family members. I hear our voices in there too, but they’re drowned out by false perceptions, media distorting research, and labels. They’re being distorted by pop-advocates who are really only catering to the medical model, and extremists only catering to anti-psychiatry.

Where do we go from here?

What do you think? Who advocates for you? How does it feel when you tell your story?

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