Following the [Darian] Leader…

Zarathustra, who’s both an occasional visitor to the comment boxes here at the Ministry and a damn fine blogger in their own right, over at Mental Nurse, currently has a very welcome guest post on the go over at my second online home, Liberal Conspiracy, which relates to the emergence of a campaign against proposals to bring psychotherapy and counselling under the regulatory ‘wings’ of the Health Professions Council.

This is, undoubtedly, a step in the right direction for both psychotherapy and counselling as professional disciplines, and mirrors a similar, and long sought after, by psychologists and their key professional body, the British Psychological Society, which is due to be completed on 1st July 2009 with the opening of the HPC’s Register of  Practitioner Psychologists.

I won’t dwell too much on the obvious benefits that the HPC’s regulatory regime has to offer, its enough to know that what it provides is a statutory system for regulating health professions and professionals that operates broadly along the same lines as the General Medical Council, one that ensures that certain professional titles may be used only be registered practitioners who have the appropriate qualifications and who must work to defined professional standards or risk being struck off the register and denied the right to practice. In short, its a system that aims to protect both the profession and the public from quacks, frauds, fakers, incompetents and the criminally malfeasant, all of which is undoubtedly a good thing even if it comes with a few bureaucratic overheads, such as proper record-keeping.

So, with psychologists already in the fold, existing representative organisations, such as the UK Council for Psychotherapy, actively engaged in working with the HPC to define appropriate standards for the regulation of psychotherapy -its submission on proficiency standards looks to be well put together and hits most of the rght spots – and the full support of the mental health charity, Mind, you’d think that psychotherapists would be jumping at the chance to improve the professional status and standing…

…but apparently not as the emergence of a self-styled ‘Coalition Against Over-Regulation of Psychotherapy‘ – which comes with its own clutch of celebrity backers, including Peter Gabriel, Michael Nyman, Hanif Kureshi, Will Self and Tracey Emin – appears to demonstrate.

Zarthustra seems to have no doubt as to the merits of this coalitions claim that HPC regulation would destroy psychotherapy by imposing a ‘clear, predetermined agenda’ on psychotherapeutic practice…

This is utter bilge, and the reason it’s bilge is because the HPC already successfully regulates arts therapy. Regulating arts therapists has not required them to “adhere to a clear predetermined agenda” (which in arts therapy would be impossible anyway), but it has required them to keep accurate records, maintain confidentiality, treat patients with respect and so on. Anyone who thinks such things impinge on their therapeutic technique shouldn’t be practising therapy.

And my own suspicions are further raised by the inclusion of a claim that the proposed regulations will ‘451 rules for the analytic session’ which not only seems entirely implausible but which appears to exist, to date, only on the coalition’s website and a number of blogposts, letters to the press and articles supporting the campaign – I’ve certainly yet to find any kind of reference to rules of this kind in the materials published by the HPC’s Psychotherapists and Counsellors Professional Liaison Group.

So, we appear to have a set of unverifiable and implausible claims on our hands, and that kind of thing invariably sets by ‘something’s not quite right’ bump itching, at which point I start asking questions like ‘who’s actually behind this campaign?’ and ‘what is there that might motivate them to opposed proposals for proper professional regulation of psychotherapy?’

The answer to the first question, i.e. who, turns out, from the WHOIS data for the site, to be Darian Leader of the Centre for Freudian Analysis and Research.

So, straight away we appear to entering Freud country, where things could certainly get a little strange, but on its own that not enough information to reach any of conclusions. However…

…it appears that Darian has a sideline as an author and one book in particular, ‘Why Do People Get Ill?’ (co-authored with David Corfield) caught my eye thanks to both its title and, when I quickly chased it down, to its associated marketing blurb…

Have you ever wondered why we get ill? Can our thoughts and feelings worsen or even cause conditions like heart disease, cancer or asthma? And what – if anything – can we do about it?

Why Do People Get Ill? explores the relationship between what’s going on in our heads and what happens in our bodies, combining the latest research with neglected findings from medical history. With remarkable case studies and startling new insights into why we fall ill, this intriguing book should be read by anyone who cares about their own health and that of other people.

Well that’s certainly woken my internal bullshit detector up and kicked it swiftly on to ‘yellow alert’.

We’ve got a book jacket blurbs which suggests the possibility of a causal relationship between our ‘thoughts and feelings’ and cancer and a reference to ‘neglected findings from medical history’, a combination that often doesn’t auger well if you’re looking for things like evidence and rational argument and this turns out to be an impression that was swiftly confirmed by a rather glutinous review of the book by Lisa Appignanesi, who’s also a signatory to the Coalition’s petition and a trustee of the Freud Museum, which appeared in the Guardian in February 2007.

After collapsing in an art gallery, a man is rushed to hospital. He has palpitations, chest pain and is short of breath. He is certain he is about to die of heart failure. But none of the drugs his worried doctors provide eases his problems. Finally, after months, he tries acupuncture and – eureka! – his symptoms dissipate, as does his anxiety.

Does this prove acupuncture works? Yes and no. As the authors of this fascinating book argue, neither the cause of illness nor its cure is straightforward. A fast diagnosis combined with prescriptions from Big Pharma may sometimes suit and often not. Patients sometimes need a particular illness.

What we have here seems to be a fairly straightforward and easily explicable account of a man who experienced a sudden onset of stress-induced anxiety, a condition that, either on its own in combination with mild depression, is just about the most common short-term mental illness in Western society, and who subsequently found some relief for his condition in a course of acupuncture.

The story itself is perfectly plausible as, indeed,  the suggestion of a ‘yes and no’ answer to the question of whether acupuncture might have worked in this case. After all what we have are a collection of psychosomatic symptoms of a kind that are likely to respond well to a convincing placebo and a treatment regime, acupuncture, which we already know serves as a perfectly good placebo.

Bingo, we have ourselves a plausible explanation for the story based solely on things we’ve come to understand by examining well-founded research evidence but, as you may well have guessed from the unabashed reference ‘Big Pharma’ and the suggestion that ‘Patients sometimes need a particular illness’, that’s not the explanation that Leader’s book advances…

Our heart patient had a story accompanying his collapse. It is this sort of story, like the timing of the onset of an ailment, that few doctors inquire about. He had secretly been seeing a lover and had always done so in a private place, but that week’s rendezvous had brought them into the public spotlight of the gallery. Here, in the middle of their embrace, he had glimpsed someone who reminded him of a friend of his wife’s. He passed out, struck by heart pain. Nothing helped relieve it until he tried acupuncture. Talking of its efficacy, he repeated excitedly how like torture the treatment was, ‘a terrible punishment’.

Whatever the benefit – or lack of it – of acupuncture, in this case it worked because it functioned as a punishment for the patient’s clandestine affair and assuaged his guilt. Much successful medicine may work, or not, for the same subterranean reasons. Illness and cure are rarely as simple as the ‘single cause’ on which much medicine is based.

Running into someone that you, at first sight, mistake for a close friend of your wife while you’re out on the town with your mistress is an eminently plausible trigger for a good old bout of stress-induced anxiety, so that much rings true, but then, oh dear… what is all this post hoc psychobabble bullshit about acupuncture serving as surrogate punishment that assuages the main protagonist’s guilt over his foray into marital infidelity?

Well, its definitely one of the more delightfully batshit attempts to account for the placebo effect that I’ve seen in a very long time – in fact, if I’m going to be perfectly honest, you can feel free to define ‘very long time’  here as ‘since the last occasion I could be bothered to read anything on Freudian psychoanalysis’ and assume, quite correctly, that at this point my personal bullshit detector has gone straight to DefCon 5 and the warning sirens have gone into overdrive… woo… w00… w00… wooo000…

I guess I could stop there, but in for a penny, in for pound – let’s take a quick look at the next paragraph of the article just to double-check that the bullshit detector is working properly…

The evidence, the cases and the statistics that psychoanalyst Darian Leader and science historian David Corfield use add up to a wholesale attack on our medical system and its increasingly ‘scientific’ bias. This assumes that body and mind are utterly separate entities which never speak to each other. But the dialogue is constant, if necessarily unconscious and, as Leader and Corfield are careful to elaborate, can start at either end. A cancer may make itself evident only after a near one’s death, though it has been growing for years, or a child may develop a diabetes that is the sign of her identification with an absent father.

So let me get this straight. What Leader and Corfield want people to believe is that science (i.e. evidence) based medicine is somehow premised on, what, Cartesian dualism???

Hell, that’s really going to come as news to the usual bunch of religionist asshats that us skeptics tend to end up picking fights with – you know the kind that get really pissed off with our distinctly monist refusal to accept stuff like the existence of a ‘soul’.

But, of course, the ongoing monist/duallist debate over the mind-body problem isn’t really what  Leader and Corfield are alluding too when they accuse evidence-based medicine of treating mind and body as ‘utterly separate entities which never speak to each other’, not that EBM does that anyway – just think of how often the word ‘placebo’ crops when discussing the efficacy of different treatments). No, what they’re actually taking a pot shot at is EBM’s refusal to buy into the kind of quasi-mystical, bullshit and voodoo, nonsense that tries to suggest that childhood diabetes is a sign of ‘identification with an absent father’ when we know, perfectly well, that its a metabolic disorder that is, typically, caused by a combination of genetic and environmental factors none of which have anything to do with whether or not daddy still lives with mommy.

There’s a word for this kind of thing… quackery.

Tell you what, let me show exactly how this works using that paragraph’s reference to cancer making itself  evident…

“only after a near one’s death, though it has been growing for years”

It’s patently obvious what Appignanesi (and by extension, Leader and Corfield) would like you to infer from that particular paragraph, i.e. that the emergence of cancer in close proximity to the death of a family member or close friend is somehow directly associated with the feelings of grief that people naturally experience in the wake of the death of someone they care deeply about. Naturally enough – and I can safely make a prediction simply from the knowledge that Leader is a Freudian – its not just any old feelings of grief that will be somehow mystically associated with cancer for reasons that Leader’s book will, I’m sure, be entirely unable to explain without resorting to a shitload of convoluted psychobabble. No,with a Freudian in play we can be pretty much certain that its going to be ‘unresolved’ and ‘subconscious’ feelings of grief that the book will suggested have some kind of ill-defined but, seemingly, statistically evidenced part to play in the emergence of cancer following a bereavement, the kind that can only be dealt with the assistance of a psychotherapist.

There are, however, a couple of much more straightforward explanations for this apparent phenomenon.

One is simply aging.

The older you get the more likely it becomes that you experience a bereavement because everyone around you is also getting older at the same rate that you are and, from your teens onwards, as you and your contemporaries get older, so your own, and their, risk of dying of any possible cause increases.

By the same token, the single most significant risk factor for developing cancer is also aging, so the older you get the more likely you are – statistically speaking – to develop some form of cancer.

Once you realise that both your probability of experiencing a bereavement and of developing cancer increase as you age then it should be pretty obvious why, when you come to look at the age-related statistics for mortality and for cancer, the two might well appear to go together. In fact a correlation between the two that increases  as you move up through the data for successive age groups, is precisely what you’d expect to find…

…but, if you’re also a scientist then you also know that such a correlation does not imply causation if its not supported by other corroborating evidence, so you know not read too much into it.

As for the second explanation, this is, if anything, even more straightforward than the first.

When people lose someone close to them, especially if the loss is an unexpected one, this will very often prompt them to question their own mortality and sense of health and well-being. This, in turn, may nudge them into going along to their doctor for a thorough check-up, one that in some cases, will result in the discovery of an illness or condition that had previous gone undetected or had not been fully diagnosed – and eh voila, there you have some previously undiagnosed cases of cancer in fairly close proximity to a bereavement.

Once again, as with the earlier case of the Lothario as his anxiety attacks, the application of a modicum of reason derived from the scientific method, leads us to straightforward explanation of a phenomenon that places no reliance whatsoever on Freudian psychobabble, all of which is great for us skeptics as it explains the apparent correlation between recent bereavements and cancer in purely naturalistic, and easily understood terms.

Where this puts us, and thus far we’ve only just begun to scratch the surface of the campaign against HPC regulation, is firmly on the pseudoscientific wing of psychotherapy,  which, in turn, suggests that what may actually be eating at Leader and other, as yet undeclared, ‘professional’ backers of this ‘Coalition’ is not so much a legitimate concern at the possibility of over-regulation or overt bureaucracy but a fear that a move to statutory regulation, underwhich the term ‘psychotherapist’ with protected and, therefore, usable only by HPC registered practitioners may attract unwelcome attention and close scrutiny from advocates of evidence-based medicine in much the same vein as that which has been directed towards ‘alternative therapies’ such as homoeopathy, acupuncture and chiropractic.

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  • Thanks for the plug.

    Incidentally, Darian Leader was in Comment is Free recently calling for a waaaahmbulance about the proposed HPC regulation.

    He doesn’t like the fact that HPC fitness to practice hearings are conducted in public (well duh, that’s what it means to be publicly accountable), he accuses the HPC of behaving like a “super-moral agency” because it disciplines people for things that you wouldn’t get hauled up in court for (again, duh. breaching professional boundaries or not keeping records wouldn’t get you arrested, but it’s still clinical misconduct) and various other spurious (IMHO) justifications.

    I posted a critique of his article here.

  • Unfortunately it is a myth to think that you will get proper regulation from the HPC. They recently waived their own rules about “evidence based practice” when they said that they were willing to take on traditional Chinese medicine and acupuncture. See it at http://www.dcscience.net/?p=1284

    They will no more protect the public against charlatans than any of the myriad other box-ticking quangos that, in the end, give credence to charlatans rather than protecting the public against them.

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