Thursday, June 21, 2012

Is mental illness curable by CBT?

The report from The Centre for Economic Performance (mentioned in my last post) boldly states that mental illness is curable. To support this claim it references three papers – Layard et al (2007), Clark (2011) and Gyani et al (2011).

Layard et al (2007) calculated the expected improvement in employment rates from CBT treatment, and estimated this to be on average about one month for each person in 2 years. They emphasise that they are not claiming huge effects and go on to give estimates of the reduction in numbers of people on benefits from the introduction of IAPT, saying that the programme will easily pay for itself. I'm not sure if they'll get the opportunity to show whether the programme has met these targets.

Clark (2011) describes the national programme for IAPT including the results from the two pilot demonstration sites. He emphasises that the demonstration sites were not set up as randomised controlled trials. It is therefore not possible to exclude the possibility that improvements may have been due to natural recovery and self-fulfilling expectancy effects. 

Gyani et al (2011) analyses data from the first year of the IAPT programme. They note that people can get worse in treatment as well as better. Considerable between site variability  in overall recovery rate between 27 and 58% was found  (median 42% - approaching target of 50%). "Recovered" does not equal symptom free. Nor is it clear that any apparent benefits can be maintained over the longer term.

In reality, this literature is insufficient to substantiate the statement about the curability of mental illness as such. As I said in my last post, I’m not wanting to undermine optimism in treatment, but we do need to be realistic about the evidence. Otherwise, scientific expertise is merely being exploited for political ends. 

Of course people do recover from mental illness, but this might be a difficult, slow, costly, painful and sometimes incomplete process. Promoting CBT as a panacea is no different from pharmaceutical quackery. 


Anonymous said...

I feel this is far too dichotomous. People are just not well or ill! Both in physical and mental health we can almost always be healthier or less healthy. We are very rarely 'cured' of anything.

Altostrata said...

Duncan Double wrote: "Of course people do recover from mental illness, but this might be a difficult, slow, costly, painful and sometimes incomplete process."

This begs the question "What is mental illness?"

(And, I might add, "Who is to judge how far along another person is in recovery?")

For many people, after 20 years of diagnosis creep, whatever has been called their "mental illness" may be an interwoven set of assumptions, expectations, life choices, attitudes, and bad experiences that have not served them well.

We shouldn't expect a total cure of this. That would be brainwashing.

Small changes can make a difference. CBT may or may not be the intellectual mode that enables a given individual to reconceptualize his or her life, if the individual chooses to change.

No, CBT is not a panacea for the sometime unhappy complexities of human life. Is even calling such a state of mind "mental illness" constructive?

Judith said...

Hi Duncan,

My name is Judith Chriqui and I am an MA student at UEA doing my dissertation on pyschotropic medications(or the debate over the medicalization of emotional and psychological problems). Do you have an email I could reach you at? I'd like to ask you some questions!



Anonymous said...

Layard is the DSM sense

Anonymous said...

There is a fascinating and growing body of research showing how inflammatory processes in the body, especially autoimmunity, can trigger intractable depression. One factor is the relaase of pro-inflammatory cytokines (the chemicals also responsible for "flu-like" symptoms in flu). It may be possible to target such depression via anti-inflammatory meds someday.

Thyroid disorders are also notorious for symptoms ranging from depression to anxiety to manic speediness. These generally involve autoimmunity and inflammation issues as well, and current diagnostic protocols (such as the TSH test) tend to result in more false-negatives than accurate diagnoses (see Moderate adrenal insufficiency (which the NHS won't test for due to costs) triggers anxiety, lassitude and the inability to cope with confrontations.

In the UK, Prof. Wesley et al continue to insist that ME is a mental illness and victims still risk being sectioned for compulsory CBT and physical jerks - at best a short-term placebo, and at worst resulting in permanent damage or death. (The WHO has been clear for decades that ME/CFS is a neurological condition). Sometimes depression is the first sign of cancer.

When will the medical establishment drop their superstitious Magical Thinking Theory of "negative thoughtcriminals creating their own negative realities" (CBT), and stop ignoring the fact that physical pathologies can and do impact mood and psychological functioning?