Read Media Reports on Mental Illness With a Critical Eye

By Marvin Ross

Despite the best of intentions of most reputable papers and their editors, nonsense still gets published. Much of that nonsense pertains to theories of mental illness.

A perfect example of that was in my own local paper, the Hamilton Spectator on September 21. The Op Ed by a social worker was headed “Bad Behaviour is Bad Behaviour. Period.” The author, Alexander T. Polgar PhD, RSW, is a forensic social worker and public safety consultant. His PhD is in social work and RSW means that he is a registered social worker.

Dr Polgar was objecting to a recent report by the John Howard Society of Ontario which pointed out that many in prison in Ontario have untreated mental illness and that people often have to commit crimes in order to get mental health treatment. One of the authors of that report said that “Ontario must stop punishing people for their mental health issues and take ‘bold and immediate action’ to decriminalize mental illness.”

Now Dr Polgar objects to the fact that the primary premise of that report is that “mental illness is a medical problem” and he comments that this speaks “to the success with which bad behaviour has been and continues to be medicalized”. He goes on to say that “throughout history, those who behaved badly or strangely were considered to be possessed by demon spirits and the solution was to ‘beat the devil out of them’”.

He says, we no longer beat them in Western cultures but we do punish them in a variety of ways including incarceration. He then adds that the medical model of madness continues to compete with the demon-possessed causes of bad behaviour. Freud, he said began to change that with a focus on family dynamics, social conditions and various relational issues. That gave rise to psychotherapy, counselling, behaviour modification and family therapy. Not surprisingly, he cites Thomas Szasz and RD Laing.

But, the resistance to Freud, Szasz and Laing are the result of two problems – the human proclivity to abdicate familial and social responsibility for troubled children who become dysfunctional adults and a profit driven pharmaceutical industry who can provide a solution that justifies the abdication of reponsibility.

He concludes his piece by saying that “we cannot and should not tolerate from anyone bad behaviour. This includes bad behaviour from those we currently label as the mentally ill.”

And, finally “the best place to modify these socially unacceptable behaviours contrary to the views of the above cited report, is in correctional institutions and in community based correctional programs provided by behaviourally trained personnel far better resourced and equipped than they are now.”

Unfortunately I can’t give you the link to the article so you can read it for yourself as it is one of the very few articles that the paper did not put online. They may have read my letter to the editor with copies to the senior editors which they did not publish.

But, who is Dr Polgar? Well, interestingly enough, he has been prosecuted by the College of Psychologists of Ontario (CPO) for the unauthorized practice of psychology. In 2006, the CPO applied to the Ontario Superior Court of Justice for an order to desist. It was alleged that “he held himself out as a person who is qualified to practice in Ontario as a psychologist or in a specialty of psychology. The Application also related to allegations that he performed the controlled act of communication of a diagnosis in the circumstances described in the Regulated Health Professions Act, without being a member authorized by a health profession act to perform the controlled act.”

The case did not get to court as Dr Polgar agreed that “Without any admission that he has done so in the past, Polgar agrees that he will refrain from communicating in any report to any client or other person, any diagnosis, meaning any statement identifying, as the cause of a person’s symptoms, a neuropsychological disorder or a psychologically-based psychotic, neurotic, or personality disorder. It shall not be considered a violation of this agreement for Polgar to make and communicate social work diagnoses as that expression is defined by the OCSWSSW.” (the College of Social Workers)

The second link downloads the CPO Bulletin and details of his unauthorized practice can be found on P 10. http://www.cpo.on.ca/Search.aspx?searchtext=Polgar

The moral of the story is to read with a very critical eye. Fact checking does not always catch everything.

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15 thoughts on “Read Media Reports on Mental Illness With a Critical Eye

  1. Marvin, your ‘critique’ of this article is missing; you’re simply attempting to discredit the author who is in fact a credible source. Many regulated health professionals have had complaints raised against them, in fact many prominent and influential leaders in the field of mental health. I challenge you to analyze the content of the article and critique it.

    In regards to the article, although the author does not include contemporary citations (from modern functional contextualist approaches to mental health including meditational analysis and the work of contextual behavioural science) he makes an excellent point. Mental health problems are largely behavioural problems not a disease. In fact, the DSM is littered with syndrome definitions. This is a problem.

    The days of diagnostics based on an arbitrary definition of mental health must come to an end. Mental health related issues are not the psychology of the abnormal, behavioural medicine has a lot to say about this and has been instrumental in developing an unquestionably better diagnostic system: functional analysis.

    I believe the paper is challenging and enlightening, all necessary in the stigmatizing, pejorative narrative that dominates mental health coverage today.

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    1. I appreciate your comments but the critique of this social science view of mental illness can be found throughout this blog. I would suggest some of the blogs by my blogging partner on schizophrenia and trauma, why he has been prescribing meds for 47+ years and his five part series of one step forward two steps back

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      1. Thanks for taking the time to respond. You have however, sidestepped the issue altogether: critique the paper. What specifically stands out to you as nonsense? A social science approach? — radical behaviourism, the works of functional contextualists and behaviour science/medicine in general is an active, alive and well geek bench science. Not simply the works of “social science.”

        You are citing that it’s a theory of mental health, what is the dominant theory you see in this paper? Do you have data on its falsification? Can you explain what is disreputable about what is written? What was not fact checked?

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    2. Functional analysis can be useful in helping the client replace a dysfunctional behaviour with one that is healthier, but it cannot be used to address a brain based mental illness like schizophrenia, in my opinion.

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      1. Kathleen, this is false and it’s misinformation like this that continues to perpetuate the stigmatization in mental health. The evidence for epigenetic’s has largely falsified what we thought we knew about “broken brain syndrome” (falsified) and “bad genes” (falsified).

        https://en.wikipedia.org/wiki/Epigenetics

        This is the most recent publication (in press) using functional analysis as a diagnostic system and intervention approach that is far superior than the mechanistic view of human experience that is currently adopted in the DSM and ICD.

        Johns, L. C., Oliver, J. E., Khondoker, M., Byrne, M., Jolley, S., Wykes, T., Joseph, C., Butler, L., Craig, T., & Morris, E. M. (2016). The feasibility and acceptability of a brief Acceptance and Commitment Therapy (ACT) group intervention for people with psychosis: The ‘ACT for life’study. Journal of behavior therapy and experimental psychiatry, 50, 257-263.

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      2. Here is a quote from the paper you cited in response to Ms Mochnacki:

        LIMITATIONS: The uncontrolled, pre-post design precluded blinded assessments, and may have inflated effect sizes. Participants may have improved as a result of other factors, and findings require replication in a randomized controlled trial (RCT).

        CONCLUSIONS: This preliminary study showed that brief group ACT interventions for people with psychosis are feasible and acceptable. Uncontrolled, pre-post assessments suggest small clinical improvements, and changes in psychological processes consistent with an ACT model. Replication in an RCT is required, before implementation can be recommended.

        See https://kclpure.kcl.ac.uk/portal/en/publications/the-feasibility-and-acceptability-of-a-brief-acceptance-and-commitment-therapy-act-group-intervention-for-people-with-psychosis(021617ea-c840-43ec-89c6-fbee25f1a813)/export.html

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  2. What I objected to in his op ed was this “Now Dr Polgar objects to the fact that the primary premise of that report is that “mental illness is a medical problem” and he comments that this speaks “to the success with which bad behaviour has been and continues to be medicalized”.

    It goes without saying that serious mental illnesses like schizophrenia, bipolar disorder, etc are medical problems. They are not behavioural! And there are many reports like the one from the John Howard Society that demonstrate that because of a lack of treatment resources in the community and hospital beds, there are many people who are untreated who run afoul of the law for minor offences and wind up in jail. In Canada, our jails are becoming psychiatric facilities and the largest psychiatric facilities in the US are the Cook County jail in Chicago and Rikers in New York City.

    I suspect that you agree with Dr Polgar that these are not medical conditions and I doubt if I can say anything to convince you but this is just one http://www.huffingtonpost.ca/marvin-ross/schizophrenia_b_1023721.html

    Case management, psychology and social work do have a place in treatment but after a person is stabilized with the appropriate medications that are far from perfect and do have side effects (as everything does including vitamin C) but do help the majority of people to a certain extent.

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    1. These issues are not behavioural? You could not be more wrong.

      A review of the scientific literature provides new insights into both experimental and clinical/applied research.

      O’Neill, J. & Weil, T. M. (2014). Training Deictic Relational Responding in People Diagnosed with Schizophrenia. The Psychological Record, 64, 301-310. doi 10.1007/s40732-014-0005-3

      For the less academically inclined:
      http://www.nytimes.com/2015/10/20/health/talk-therapy-found-to-ease-schizophrenia.html?smid=fb-nytimes&smtyp=cur&_r=2

      http://www.madinamerica.com/2015/10/landmark-schizophrenia-study-recommends-less-drugs-and-more-therapy/

      http://www.rte.ie/radio1/doconone/2013/1129/647579-radio-documentary-sounds-mad-hearing-voices-psychology/

      http://blog.oup.com/2015/06/schizophrenia-cognitive-behavioral-therapy/?utm_content=buffer46ff8&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

      Your suspicion about my agreement with Alex/not being able to convince me is amiss. I am a believe in the research and the data that it produces.

      Personally, I’ve seen Alex work, he is an expert (qualified) and works for the ministry of community safety and correctional services. He actually does this work with offenders in Ontario’s prisons and is excellent at what he does, his ideas, opinions and decades of experience are appreciated by professionals doing this work and researching it. I however challenge his work regularly and prefer to see the data, which I have respectfully brought to this post rather than anecdotal evidence.

      I find your dismissal and discredit of Alex Polgar and his work to be in poor taste.

      Psychiatry and psychiatric medications do have an important role to play in the treatment of mental health. However, we need independent evaluations of medication, destigmatization of people who suffer with mental health related problems and a science that is worthy of the people who need it most. A science that sees mental health problems as a part of the human condition and not the psychology of the abnormal. Telling people that they are broken is a lie and only continues to stigmatize them and disempower their healing.

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      1. You cite the study as reported in the New York Times but the NYT published a correction of their interpretation of that article. This is what it said:
        Correction: October 23, 2015
        An article on Tuesday about a study of the treatment of first-episode schizophrenia referred incorrectly to the conclusions of the study. Though it studied a program intended to reduce medication dosages, the researchers do not yet know for sure if dosages were lowered or by how much. Therefore, the study did not conclude “that schizophrenia patients who received smaller doses of antipsychotic medication and a bigger emphasis on one-on-one talk therapy and family support made greater strides in recovery.” (The study did conclude that the alternative treatment program as a whole led to better outcomes.) The article also erroneously attributed a statement to Dr. Robert K. Heinssen, who oversaw the research. It was scientists familiar with the project — not Dr. Heinssen — who said that the study’s original proposal, calling for two nearly identical trials, was changed in part because of recruiting problems. (Dr. Heinssen said that one trial was redirected, but did not say why.) And because of an editing error, the article misidentified the institution where Dr. Heinssen is director of services and intervention research. It the National Institute of Mental Health, not the Centers for Medicare & Medicaid.See http://www.nytimes.com/2015/10/20/health/talk-therapy-found-to-ease-schizophrenia.html?_r=0

        As for Mad in America well they are hardly great scientific sources. I’m not replying to you any more as I have better things to do but I suggest you read what I’ve said about them in this blog and in my Huffington Post blogs (including my comments on Whitaker) and what Dr Dawson said in this blog of one of their Canadian columnists. Enjoy the weekend.

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  3. Reading through Tim Gordon’s comments I notice that he almost certainly has nor real understanding of epigenetics. he appears to be making them mean what he wants them to mean.

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