Tag Archives: James Coyne

Skeptical Musings on Mindfulness

By Marvin Ross with an Addendum by Dr David Laing Dawson

I am pleased to say that I now have something in common with an apologist for Catholicism when it comes to Mindfulness. Susan Brinkman warns Catholics about the dangers of this practice in her book A Catholic Guide to Mindfulness. We have some criticisms in common although part of her objection to this overly touted strategy is that it is too closely linked to Bhuddism. She is concerned that people will abandon prayer and move away from talking to God for the relaxation of the mindful strategies.

Where we do agree is that Mindfulness is oversold and not well researched with valid studies. As we all have likely seen, mindfulness is promoted for stress reduction, depression, anxiety, pain control and likely more. Ms Brinkman cites a metaanalysis from Johns Hopkins University from 2014 that looked at 18,000 studies and found that only 47 (or .0026%) were methodologically sound. Over 99% of the studies to evaluate efficacy were not sound.

Of those 47 studies, “the research found only ‘moderate evidence’ of decreased anxiety, depression and pain and ‘low evidence’ of improved mental health-related quality of life.” She also points out that there is a great deal of money to be made by practitioners.

The poor methodological quality of mindfulness studies mentioned by Ms Brinkman have not gone unnoticed in the field. This past October, a new study was published that set out to evaluate studies over the past 16 years for signs of improved methodological rigour. They found that of the 142 research projects they looked at, there was only a slight improvement in methodology and the studies still appeared to lack scientific validity.

In reporting on this latest study, psychologist James Coyne asks this:

Should we still take claims about mental health benefits of mindfulness with a grain of salt?

His answer:

“A systematic review by one of mindfulness training’s key promoters suggests maybe so.”

Addendum from Dr Dawson sent from Australia

Two popular contemporary forms of counselling can each be summed up in a simple piece of advice, and a piece of advice most of us have heard at least once from our parents and grandparents. “Look on the bright side.” (CBT) and “Stop and smell the roses.” (Mindfulness).

They do not speak to mental illness, suffering, disease, or much of reality. But they do address the existential problem of we humans being conscious life forms with an awareness of ourselves as vulnerable bags of mostly water with limited life spans.

We must anticipate danger and threat to survive, but failing a math test is not a terminal diagnosis. We must, as I must now, remember to look first to my right (Australia) before crossing the road. This is a moment when it is not wise to let the roses distract.

We know it is not good to be pessimistic and constantly worried, but there are moments when anxiety and worry are required. We know it is not good to miss the calm, the peace, the beauty of this world and always be distracted by the traffic but I still need to remember to look to my right and then my left before crossing the street.

The popularity of Mindfulness (and Buddhism for that matter) speaks to how hard it is to find that balance, how hard it is to be a sentient being not always terrified, worried, fearful, angry, jealous and preoccupied by the intricacies of life and the certainty of death.

Yesterday at The Rocks in Sydney among the tourists and locals we several times watched a man trudge by dressed in brown monk’s robes, a large hat and boots, wondering what he was up to. Then in a moment when I was distracted he approached my wife and slipped a cheap beaded bracelet on her wrist, and then another on the wrist of our granddaughter, and then said something about money and showed her a book of initials beside a list of sums. The figures were each between 20 and 50 dollars. I muttered “no, no, no” as my wife reached for her purse and came up with five dollars. I told him it was bad karma to con people. I’m not sure if he said, “f***k off” or “father” as he left us. He also gave her a gold (thin plastic) medallion with the words “Work Smoothly” and “Lifetime Peace” printed on it.

We had at least five dollar’s worth of laughter and chatter from this, before falling back to enjoying the warm sun, the pigeons and Rainbow Larakeets, the parade of old and young humans from several continents, the busker at the corner, and the delightful teasing inquisitive grandchild sitting between us. My daughter arrived 20 minutes late having been stuck in Sydney traffic and forced to park four blocks away in an expensive arcade. This put her in a foul mood, which was quickly alleviated by a bit of paternal mindfulness and CBT.

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On the Sad State of Mental Illness Knowledge in Britain

by Marvin Ross

What is it with the Brits, or maybe just some of them, that they promote strange theories of mental illness and, in particular, schizophrenia? First we had the very controversial British Psychological Society report Called Understanding Psychosis and Schizophrenia that generated a great deal of controversy. See the summary of it by James Coyne. Now we have a course being offered by King’s College London for caregivers of people with schizophrenia.

This sounds like a very worthwhile course given by a university that claims to be one of the world’s leading research and teaching universities based in the heart of London”. I was encouraged to sign up for it and did so much to my chagrin. After the introductory explanations of what schizophrenia is, they tell us that trauma is an important cause of this ailment and that this concept is gaining greater interest. The traumatic event they mention first is the loss of a parent either through death or separation. They then suggest that trauma may be associated with the hearing of voices and that the symptoms of schizophrenia may actually be Post Traumatic Stress Disorder (PTSD).

I looked for references but could find none. As a medical writer I’ve been involved in producing learning materials for doctors and other health care providers and the first rule is that whatever you write has to be evidence based and the evidence must be cited. I recall once being told to find references to prove a statement in a document I was writing on blood pressure that exercise is beneficial.

I left a comment in the King’s College course asking for references but received no reply.

So, lets look at some of the evidence. According to Dr Cheryl Corcoran, a psychiatrist at Columbia University Medical School, chronic stress may lead to psychotic symptoms (hallucinations, delusions) in the context of PTSD or depression. However, she points out that schizophrenia is more than just those symptoms. Schizophrenia, she says “also includes problems in thinking (concentration, planning, memory, etc.) as well as what are called “negative” symptoms (low motivation, difficulty enjoying things, lack of strong feelings, little emotional expression). Schizophrenia can also include odd and disorganized thinking and behavior. She concludes that there doesn’t seem to be any evidence that stress leads to these other symptoms of schizophrenia.

The National Health Service in the UK also disagrees. They say “some people may be prone to schizophrenia, and a stressful or emotional life event might trigger a psychotic episode. However, it’s not known why some people develop symptoms while others don’t.” They point to a variety of possible causes including genetics, brain development, neurotransmitters, pregnancy and birth complications.

According to the Australians Any evidence that childhood trauma directly causes psychosis or schizophrenia is controversial. Psychotic disorders may be secondary to co-morbid affective ilness, substance use, personality, or post-traumatic stress disorders, all of which have been linked to early trauma and all of which are common in those with a psychotic mental illness. Another difficulty for reporting childhood trauma in adulthood is accurately recalling events, and for some people memory is affected by the psychotic disorder. In other areas of research, such as depression, instruments have been developed which employ strategies to overcome recall problems such as the use of multiple sources of information. To date, these strategies have not been employed in most studies of schizophrenia.”

The number one cause of trauma that the King’s College Course cites is coming from a one parent family. Well, as I’m sure that most people know, this is a growing phenomenon. According to the Child Trend’s Database in the US, the proportion of children living with both parents has been in decline since 1970 and reached 64% in 2014. That means that in the US, 36% of children are in one parent families. This is a trend that is universal in the developed world and yet there is no increase in the number of people who develop schizophrenia. One study conducted in England over the period of 1960 to 2009 concluded that “We found no evidence to support an overall change in the incidence of psychotic disorder over time, though diagnostic shifts (away from schizophrenia) were reported.”

This course also suggests treatment modalities such as Cognitive Behavioural Training for Trauma and Eye Movement Desensitization and Reprocessing (EMDR). Both are tried as treatments for PTSD and may or may not be effective but they are not a first line for schizophrenia. The other risk factor that is talked about is marijuana use but I suggest taking the course and deciding for yourself how relevant it is.

One psychiatrist to whom I mentioned the emphasis on trauma as a cause of schizophrenia commented that this is both insulting to the families and potentially dangerous. But, let me end by quoting my blogging colleague, Dr David Laing Dawson from his blog called As For Trauma Causing Schizophrenia: No! No! No!

People with psychotic illness do not need someone probing the wells of their psychic discomfort; they do not need (no matter how well-intended) a therapist scouring their childhood memories in search of an unhealed wound. They need support, safety, security, grounding,  and satisfying routine before they can get better. And good medical treatment.”

A Comment on “Me, My Mind and Baked Beans” & “The Holocaust Intrudes…”

stone of madness     By Dr David Laing Dawson

There is no doubt we need to be careful and cautious with labels. And comparing The Holocaust (as Peter Kinderman did) to anything other than another systematic and extensive act of genocide trivializes the former and reduces whatever criticism was intended of the target to a nasty school yard epithet. It is just plain thoughtless, stupid, and insensitive – as James Coyne pointed out.

But the concept of disease is just that, a concept. The word itself is a conjunction of “dis” and “ease”. The modern concept of disease has a two or three hundred-year history. And it is, after all, the very concept that allowed us to eradicate – well, almost eradicate – measles, mumps, polio, diphtheria, cholera, to treat some cancers, heart disease, pneumonia, and to improve the lives of those suffering from the conditions of bipolar disorder, depression, and schizophrenia.

We have philosophical and scientific approaches to the concept of disease, and folk definitions. These may invoke evolution, constructivism, objectivism, adaptation, and concepts of “abnormal” and “normal”. And “normal” itself, can entail ideas of function, value, ideals, averages, and adaptation, as well as bell curves, actuarial tables, standard deviations.

The concept of disease does also imply a biological insult, difference, or malfunction of some sort, from its history of scientifically seeking cause and effect and the linkages between them, of leaving older explanatory concepts of magic, karma, miasma, destiny, god, evil, the devil and possession behind, to say nothing of the wholly unfounded notion that a “refrigerator mother” can cause autism or psychosis in her child.

We do have a recent history of overusing the disease concept in our modern world, of allowing flawed ideals and values (and commerce) to inform some of our definitions. But, in truth, it was not the overreaching concept of disease that caused damage, but the laws of the time that allowed abuse to follow. And the abuse, as is usually the case, was of power, not of semantics.

Today, on one side of the coin, we have the advocates for addictions and alcoholism petitioning for those afflictions to be called diseases, and on the other side, certain U.K. psychologists  asking that all mental disorders be removed from under the rubric of disease. The former, I’m sure, because the concept of disease does absolve one of some moral responsibility for his or her behaviour, and the latter, I’m sure, because the concept of disease requires a physician to head the team of professional helpers.

But let us bring this down to basics:

We perceive someone to be “badly off.” He may or may not perceive himself to be badly off. We then ask ourselves if the disease concept will be of benefit in this situation. Does the idea of “illness” fit? Is he suffering? Is he causing others to suffer? Folk definitions may be applied at this point: “Call the cops.” “He needs a doctor.” “He seems to be okay, he’s not bothering anybody.” “He needs his medications adjusted.” “He’s just a little eccentric.” “That’s just Joe being Joe.” Or even that contradictory but common conclusion, “What a sick bastard.”

This person is brought to or finds his way to a medical professional. The medical professional asks herself similar questions: “Is he badly off?” “Does he perceive himself to be badly off?” “Is he suffering?” “Is he causing others to suffer?” And, then, “Does the concept of disease offer any help in this situation?”

And there is absolutely no doubt (how could there be any doubt today?), that for those behaviours and experiences, those symptoms and signs and suffering that constitute severe mental and emotional disorders, that fulfill the definitions of schizophrenia, bipolar disorder, severe anxiety disorder, severe depression, the answer is YES, ABSOLUTELY.

And that ‘yes’ encompasses treatment today, and research tomorrow.