Trendy Psychiatric Research: A need to sanitise hubris and bad faith?

An article in the Times by Dorothy Bishop explores some of the problems in biomedical research which arise from the obsession with high-impact journals and expensive grants.

monopoly boardHer critique is especially apt in the case of the physical basis of mental illness, in which researchers seeking fame and fortune must master the storytelling arts of simplicity, metaphor and metonymy. Those seeking H-impact & lucre must stay “on message” and above all, never stray into the chaos of imperfect methods and noisy data.

Bishop concludes with a warning, that the relentless focus on publishing in prestigious journals encourages…

1. Over-claiming the significance of research findings.

2. Leaving important, but contradictory results unpublished.

Hubris is the orientation of the former, bad faith the foundation of the latter.

“…what changes everything is the fact that in bad faith it is from myself that I am hiding the truth“.

Is CBT really ineffective for schizophrenia? – 2 rounds: Marquis of Queensbery Rules

CBT-for-Psychosis-Final-Poster399x282In the UK the National Institute of Clinical & Health Excellence (NICE) has recommended that the treatment of psychosis should include cognitive behavioural therapy (CBT). As a result CBT has been ‘rolled out’ for people suffering schizophrenia and other psychotic disorders.

But the efficacy of CBT in schizophrenia has been challenged. A recent paper in the British Journal of Psychiatry has argued that the returns of CBT are small, and if the highest standards of the clinical trial are applied, any benefits disappear into nothingness. Not surprisingly – given the stakes – there has been a robust counter argument in favour of CBT for schizophrenia.

Ahead of a forthcoming Maudsley debate, the protagonists have made their case in a ‘head to head’ article published in the British Medical Journal [available here]. This is the preamble to the main event, a tag-match involving two rounds of ‘live action’, between…

in the Blue corner: CBT critics

Peter McKenna, Research Psychiatrist, Barcelona &                                                         Keith Laws, Professor of Cognitive Neuropsychology, University of Hertfordshire

& in the red corner: CBT defenders

David Kingdon, Professor of Mental Health Care Delivery, University of Southampton Peter Kinderman, Professor of Clinical Psychology, University of Liverpool

(& your match referee: Professor Sir Robin Murray FRS)                                                                    

Cool Memories: The Recurring Crisis of Psychiatry.

The diagnostic system for delineating psychiatric disorders ('The DSM') is in it's fifth rewrite. It had been anticipated that advances in fMRI imaging and molecular genetics would have finally put psychiatric diagnoses on a medical footing. Alas fMRI has failed to live up to it's promise. And genetics, if anything, has been too powerful – by toppling the whole framework of DSM.

A new paper by Juan & Maria-Ines Lopez-Ibor captures the zeitgeist, but also reveals that the current debates and controversies are nothing new. For over 150 years, psychiatry/psychology has struggled to establish itself as a natural science because of three major issues – 1. Classification difficulties. 2. The mind-brain duality problem. 3. The perils of phrenology (localisationism).

[The full paper can be read here].

These issues have been acknowledged many times before, but never as a collective – and perhaps never as elegantly (even with some minor errors of translation from Spanish into English).

On classification…

“Psychopathological phenomena certainly exist and can be observed and experienced as such. However, psychiatric diagnoses are arbitrarily defined and do not exist in the same sense as psychopathological phenomena do”.

On dualism…

“Dualism manifests itself in the separation of mental and physical diseases, of psychiatry and the rest of medicine, of neuroses and psychosis, of biological research and interventions from other psychosocial approaches and in the proliferation of psychiatric sub-disciplines”.

& on phrenology (localisationism)…

“A phrenological approach still survives in neurological and psychiatric research…This approach has been extended to the neuropharmacology attributing specific neurotransmitters psychological functions”.

The text may be gloomy, for some. Others may engage in playful delight at references to Plato, Greisinger and the Upanishads. A follow up paper is in press (this was part 1), and much is promised…

“Modern science and modern medicine are, no doubt, the greatest achievements of humankind having change for the better of millions of human beings. We are not arguing to throw the baby with the water in the tub, but to look for fresh water to replace or replenish the existing one. This we will do in the second part of this article”.