More on Pseudoscientific Mental Health Treatments

Illusory Scientism in Unfounded Therapies

Think back to the last time you went to the dentist and needed a filling. When the dentist explained the procedure, it was likely with a clear understanding of how tooth decay forms, how the work would involve removing the decayed portions of the tooth, and why the filling would be inserted as a means to protect the remaining healthy tooth and nerves. Oh, you didn’t get that explanation? Well, you might not have because most people understand the rationale for how and why fillings are necessary.

What was laid out in the above simple example of a treatment most people have had is a basic illustration of a mechanism of pathology (causes of tooth decay) and mechanisms of treatment (drilling and filling). And this is the kind of detailed, scientifically informed approach to treatment that most people should get for any therapeutic intervention. The phrase doing all the work in this paragraph is scientifically informed. Unfortunately, the mental health professions have a lot of interventions that are not scientifically informed, but instead have the appearance of being scientifically informed. These treatments that just look scientifically informed are often pseudoscientific, and consumers of mental health care must beware.

There are some tell-tale signs of treatments that are pseudoscientific, and I’ve discussed these previously. The issues with these interventions are extensive, and in this entry, I’d like to delve into another aspect that runs through many of these approaches, namely the lack of established or theoretically reasonable mechanisms that explain the condition these approaches purport to treat, nor how these treatments do their work. The public can be easily misled into believing there’s a science to them when there isn’t. This is a problem of illusory scientism. To remind readers, scientism is an uncritical acceptance of findings that are ascribed to ‘science’ when there are easily identified limitations in the research. Zealous adherents to pseudoscientific methods are guilty of this kind of scientism, where the treatments often have a few case studies or a handful of clearly limited trials, and these findings are treated as evidence of the highest order. Thus, while scientism would be the uncritical acceptance of bona fide science, this is compounded by the research having the illusion of being legitimate scientific investigations.

There is an additional problem evident in pseudoscientific mental health treatments that distinguishes them from other approaches. That is the concept of medical materialism. This is the idea that medical methodologies can fully explain mind-body experiences. There is a wide range of expressions of medical materialism that can encompass neurological investigations of religious experiences, and has been considered a reductionistic way to account for complex human phenomena. For example, in the prior article on this Substack on pseudoscience, brainspotting was used as a clear example of a bogus treatment that purported to have a neural sequence that accounted for storing traumatic memories. This neural pathway has not been demonstrated to store these memories, but medical materialism would dictate that it can and does. Further, since there are a handful of cases, the excess scientism, or uncritical acceptance of the findings, drives those endorsing the treatment to promote it aggressively as ‘evidence-based’ when that is not remotely the case.

Another Illustrative Pseudoscientific Approach, Possibly Worse than Brainspotting

Allow me to introduce you to Accelerated Resolution Therapy (ART). As with brainspotting, the treatment relies on rapid eye movements. Ok, let’s pause for a second. The mental health professions have been held in thrall to treatments involving eye movements for over 35 years now, dating back to the original formulation of eye movement desensitization and reprocessing (EMDR). I won’t tackle that one today, but perhaps on another occasion. It is worth noting that eye movement patterns and their relation to different emotional conditions have been studied since the early 1900s. While it has been suggested that what is called ‘smooth pursuit’ eye tracking may be impaired for a wide range of conditions, no treatment models have been formulated and tested that demonstrate that targeting this motoric system has any impact on psychiatric conditions.

Ok, now what does ART entail? Like EMDR, the treatment involves eye movements to target distressing memories, primarily those associated with traumatic events. Unlike EMDR or brainspotting, the aim is to ultimately replace the distressing memories with positive ones. The promoters indicate on their website that ART is “recognized as evidence-based by the Society of Clinical Psychology, Div. 12 of the American Psychological Association (APA).” Interesting assertion since I am one of the co-authors of the current standards on which evidence-based treatments are designated and adopted by Division 12, and this treatment does not even come close to meeting those standards. In order to verify this claim, the site requires that readers go to the Division 12 page where it shows ‘modest’ support under the 1998 guidelines. In order to achieve a designation of modest support under the old guidelines, it only required one well-designed study showing the treatment worked in comparison to no treatment. However, those guidelines were updated and adopted by Division 12 in 2015 and are now far more rigorous, where modest support would require several registered trials to show support for the treatment. The Division 12 site itself shows that it is pending evaluation using the current criteria that have been in force for a decade now.

The excessive claims of pseudoscientific methods are also there. In their promotional website, the following diagnoses and problems are listed as appropriate to apply ART: OCD, Eating Disorders, Generalized Anxiety, and Depressive Disorders. Needless to say, there is no persuasive evidence that the treatment is helpful for any of these.

Why Medical Materialism?

For several decades, psychological sciences have fetishized brain circuitry and neural localization to explain the full gamut of behavioral and emotional disorders. This includes thoughts and other human experiences that have been historically difficult to explain, such as existential challenges, including, in this case, the emotional reactions that some people experience following life-threatening traumatic events. Most of this research aims for a reductionism that is in line with medical materialism. The medical materialism present in the untested mental healthcare procedures is interesting when contrasted with the following quote in one of the top mental health professional journals: “I propose 11 categories of difference-makers for psychiatric illness from molecular genetics through culture…” Notice that the emphasis is on the multi-layered nature of psychiatric conditions that all deserve investigation, and that it is not all reducible to genes and neural circuitry. This quote was from a well-known psychiatric geneticist, Kenneth Kendler, and was published in the journal Molecular Psychiatry. Treatments that are implicitly based on medical materialism sidestep the full range of human experience to reduce the entire enterprise to hypothesized neural structures, eye movements, and the persuasive connections laid out by the clinician.

The problem that immediately arises with pseudoscientific methods like ART is that it attracts practitioners who find the marketing appealing. These marketing gambits, along with the extravagant claims of benefits, make their way onto professional networks. To be fair, most full-time practitioners are extremely busy and eager to bring relief to their clients. Add to this mix that most busy professionals simply don’t have the time to appraise treatments for their scientific foundation, and so when someone reports incredible benefits, it is seductive. To illustrate, I am part of one practitioner network that has a strong scientific culture. And even with that firm foundation among the professionals, the screenshot below was shared for discussion, with the person posting it implying it may be worth trying with clients:

A few things with this, aside from the various spelling errors. First, a single case reported on a social media network is not justification for anyone to start using a treatment. I imagine you, my dear reader, would not want a surgeon operating on you based on a procedure she or he heard about in a breathless social media post on their professional network. Second, this kind of reporting neglects all kinds of very legitimate other reasons for improvement, including the potential for placebo effects when trying a new treatment. Third, we have no idea what this person means by it working. They make no mention of how the outcome was assessed. Again, imagine that you had surgery, and the doctor exclaimed success because some foreign object was removed, and you felt better when it was over. That would not be a sign of success; the sign of success is that the specific pathogen that caused the ailment was removed, and that you could feel confident the problem would not recur. Reviewing the research that is posted on the ART site itself does not deliver any of these, nor does the enthusiastic account in the above illustrative post. You will be relieved to know that the scientifically informed mental health network where this was posted led to numerous professionals roundly rejecting ART for its lack of science, lack of applicability to OCD, and lack of anything resembling a reasonable treatment.

The hazards of delivering pseudoscientific treatments are that an unsuspecting public has no way of knowing bona fide evidence-based treatments from ones made up out of whole cloth. ART is a particularly serious offender, especially given the blatantly false claims of efficacy listed on their site. This is another instance where the consumer has to really investigate and ask practitioners the hard questions about why the treatment they are offering has any potential for benefit at all.