Pseudoscience in Mental Health Treatment

It’s Far More Common Than You Think

The mental health professions collectively have lots of extremely well-meaning professionals who work incredibly hard to aid people with their emotional and behavioral difficulties. I want to stress this at the outset because what comes next is a damning indictment of the state of the professions collectively.

Pseudoscience is at the heart of a lot of bad practices, and not just in mental healthcare. Some of these practices are aimed specifically at common and impairing psychological conditions. Others have a clear political framework that allows them to target specific groups. The latter form of pseudoscience will be the topic for another time. Today, the spotlight shines directly on ill-formed treatments intended for specific forms of psychopathology.

What is Pseudoscience in Mental Healthcare?

Even if you already know what constitutes pseudoscience, I find some things are worth repeating. Imagine that you wanted to become low-key famous in the mental health arena. I say ‘low-key’ because that is generally how fame in the mental health professions operates. One way to find the fame that will follow you to conferences but will cease to exist once you cross the hotel exit is to develop your own brand-new type of treatment. Now, you have some important decisions to make in this endeavor. First, what problem are you aiming to treat? Well, you should seriously consider one that already has an established effective treatment but for which clinicians are generally unfamiliar. Given the low rate at which clinicians actually employ evidence-based treatments, step one completes itself almost immediately. Second, you need to think about how to make it ‘science-y.’ It has to have a level of complexity that makes it seem like you, the developer, are some kind of mental health Svengali. Again, this should be easily accomplished since there is a vast array of neural structures that could plausibly be associated with your treatment, even if these are completely unrelated to the actual problem. Third, you need to create a treatment that has a loophole that defies falsifiability. This is where some creative tinkering is necessary. It needs to be one that is a seemingly clear approach, but should treatment fail, you can blame it on user error and not the treatment itself. Fourth, it should be something that came to you surreptitiously, like in a dream or while receiving treatment yourself. Finally, it has to include something gimmicky, something that is solely the province of your treatment, something that is a seemingly esoteric aspect that makes the treatment mysterious.

A Clear and Popular Example

The mental health profession has a few treatments that really fulfill the criteria laid out above. To really illustrate this clearly, I’ll describe one particularly egregious example. Last year, my colleague Angela Coreil and I wrote about Brainspotting (McKay & Coreil, 2024a), a treatment that unquestionably fulfills the criteria listed above. It has the added benefit that the creator had the treatment occur to him while receiving a different treatment. That added element puts the treatment directly in league with so many questionable treatments that preceded it.

What is brainspotting, you ask? It’s a treatment formulated specifically for trauma. The premise is that while re-imagining a traumatic event, the ordinary lateral eye movements (called saccades) pause at specific points. These pauses, according to the creator, are ‘spots’ where the optic nerve lines up with a series of brain areas that correspond to the neural regions where trauma is stored. By ‘holding’ the gaze on these spots, then the traumatic memory is relieved.

Now, to the uninitiated, the above treatment sounds potentially compelling. It’s a treatment for a specific and common problem that already has an evidence-based approach and that mental health practitioners deal with regularly. Brainspotting is very ‘science-y’ given the brain areas that are hypothesized to be involved. It is complex, as it demands precision in identifying the ‘spot.’ And it seems pretty clear how it works despite a lack of actual empirical support.

But what about the model loophole? Where is that, you ask? Well, here’s where one needs to scrutinize the science. You know those brain areas mentioned before that are considered functional in storing traumatic memories? Well, those brain areas have not been demonstrated as being related to trauma, with the exception of one, and that is only in laboratory rats. And, you know that part about identifying the ‘spot’? Well, it turns out the ability to detect those pauses is simply not possible for either an observer of the eye movements or for the client receiving the treatment. And that, my friends, is the model loophole. If treatment does not produce the desired benefit, well, the fault lies with the clinician for failing to identify the spot. If the treatment works well, then there’s vindication for the central hypothesized mechanisms.

When we wrote about the problems with brainspotting, according to the promoters of the treatment, there had been over 13,000 mental health professionals trained in the procedure by that point. And, devote any amount of time on mental health professional networks and you will invariably hear someone extol the virtues of brainspotting, and not just for trauma but for everything from phobias to bad hair days. And, since the clinicians who have adopted this approach are sticklers for precision, our piece was quickly criticized for indicating that the clinician was the one who identified the ‘spot’ when it was actually the client (Talbot et al., 2024). Well, stop the presses, people, that makes…well, it makes absolutely none of the difference in the world. In short, the way brainspotting is said to work is a fantasized mechanism that is based on no evidence whatsoever (McKay & Coreil, 2024b). Considering the complete absence of evidence-base, literally no reason to hypothesize the mechanisms of action, and model loopholes, the only thing accomplished with brainspotting is the creator has effectively separated a lot of practitioners from their money.

The challenge with pseudoscience is that an unsuspecting public would simply not be expected to know these issues. And, contemporary mental health training does not prepare practitioners sufficiently to detect these problematic treatments.

Coming Up on Anxiously Waiting…

I’ve dropped some breadcrumbs for you for future entries. Foreshadowed in this post are some of the following items that will be part of upcoming pieces. First, what makes evidence-based treatments less likely to be administered in mental healthcare? There are some answers to this question. Second, I noted that pseudoscience can be part of practices that are harmful to specific groups. This has a decided political tilt and will be central in numerous upcoming entries. Third, brainspotting was highlighted here, but it is hardly the only popular pseudoscientific method. There are others, and these will get their day in the spotlight here. Fourth, why is the public at risk with pseudoscientific methods in mental health? There has been a growing acknowledgment that even benign mental health interventions have harmful effects, and that will be discussed.

Not mentioned in this piece is that there will soon be material on the social, political, and clinical aspects of disgust. Word to the wise – when reading Anxiously Waiting, perhaps do so on an empty stomach, depending on the title.

References

McKay, D., & Coreil, A. (2024a). Hypothesis testing of the adoption of pseudoscientific methods. Medical Hypotheses, 182, 111229.

McKay, D., & Coreil, A. (2024b). A reply to “Comment on Hypothesis testing of the adoption of pseudoscientific methods”. Medical Hypotheses, 182, 111339.

Talbot, J., Robb, M., & Evans, J. (2024). Comment on: Hypothesis testing of the adoption of pseudoscientific methods. Medical Hypotheses, 184, 111295.