The ISTC "Baloney Watch" Archives
If your are looking for something that once appeared on the ISTC "Baloney Watch" pages, you'll find it here!  The content of the "baloney archives" is broken up over four separate sections.  In this section, we review baloney related to the field's emphasis on and continuing romance with psychiatric diagnosis a la the Diagnostic and Statistical Manual of Mental Disorders.

Diagnostic Baloney

Job Interviews: Do they Work?

What's the best way to finding a good employee?  According to the data, at least, the answer is NOT via a traditional job interview.  According to researcher Tom Gilovich, "no unstrucured interview for any kind of position--graduate school, medical school, the military, or professional jobs--has anything but a low validity for predicting the interviewees future performance."  Strangely, the opposite is widely believed and practice.  In an article in the March 2005 issue of Costco Connection, writer and business consultant Harvey Meyer suggests frequent interviews increases the chance of a good hire several fold.  And, in fact, a recent staffing.org interview found that the average new hire was interviewed 2.3 times.  Again, the research indicates this practice to be a serious waste of money and resources.  "But," says Gilovich, "we can't contain it.  You meet someone and the feeling that you know who that person is after talking to them is just overwhleming."

Greer, M. (March 2005).  When intuition misfires.  Monitor on Psychology, 35(2), 58-60.
Meyer, H. (March 2005).  You're Hired.  Costco Connection, 17-18.  

External Threat and suicidality
In a remarkable study undertaken in the United Kingdom, suicide and homicide rates in England and Wales in the twelve weeks before and after 11 September 2001, and during the same periods in previous years were compared. The number of suicides reported in the month of September 2001 was significantly lower than other months in the same year and during any September of the previous 22 years in England and Wales. There was no evidence of a similar effect on homicide. This finding supports Emile Durkheim¹s theory that periods of external threat create group integration within society and lower the suicide rate through the impact on social cohesion. There are historical parallels in that suicide rates dropped during World War I and World War II, and not just in countries that participated in those wars but in some others as well. Further, the American suicide rate fell after the assassination of President John Kennedy in 1963.
Salib, E. (2003) Effect of 11 September 2001 on suicide and homicide in England and Wales. British Journal of Psychiatry, 183, 207.

The State of American Mental Health
So how are we doing anyway? If you listened to the polls and pundits of mental health, the answer historically is, "not well and getting worse." Every year brings pronouncements from experts claiming that an increasing number of Americans is suffering some psychiatric malady or another. So many people are suffering, we actually need mental health professionals to volunteer their time on street corners and in supermarkets for the National (state the current plague here) Day to do evaluations and recommend getting help. The one-two punch of mental health? Claims that stigma are really what prevent these "sick" people from getting the treatment they need. Hmm. Maybe...not.

You often hear claims that as much as 30% of American adults had/would experience a mental illness during their lifetime. A recent study suggests the popular figure may be off by as much as half. In an article published in the Archives of General Psychiatry researchers say that about 19.2 million Americans thought to be ill enough to require treatment are better than thought. This difference is not benign. Funding decisions by the government are based on such epidemiological research.

Cooper, G. (2002). Americans are feeling better than thought. Psychotherapy Networker, 26(3), 17.

Must the Field of Mental Health Always find Something to Make the Public (Appear) Unhappy?

"Twas the night before Christmas,
and everyone was inside,
except for the Therapists,
who were out working,
to prevent mass suicide,
and Ma took her Prozac,
and Pa did his CBT,
in hopes that one day,
they'd be a happy family . . ."

Perhaps the famous poem should be changed to reflect the received wisdom of the mental health field when it comes to the Holidays and rates of suicide. Every winter, the media brings us some mental health expert warning the public of the "Holiday Blues" and the attendant increase in suicide rates. Mothers and fathers hold their children a little closer in hopes that the dreaded depression demon will pass them by. And yet, the data show that warnings of increased suicide rates during the Holidays are a myth. In truth, the months of November and December actually have the lowest rates of suicide! Given the data, one must wonder why the field dedicated to helping always seems to be on the "cutting edge" of the dark side?

Myth Says Suicides Increase During Holidays, Facts Prove Contrary. Behavioral Healthcare Bulletin (12-28-01). www.consultnews.com.

	Dentists, in spite of the widespread belief to the contrary, are not the most suicide prone profession (neither are therapists for that matter).
	Media coverage or exposure to victims of suicide does not increase the risks of suicide and may actually decrease potential suicide risks.

Here are some facts about suicide:

	80% of completed suicides are men (elderly white men 42.7/100K versus 16.7/100K (minority) and 6.0/100K (women).
	Drug overdose is the most common method (70%) which people try while firearms are the most successful.
	Click here to read more about ways to prevent suicide.

Perina, K. (2001). Suicide fact or fiction. Psychology Today, 34(6), 14.

Some Difficult Questions for the Mental Health Industry . . .
First, the good news. Over the last few decades the rate of many childhood illnesses has declined, including mental retardation. At the same time as these successes, however, diagnoses of emotional, psychiatric, and behavioral problems have soared a whopping 300% among kids aged 4-15. Mental health symptoms now account for fully one-third of all schools days missed by adolescents. Psychosocial problems have eclipsed asthma and heart disease as the most common chronic problems among children.

The question of course is why? Some blame the rising divorce rate, others the decline of the traditional family, still others the lack of services for those at risk. Another possibility is simply the rising number of diagnosable conditions. As a whole, the DSM--the bible of mental health classification--has experienced a dramatic growth in size over the last several decades. Between the second and third version, for example, the number of diagnoses doubled! Version four added even more. Perhaps kids nowadays aren't really any crazier than their predecessors. Maybe the label has simply changed.

The hole in American prosperity (2001). American Enterprise, 12(1), 10.

Psychiatry's Gaff with the G.A.F!
You know the measure, right? In order to receive insurance reimbursement, clinicians increasingly have to report G.A.F. scores for their clients. Momentarily setting aside questions about the reliability and validity of this little scale, the dilemma clinicians often find themselves in when it comes to these ratings is how to rate a client's functioning and still be eligible for reimbursement. Too high, and the insurer might deny payment because the client does not meet, "medical necessity." Even worse, if the scores begin to improve, payment for more treatment may be curtailed.

Now the research seems to show that the entire G.A.F. scale is empirically bankrupt. First of all, in spite of supposedly reflecting the client's GLOBAL functioning, the data show that G.A.F. scores correlate largely with diagnosis and symptoms. More troubling, in spite of the current focus on outcomes an accountability in mental health care, the data indicate that the G.A.F. predicts neither functioning (at one year post treatment) or re-admission to services! Like much else found in the DSM, the G.A.F. seems to have little empirical support or utility. It's a pitty the scale has been adopted on such a wide scale when empirically valid and reliable alternatives exist.

Moos, B. (2000). Global assessment of functioning (GAF) ratings. Journal of Clinical Psychology, 56, 449-461.

Therapy for schizophrenic-diagnosed clients?! Of course...
It wasn't so long ago that talk-therapists were shamed out of working with clients diagnosed schizophrenic. Blamed into silence for having once blamed parents, the talking professionals disappeared into quiet obscurity, turning over the care of these clients to the pharmaceutical industry and their handmaiden, the American Psychiatric Association. Never mind the years of overwhelming evidence in support of non-medically-oriented treatment. And now, more evidence: people diagnosed schizophrenic but labeled "medication resistant" who were treated with either CBT or supportive counseling were found to have significant superior outcomes to routine care for both positive and negative symptoms. While the results are labeled "exciting" by the researchers, they are, in fact, mostly sad given that similar findings have been around in the literature for years but largely ignored in the "drug-em Dano" culture of American mental health.

Tarrier et al. (2000). Two year follow-up of CBT and supportive counseling in the treatment of persistent symptoms in chronic schizophrenia. Journal of Consulting and Clinical Psychology, 68, 17-22.

In the World of Mental Health, the Sky is Always Falling . . .
Hardly a day goes by without some mental health mogul pontificating on the sorry state of America's mental health. The key to the problem, we are told, is educating people about the nature of mental illness and working to de-stigmatize the process of seeking therapeutic intervention. Hence, the country is now replete with offers for "free mental health check ups." For example, National Depression Day, National Anxiety Day, blah, blah, blah . . . The sheer number of these programs leaves one wondering who the real beneficiaries are of such efforts to "get out the 'sick.'" All the more troubling are such attempts to scare the mental health out of the public when one considers recent and historical surveys which consistently find that the majority of the American public consider themselves happy. The numbers from this year's survey are similar to those dating back a quarter of a century. As in previous years, a whopping 84% of those surveyed indicated that were fairly to very happy with their lives. Moreover, city dwellers beat out those living in rural areas and the suburbs (50 v. 48% and 45%), and women rated higher than men (49 v. 45%). A similar percentage of those surveyed indicated that they were optimistic about the future.

USA Today (Oct 17, 2000). We're happy and we know it. 6D.

More on Pessimistic Therapy . . .
Consider the following factoids:

	In the psychological literature over the last 30 years, there have been 54,000 abstracts containing the word depression, 41,416 naming anxiety, but only 415 mentioning joy. Strange that the field of mental health, dedicated as it claims to be to helping, contains so little joy . . .
	In a recent sampling of Psychological Abstracts, researchers found that studies and articles on negative emotions exceeded those on positive emotions 14 to 1 (greater than the 7 to 1 margin by which the word treatment exceeds that of prevention).

Wellner, A. et al. (2000). Happy Days. Psychology Today, 32(3), 32-34.

Myers, D. (2000). The Funds, Friends, and Faith of Happy People. American Psychologist, 55(1), 56-67.

Race and Psychotherapy: Diagnosis and Prognosis
When it comes to diagnosis and prognosis, the evidence is clear: race is more important than clinical facts. Researchers led by Atkinson found that black clients were more likely to be given a poorer prognosis and more serious diagnosis (e.g., borderline personality disorder) by white psychologists than black psychologists. So convincing were the results that the lead researcher argued, "Until it can be shown empirically that harm is not being done to African-American Clients by pairing them with European-American psychologists, every effort should be made to assign [such] clients to to an ethnically similar help-provider."

Atkinson, Donald R.; Brown, Michael T.; Parham, Thomas A.; Matthews, Linda G.; et al (1996). Professional Psychology: Research & Practice. 27(5) 500-505

Diagnosis . . . one more time . . . depends more on the diagnoser than on clinical facts . . .
You'd think the mental health professionals would know better by now. The research is clear at least: psychiatric diagnosis as codified in the DSM is unreliable. In this study, researchers investigated degree of agreement among psychiatrists in an emergency service setting. Once again, they found appallingly low agreement both in terms of diagnosis and treatment recommendations. Indeed, the particular diagnosis and treatment recommendation--as has been the case throughout history--depended more on who was doing the diagnosing than on the particulars of the clinical situation. Isn't it time to bag the DSM?

Way, B. et al. (October, 1988). Interrater agreement among psychiatrists in psychiatric emergency settings. The American Journal of Psychiatry, 155(10), 1423-1428.

Bad News for the Matthews, Waynes, and Traceys of the Psychiatric World . . .
The developers of the DSM act as if problems with the reliability and validity of categories in the much vaunted volume have been solved. Falling in step with the medical profession, the insurance industry now requires a diagnosis for reimbursement. The helping professions, acting as if diagnosis aids in treatment, use the labels to discuss their clients and receive payment for their services. And yet, the research continues to show that the entire volume is fraught with problems. Researchers in England found that the first names of people significantly influenced the type of diagnosis given. For example, people named Matthew were more likely to be assigned a diagnosis of schizophrenia while those named Wayne were more likely to be viewed as malingerers, addicts, or personality disordered. The result was the people with the unfortunate names were less likely to receive sympathy from their treaters. Women's names were more often viewed as "bad" while men's were seen as "sick or mad." The conclusion? If you're going to see a shrink, change your name to Fiona--it was viewed, probably for some as yet unidentified biochemical reason, more positively.

Sydney Morning Herald (July 6, 2000). Wrong names for the couch.

	The volume continues to be plagued by poor reliability. Some disorders, like the always damaging personality disorder labels, continue to have no individual reliability!
	Poor validity.
	Little actual help in differential treatment selection. The truth is the clients get what the therapists knows how to do.
	Low correlation with outcome of treatment!

Hubble, M.A., Duncan, B.L., and Miller, S.D. (in press). The Heart and Soul of Change. Washington, D.C.: APA Press.

The DSM Money Game:
Higher and higher rates of mental disorders have been reported in epidemiological studies using the DSM-III and DSM-IV. Far from benign, such reports are typically used to argue for increased social spending for assessment and treatment. Unfortunately, such studies strain credibility to the breaking point. As a case in point, consider that studies suggest that the lifetime prevalence of having a mental disorder ranges from 29% to 48%! As many researchers have pointed out, the idea hat one-third to half of the American population at some time suffers from a DSM diagnosis is simply non-sense. Not that many people are sick! The developers of DSM are not dissuaded by the facts, however. Instead, the offer a variety of explanations for the failure of DSM to accurately represent the mental health of the nation. Most notably : (1) they blame the questionnaires; and (2) they blame the questioners. One of the primary developers of the DSM--Spitzer--suggests that having a diagnosis is not the same as needing treatment--a curious idea that leads one to wonder why the field needs the book at all then? Hey, Dr. Spitzer, maybe the entire DSM is the problem, eh?

Regier, D.A. (1988). Limitations of diagnostic criteria and assessment instruments for mental disorders. Archives of General Psychiatry, 55, 109-15.

Frances, A. (1988). Problems in defining clinical significance in epidemiological studies. Archives of General Psychiatry, 55, 119.

Racism and the Diagnostic Tradition
You've heard it: the DSM-IV is an improvement over the previous editions. The professional organizations of psychiatry and psychology argue that diagnosis enables mental health practitioners to identify and apply the appropriate treatment for people who are suffering. One more time, the rhetoric simply does not match up to reality. In this study, researchers Zito et al. (1998) found that the race and social status of children affected the diagnosis and treatment they received. In both instances, children who were culturally different and from low socioeconomic backgrounds were less likely to get the care needed! Indeed, the authors explain that clinicians may not expect black children to show any improvement and, therefore, forgo offering treatment. This finding adds to the overwhelming evidence showing that poor or culturally different clients are more likely to: (a) receive a more serious diagnosis; and (b) be treated medically rather than offered psychological interventions.

Zito, et al. (1988). Racial disparity in psychotropic medications prescribed for youths with Medicaid insurance in Maryland. Journal of the Academy of Child Adolescent Psychiatry, 37, 179-184.

More News on the Multiple Personality Front
In the last several updates of the ISTC website, reports have followed lawsuits against Dr. Bennet Braun--the Chicago psychiatrist and expert on Multiple Personality and Satanic Ritual Abuse (Click here for previous reports). Now, it seems, the dust has settled and Bennet Braun is out of commission as a physician in Illinois. Prior to the scheduled November hearings, the Illinois Department of Professional Regulation agreed to a settlement which results in a two year suspension of Braun's medical license and a probationary period of five years. The prosecutor in the case notes that the agreement, does what it's supposed to do and sends a "very powerful message" that doctors should not be practicing "hocus pocus psychiatry." He added that there is not now, nor was there at the time of treatment, any scientific evidence that Braun's methods were accepted. For his part, Braun seems unrepentant reportedly saying that he settled with the Department only for monetary reasons.

Skeptical Inquirer (1999). Bennet Braun case settled. 24(1), 7-8.

More Multiple Personality malarkey
Remember Sybil? The woman with all the personalities? The book? And later , the movie starring Sally Fields? Well, now here's the rest of the story. Psychologist Robert Reiber has discovered long lost audiotapes of Sybil meeting with her psychiatrist, Dr. Cornelia Wilbur, which "suggest that the personalities were in fact created by her psychiatrist through inadvertent suggestions." Along with the tapes, Reiber discovered a letter from Sybil to Dr. Wilbur in which she denies having multiple personality. Reiber's discoveries are confirmed by Dr. Herbert Speigel, who treated Sybil when Dr. Wilbur was unavailable. His conclusion? Sybil's personalities were iatrogenic! Oh well. It was just a passing fad anyway.

Radford, B. (1999). Tapes said to show Sybil's multiple personalities bogus. Skeptical Inquirer, 23(1), 7-8.

Researchers conclude "Recovered Memory Therapy" . . . Dubious and Dangerous
It was all the rage from the mid-80's into the early 90's. If you were mildly depressed and couldn't remember parts of your childhood, a variety of self-appointed experts claimed you were likely to have been sexually abused. The cure? Undergo regressive hypnosis and your recall traumatic memories (even ones that never happened). In a nutty cycle that seems to occur with regularity, researchers have finally conducted enough research to conclude that the claims and practices of "recovered memory therapy" are not only dubious but also dangerous. Stocks (1998) reviewed the available empirical literature and found the following: (1) evidence suggests that both real and false memories can be recovered using memory work techniques; but (2) there is no evidence that reliable discriminations can be made between them. Finally, Stocks found that the approach does not translate into better treatment outcomes although the cost associated with the treatment is documentably greater than other less controversial approaches. He concludes "participation in recovered memory therapy may be harmful to clients" (p. 423).

The courts are also weighing in on the subject: practice such techniques with your clients and risk being sued in a major way. One of the most well-known and respected proponents of repressed memory therapy, Bennet Braun, MD, recently settled a 10.6 million dollar lawsuit with a former client on which he practiced the approach. At the time of the report, there were a total of five suits against Braun. Along with repressed memories, he believed that multiple personality disorder was highly prevalent and in the existence of huge satanic conspiracies. A complaint has been filed against him with the State of Illinois Department of Professional Regulation that includes charges of, "unorthodox treatment, gross negligence, making false statements regarding the skill or efficacy of treatment," etc. Scores of similar lawsuits have been filed in other states.

Stocks, J.T. (1998). Recovered memory therapy: a dubious practice technique. Social Work, 43(5), 423-436.

Bloomberg, D. (January/February, 1999). News and Comment: Illinois Files Complaint Against Repressed Memory Doctors, Skeptical Inquirer, 23(1), 6-7.

MPD Update . . .
At a pre-trial hearing in November 1998, an administrative law judge denied two motions by the counsel for Bennet Braun, MD. One claiming that the medical board was biased against him, and another asking that the clients now suing him undergo psychological tests. Prosecutors called the latter motion "offensive" and an attempt to "bully and intimidate" the clients. Meanwhile, two of Braun's colleagues, Drs. Elva Poznanski and Roberta Sachs, have been charged with offenses similar to those lodged against Braun. Namely, that Braun's treatments were amounted "re-education . . . more like a North Korean concentration camp than a hospital."

Bloomberg, D. (1999). Bennet Braun case update: Trials set for May, July. Skeptical Inquirer, 23(2), 12-13.

Sex Offenders have a High Rate of Recidivism: Clinical Truth or Myth?
Clinical tradition and lore hold that sex offenders are untreatable and likely to re-offend in the future. However, a meta-analytic study of 61 studies on 28, 792 sex offenders with an average follow-up of 4-5 years strongly suggests otherwise. Researchers Hanson and Bussiere (1998) found an overall recidivism rate of 13.4% with the strongest predictor being deviant sexual interest as measured by phallometric assessment. Other predictors included: failure to complete treatment, total number of prior offenses, first offending at an early age, victim choice (strangers, boys), and antisocial personality disorder. Neither the degree of sexual contact in the offenses, the use of force in the offense, nor a perpetrator's history of sexual abuse in childhood predicted recidivism. The authors conclude: (1) there is no evidence that recidivism is inevitable or even probably in the general sex offender population; and (2) clinical presentation of denial, low remorse, and low motivation does not predict recidivism but does predict general criminal recidivism.

Hanson, R.K, and Bussiere, M.T. (1998). Predicting relapse: A meta-analysis of sexual offender recidivism studies. Journal of Consulting and Clinical Psychology, 66, 348-362.