Our Field May Need Rehab to Eradicate Misconceptions

Psychotherapy helps people eliminate dysfunctional beliefs and behaviors. It often requires a new level of honesty and new ways of functioning. Institutions need their own therapy from time to time since they can get off track. Our field might be due for some honest self-examination. We are providing valuable services to millions, but the public maintains a very mixed image of us.

Stigma is still a major problem. Behavioral conditions are highly stigmatized, and there are possibly as many people avoiding our services as seeking them. We may need a new strategy for eradicating stigma that goes beyond changing the public’s image of certain conditions. Our field’s image may need to change too. A rigorous scientific model may be needed for us to achieve that. Consider these elements.

1. Stay grounded in evidence and avoid speculation. Why should we continue to overpromise and underdeliver? Consider psychotropic medications, starting with antidepressants. We do not understand the biology of depression, despite various findings and theories, and antidepressants are not helpful for everyone. Telling someone that their problem is surely biological and that drugs will fix a chemical imbalance (or other generality) is well intentioned but false.

A basic area needing clarity is our inconsistent language about diseases in behavioral healthcare. People commonly talk about depression and alcohol addiction as being diseases. They are surely syndromes, but are they diseases? A respected medical source on this distinction defines a syndrome as a recognizable group of symptoms and findings, while a disease exists once we validate the causal agent or process.

Some syndromes like depression and alcohol addiction have qualities suggesting a likely biological cause. Yet causes have not be found. Promoting the disease concept prematurely leads people to have certainty in something that may not exist. We should wait for the biology. Evidence is more powerful than opinion. Those being helped by our care today need no speculative theories to provide additional comfort.

2. Adopt the scientist-professional model. We tell people to trust us and then offer no data on rates of success with treatment. Recovery from addiction might be comparable to chronic conditions like diabetes, but our main data sources are research studies, not routine program evaluations. Psychotherapy research shows it to be remarkably efficacious, but clinicians have a tradition of not measuring results during treatment.

Our commitment to science should not be abstract, but rather the organizing principle for who we are and what we do. Our dual identity is best captured in the scientist-professional model. Science is our anchor to the extent we embrace the centrality of the scientific method. In terms of identity, we might best adopt behavioral healthcare as our common profession, with our degrees being secondary.

Psychiatrists provide biological solutions but should recommend the full range of validated solutions. This is true for therapists as well. Specialize as you like but know the field. We should not let siloed programs, splintered knowledge or turf be among the reasons stigma endures. End discrimination across our field for those with disabling conditions and those with ordinary vulnerabilities.

Our field can be confusing. We offer many traditional practices without empirical evidence. We tout hypothetical biological solutions that may never exist. We save lives but do not help everyone. Consumers cannot make sense of it all. We need a data-driven, unified approach to defeat stigma and eradicate its negativity. Let us speak collectively as scientist-professionals to everyone in need.

3. Accentuate our values of acceptance and transparency. The public needs a clear message from us that labelling harms others. Consider alcohol addiction. The public gets a mixed message from us since many people call themselves alcoholic as part of their recovery. This is a private matter for those individuals. Outside of such private fellowship meetings, labelling someone is derogatory and always to be avoided. Our field should speak with one voice on this.

People with behavioral problems are often treated as “other,” as categorically apart. Some problems are visibly out of the ordinary due to behavioral extremes, and this can lead to avoidance and isolation. We must combat isolation in all forms, including the way people get behavioral help. Behavioral care should not remain separate. It belongs integrated into primary care. Isolation fosters otherness.

The fight we have been waging against stigma is too narrow. We should place it within a larger focus on how our field is perceived. The foregoing ideas are debatable, and that is the goal. We should subject traditional beliefs and practices to debate and be more transparent about our work and our data. Let us expose the great diversity of human experience and the many paths to health and wellbeing.

Ed Jones, PhD, is senior vice president for the Institute for Health and Productivity Management.