Discussion Another expert weighs in on the cause of suicide

[OneBigBlur]

I wish I had the intellectual energy to get more into this. Operant Conditioning is the foundational basis of Cognitive Behavioral Therapy (and ALLLLL the derivations). This style is what's available to most people. I think there is ZERO evidence that it offers sustainable relief from emotional problems. It continues being used because....whatever....just because the people with the degrees/money do not really give a shit. (When they do, it's to assuage their own guilt - or to avoid dealing with their own emotional issues).


Cognotive Behavioral Therapy can provide help for some - but I bet those are the people who would eventually improve, regardless of the intervention.

Sorry...you didn't ask for more....but there it is...

Do you have a link to Chomsky saying this stuff? I told my own therapist outright that I'd never do CBT because it's victim blaming and it ignores the underlying problems but she ended up suggesting DBT which I also refused. I think it's inhumane to even attempt to modify someones behavior when their emotions are perfectly appropriate to the adversity that they've gone through, it doesn't make any sense and I know that it doesn't work.

 

[Misanthrope]

I wish I had the intellectual energy to get more into this. Operant Conditioning is the foundational basis of Cognitive Behavioral Therapy (and ALLLLL the derivations). This style is what's available to most people. I think there is ZERO evidence that it offers sustainable relief from emotional problems. It continues being used because....whatever....just because the people with the degrees/money do not really give a shit. (When they do, it's to assuage their own guilt - or to avoid dealing with their own emotional issues).


Cognotive Behavioral Therapy can provide help for some - but I bet those are the people who would eventually improve, regardless of the intervention.

Sorry...you didn't ask for more....but there it is...

I would appreciate the link on Chomsky as well on this issue.

@OneBigBlur I am curious what makes you think it is victim blaming. Can you explain why you view it that way?

 

[CyanideSoup]

(most) people commit suicide because life is shit.

 

[Talokin]

When I mentioned Chomsky and Operant Conditioning, I was simultaneously hoping no one would ask for the link. AND, that someone would understand/care, and want the link.
I was just afraid I'd have trouble finding it. But I"m glad for the interest. So I will start looking.

I've never thought about CBT being victim blaming - but it does make sense. CBT implies that the patient needs to learn to tolerate the pain that is caused by others. I was always annoyed that CBT just focuses on symptoms, instead of root causes. But, by ignoring root causes, the perpertrators don't get addressed.

Do you have a link to Chomsky saying this stuff? I told my own therapist outright that I'd never do CBT because it's victim blaming and it ignores the underlying problems but she ended up suggesting DBT which I also refused. I think it's inhumane to even attempt to modify someones behavior when their emotions are perfectly appropriate to the adversity that they've gone through, it doesn't make any sense and I know that it doesn't work.

 

[ronigail9]

I recently heard Noam Chomsky say that the academic research into operant conditioning is actually bullshit. The conclusions are often mis-attribution errors. If you teach a bird to push pieces on chess board, the "expert" will declare "I've taught the bird to play chess!!"

no. you taught the bird to use it's beak to push random figurines.

But, mental health professsionals use these same mis-attribution errors. If the client is cutting themselves, the therapist gives them skills to stop cutting. The therapist THINKS she cured client. But, really, client is now engaging in other "unwanted" behaviors, bc the root causes have been not addressed. And.....client has learned to HIDE these behaviors from providers.

I worked in mental health for 10 years. ALL OF MY COLLEAGUES used positive affirmations and sticker charts.

I saw it help ZERO people.

But they CONTINUED to use these things. Exclusively. Even worse, clients would sincerely try to make positive affirmations work - and when it failed, clients blame themselves. This adds to their shame and hopelessness.

I saw this happen as the professional. And it happened to me as the client too.

affirmations worked for me 10 years ago, when I have severe black and white thinking. i put them on post its around the house and have reading ocd where i compulsively read everything I see so it actually worked for me... however, now I am past all that

 

[Talokin]

I heard the Chomsky stuff in podcast form. I looked into my podcast history, and found about 20 hrs worth from Chomsky. Too much to go through. But I remember it was a short interlude during another interview. He spoke about academics being lazy/dishonest.

When I heard it, I wanted to use it to prove to others that CBT doesn't work. But I think I gave up, bc I realized CBT is so ingrained and Chomsky is too complex for most to understand, it wasn't worth it.

I"d be glad to talk about this though, with others who understand...

Do you have a link to Chomsky saying this stuff? I told my own therapist outright that I'd never do CBT because it's victim blaming and it ignores the underlying problems but she ended up suggesting DBT which I also refused. I think it's inhumane to even attempt to modify someones behavior when their emotions are perfectly appropriate to the adversity that they've gone through, it doesn't make any sense and I know that it doesn't work.

 

[OneBigBlur]

I would appreciate the link on Chomsky as well on this issue.

@OneBigBlur I am curious what makes you think it is victim blaming. Can you explain why you view it that way?

This person explains it very well:

4. DBT is victim-blaming. Since DBT is focused on mitigating one's emotional response, it ends up blaming individuals to responding "inappropriately" to difficult situations. Given that many people end up in APC due to abuse, trauma, and difficult life circumstances, DBT is forcing these individuals to accept things the way they are (literally DBT teaches "radical acceptance") and just change how one responds to things. This blames victims for their emotions and fails to provide the necessary resources to cope with difficulties.

Source:

 

[Misanthrope]

I heard the Chomsky stuff in podcast form. I looked into my podcast history, and found about 20 hrs worth from Chomsky. Too much to go through. But I remember it was a short interlude during another interview. He spoke about academics being lazy/dishonest.

When I heard it, I wanted to use it to prove to others that CBT doesn't work. But I think I gave up, bc I realized CBT is so ingrained and Chomsky is too complex for most to understand, it wasn't worth it.

I"d be glad to talk about this though, with others who understand...

Sure I would be up for discussing this, shame you can't find the particular bit. Shame also it feels like a truck has hit me in the guts so i will have to get back to you at a later date. I am also really curious about other observations you may have from your ten years experience.

This person explains it very well:



Source:

Very interesting. I could add some other observations about DBT as well. Would you be interested in my anecdotal account of my experiences with various therapies? All though with DBT I was thrown out in the first session.. lmao. But I gained some use from CBT and CAT that has stuck with me to this day.

 

[Talokin]

Other observations about working in mental health...

First, you should know, I live in an area with lots of respected academic insititutions, fairly wealthy, and considers itself on the cutting edge of love and tolerance.

I worked in community mental health, with mostly poor families. My colleagues had disdain for their way of life, and would prioritize THEIR priorities above those of the suffering families.

Okay, I have a lot of anger toward my colleagues, and my job was very specific (working with families in their homes).

You are probably wondering about mental health professionals in general.

Many go into the field bc of guilt and/or desire to avoid their own (usually pretty trivial) problems. While getting Masters degrees, they aren't taught techniques. It's mostly teaching about legal issues and how to diagnose, using the DSM, as if it's the ONLY POSSIBLE WAY to understand emotionall problems.

Many young clinicians are VERY idealistic, while simulataneously thinking "This family is suffering bc they just don't know how to do better. IF I tell them, then they will know, and will be fixed." This is how many clinicians work.

I could complain about this ssytem for the next 10 years.

But that won't do any good. However, I've been watching videos of police interviewing suspected criminals (Jim Can't Swim is an excellent Youtube channel). The psychologocial training and techniques that the detectives use SHOUld be taught to clinicians.

Agh. sorry, that was rambly and probably confusing. But I wanted to respond...so there it is.

If you have specific questions, I may be less rambly.

 

[OneBigBlur]

Other observations about working in mental health...

First, you should know, I live in an area with lots of respected academic insititutions, fairly wealthy, and considers itself on the cutting edge of love and tolerance.

I worked in community mental health, with mostly poor families. My colleagues had disdain for their way of life, and would prioritize THEIR priorities above those of the suffering families.

Okay, I have a lot of anger toward my colleagues, and my job was very specific (working with families in their homes).

You are probably wondering about mental health professionals in general.

Many go into the field bc of guilt and/or desire to avoid their own (usually pretty trivial) problems. While getting Masters degrees, they aren't taught techniques. It's mostly teaching about legal issues and how to diagnose, using the DSM, as if it's the ONLY POSSIBLE WAY to understand emotionall problems.

Many young clinicians are VERY idealistic, while simulataneously thinking "This family is suffering bc they just don't know how to do better. IF I tell them, then they will know, and will be fixed." This is how many clinicians work.

I could complain about this ssytem for the next 10 years.

But that won't do any good. However, I've been watching videos of police interviewing suspected criminals (Jim Can't Swim is an excellent Youtube channel). The psychologocial training and techniques that the detectives use SHOUld be taught to clinicians.

Agh. sorry, that was rambly and probably confusing. But I wanted to respond...so there it is.

If you have specific questions, I may be less rambly.

Sounds like a lot of them think they're better than their patients and know more about life when the exact opposite is true. Many are trapped in their circumstances for various reasons and ultimately coping methods and words aren't going to do much of anything. I don't think most realize how much suffering people go through and the idea of "recovery" for those at the bottom is mostly something grounded in fantasy.

The things that might actually help are either behind a significant amount of money or are illegal (MDMA therapy etc). I've told my own therapist that I don't lack insights into my problems or what I want out of life, but the society we live in is not designed for recovery, it's designed for complacency and obedience for the sake of others. I don't have the money to get real help and the offers that are on the table require me to spend 15 years in therapy for marginal improvement. I know that the only thing that would help me and many other people is having someone that really cares about them and values them as a human being, but you can't even find that within therapy much less in the real world.

This is slightly off topic but pretty much all of the psychology books I've read have patients that recovered because they were already highly functional to begin with in many areas of life, they almost never mention the people like on this forum. I personally think even someone like Van Der Kolk is delusional about how the world works and what the reality is for many of us or he wouldn't suggest absurd things like "horse therapy" and "neurofeedback" as if those things were even within peoples means.

 

[Talokin]

Van Der Kolk - he's a Boston guy, so he has lots of clients with access to horse therapy. Anyways, he's more of a researcher who was trying to get the medical establishment to formally acknowledge that ongoing, low-level traumas can be devastating for some (eg. hearing your parents daily, verbal fighting). An influential research group who has "invented" TFCBT (Trauma Focused CBT) refused to use his research bc he included low-level trauma.

Trauma-Focused Cognitive Behavioral Therapy

TF-CBT is an evidence-based treatment for children and adolescents impacted by trauma and their parents or caregivers.

www.nctsn.org

This "technique" is pathetic and stupid bc it uses a very rigid curriculum, including:
-encouraging child to talk about trauma by 3rd session
-a different set of interventions based on age (going by one year at a time. Implying after each birthday, a new set of inteventiosn should be used)


And then, at Smith College School of Social Work, you've got professors like Yoosun Park who are formally stating that society IS indeed structured against certain people. They suggest that anyone who is white, male and/or wealthy should stop complaining, because any failures you experience are purely due to your own laziness.
https://journals.sagepub.com/doi/abs/10.1177/1468017318792953

I saw this sentiment impact numerous white, male elementary aged kids who needed mental health crisis services. (eg - during an intake for psychiatric hospitalization, parents of a 10yr old white boy were forced to apologize bc their child said a racial slur, to his own white family, while trying to jump out a 2nd story window.)

Yes, I fully agree on the things that can help (they are wildly expensive, include authentic community connections or illegal substances). Thus....not available to most.

Ever heard of Dr. Gabor Mate? He redefines "addiction" and "ADHD" to be a reasonable response for someone with a sensitive system, who experiences low-level, ongoing trauma in early childhood. Also saying
- a person can be harmed by addiction to almost anything (doesn't need to be just substances)
-ADHD - ability to stop focusing on something is a useful coping mechanism if your environment is hurting you (again, ongoing parental fighting)
-advocates ayahuasca, and other psychedelics
-good interview on Tim Ferris podcast (I'm not usually a fan of TF, fyi) https://tim.blog/2018/06/04/the-tim-ferriss-show-transcripts-dr-gabor-mate/

Sounds like a lot of them think they're better than their patients and know more about life when the exact opposite is true. Many are trapped in their circumstances for various reasons and ultimately coping methods and words aren't going to do much of anything. I don't think most realize how much suffering people go through and the idea of "recovery" for those at the bottom is mostly something grounded in fantasy.

The things that might actually help are either behind a significant amount of money or are illegal (MDMA therapy etc). I've told my own therapist that I don't lack insights into my problems or what I want out of life, but the society we live in is not designed for recovery, it's designed for complacency and obedience for the sake of others. I don't have the money to get real help and the offers that are on the table require me to spend 15 years in therapy for marginal improvement. I know that the only thing that would help me and many other people is having someone that really cares about them and values them as a human being, but you can't even find that within therapy much less in the real world.

This is slightly off topic but pretty much all of the psychology books I've read have patients that recovered because they were already highly functional to begin with in many areas of life, they almost never mention the people like on this forum. I personally think even someone like Van Der Kolk is delusional about how the world works and what the reality is for many of us or he wouldn't suggest absurd things like "horse therapy" and "neurofeedback" as if those things were even within peoples means.

 

[Misanthrope]

Other observations about working in mental health...

First, you should know, I live in an area with lots of respected academic insititutions, fairly wealthy, and considers itself on the cutting edge of love and tolerance.

I worked in community mental health, with mostly poor families. My colleagues had disdain for their way of life, and would prioritize THEIR priorities above those of the suffering families.

Okay, I have a lot of anger toward my colleagues, and my job was very specific (working with families in their homes).

You are probably wondering about mental health professionals in general.

Many go into the field bc of guilt and/or desire to avoid their own (usually pretty trivial) problems. While getting Masters degrees, they aren't taught techniques. It's mostly teaching about legal issues and how to diagnose, using the DSM, as if it's the ONLY POSSIBLE WAY to understand emotionall problems.

Many young clinicians are VERY idealistic, while simulataneously thinking "This family is suffering bc they just don't know how to do better. IF I tell them, then they will know, and will be fixed." This is how many clinicians work.

I could complain about this ssytem for the next 10 years.

But that won't do any good. However, I've been watching videos of police interviewing suspected criminals (Jim Can't Swim is an excellent Youtube channel). The psychologocial training and techniques that the detectives use SHOUld be taught to clinicians.

Agh. sorry, that was rambly and probably confusing. But I wanted to respond...so there it is.

If you have specific questions, I may be less rambly.

Wanted to get back to you for a while, but running on empty. Much of what I intended to respond with is covered here. https://sanctioned-suicide.net/threads/broken-systems-burnout-and-bitterness.23217/#post-428144

It is ironic almost, that I took up my former profession in response the utter contempt I had for yours. This though is not a personal attack I hope it does not come off that way. I feel we likely are on the same page when it comes to working amidst broken systems and having no choice but to do the best we can while simultaneously wanting it to be better and all feel less obscene on a daily basis.

Also entirely disagree with the statement about victim blaming. The technique is sound, the way it is sometimes wielded though is not. Often lazily with time limited sessions all the while gambling on the competency of the therapist and what ever constraints they are limited by. That, and every one is different some styles are just the wrong fit. One technique had me walking out/thrown out, the other I have found valuable to this day. CAT skills will make this Christmas doable as past vulnerability to a certain individual no longer applies. The more mechanistic therapies have sadly become a cheap attempted quick fix in this country. Delivered like a one size fits all solution. There is almost a cult like attitude to DBT and CBT that seems rife in the profession. DBT is spreading into areas it has little proven value in. Often not delivered as Linehan herself intended. I can't radically accept cracks in the universe opening with god's humourous voice speaking to me, telling me the secrets of the holographic universe and how street lamp placement is all related just as much as where the sun's rays illuminate a patch of the hospital wall...

Cognitive Behavioral Therapy for Mood Disorders: Efficacy, Moderators and Mediators

Cognitive behavior therapy (CBT) is efficacious in the acute treatment of depression and may provide a viable alternative to antidepressant medications (ADM) for even more severely depressed unipolar patients when implemented in a competent fashion. CBT ...

www.ncbi.nlm.nih.gov

How effective are cognitive behavior therapies for major depression and anxiety disorders? A meta‐analytic update of the evidence

We report the current best estimate of the effects of cognitive behavior therapy (CBT) in the treatment of major depression (MDD), generalized anxiety disorder (GAD), panic disorder (PAD) and social anxiety disorder (SAD), taking into account publication ...

www.ncbi.nlm.nih.gov

Meta-Analysis and Systematic Review Assessing the Efficacy of Dialectical Behavior Therapy (DBT)

The objective was to quantitatively and qualitatively examine the efficacy of DBT (e.g., decreasing life-threatening suicidal and parasuicidal acts, attrition, and depression) explicitly with borderline personality disorder (BPD) and using conservative ...

www.ncbi.nlm.nih.gov

Same issue as always, attempting to measure objective outcomes of abstract things like wellness has methodology issues. Still more promising than doing nothing though.

My specific question, is if you had the option to change one singular thing about mental health provision in its current form what would you change and implement?

I would be happy to complain about the system alongside you, but have no intention of enduring another ten years.