At least 3 reasons you don’t have to read Understanding Psychosis and Schizophrenia 2

Has the British Psychological Society lost its audience for misrepresentatingn of serious mental disorder?

understanding psychosisThe excellent post by Sameer Jauhar and Paul Morrison about the second edition of Understanding Psychosis and Schizophrenia is getting few comments. Perhaps this is because much of the second edition repeats the heavily criticized first edition, while further eliminating citation of research that would prove embarrassing to what is said.

 

#UnderstandingPsychosis?

An earlier post by Keith Laws, Alex Langsford, and Samei Huda about first edition was probably among the most accessed Mental Elf blog post ever.

Understanding Psychosis and Schizophrenia (2014) National Elf Service

I took the first edition seriously enough to respond with some heavily accessed posts my own, including one with a slideshow.

“Understanding Psychosis and Schizophrenia” and mental health service users 

Barney Carroll on domesticating psychosis [with slide show providing a detailed, evidence-based critique]

But I’m not to be lured  into a discussion again that goes nowhere with BPS authors who react like vampires to garlic whenever evidence is brought up that contradicts their cherished fixed beliefs.

Thankfully, Sameer Jauhar and Paul Morrison zero in on some key points that show the aversion to debating evidence persists. Here are three, but you can find more in their post.

Unwarranted claims that cognitive behavior therapy has effects equivalent to medication for psychosis.

The [BPS] authors state: Experiencing multiple childhood traumas appears to give approximately the same risk of developing psychosis as smoking does for developing lung cancer.

They cite a study where items on a screening questionnaire correlated with recall of adverse events, with an odds ratio of 11 (Bentall et al., 2012).

They state half of people who experience psychosis will experience problems only once, and recover completely, quoting a review which cites 9 studies.

On average, people gain around as much benefit from CBT as they do from taking psychiatric medication.

The authors cite various meta-analyses, but the effect sizes given are not comparable to those for psychotropic medication, especially when considering effects of blinding, even taking into account criticisms regarding included studies (Jauhar et al., 2014), see below.

The discussion thread on the earlier edition of UPS by Keith Laws and colleague drew heavily on Jauhar et al’ excellent meta analysis to demolish claims about the effectiveness  of CBT. That the authors don’t now cite it at all is telling. I don’t believe in the repression of traumatic memories, but I do believe in authors selectively citing only evidence that fits with their biases.

 Exaggerated claims that trauma is strongly linked to psychosis

The [BPS] authors state:

Experiencing multiple childhood traumas appears to give approximately the same risk of developing psychosis as smoking does for developing lung cancer.

They cite a study where items on a screening questionnaire correlated with recall of adverse events, with an odds ratio of 11 (Bentall et al., 2012).

They state half of people who experience psychosis will experience problems only once, and recover completely, quoting a review which cites 9 studies.

And

It is mathematically impossible to explain how the factors they give could contribute to the prevalence they mention; the odds ratio for childhood trauma is between 2-4 in most meta-analyses (Morgan and Gayer‐Anderson, 2016) (with methodological limitations). The odds ratio for smoking and lung cancer varies depending on smoking status and cell type, anywhere up to around 100 (Pesch et al., 2012) and evidence they put for a similar association is based on items from a screening questionnaire that measures phenomena that are not related to what people conventionally call psychosis. Even then, the odds ratio of 11 does not sit well with odds given for current smokers and lung cancer.

Put simply, not everyone who experiences psychosis (however defined) has these risk factors, and not everyone who has these risk factors develops psychosis.

Exaggerated recovery rates for schizophrenia and other psychosis

The review stating 50% of people have recovery at follow-up is not a systematic review. A more recent systematic review suggested that only 13% of people with a diagnosis of schizophrenia met the criteria for recovery (Jääskeläinen et al., 2013). Long-term follow-up of people presenting with first episode psychosis show significant heterogeneity in symptomatic and functional outcome: a multi-centre UK first-episode study showing, in geographically defined populations, that 50% were in symptomatic remission at 10 years (a number of whom were taking antipsychotics), though only 15% fulfilled criteria for functional recovery (Revier et al., 2015).

Preorders are being accepted for e-books providing skeptical lookseBook_PositivePsychology_345x550 at mindfulness and positive psychology, and arming citizen scientists with critical thinking skills. Right now there is a special offer for free access to a Mindfulness Master Class. But hurry, it won’t last.

I will also be offering scientific writing courses on the web as I have been doing face-to-face for almost a decade. I want to give researchers the tools to get into the journals where their work will get the attention it deserves.