Jonah Lehrer’s written a good piece in Wired about the importance of therapy
By therapy, he’s specifically referring to talking therapy as opposed to drug therapy. We’ve got a very drug-centric approach to health care, but the research evidence into anti-depressants clearly shows they are no more effective than placebo for all but the most severe depressions. So why do we persist in using drugs as first line treatments for depression? In fact, we often dismiss the value of the “talking therapies” (psychoanalysis has found it very hard to present an “evidence based” case, the way Cognitive Behavioural Therapy has done, and, as a result, often loses out in decisions about resource allocation)
Lehrer refers to some work comparing a mindfulness approach to depression to drug treatment and the conclusion on long term effectiveness was –
The results were stark. Not surprisingly, patients who escaped depression with the help of anti-depressants, and then stopped taking the drugs, relapsed about 70 percent of the time. The chemical boost was temporary. However, during the 18 month follow-up period, only 28 percent of patients in mindfulness therapy slipped back into the mental illness.
As he helpfully concludes –
What we often forget is that therapy alters the chemical brain, just like a pill. It’s easy to dismiss words as airy nothings and talk therapy as mere talk. Sitting on a couch can seem like such an antiquated form of treatment. But the right kind of talk can fix our broken mind, helping us escape from the recursive loop of stress and negative emotion that’s making us depressed. Changing our thoughts is never easy and, in severe cases, might seem virtually impossible. We live busy lives and therapy requires hours of work and constant practice; our cortex can be so damn stubborn. But the data is clear: If we are seeking a long-lasting cure for depression, then it’s typically our most effective treatment.
And this is the nub of the issue, isn’t it? Life is complex and resolving difficulties takes time, effort and practice. It’s foolish to consider human beings as chemical/mechanical beings which can be “fixed” with chemical and mechanical “solutions”. Human interaction, awareness, consciousness, communication, all bring about changes in the internal “chemical” environment. My preference would be that we address people as people not as examples of some “chemical imbalance”.
Heroes Not Zombies 
How about a hug, and a cuppa too?
here’s hoping we are riding on the crest of a new paradigm bob. is this kind of thinking being communicated in medical school?
I like to think of psychotherapy (whichever model) as effecting a sort of delicate “field effect change” on the neurochemistry of the brain, thus enabling alternative patterns of though.
As opposed to the blunt tool/sledgehammer approach to altering neurochemistry employed by even the most advanced psychotropic drugs.
Of course, the nature of a subtle field effect change is that is it harder to determine causality and therefore “evidence”. But I suspect as medical imaging and other technologies advance, we will be able to better visualise the undoubtedly potent – if subtle – effects of talking therapies on the brain.
I think the ‘hug’ and cuppa makes sense ——Its not only talk that has evidence …..Most cultures seem to offer approaches which intuitively value other forms of non verbal communication . Below the head there is a person too.
Touch , movement , dance , social forms of communication are all have ‘evidence’ but are seldom considered valid forms of intervention by medicine. I don’t think this is communicated in medical school . Certainly new trainees where I work seldom consider ways of promoting ‘neurogenesis’ which are non pharmacologically based.
http://www.mhf.org.uk/campaigns/exercise/
Ed Haliwell did research on the role of exercise and depression for example and he as a practicing Buddhist validates mindfulness and movement …..
ian, i had a chat with a district nurse last week and she mentioned how an elderly woman remarked that as the nurse was massaging cream onto her lower leg she ‘hadn’t been touched in years’. she literally had no physical contact with another human being to the extent it was a subject to be remarked upon.
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