Dr Caroline Leaf and the shotgun approach

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“It has been collectively demonstrated by researchers around the world that just about every aspect of our brainpower, intelligence and control – in normal, and psychiatrically and neurologically impaired individuals – can be improved by intense, efficient, organised and appropriately direct mind training … thank you Jesus.”

Sounds impressive doesn’t it.

Unfortunately for Dr Caroline Leaf, communication pathologist and self-titled cognitive neuroscientist, grandstanding does not equate to authority.  It’s all very well and good to publish broad, sweeping generalisations, but it’s like firing a shotgun at a cork from thirty paces.  Sure, you might hit your target, but the scatter pattern of the ammunition misses more times than it hits.

If Dr Leaf wants her statement to be taken seriously, then she needs to do a couple of small things.
(1) Reference her statement.  This should be fairly easy if “researchers around the world” really have demonstrated the power of mind training.  To sum it up more effectively, perhaps Dr Leaf could cite a meta-analysis that proves the value of mind training.
(2) Stop confusing the mind with the brain. This is the biggest problem with her statement. The mind does not control the brain.  If Dr Leaf produced any references in support of her statement, they would be along the lines of training or retraining the brain, not the mind.

It may seem trivial, because most people think the mind and the brain are the same, but they’re two distinct things.  Old psychological therapies were based upon the notion that fixing your thoughts was the key to improving your mental health, but this notion is now outdated, considered part of “Western folk psychology” [1]. By using the concept of “mind” and “brain” interchangeably, Dr Leaf confuses the issue for the average person trying to come to grips with modern science.

I’d be grateful if Dr Leaf could publish some evidence to support her claim, because I’m unfamiliar with research showing that things like intelligence can be improved with brain training. Sure, there’s good evidence for the improvement in the damaged brain with specific physical exercises – it’s one of the primary tools in Rehabilitation Medicine. There is also good evidence for psychological therapies such as ACT, or Acceptance and Commitment Therapy, in improving mood amongst other things [2, 3]. Though I’ve read a recent meta-analysis of multiple studies that suggests “brain training” for working memory offers minimal benefit which is not maintained and not transferable across categories [4], which means there’s no proof that “brain training” improves intelligence.

In future posts, I hope that Dr Leaf provides something more accurate instead of grandiose shotgun statements.

References

  1. Herbert, J.D. and Forman, E.M., The Evolution of Cognitive Behavior Therapy: The Rise of Psychological Acceptance and Mindfulness, in Acceptance and Mindfulness in Cognitive Behavior Therapy. 2011, John Wiley & Sons, Inc. p. 1-25.
  2. Harris, R., Embracing Your Demons: an Overview of Acceptance and Commitment Therapy. Psychotherapy In Australia, 2006. 12(6): 1-8 http://www.actmindfully.com.au/upimages/Dr_Russ_Harris_-_A_Non-technical_Overview_of_ACT.pdf
  3. Harris, R., The happiness trap : how to stop struggling and start living. 2008, Trumpeter, Boston:
  4. Melby-Lervag, M. and Hulme, C., Is working memory training effective? A meta-analytic review. Dev Psychol, 2013. 49(2): 270-91 doi: 10.1037/a0028228

 

Labels – the good, the bad, and the ugly

Yesterday, I wrote a rebuttal to Dr Caroline Leaf’s social media post, that “Psychiatric labels lock people into mental ill-health.” In my rebuttal, I suggested that psychiatric labels don’t lock anyone into mental ill-health any more than a medical diagnosis locks people into physical ill-health.

In the feedback I received, one intelligent young lady commented that, “I understand your point completely, but I took her words differently. I have often seen people who use their diagnosis as an excuse. For example, a kid gets diagnosed with Autism or ADHD, and suddenly the parents are using that as an excuse for their bad behaviour instead of teaching and helping them to deal with it. Another example, an adult is diagnosed with something mild, but uses it as an excuse to no longer care about trying to get a job or trying to get treatment and make an effort to get better”.

I certainly understand where she’s coming from. I’ve seen it too. A diagnosis is used as an excuse for someone’s avoidance, or a tool to milk every drop of sympathy from another. Giving someone a label seems to hinder some people more than help them.

Thankfully, there’s more than one side to the label story. I wanted to use today’s post to discuss the good, the bad, and the ugly side of diagnostic labels.

First, lets look at the ugly side of a diagnostic label. There will always be emotional and social connotations to every diagnosis that a person receives. Sometimes that’s sympathy, and sometimes that’s stigma. If a young woman told her friends that she had breast cancer, I’m sure that news would be met with an outpouring of care and support. If the same young woman told the same friends that she had chlamydia or genital herpes, I’d bet that most of the responses would be blaming or shaming, which is one reason why no one tells other people they’ve got chlamydia or herpes.

The same goes for mental health. The media often portrays people with mental illness as either homicidal or weak [1]. So the general response to mental health diagnoses is either fear or contempt. Even those who are neutral towards mental health often don’t understand it, so it’s difficult for those with mental health issues to receive true empathy for their plight.

Then, there is the bad side of a label. Labels can be misused, intentionally or unintentionally, for all sorts of reasons. They can also be wrongly applied. It might be that someone uses their diagnosis to draw sympathy from people, or money, or help when they don’t really need it. They might use their label as an excuse to avoid certain things they don’t like. There are innumerable ways that people can milk secondary gain from their problems.

However, appropriate diagnosis can bring many benefits. For example, correct labelling brings with it understanding and empowerment.

A diagnosis can help us understand more about ourselves, or the person with the diagnosis. That child with ADHD isn’t just being naughty, but has difficulty regulating their behaviour. That person with Asperger’s isn’t being intentionally rude, but has trouble with social cues, understanding body language, and communicating in an empathic way. A correct diagnosis also helps us understand our own strengths and weaknesses. They help us recognise what it is about ourselves that we can’t change, what we can change, and what we need to change.

Once you understand what it is you can change and what you can’t change, it empowers you to change what you can for the better, and accept and adapt to what you can’t change. You stop wasting precious strength and time fighting what you can’t change. Instead, all of the effort that would have been needlessly spent on the unchangeable can be effectively spent on improving what needs to be, and can be, changed.

In fairness, I should point out that a diagnosis isn’t always needed to make positive change. Acceptance and Commitment Therapy is a form of psychological therapy that encourages flexibility to accept those parts of our lives that are uncomfortable, whether they have a label or not, and allow our values to shape our life direction. Sometimes we can spend so much energy looking for a diagnosis that we stagnate, forgoing the forward momentum of what we value to focus on having a label for the symptoms.

But where a diagnosis can be made without undue effort, it can provide clarity to what often seems to be a jumbled mess of dysfunctional traits.

So, sure, sometimes labels can be used for the wrong things. That doesn’t mean they’re not useful or we should stop using them. There may be a stigma to a diagnosis of herpes or depression, but there are also good treatments available. The diagnosis may provide a way of changing a life of ongoing suffering to a life fulfilled.

More often than not, a good diagnosis helps bring clarity to a situation, enabling understanding, acceptance and empowerment. Rather than locking people in, a correct label usually unlocks a person’s potential to grow despite the problems they face.

References

  1. Corrigan, P.W. and Watson, A.C., Understanding the impact of stigma on people with mental illness. World Psychiatry, 2002. 1(1): 16-20 http://www.ncbi.nlm.nih.gov/pubmed/16946807

Dr Caroline Leaf and the brain control misstatement

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“Always give credit where credit’s due.”

Dr Leaf is a communication pathologist, and a self-titled cognitive neuroscientist. Yesterday, Dr Leaf made a couple of carefully worded statements on her social media feeds, which given the quality of her previous couple of neuroscience-based factoids, is a definite improvement.

First, she said that, “Your brain is being continuously rewired throughout your life …”. Yep, I can’t disagree with that one. The brain is a very dynamic tissue, constantly remodelling the synaptic wiring to process the information it receives on a daily basis. That’s why the brain is referred to as ‘plastic’, reflecting the property of plastic to be moulded into any shape.

Her next offering sounds really good too. It’s full of encouragement, positivity and hope … the classic feel-good quote: “You can bring your brain under your control, on the path to a better, healthier, stronger, safer and happier life.” Whether it’s true or not depends on how literally you interpret it.

If you loosely interpret it, then it sounds ok. Sure, we have some control over how we act, and if we live our life in the direction dictated by our values, then we will have a better, healthier, stronger, safer and happier life. Modern psychological theory and therapies confirm this [1].

However, what Dr Leaf actually said was, “You can bring your brain under your control”. Having some control over our actions is entirely different to bringing our brain under our control. We can control some of our actions, but we don’t control our brain any more than we ‘control’ our car.

When we say that we’re ‘controlling’ the car, what we actually mean is that we are controlling the speed and direction of the car. But there are thousands of electrical and mechanical actions that take place each second that are vital for the running of the car, and that we have absolutely no direct control over. It just takes one loose nut or faulty fuse to make the car steer wildly out of control, or stop functioning entirely, and then we’re not in control at all.

In the same way, various diseases or lesions in the brain show that brain is really in control, tic disorders for example. These can range from simple motor tics (sudden involuntary movements) to complex tic disorders, such as Tourette’s (best known for the involuntary tendencies to utter obscenities). Another common example are parasomnias – a group of disorders in which people perform complex behaviours during their sleep – sleep talking, sleep walking, or sleep eating.

The fact we don’t see all of the underlying processes in a fully functional brain simply provides the illusion of control. Our brain is driving, our stream of thought just steers it a little, but it doesn’t take much to upset that veneer of control we think we possess.

Ultimately, our brain is still responsible for our action. We don’t have a separate soul that is able to control our brain. Any decisions that we make are the result of our brain deciding on the most appropriate course of action and enacting it [2] (and see also ‘Dr Caroline Leaf, Dualism, and the Triune Being Hypothesis‘ for a more in-depth discussion on the subject of dualism). Therefore, we can’t ever bring our brain under control.

This is important because if we believe that we can bring our brain under control, then by simple logical extension, we can control everything our brain is responsible for – our emotions, our feelings, our thoughts, our memory, and every single action we make. This is Dr Leaf’s ultimate guiding philosophy, though it’s not how our neurobiology works. If we were to believe that we control our thoughts and feelings, we set up an unwinnable struggle against our very nature, like trying to fight the tides.

We are not in control of all our thoughts, feelings, emotions or all of our actions, and neither do we have to be. We just need to make room for our uncomfortable emotions, feelings and thoughts, and to move in the direction of those things we value.

So if you were to take Dr Leaf at her word, she still missed the mark with her post. It sounds ok in a very general sense, but closer inspection reveals a subtle but significant error.

Giving credit where credit’s due, Dr Leaf has tried to tighten up her social media statements. It’s commendable, but unfortunately she needs to bring her underlying philosophy closer to the accepted scientific position to further improve the quality of her teaching.

References

  1. Harris, R., Embracing Your Demons: an Overview of Acceptance and Commitment Therapy. Psychotherapy In Australia, 2006. 12(6): 1-8 http://www.actmindfully.com.au/upimages/Dr_Russ_Harris_-_A_Non-technical_Overview_of_ACT.pdf
  2. Haggard, P., Human volition: towards a neuroscience of will. Nat Rev Neurosci, 2008. 9(12): 934-46 doi: 10.1038/nrn2497

Dr Caroline Leaf and the case of the killer reactions

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Stress! Believe the media and seemingly every disease known to man is in some way linked to it. Heart disease = stress. Cancer = stress. Flatulence = stress.

Dr Caroline Leaf, Communication Pathologist and self-titled cognitive neuroscientist, has been of a similar opinion for the last couple of decades. Dr Leaf must have been kind enough to read my book, because after teaching for the last fifteen years that stress is toxic, a subtle shifting under the weight of evidence has appeared.

In her 2009 book [1], Dr Leaf wrote,
“The result of toxic thinking translates into stress in your body.” (p15)
“Stress is a global term for the extreme strain on your body’s systems as a result of toxic thinking.” (p15)
“Stress is a direct result of toxic thinking.” (p29)
“These stages of stress are scientifically significant because they illustrate how a single toxic thought causes extreme reactions in so many of our systems.” (p39)

In 2013, her position on stress hadn’t really changed that much: “Even a little bit of these negative levels of stress from a little bit of toxic thinking has far-reaching consequences for mental and physical health”, and “The association between stress and disease is a colossal 85 percent.” [2: p36-37]

Again in her 2009 book [1], Dr Leaf devotes an entire chapter to the alleged effects of the toxic stress pathway on our body (chapter 4, p39-43).

Now in her latest social media update, tucked in amongst the gratuitous selfies and holiday snaps, comes something that’s actually about mental health: “Stress does not kill… is good for us! Its our negative reactions to stressful events that pushes into negative stress…and this is what kills! Sistas 2014 NZ”

The problem for Dr Leaf is that any stress, whether it’s caused by our “negative” reactions or not, doesn’t actually kill us.

There is a phrase used in science, “Correlation does not equal causation”. This simply means that just because two things occur together, one doesn’t necessarily cause the other. For example, do my red watery eyes cause my hives? They always appear together, but they don’t cause each other. The common element that causes both of them is actually the cat that I’ve just patted.

Just because stress is correlated with certain illnesses does not mean that stress causes or contributes to those illnesses. In fact, one of Dr Leafs own pivotal references, an article by Cohen and colleagues in the Journal of the American Medical Association in 2007, discussed the weakness of assuming that stress causes most diseases. As they say, “Although stressors are often associated with illness, the majority of individuals confronted with traumatic events and chronic serious problems remain disease-free.” [3]

Even if it were true that it how we react to stress contributes to the outcome of that stress, Dr Leaf’s statement about our killer reactions incorrectly presumes that both how we cope with stress, and the physical outcome of stress are the result of our choices.

Our levels of stress, and the way we cope with our stress, is mostly caused by our genetics. Some people will be naturally less stressed, and some people will be naturally better at coping with stress (see chapter 5 of my book [4] for a full discussion on the science of resilience). Just because you’re more prone to stress doesn’t mean that it’s all down to your bad choices. Assumptions like these only add to your already high levels of stress.

That’s not to say that we don’t have a way to improve our responses. For those of us at the stressed end of the spectrum, successful psychological therapies such as Acceptance and Commitment Therapy will help to improve our coping, and certainly have been shown to improve (not cure) mental illnesses like anxiety and depression, and other chronic conditions like chronic pain (see [5] for a review).

ACT and other modern psychological therapies recognise that trying to change our thoughts doesn’t make any difference to how we cope. So like I said before, it’s partly true that how we react to normal life experience will help us live full and productive lives, but it’s not about fighting or changing our thoughts. It’s about being mentally flexible enough to make room for our thoughts and fears and move forward towards meaningful action. I’m sure that the ladies at ‘Sistas 2014’ wouldn’t be hearing that from Dr Leaf.

Anyways, I’m glad that Dr Leaf is changing her tune on stress, but there’s still more room for change before she meets up with current scientific understanding.

For an in-depth review of the teachings of Dr Leaf, visit http://www.smashwords.com/books/view/466848 where you can download a free copy of “Hold That Thought: Reappraising the work of Dr Caroline Leaf.

References

  1. Leaf, C., Who Switched Off My Brain? Controlling toxic thoughts and emotions. 2nd ed. 2009, Inprov, Ltd, Southlake, TX, USA:
  2. Leaf, C.M., Switch On Your Brain : The Key to Peak Happiness, Thinking, and Health. 2013, Baker Books, Grand Rapids, Michigan:
  3. Cohen, S., et al., Psychological stress and disease. JAMA: the journal of the American Medical Association, 2007. 298(14): 1685-7
  4. Pitt, C.E., Hold That Thought: Reappraising the work of Dr Caroline Leaf, 2014 Pitt Medical Trust, Brisbane, Australia, URL http://www.smashwords.com/books/view/466848
  5. Harris, R., Embracing Your Demons: an Overview of Acceptance and Commitment Therapy. Psychotherapy In Australia, 2006. 12(6): 1-8 http://www.actmindfully.com.au/upimages/Dr_Russ_Harris_-_A_Non-technical_Overview_of_ACT.pdf