MIND CHANGES BRAIN? READ THIS …

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They say that if you want something badly enough, you can make it happen … you just have to believe in it to make it work.  Wish upon a star, believe in yourself, speak positively, think things into being … it’s the sort of magical thinking that forms the backbone of Hollywood scripts and self-help books everywhere.

But that’s not how science works.  In the real world, believing in something doesn’t make it magically happen.  Holding onto a belief and trying to make it work leads to bias and error.  Instead of finding the truth, you end up fooling yourself into believing a lie.

This is the trap that Dr Leaf has fallen into as she continually tries to perpetuate the unscientific notion that the mind changes the brain.

Dr Caroline Leaf is a communication pathologist and a self-titled cognitive neuroscientist.  Her philosophical assumptions start with the concept that the mind is separate from and controls the physical brain, and continue to unravel from there.

The problem is that Dr Leaf can’t (or won’t) take a hint.  I’ve discussed the mind-brain link in other blogs in recent times (here and here), but yet Dr Leaf continues to insist that the mind can change the brain.  It’s as if she believes that if she says it for long enough it might actually come true.

Today, Dr Leaf claimed that “newly published” research from Yale claimed that, “Individuals who hold negative beliefs about aging are more likely to have brain changes associated with Alzheimer’s disease.”  Except that this research is not really new since it was published last year, and Dr Leaf tried to draw the same tenuous conclusions then as she’s doing now.

She quoted from the interview that one of the authors did for the PR puff piece that promoted the scientific article:

“We believe it is the stress generated by the negative beliefs about aging that individuals sometimes internalize from society that can result in pathological brain changes,” said Levy. “Although the findings are concerning, it is encouraging to realize that these negative beliefs about aging can be mitigated and positive beliefs about aging can be reinforced, so that the adverse impact is not inevitable”.

Well, the issue is clearly settled then, all over bar the shouting.  Except that the promotional article doesn’t go through all of the flaws in the methodology of the study or the alternative explanations to their findings.  Like that the study by Levy, “A Culture-Brain Link: Negative Age Stereotypes Predict Alzheimer’s Disease Biomarkers” [1], only showed a weak correlation between a single historical sample of attitude towards aging and some changes in the brain that are known to be markers for Alzheimer Dementia some three decades later.

They certainly didn’t show that stress, or a person’s attitude to aging, in anyway causes Alzheimer Dementia.  And they didn’t correct for genetics in this study which is the major contributor to the risk of developing Alzheimer’s [2].  So no matter what Dr Leaf or the Yale PR department thinks, the results of the study mean very little.

But why let the lack of ACTUAL EVIDENCE get in the way of a good story.

It’s sad to see someone of the standing of Dr Leaf’s shamelessly demoralise themselves, scrambling to defend the indefensible, hoping beyond hope that what they believe will become the truth if they try hard enough.  It doesn’t matter how much Dr Leaf wants to believe that the mind changes the brain, that’s not what science says, and clutching at straws citing weak single studies and tangential press releases isn’t going to alter that.

References
[1]        Levy BR, Slade MD, Ferrucci L, Zonderman AB, Troncoso J, Resnick SM. A Culture-Brain Link: Negative Age Stereotypes Predict Alzheimer’s Disease Biomarkers. Psychology and Aging 2015;30(4).
[2]        Reitz C, Brayne C, Mayeux R. Epidemiology of Alzheimer disease. Nat Rev Neurol 2011 Mar;7(3):137-52.

Dr Caroline Leaf and the mind-brain revisited

 

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Dr Leaf has been promoting her food philosophy lately, but yesterday and today, she has come back to one of her favourite neuroscience topics.

Dr Caroline Leaf is a communication pathologist and a self-titled cognitive neuroscientist. It’s her belief that “as triune beings made in God’s image, we are spirit, mind(soul) and body – and our brain being part of the body does the bidding of the mind …”.

This is one of the flaws that terminally weakens her teaching, and leads to scientifically irrational statements like yesterday’s meme:

“God has designed the mind as seperate from the brain. The brain simply stores the information from the mind and your mind controls your brain.”

On what basis does she make such a claim? I’ve reviewed the scripture relating to the triune being hypothesis. The Bible doesn’t say that our mind is seperate to our brain, nor that it dominates and controls our brain. Dr Leaf’s statement yesterday is simply assumption based on more assumption. It’s like an intellectual house of cards. The slightest puff of scrutiny and the whole thing comes crashing down on itself.

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To try and reinforce her message today, Dr Leaf quoted Dr Jeffrey Schwartz, psychiatrist and neuroscientist, “The mind has the ability to causally affect and change pathways in the brain.” Jeffrey M. Schwartz is an OCD researcher from the UCLA School of Medicine. It appears he lets his Buddhist anti-materialism philosophy cloud his scientific judgement.

Well Dr Leaf, I see your expert and I raise you. Dr David Eagleman is an author and neuroscientist at Baylor College of Medicine in Texas. He has written more than 100 scientific papers on neuroscience, and has published numerous best-selling non-fiction books including ‘Incognito, The Secret Lives of the Brain’ which was a New York Times best-seller. He isn’t an irrational anti-materialist.

He said, “It is clear at this point that we are irrevocably tied to the 3 pounds of strange computational material found within our skulls. The brain is utterly alien to us, and yet our personalities, hopes, fears and aspirations all depend on the integrity of this biological tissue. How do we know this? Because when the brain changes, we change. Our personality, decision-making, risk-aversion, the capacity to see colours or name animals – all these can change, in very specific ways, when the brain is altered by tumours, strokes, drugs, disease or trauma. As much as we like to think about the body and mind living separate existences, the mental is not separable from the physical.” https://goo.gl/uFKF47

This statement makes much more logical sense. The functions of the mind are all vulnerable to changes in the brain. Take medications as one particular example. Caffeine makes us more alert, alcohol makes us sleepy or disinhibited. Marijuana makes it’s users relaxed and hungry, and sometimes paranoid. Pathological gambling, hypersexuality, and compulsive shopping together sound like a party weekend in Las Vegas, but they’re all side effects linked with Dopamine Agonist Drugs, which are used to treat Parkinson’s disease. There are many other examples of many other physical and chemical changes in the brain that affect the mind.

Conversely, there is limited evidence of the effect of the mind on the brain. Sure, there is some evidence of experienced meditators who have larger areas in their brain dedicated to what they meditate on, but the same effect has been shown in other parts of the brain unrelated to our conscious awareness.

But since the mind is a function of the brain, whatever effect the ‘mind’ has on the brain is, in reality, just the brain effecting itself.

So Dr Leaf can cherry-pick from her favourite authors all she wants, but quoting a supportive neuroscientist doesn’t diminish the crushing weight of scientific evidence which opposes her philosophical assumptions. If she wants to continue to proffer such statements, she would be better served to come up with some actual evidence, not just biased opinion.

Anti-depressants – Not the messiah

 “He’s not the messiah, he’s a very naughty boy, now go away!” 

 Ah, Monty Python – six university students with a penchant for satire who changed the face of comedy.  They say that “Imitation is the sincerest form of flattery”, and if that’s the case, Monty Python should be very flattered!  Nearly five decades later, you still hear people throwing around lines from their sketches and getting a laugh.

Their movie, “The Life of Brian” remains one of the most critically acclaimed and most controversial of all movies.  It was the story of Brian, born in the stable next door to Jesus, and who later in life unintentionally becomes the focus of a bunch of people who mistakenly believe he’s the messiah.  One morning he opens his window to find a large crowd of people waiting for him outside his house, leaving his mother to try and dismiss the crowd with that now famous rebuke.

The crowd at Brian’s window aptly demonstrates a quirk in our collective psyche.  We humans have a bipolar tendency to latch on to something that seems like a good idea at the time and blow it’s benefits out of all proportion, only to later discover it wasn’t as good as our overblown expectations and unfairly despise it on the rebound.

Anti-depressant medications are a bit like Monty Python’s Brian.  Back in the late 1980’s when Prozac first came on the market, doctors saw it as the mental health messiah.  Prozac improved cases of long-standing severe depression and was much safer in overdose compared to older classes of psychiatric medications.  The idea that depression and other mental illnesses were related to chemical imbalances fit nicely with the cultural shift away from the Freudian psychotherapy model that was prevalent at the time.  People were describing life changing experiences on Prozac: “One morning I woke up and really did want to live … It was as if the miasma of depression had lifted off me, in the same way that the fog in San Francisco rises as the day wears on.” [1]  Prescribing for Prozac and other SSRI anti-depressants took off.

Fast forward to the present day, where the pendulum has swung back violently.  Anti-depressants are considered by some to be nothing more than over-prescribed placebo medications used by a pill-happy, time-poor culture demanding simple cures for complex problems.  Some commentators have gone so far as to label anti-depressants as an evil tool of the corrupt capitalist psychiatric establishment.

“Anti-depressants are not the messiah, they’re very naughty boys, now go away!” they exclaim.

But are anti-depressants really the enemy, or could they still be friendly, even if they’re not the messiah?

In the Medical Journal of Australia this month, two Australian psychiatrists, Christopher Davey and Andrew Chanen, carefully review the place of anti-depressants in modern medicine [2].  It’s a very balanced and pragmatic view.

They bring together all the evidence to show that while anti-depressants aren’t the elixir of happiness that we once assumed, they also don’t deserve the accusation that they’re nothing but fakes.

When drugs are scientifically tested, they’re usually studied in placebo-controlled trials.  The medications are given to one target group of people and a fake medicine is given to a similar group.  In the best trials, the patients aren’t aware of which they’re actually getting, and the physicians aren’t aware either.  That way personal bias and expectations can be reduced.  To reduce these biases even further, other scientists can pool all of the quality research on a topic in what’s called a meta-analysis.

Trials on anti-depressants initially showed very strong positive results, or in other words, the patients on the drug did much better than those on the placebo.  Anti-depressants lost a lot of their shine in the last decade or so as researchers began pointing out that the placebo effect, the number of patients improving on the fake medicine, was also very high.

There was also the serious, and largely legitimate accusation that drug companies ignored trials with less favourable results to make their drugs look better.  The reputation of anti-depressants was forever tarnished.

One of the most out-spoken critics of anti-depressants, Harvard psychologist Irving Kirsch, tried to show that when all of the trials on anti-depressants were taken together, the placebo effect wasn’t just close to the effectiveness of the real medicine, but was actually the same.

The problem with Kirsch’s analysis is that not all trials are created equal.  Some have negative results because they were poor trials in the first place.  When experts reapplied Kirsch’s methods to the best quality trials, the results suggested that anti-depressants are still effective, but for moderate and severe depression [1].  Anti-depressants for mild depression weren’t of great benefit.

This is take home point number one: Don’t believe the hype.  Anti-depressants are useful, but not for all cases of depression. #happypillshelp

So if anti-depressants aren’t useful for all cases of depression, are other therapies better? This is where psychological therapies come in to the equation.  Those who are the most vocal opponents of modern psychiatry and psychiatric medications are also the most vocal promoters of the benefits of talking therapies.  They won’t admit it, but there’s usually an ideological bias or financial incentive driving the feverish worship of talking therapies and their overzealous defence.

Though in the cold hard light of evidence-based science, talking therapies aren’t much of a panacea either.  Pim Cuijpers, a professor of Clinical Psychology in Amsterdam lead a team who reviewed the effectiveness of trials of psychotherapy, and found that their effectiveness has also been overstated over the last few decades.  Quality studies show that talking therapies are equivalent in effectiveness compared to anti-depressants for depression [3].

What’s important to understand about talking therapies in general is that any benefit they have is related to changing behaviour, but that’s not dependent on changing your thoughts first [4-6].  Talking and thinking differently is fine, but unless that results in a change to your actions, there will probably be little benefit.

This is take home message number two: Talking therapies help, but you don’t need to change your thinking, you need to change your actions. #walkthetalk

The million-dollar question is how to apply all of this.  If talking therapies have the same benefit as anti-depressants, then do we go for tablets before talking or the other way around?  Are both together more powerful than each one alone?

In their paper, Davey and Chanen outline what has become the generally accepted pecking order for anti-depressant therapy.  They recommend that all patients should be offered talking treatments where it’s available.  Medication should only be considered if:

  1. a person’s depression is moderate or severe;
  2. a person doesn’t want to engage with talking therapies; or
  3. talking therapies haven’t worked.

Some overseas guidelines recommend this order based on projected bang for your buck.  While talking therapies are initially more expensive, they seem to have a more durable effect than medications, which are initially cheaper and easier, but have a greater cost with prolonged use [7].  In other words, if you learn better resilience and coping skills, you’re less likely to fall back into depression, compared to the use of the medications.

This is take home message number three: Use talking therapies first, with medications as a back up. #skillsthenpills

At this point in history, we seem to finally be finding some balance.  Just as anti-depressants aren’t the messiah, they’re not the devil either, despite the vocal minority doing their best to demonise them.

With a few decades of research and clinical experience since Prozac was first released on to the market, we’re finally getting an accurate picture of the place of talking therapies and medications in the treatment of depression.  Both are equally effective, and each have their place in the management of mental illness in our modern world.

References

[1]        Mukherjee S. Post Prozac Nation – The Science and History of Treating Depression. The New York Times. 2012 Apr 19
[2]        Davey CG, Chanen AM. The unfulfilled promise of the antidepressant medications. Med J Aust 2016 May 16;204(9):348-50.
[3]        Cuijpers P, van Straten A, Bohlmeijer E, Hollon SD, Andersson G. The effects of psychotherapy for adult depression are overestimated: a meta-analysis of study quality and effect size. Psychological medicine 2010 Feb;40(2):211-23.
[4]        Herbert JD, Forman EM. The Evolution of Cognitive Behavior Therapy: The Rise of Psychological Acceptance and Mindfulness. Acceptance and Mindfulness in Cognitive Behavior Therapy: John Wiley & Sons, Inc., 2011;1-25.
[5]        Longmore RJ, Worrell M. Do we need to challenge thoughts in cognitive behavior therapy? Clinical psychology review 2007 Mar;27(2):173-87.
[6]        Dobson KS, Hollon SD, Dimidjian S, et al. Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression. Journal of consulting and clinical psychology 2008 Jun;76(3):468-77.
[7]        Anderson I. Depression. The Treatment and Management of Depression in Adults (Update). NICE clinical guideline 90.2009. London: The British Psychological Society and The Royal College of Psychiatrists, 2010.

IMPORTANT

If you have questions about what treatment type might be better for you in your situation, please talk to your local GP, psychologist or psychiatrist, or if you need urgent crisis support, then:

In Australia

  • you can call either Lifeline on 13 11 14,
  • BeyondBlue provides a number of different support options
  • the BeyondBlue Support Service provides advice and support via telephone 24/7 (call 1300 22 4636)
  • daily web chat (between 3pm–12am)
  • email (with a response provided within 24 hours) via their website https://www.beyondblue.org.au/about-us/contact-us.

In the US
-> call the National Suicide Prevention Lifeline by calling 1-800-273-TALK (8255).

In New Zealand
-> call Lifeline Aotearoa 24/7 Helpline on 0800 543 354

In the UK
-> Samaritans offer a 24 hour help line, on 116 123.

 

Book review: “Think and Eat Yourself Smart” by Dr Caroline Leaf

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Think and Eat Yourself Smart
Dr Caroline Leaf
328 pages, Published by Baker Books USA

My rating: 2 / 10

As a society, we are obsessed with food.  With copious food blogs, celebrity chefs and reality cooking shows, food has become more about our social status and self-identity than about nourishment.

Food has always been intimately connected to our health and well-being, and the modern food obsession has taken that to extreme levels as well.   Organic, paleo, sugarless, raw food, cleansing and other popular diets have morphed into ‘movements’, the polite shorthand way of describing popular obsessions that are borderline cults.

Trying to cash in on this wave of cultural orthorexia is Dr Caroline Leaf with her latest book, “Think and Eat Yourself Smart”, published in early April by Baker Books.

Dr Leaf describes the book as “an attempt to reintroduce a culture of thinking and effort back into eating, one based on diligently stewarding the body and world God entrusted to us.  In the spirit of renewing the mind, it is a lifestyle book that seeks to reimagine what we eat within an integrated spirit, mind and body framework.”

And that would be fine in theory, though in practice, Dr Leaf uses the book more as a vehicle for divulging her personal food preferences and her socio-political ideology while recycling most of her dubious brain science.

But before we go any further, let me issue a disclaimer: There’ll be some who will look this review and assume I’m being critical of Dr Leaf’s book for the sake of being critical.  I recognise that I’m not Dr Leaf’s number one fan, however, I want to say from the outset of this review that I have approached this as dispassionately and objectively as I can.

“Think and Eat Yourself Smart” is certainly not all bad.  Dr Leaf raises some legitimate issues.  For example, she’s critical of the vitamin and supplement industry and the staggering cost of supplements compared to their very limited benefits.  She discusses the previous dietary advice regarding low-fat foods, and how the misguided attempt to reduce our dietary fat intake lead to a compensatory increase in starch and sugars.  She also discussed the current concerns about too much sugar and refined carbohydrates, and raises the very real problem of food waste and food security.  The recipes at the back of the book contain the usual over-rated hipster foodie ingredients like dandelion, kale, quinoa and chia seeds to maintain Dr Leaf’s foodie creds, although some of the recipes themselves sound alright.

Unfortunately, every truth is outweighed by a multiplex of factoids and misrepresentations.  Dr Leaf clearly favours organic food, which despite her claims, have not been shown to be better tasting, more nutritious, less toxic, and better for the environment.  She’s clearly against genetically modified organisms (or GMO’s), a stance which is more populist than scientific.

Dr Leaf’s underlying premises are also deeply flawed.  It’s clear that she’s been heavily influenced by the work of Michael Pollan and other post-modern food gurus of the same ilk.  She’s critical of modern food systems including all food processing, food transportation, and supermarkets, claiming that modern agriculture and food processing destroys all nutrients and taste.  Dr Leaf claims that “Real food is food grown the way God intended: fresh and nutritious, predominantly local, seasonal, grass-fed, as wild as possible, free of synthetic chemicals, whole or minimally processed, and ecologically diverse.” (p29)

Dr Leaf’s definition of “real food” is nothing more than a romanticised post-modern social construct, and claiming it’s God’s idea doesn’t make it any less misleading.  Of course we want our food to be fresh, and we also want it to be nutritious.  But fresh and nutritious are not dependent on being local, seasonal, ecologically diverse (whatever that means), grass-fed and wild.  In fact, how something can be grass-fed and wild seems contradictory.  Processing food makes it safer, and in most cases, more nutritious that the unprocessed farm gate versions.  There’s virtually no pesticide residues left on conventional produce either, so that’s a moot point.

In fact, modern food is actually easier to eat and digest, more nutritious, tastier, safer, and longer lasting than ever before in human history. Today’s canned and frozen foods are infinitely healthier than in the past, and in some cases, more nutritious than the vegetables straight off the farm (canned tomatoes, for example, because nutrients are more easily absorbed from cooked tomatoes).  Dr Leaf’s idealised view of our agrarian past is false, and the notion that we should return to it is inane.

Dr Leaf also spends a great deal of time trying relate our nutritional health to our thinking.  I discussed this in the pre-review of the book, here.  She claims that “Research shows that 75 to 98% of current mental, physical, emotional and behavioural illnesses and issues come from our thought life; only 2 to 25% come from a combination of genetics and what enters our bodies through food, Medication, pollution, chemicals, and so on.  These statistics show that the mindset behind the meal – the thinking behind the meal – plays a dominant role in the process of human food related health issues, approximately 80 percent.” (p84)

Again, this is a false premise based on bogus science.  75 to 98% of current mental, physical, emotional and behavioural illnesses and issues do not come from our thought life.  What you think and how you feel makes no difference to how your body processes the nutrients you put into it.

This excessive focus on the power of thought is a segue back to her previous teaching, a justification as to why she as a self-titled cognitive neuroscientist should be writing about food.  Unfortunately, the information contained in the second part of the book makes it obvious that she’s not an expert on either.

Sure, Dr Leaf discusses responsibility and choices which are important to what we put in our mouths, but there are so many other variables that are more intrinsic to our individual diets than just personal responsibility.  Like, poverty, income, education, cooking skills or geographic location for example.

Dr Leaf claims that how you think changes how you eat, and how you eat changes how you think.  Except the last part of that statement is mutually exclusive to her premise that the mind is separate to the brain and controls the brain.  What you put in your mouth might change the function of your brain, but how can that change the way you think if the mind is separate to the brain?

This paradox is the death-knell to her books credibility and usefulness.  Not that it makes any difference to Dr Leaf, who conveniently forgets this central tenet of her teaching whenever it suits her.

The advice she provides is also off-track.  The answer to processed food isn’t to plant your own garden, or raise your own chickens, or join a local agro-economic food co-op.  That sort of advice is impractical for the vast majority of her audience.  It excludes everyone who lives in a modern city, or who, like me, has an uncanny ability to kill all but the hardiest of plants.  Even her exhortation to eat “real food” is unnecessarily complicated.

Ultimately, Dr Leaf’s advice isn’t dangerous, but just old and confusing.  Most of the useful information she gives is obscured by the plethora of unnecessary and irrelevant opinions and factoids.  It’s also nothing new.  There have been countless books and blogs written by real nutritionists and dieticians that say the same essential things in much simpler ways.  Even John Oliver did a better job of explaining problems associated with sugar and our modern food systems (* Warning * – Strong language and adult themes).  He’s an agnostic satirical comedian who doesn’t pretend to be a scientific expert, and he still get’s the message across more effectively than Dr Leaf.

To conclude, if you want sound nutritional advice, I’d suggest you head for books by actual dieticians. Professor Rosemary Stanton is one author I would recommend. She’s a Professor of Nutritional Science and Visiting Fellow of the School of Medicinal Sciences at the University of New South Wales.  She’s published hundreds of academic and consumer articles including 33 books on good nutrition.  She’s been lecturing and writing about good food for longer than I’ve been alive.

In contrast, Dr Leaf’s book “Think and Eat Yourself Smart” is a repackaging of stale opinion and dubious science by an author who isn’t a nutritionist, or even a cognitive neuroscientist for that matter.  There might be some helpful advice in there, but it would be difficult for an average reader to pick out what’s beneficial and what’s bogus.

To that end, “Think and Eat Yourself Smart” is a lot like a frozen microwave dinner.  It looks good on the packaging, but what you get on the inside isn’t the same.  There’s a few nutritional morsels, to be sure, but most of it is just offal and gristle that’s been homogenised to an unrecognisable mush and then reassembled.

If you’re a Dr Leaf devotee, or you’re interested in her socio-political views, then by all means, buy this book.  If you want sound nutritional advice, look elsewhere.

 

“Think and Eat Yourself Smart”: a pre-review

Update: Read my full review of “Think and Eat Yourself Smart” here.

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They say, “Never judge a book by its cover.”  What about judging it by its marketing?

Dr Caroline Leaf is a communication pathologist and self-titled cognitive neuroscientist.  She’s also a wannabe nutritionist.  Her latest book is “Think and Eat Yourself Smart”, due for official release at the end of April.

I haven’t read her book yet so I’m not really sure what she’s going to say.  It might be a well reasoned and soundly researched discussion about healthy eating, except there are some conflicting ideas that are appearing in Dr Leaf’s own marketing of the book, so I’m not holding out much promise.

For example, yesterday Dr Leaf suggested that “the mindset behind the meal – the thinking behind the meal – plays a dominant role in the process of human food related health issues, approximately 80 percent.”

This is bogus science.  It doesn’t matter if I’m convinced that eating a half gallon tub of ice cream is nutritious or not, it’s going to have the same nutritional effect on my body (namely, none).  It’s not 80 percent healthy because I believe it’s healthy.

Dr Leaf has made this assertion based on other bogus science – “How does thinking affect eating, and how does eating affect thinking? Research shows that 75 to 98% of current mental, physical, emotional and behavioural illnesses and issues come from our thought life; only 2 to 25% come from a combination of genetics and what enters our bodies through food, Medication, pollution, chemicals, and so on.”

Dr Leaf’s assertion that “75 to 98% of current mental, physical, emotional and behavioural illnesses and issues come from our thought life” is a favourite factoid of hers that forms the basis of most of her teaching.  Except that it’s wrong.  It has no basis in fact.  I’ve discussed this at length in several blogs and in my book (see here for a more detailed explanation of Dr Leaf’s 98% myth).

It’s unclear just how much of her book Dr Leaf has based on this false assumption, but the fact that it’s there in the first place sets a bad precedent for the rest of the book.

Only time will tell, of course.  I’d like to be proven wrong, but unfortunately, Dr Leafs latest book seems to be plagued with the same poor science as her other tomes.

Watch this space …

Dr Caroline Leaf – Increasing the stigma of mental illness again

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Let me tell you a story.

A couple of years ago, one of my patients was an elderly gentleman in his late seventies.  He was living in a nursing home at the time, but because of his history of psychosis, he remained on a treatment order – a requirement by law that if he was to remain outside of a mental facility, he had to have regular anti-psychotic medication every few weeks.

This man was on a treatment order because his disease caused him to have delusions.  He misinterpreted what was going on around him, and would not consider that he could be wrong.  In his particular case, he was convinced that his next-door neighbour was a paedophile, and he was planning to ambush his neighbour and castrate him.  Luckily the police had taken my patient into custody before he got the opportunity.  With treatment, my patient had clear thoughts, although needed close supervision.  Without his medication, he became confused and violent.

According to a post on the blog Mad in America and promoted by Dr Caroline Leaf, my patient’s diagnosis was spurious, and he was denied his basic human rights by being forced to take medications.

Dr Caroline Leaf is a communication pathologist and self-titled cognitive neuroscientist.  She is also a self-declared expert in mental health, despite not having any professional training in medicine, psychiatry, psychology or even cognitive neuroscience for that matter.

Indeed, if she had any experience or expertise in mental health, she would have recognised the basic factual errors and logical fallacies that riddled the post she quoted from.

Take the quote that Dr Leaf posted on social media.  The full quote from the Mad in America post is:

“Despite the fact that no one in history, not even the omnipotent American Psychiatric Association – which produces and profits mightily from the ‘Bible’ of mental disorders — has come up with a halfway good definition of “mental illness,” and despite the fact that the process of creating and applying the labels of mental illness is unscientific, any of those labels can be used to deprive the person so labeled of their human rights. This is terrifying. It ought to terrify those who are so labeled and those who are not, because deprivation of human rights on totally arbitrary grounds is inhumane and immoral.”

This is the same tired, emotionally laden and misleading rhetoric that’s so often barked in fervent paroxysms through the foaming lips of those opposed to modern psychiatric practice:

  1. There is no good definition of ‘mental illness’
  2. The American Psychiatric Association is just a profit-driven cabal
  3. The DSM5 (which the author alludes to as the ‘Bible’ of mental disorders) is unscientific
  4. Psychiatric diagnoses are unscientific
  5. Any psychiatric diagnosis can be used as a trigger to force people into unwanted treatments or incarceration
  6. Therefore psychiatric diagnosis and treatment is against basic humans rights and is inhumane and immoral.

Inhumane and immoral hey?  Tell that to my patients neighbour who almost became a eunuch except for that “inhumane and immoral treatment” of my former patient.

Caplan claims just don’t stand up to any rational scrutiny.

  1. There are lots of good definitions of mental illness … modern psychiatry critics just don’t like them. But take the definition used by the CDC, “Mental illness is defined as … ‘health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning.’” There’s nothing wrong with this definition. It describes mental illness and helps differentiate mental illness from variations of mood, thought and behaviour that are part of the everyday human experience.
  1. The American Psychiatric Association isn’t the only group to have created a classification of psychiatric illnesses. The World Health Organisation publishes the International Classification of Diseases, or the ICD, which is also used for psychiatric diagnosis. Is the WHO an evil profit-driven junta too?
  1. The DSM, the ICD, and any other system of diagnosis, are simply different classification systems. Over the last century, clinicians have noted clusters of symptoms and have tried to classify them into common groups. How is that unscientific?  It’s no different to scientists looking at the different characteristics of various animals and creating a taxonomy, to provide a common system and language for clinicians and researchers across disciplines and across countries.The DSM system isn’t perfect, but what system ever is?  As knowledge of neuroscience grows, the classifications are reviewed and tightened in an ongoing process of improvement.  If those who oppose the DSM want to come up with something better, they’re welcome to put something forward.
  1. The old saying goes that medicine is an art and a science. Human beings, as nuanced as we are, often don’t fit into diagnostic criteria as easily as we would like. That doesn’t invalidate the diagnostic criteria or make the process unscientific as critics of modern psychiatry would have us believe, just like an unusual and hard-to-classify form of cancer doesn’t invalidate the other cancer classifications that are well defined.  Psychiatry, by it’s nature, relies on verbal report from patients rather than a clean-cut blood test or piece of tissue under a microscope, so at this stage in history, it seems imprecise.  That doesn’t make it any less scientific.
  1. The allegation that any psychiatric diagnosis can any be used to deprive the person so labeled of their human rights is utter nonsense. It’s a giant scarecrow – it seems really scary, but on closer inspection, it’s just a tarted-up mound of straw.People are never forced into treatments unless they really are “dangerous to themselves and/or others”.  This rule can’t be invoked willy-nilly.  There are multiple checks and balances, and a whole school of civil rights lawyers expectantly circling, ready for the whiff of blood in the water (http://www.mhrt.qld.gov.au/?page_id=2 is an example of the process in my home state, but each jurisdiction has their own version).

Caplan rightly pointed out that those with mental illness were less likely to be the perpetrators of violence and more likely to be the victims, but that doesn’t negate the need for protection of the community from those with mental illness who have shown violent intent and no capacity to control their behaviour.

If you want to find a group that really are suffering from inhumane and immoral deprivations of their human rights, then that would be Christians.  Around the globe, millions of Christians are oppressed, imprisoned, tortured, raped, and murdered every year.

Time and space preclude a full analysis of Caplan’s post, but what’s really important is that both the American Psychiatric Association and the U.S. Department of Health and Human Services’s Office of Civil Rights, an independent ombudsman, dismissed formal appeals by Caplan relating to her hysterical claims of inhumane forced psychiatric treatment.  Dr Leaf conveniently left that out of her social media post.

Instead, Dr Leaf chose to publish one of the most alarming quotes from an article heavy on scaremongering, from a disaffected author on an extremist blog.  If Dr Leaf was a real expert on mental health instead of being a self-declared one, she would have easily seen how nonsensical Caplan’s post was.

By posting this quote on social media today, it’s highly likely that Dr Leaf has caused harm to thousands of vulnerable Christians by unnecessarily increasing the stigma and fear of a mental health diagnosis.  This, in turn, is likely to lead to these same vulnerable Christians missing out on (drug and non-drug) treatment which would help them rise to their true potential in God and in life, leaving them trapped and suffering in their mental destitution.

Dr Leaf has a track record of misinformation when it comes to mental health.  Christians suffering mental illness need more support, not more stigma.  It’s time Dr Leaf stepped aside, and stopped making things worse.

Dr Caroline Leaf and the nonsense of ‘negative’ thinking.

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The power of positive thinking. It’s like rust on our collective consciousness, an idea that’s seems virtually impossible to eradicate, slowly eating away at our collective psyche. The idea has become so ingrained in our culture that it’s part of our folklore and our idiom, and it continues to be deliberately perpetuated by success coaches, business leaders and others who make a very tidy living by peddling baseless optimism. It’s been repeated so often that the ‘power of positive thinking’ has become an Availability Cascade (a self-reinforcing process by which an idea gains plausibility through repetition).

Herbert and Forman summarise it nicely, “The ideas that thoughts and beliefs lead directly to feelings and behavior, and that to change one’s maladaptive behavior and subjective sense of well-being one must first change one’s cognitions, are central themes of Western folk psychology. We encourage friends to ‘look on the bright side’ of difficult situations in order to improve their distress. We seek to cultivate “positive attitudes” in our children in the belief that this will lead to better academic or athletic performance. Traditional cognitively-oriented models of CBT (e.g., CT, stress inoculation training, and rational emotive behavior therapy) build on these culturally sanctioned ideas by describing causal effects of cognitions on affect and behavior, and by interventions targeting distorted, dysfunctional, or otherwise maladaptive cognitions.” [1]

Dr Caroline Leaf is a communication pathologist and a self-titled cognitive neuroscientist. She is one of the many that continue to perpetuate the myth of positive and negative thinking.

Today’s social media meme was yet another promotion of this misguided idea, and to top it off, she misquoted scripture again in an attempt to reinforce it.

“If you randomly allow any negative thought into your mind damage can ensue on a mental & physical level. ‘We destroy every proud obstacle that keeps people from knowing God. We capture their rebellious thoughts and teach them to obey Christ.’ 2 Corinthians 10:5 NLT”

Lets quickly break meme down to see exactly why Dr Leaf is, yet again, misleading her audience.

1. The mind does not control the brain

Dr Leaf’s meme implies that negative thought damages us mentally and physically. The problem with that is that the mind doesn’t control our brain or our body, so negative thought can’t damage us mentally or physically.

Instead, it’s our brain that gives rise to, and controls our thoughts and feelings. We don’t see what goes on ‘under the hood’ so to speak, we only experience our thoughts and feelings, so we assume that regulate each other. But it’s our brain and a number of other processes that are responsible for generating both our thoughts and feelings (CAP blog).

‘Negative’ thoughts can sometimes be the result of damage to our brain, but ‘negative’ thoughts don’t damage the brain.

In fact, often the so-called ‘negative’ thoughts are actually good for us.

2. Negative thinking is normal and healthy

Dr Leaf’s meme also implies that we control the content of our thoughts by suggesting that we ‘allow’ negative thoughts into our minds. But negative thoughts are meant to be there, which is why we have them. ‘Negative’ thoughts have a positive function. We need them to survive.

For example, we have a fear response to prevent us from continually putting ourselves in danger. We have an anger response to motivate us through difficult obstacles. We have feelings of embarrassment to help maintain social cohesion. As Skinner and Zimmer-Gembeck state, “adaptive coping does not rely exclusively on positive emotions nor on constant dampening of emotional reactions. In fact, emotions like anger have important adaptive functions, such as readying a person to sweep away an obstacle, as well communicating these intentions to others. Adaptive coping profits from flexible access to a range of genuine emotions as well as the ongoing cooperation of emotions with other components of the action system.” [2]

Dr Leaf isn’t helping anyone with her meme today. She’s simply promoting an outdated and unscientific notion, encouraging her audience to suppress normal, helpful adaptive functions for fear of harm that’s not scientifically possible.

Then as if to add insult to injury, she follows up her misleading meme with an equally misleading misrepresentation of 2 Corinthians 10:5.

3. Taking every thought captive?

2 Corinthians 10:5 is Pauls famous scripture about taking every thought captive, a concept which seems to support Dr Leaf’s ideas, except that Paul isn’t speaking generally to us, but specifically about the Corinthian church. Look at the verse in context:

“By the humility and gentleness of Christ, I appeal to you – I, Paul, who am ‘timid’ when face to face with you, but ‘bold’ towards you when away! I beg you that when I come I may not have to be as bold as I expect to be towards some people who think that we live by the standards of this world. For though we live in the world, we do not wage war as the world does. The weapons we fight with are not the weapons of the world. On the contrary, they have divine power to demolish strongholds. We demolish arguments and every pretension that sets itself up against the knowledge of God, and we take captive every thought to make it obedient to Christ. And we will be ready to punish every act of disobedience, once your obedience is complete.
You are judging by appearances. If anyone is confident that they belong to Christ, they should consider again that we belong to Christ just as much as they do. So even if I boast somewhat freely about the authority the Lord gave us for building you up rather than tearing you down, I will not be ashamed of it. I do not want to seem to be trying to frighten you with my letters. For some say, ‘His letters are weighty and forceful, but in person he is unimpressive and his speaking amounts to nothing.’ Such people should realise that what we are in our letters when we are absent, we will be in our actions when we are present.” (NIV UK, 2 Corinthians 10:1-11)

This chapter is a specific rebuke to some of the Christians within the church at Corinth, and also a defence against some of the murmurings and accusations that some in that church were levelling at Paul. For example, in verse 2, “I beg you that when I come I may not have to be as bold as I expect to be towards some people who think that we live by the standards of this world.”

Verses 3-6 are a specific and authoritative rebuttal against the accusations levelled at Paul, paraphrased as, “You may speak against us and the church, but we have weapons that smash strongholds, and we’re coming to take down those pretensions of yours and take every thought of yours captive to make it obedient to Christ, and punish every act of disobedience …”

The specific nature of the verse is also supported by some Bible commentary: “But how does St. Paul meet the charge of being carnally minded in his high office? “Though we walk in the flesh [live a corporeal life], we do not war after the flesh,” or “according to the flesh,” the contrast being in the words “in” and “according.” And forthwith he proceeds to show the difference between walking in the flesh and warring according to the flesh. A warrior he is, an open and avowed warrior – a warrior who was to cast down imaginations and every high thing that exalteth itself against the knowledge of God, and bring into captivity every thought to the obedience of Christ; a warrior too who would punish these Judaizers if they continued their disorganizing work; but a prudent and considerate warrior, deferring the avenging blow till “I am assured of your submission” (Stanley) “that I may not confound the innocent with the guilty, the dupes with the deceivers.” What kind of a preacher he was he had shown long before; what kind of an apostle he was among apostles as to independence, self-support, and resignation of official rights in earthly matters, he had also shown; further yet, what kind of a sufferer and martyr he was had been portrayed.” (C. Lipscomb – http://biblehub.com/commentaries/homiletics/2_corinthians/10.htm)

Similarly, the translation from the original text is more specific than general. The verb used for “bringing into captivity” is aichmalōtízō, “to make captive: – lead away captive, bring into captivity” which is in the Present Active Participle form of the verb. The present tense represents a simple statement of fact or reality viewed as occurring in actual time. The active voice represents the subject as the doer or performer of the action. The Greek participle corresponds for the most part to the English participle, reflecting “-ing” or “-ed” being suffixed to the basic verb form. Actions completed but ongoing or commands are different verb tenses (see https://www.blueletterbible.org/help/greekverbs.cfm for a better explanation). So Paul wasn’t making a general statement, but a specific statement about what he would do in his present time, not the future.

So, Paul isn’t telling us to “bring every thought captive into obedience to Christ”. Dr Leaf is perpetuating a common scriptural misunderstanding.

A verse which better clarifies what God wants for our thought life is Paul’s exhortation to the Philippian church in Philippians 4:8, “Finally, brothers and sisters, whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable – if anything is excellent or praiseworthy – think about such things.” Both the context, and the form of the verb, suggest that this is an ongoing command. And it makes better sense too. If we spend all of our time trying to fight against every thought that comes into our head, we’d become exhausted, but we can divert attention to those things that are worthy of our attention. And in many ways, what Paul is encouraging is what would be considered now as simple meditation, which is more scientific than the power of positive thinking.

The moral of this story … ‘negative’ thoughts and feelings don’t do us damage, but trying to unnecessarily suppress them does.

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]     Skinner EA, Zimmer-Gembeck MJ. The development of coping. Annual review of psychology 2007;58:119-44.