Dr Caroline Leaf on Drugs

We all have a drug problem.

Well, we do according to communication pathologist and self-titled cognitive neuroscientist-come-health guru, Dr Caroline Leaf.  She’s pretty chirpy for a woman with essentially no health credentials.  She did a PhD two decades ago on a specialized area of educational psychology, but she has no medical training or experience.  Essentially she is the Christian equivalent of the health and relationships section of a tabloid newspaper.  Her information lurches between unfounded and the bleeding obvious.

Today’s e-mail newsletter, “Mental Health News March 2017” is a mixture of both. It’s more moderate than usual in its tone, but it’s still inspired by her open rejection of pharmaceuticals, especially medications for mental health which she has railed against many times.

Her second paragraph is a specific case in point.  “Although many medications have saved lives and can help us, we cannot have a quick-fix-pop-a-pill mentality for everything in life, and we should not denigrate alternative methods of health and healing, such as diet, exercise, human relationship, love, compassion and therapy, particularly when it comes to mental health.”

She’s right – we shouldn’t have a quick-fix-pop-a-pill mentality, but she overstates her case.  Most people don’t want pills for everything – people want good care and good treatment.  Sometimes that involves a pill, sometimes it just involves reassurance.  This is bread and butter for any good GP, and I’d love to show Dr Leaf what the front-line of medicine looks like if she ever wanted to see (seriously, the offer’s open).

And who’s denigrating diet and exercise?  Diet and exercise aren’t “alternative” health, they’re mainstream.  Is Dr Leaf so out of touch that she can’t see this?

Her bias against pharmaceuticals is more obvious in their third paragraph.  Pharmaceutical medications are not a major cause of death. According to the Centre of Disease Control, the top ten causes of death in the US are:

* Heart disease
* Cancer (malignant neoplasms)
* Chronic lower respiratory disease
* Accidents (unintentional injuries)
* Stroke (cerebrovascular diseases)
* Alzheimer’s disease
* Diabetes
* Influenza and pneumonia
* Kidney disease (nephritis, nephrotic syndrome, and nephrosis)
* Suicide

Notice how medications do not feature on that list.  Dr Leaf is so biased against medications that she is willing to ignore official government data in favour of her own bias.

But the truth is, pharmaceutical grade medications have revolutionised our lives.  When used in the right way, for the right people, they improve our quality and quantity of life. They give people independence.  They give people choice.   They help people work, spend time with their family and care for others where that may not have been possible otherwise.

Do medications have side effects? Can people feel worse sometimes while taking them? Of course! We need to be realistic. Pharmaceutical medications are powerful agents and we have to use them respectfully.  Prescription drugs are like power tools.  In the right hands they can do wonders, but they can also be very dangerous when used incorrectly.  But while medications can be used incorrectly, using that as a reason why we should use less drugs is like arguing that we should use less knives because sometimes they cut people, or that we should drive less cars because there are car accidents.

Oh, and what was that about the widespread manipulation of data and results in the world of science?  Dr Leaf would never misrepresent the results of her studies, or misrepresent the results of other people’s research, in order to make her products look better than they are?

Lifestyle is important, and in some cases, lifestyle is more important than medication, but there is much more nuance involved.  You need different tools for different jobs.  Imagine a surgeon going into surgery and the scrub nurse passed over a nerf scalpel.  It wouldn’t be particularly helpful would it.  Or what if the scrub nurse passed over a butter knife?  The surgeon might get the job done but with great difficulty, without the precision needed.

What a surgeon needs to perform surgery is an extremely sharp stainless steel scalpel blade.  It is more effective and more precise.  It might occasionally do some unintentional harm, but it will be a lot more effective than a butter knife (and a nerf scalpel!)

There are three different levels of treatment in health – “alternative” medicines, lifestyle treatments, and pharmaceuticals.  “Alternative” medicines are, by definition, useless.  As comedian Tim Minchin says, “Do you know what they call alternative medicine that’s been proven to work? Medicine.”  Alternative medicines are probably not going to cause a lot of harm other than making their user poorer for wasting their time, but they’re highly unlikely to do any good.

Lifestyle treatments are the equivalent of the butter knife.  They work, but their effect is non-specific and cumulative.  Hear me right, “non-specific and cumulative” is not code for “ineffective”.  Exercise is one of the most effective non-pharmacological health strategies with clearly proven benefits, but like all lifestyle changes, the effect is fairly general, and the benefit accumulates.

And sometimes, despite doing everything right, people still get sick, and this is where pharmaceuticals have their place.  They are like the scalpel – they might have some unwanted effects, but in the right hands, when used correctly, they make a specific and tangible difference to a person’s life and health.

Dr Leaf then goes on to assert that “Changing your lifestyle and, significantly, the way you THINK can have dramatic effects on your health”.  That’s a furphy.  Thoughts make no difference to our health (I’ve shown how little difference thought makes to our health in my review of Dr Leaf’s book “Think and Eat Yourself Smart”).  Some scientists may have recommended produce over Prozac, but that doesn’t mean to say they’re right.

And Dr Leaf has trotted out the same worn, tired old factoid about loving and serving others that I’ve shown to be inaccurate as well.

If you want to improve your health without medications, then start walking.  Eat vegetables.  Drink water.  Don’t waste your time and money buying into Dr Leaf’s inaccurate teaching.

Dr Caroline Leaf and osteoporosis – Brittle facts on brittle bones

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In the fifteenth chapter of his gospel account, Matthew described a conversation that Jesus had with his disciples. Jesus had just reprimanded the Pharisees for their hypocrisy, and the disciples came back to Jesus to report that the Pharisees weren’t very happy about it.

“Then the disciples came to him and asked, ‘Do you know that the Pharisees were offended when they heard this?’ He replied, ‘Every plant that my heavenly Father has not planted will be pulled up by the roots. Leave them; they are blind guides. If the blind lead the blind, both will fall into a pit.’” (Matthew 15:12-14)

When it comes to many subjects, Dr Leaf is a blind guide. Dr Caroline Leaf is a communication pathologist and self-titled cognitive neuroscientist. She’s not a medical doctor – her title is academic, an award for her PhD in communication pathology over twenty years ago. She has no medical training whatsoever, which makes it a little offensive when she feels she’s qualified to lecture people about medical conditions like osteoporosis.

In an episode of her TV show broadcast this week, Dr Leaf offered a B-grade attempt at mimicking Dr Oz by trying to use her biased ideology to explain a serious medical condition, and in so doing, gave a performance laden with droll irony, a example of the Dunning-Kruger effect in its purest form.

Her co-host was Dr Avery M. Jackson III, a neurosurgeon in Michigan, who Google confuses with Dr Jackson Avery of Grey Sloan Memorial Hospital fame. Dr Jackson has an impressive bio which is replete with advanced work on osteoporotic crush fractures of the spine. One wonders why a specialist of such high regard would associate himself with a scientific philistine who doesn’t understand how genes work, and who regularly contradicts her own position.

Or why he would allow Dr Leaf to publicly associate him with claims like:
“Osteoporosis can be caused by bad thinking and bad eating”,
Not only is it considered a silent epidemic, but (osteoporosis) has its roots in mind and lifestyle choices”, and
“much can be done on a preventative level like diet and starting young with lifestyle choices and the way we use our minds. Mind is involved in everything!”

Actually, the biggest contributors to the risk of osteoporosis are genetics, ageing and the loss of gonadal function (menopause or low testicular function). Which of these are controlled by the mind, Dr Leaf? It’s not that lifestyle has no influence on osteoporosis, but Dr Leaf overstates the case.

If you want some useful advice on osteoporosis, I’d encourage you to get your information from reputable experts, not wannabe experts like Dr Leaf. To reduce your risk of developing osteoporosis, Osteoporosis Australia recommends
* 3-5 serves of calcium rich food daily
* adequate sunlight
* regular weight bearing exercise
(you can get more specific information here: http://www.osteoporosis.org.au/prevention. For medical advice tailored to your circumstances, see your GP or physician)

Dr Leaf needs to move on from her unscientific premise that the mind is in control of everything. It’s patently false, and it terminally biases nearly everything she says. She needs to open her scientific eyes rather than staying blind to the truth.

Free will isn’t free

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It’s only two days before Christmas.  I know most people in the last forty-eight hours before the Yuletide would be focussing on last minute shopping for presents or foraging for the ingredients for their Christmas feasts, or making their last minute arrangements for their holiday celebrations.  So now may not be the right time to post something meaty about the philosophy of free will, but hey, it might just make for a welcome distraction.  Come with me, if you’re game, down the rabbit hole of our choices.

Dr Leaf, communication pathologist and self-titled cognitive neuroscientist, posted a quote today from former Regius Professor of Divinity at the University of Oxford, Keith Ward: “Free will is a place where people can decide to do what is right or to do what is wrong and nothing determines their choice – lots of things influence their choice but nothing determines it except them”.

But is it, really?  Clearly Professor Ward is a very learned fellow, but what strikes me about Dr Leaf’s quote of the day is Professor Ward’s false moral dichotomy, and his over-simplistic implication that every choice is a fully conscious choice.  Perhaps his quote is taken out of context by Dr Leaf and his intended message has been skewed.  It wouldn’t be the first time Dr Leaf has cherry-picked and misquoted.

Dr Leaf added in her ‘me too’ comment – “So we are responsible and can be held responsible for our choices – this is confirmed by science and scripture”.

I should say, it’s not that Dr Leaf’s comment is completely wrong – we are held responsible for our choices, but this isn’t confirmed by science or by scripture, it is something that is legal more than it is scientific or scriptural.

As humans, we have a strong feeling of voluntary control over our actions, that everything we do is something that we choose to do.  This sense of control is so fundamental to our existence that much of our social system depends on it, such as our laws and the penalties for breaking them [1].

Except that science has proven that our sense of full control is largely an illusion.

I understand this idea might be hard for some people to accept.  We’re taught that we have full control over our actions or ideas.  We experience this sense of control from the vantage point of our own perception.  It’s hard to believe that we’re not really in full control of our actions and choices.  The dominant paradigm in the Christian church is the idea of free will.  We’re taught that the words we say and things we do are the exclusive product of our will.  Cognitive neuroscience paints a different picture.

The modern neuroscience of the will started with Benjamin Libet.  Professor Libet was a researcher in physiology at the University of California San Francisco.  He was initially studying the electrical properties of different sensations in the brain, but in the early 1980’s, he performed an experiment to look at the electrical readings that take place when a person decides on an action.  His subjects would decide to perform a simple movement of their arm or hand, and say when they were aware of the intention to act.  Electrodes connected to the subject’s heads measured their brain activity before, during, and after their decision to act.

What was remarkable was that there was a clear spike in electrical activity occurring up to a full second before a test subject was consciously aware of the intention to act [2].  Libet suggested that an unconscious process was responsible for the ‘willed’ action.

Other studies since that time have confirmed Libet’s results.  In fact, a study in 2008 showed that predictable brain activity occurred up to eight seconds before a person was aware of their intention to act [3].

This predictable unconscious spike of brain activity prior to awareness of our intention to act has been verified over and over and is beyond doubt, but there’s still lots of debate as to exactly what it means.  Defenders of the idea of free will have tried presenting alternative explanations of the pre-awareness unconscious activity, but none of them line up with the proven, repeatable science.

So if we don’t have full conscious control of our actions, what does go on in our brains when we perform an action?

Again, I won’t go into the fine print, but it’s important to understand that our brain does most of its work at a subconscious level, which includes the planning and execution of our actions [4, 5].  The brain takes the information presented to it, as well as information from memories, and makes a prediction of the best course of action.  This means that our processing of goals, rewards, and actions can be affected by ‘subliminal priming’ (in other words, information we process below our conscious level can affect the decision about the best course of action [5]).

Even though we’re not aware of every process the brain employs in our subconscious to formulate the best plan of action and to prime our system ready for that action, there is a element of awareness that provides real-time monitoring and a veto function [4].  Like if you were about to complain about your job and then suddenly remembered you were talking to your boss, you could stop yourself from saying something you might later regret.

What does it all mean?  The take-away message here is this: We have limited will, not free will.

We still have some capacity to choose, but our conscious choices are dependent on our subconscious brain activity, our experience and knowledge.

We can make choices, or “exercise our will”, if you like, but within the constraints of a number of factors beyond our conscious control.  We can “pull the brake”, so to speak, and stop an action that our subconscious brain activity primed us for, but wasn’t such a good idea when a bit more thought was applied.  Our brain also uses our experience and knowledge to predict the best action to take, and because some of our knowledge and experience comes from exercising our limited choices, we can also say we have some input into our decisions.

So in this sense, Prof Ward is correct – lots of things influence people’s choices and ultimately, the choice someone makes is their choice.  I don’t make your choices for you, they are your choices.  Except that it’s inaccurate and misleading to think of our will as being entirely conscious and thought driven.  We make a lot of subconscious decisions every day, often based on subconscious priming.  Most actions we take, day in and day out, are not influenced by our conscious thought.  They may sometimes make it into our subconscious awareness, and if they do, it’s often after the fact.

Have ever had a “Why did I say that” experiences, where your brain is thinking one thing and your mouth says another?  These are times that demonstrate the difference in the systems at work in our brains, which are usually co-ordinated, but not always.  There are other demonstrations of this as well, like specific brain pathologies leading to conditions such as Alien Hand Syndrome.

These sort of conditions show that intention is not the same as action.

Sure, most of the time they’re aligned, but not always.  And this is the key to Dr Leaf’s quote of the day today – the underlying assumption is that all of our choices are reflected in our actions, when really, our choices are better thought of as our intentions (although again, it’s still not that simple … is it morally wrong if you try to hurt someone but you don’t, or is it morally wrong if you try not to hurt someone, but you do?)

Professor Ward’s quote also sets up a false dichotomy of free will into only right or only wrong, and doesn’t take into account the intellectual or developmental capacity of a person to make a choice.  Would you expect a two-year-old to judge a complex moral life or death situation?  A more practical example is should people with dementia be able to make their own financial and health-related decisions?

Most reasonable people would say, “Well, that depends …” and that’s the correct answer here.  Nothing in the real world of human morality and choice is black or white.  There is always some subtlety, some nuance.

When put in context, the black-and-white thinking and teaching of Dr Leaf is shown up as shallow and inadequate.  Her little quote of the day doesn’t prove that free will is Biblically and scientifically supported, far from it.  All it shows is that Dr Leaf’s views are narrow and blinkered, and aren’t reflective of any scientific or scriptural expertise.

Dr Leaf is welcome to her opinion, but until she gains some actual expertise, she should reconsider her choice to share it.

References

[1]        Haggard P. Human volition: towards a neuroscience of will. Nature reviews Neuroscience 2008 Dec;9(4):934-46.
[2]        Libet B, Gleason CA, Wright EW, Pearl DK. Time of conscious intention to act in relation to onset of cerebral activity (readiness-potential). The unconscious initiation of a freely voluntary act. Brain : a journal of neurology 1983 Sep;26 (Pt 3):623-42.
[3]        Soon CS, Brass M, Heinze HJ, Haynes JD. Unconscious determinants of free decisions in the human brain. Nature neuroscience 2008 May;3(5):543-5.
[4]        Bonn GB. Re-conceptualizing free will for the 21st century: acting independently with a limited role for consciousness. Frontiers in psychology 205;4:920.
[5]        Horga G, Maia TV. Conscious and unconscious processes in cognitive control: a theoretical perspective and a novel empirical approach. Frontiers in human neuroscience 204;6:199.

The soul, stress, sugar and spin

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Stress and sugar.  In our post-modern society’s orthorexic narrative, these are two of the biggest villains.  So combining them into a diabolical duo reinforces their evil even more.

Dr Caroline Leaf is a communication pathologist, self-titled cognitive neuroscientist and Christian life coach.  In her latest newsletter to her adoring fans, Dr Leaf has accused sugar and stress of mass murder, with our soul’s approach to stress as their accomplice.

I’m sure Dr Leaf means well, but just because she’s not trying to frighten sales out of the gullible and vulnerable doesn’t mean she gets a free pass on the accuracy of her information.

To boil it down, Dr Leaf’s argument goes something like this:

Our choices turn good stress into bad stress
Bad stress releases excess cortisol which leads to disease and death
Therefore our choices to stress causes disease and death

We control our choices through our minds
Therefore, our mind is the key to stress illness
(oh, and sugar …)

The arguments seem plausible on the surface.  Most people have heard enough about stress to know about ‘good’ stress and ‘bad’ stress.  It doesn’t seem too much of a stretch to say that ‘bad’ stress is a significant cause of disease and death.  In the middle of her essay, Dr Leaf jumps from stress to sugar with no preceding link, but again, most people have heard that sugar is unhealthy, so they would probably just accept that statement too.

Unfortunately for Dr Leaf, her article has several critical errors which turn her well-meaning educational essay into a science-fiction short story.

To start with, her essay is built on the dysfunctional premise that the mind controls the brain, so each higher argument or premise is fundamentally skewed from the outset, and in doing so, Dr Leaf simply creates a circular argument of distorted factoids.

For example, her opening sentence: “The hypothalamus is a central player in how the mind (soul) controls the body’s reaction to stress and foods.”  The hypothalamus is a part of the limbic system deep in the brain.  It’s the main pathway from the brain to the endocrine system as Dr Leaf goes on to correctly assert, but essentially it runs on auto-pilot, responding automatically to information already being processed at a level beyond the reach of our conscious awareness and control.  For example, the hypothalamus regulates our body temperature, but it does so without our conscious control.  We can not consciously will our body temperature up or down just with our minds.

It’s the same with the stress response – there are many times where people have a subconscious stress response, where their mind feels like there’s nothing to be afraid of, but their hypothalamus is still priming their system for fight or flight.  White coat hypertension is a prime example.  White coat hypertension, or “White Coat Syndrome” is the phenomenon of people having high blood pressure in their doctor’s office but not at home.  Patients will say to me all the time, “I don’t know why my blood pressure is so high in here.  I feel fine.  I know there’s nothing to be afraid of here.”  But while their conscious mind is relaxed, their deeper subconscious brain remembers those injections that hurt, or that one time a doctor stuck the tongue depressor too far down their throat and they felt like they choked on it, and their hypothalamus is preparing them for whatever nastiness the doctor has for them this time.

Dr Leaf’s statement fails because she wrongly equates our brain with our mind, a subtle perversion which doesn’t just invalidate her premise, but significantly skews the essay as a whole.

As a quick aside, Dr Leaf also says that the hypothalamus “integrates signals from the mind and body, sending them throughout our bodies so that we can react in an appropriate and functional manner, ‘so that the whole body is healthy and growing and full of love’ (Eph. 4:16 NLT)”.  Ephesians 4:16 isn’t talking about the physical body, but about the body of Christ.  You don’t need to be a Biblical scholar to know this, you just have to be able to read.  Here is what the Bible says, “And He Himself gave some to be apostles, some prophets, some evangelists, and some pastors and teachers, for the equipping of the saints for the work of ministry, for the edifying of the body of Christ, till we all come to the unity of the faith and of the knowledge of the Son of God, to a perfect man, to the measure of the stature of the fullness of Christ; that we should no longer be children, tossed to and fro and carried about with every wind of doctrine, by the trickery of men, in the cunning craftiness of deceitful plotting, but, speaking the truth in love, may grow up in all things into Him who is the head — Christ — from whom the whole body, joined and knit together by what every joint supplies, according to the effective working by which every part does its share, causes growth of the body for the edifying of itself in love.” (Ephesians 4:11-16, emphasis added).

There’s no subtlety about this misuse of scripture.  Even non-Christians would be able to figure out that this verse has nothing to do with the physical body.  Dr Leaf has demonstrated that she either doesn’t read the Bible or doesn’t understand it.  Either way, this is a shameful indictment on Dr Leaf’s claim that she’s a “Biblical expert”, and should be ringing alarm bells for every pastor that is considering letting her get behind the pulpit of their church.

Dr Leaf rolls on with her list of medical misinformation.  Some of it is subtle (the “stages of stress”, also termed the General Adaptation Model, is an outdated model of the stress response [1], and CRF and ACTH are released during all stages of stress, not just stage 1).  Some of it is outlandish, like her claim that high levels of stress leads to Cushing’s Syndrome (see http://emedicine.medscape.com/article/2233083-overview#a4 for a list of the causes of Cushing’s Syndrome and note that stress isn’t on the list).

Dr Leaf’s also suggested that it was solely our perception of stress that was the key factor in the outcome of stress, making reference to “a study” showing a 43% increase in mortality if you thought stress was bad.  This is an example of cherry-picking at it’s finest, where one study’s findings are misrepresented to try and support one’s pre-existing position.  Dr Leaf didn’t bother to list her references at the end of the article, instead expecting people to find it for themselves, but I’ve previously seen the study she’s referring to.  Keller and colleagues published the study in 2012 [2].  Their survey suggested a correlation between overall mortality and the combination of lots of stress and the belief that stress is bad.  But remember, correlation does not equal causation, a golden rule which Dr Leaf is quick to ignore when the correlation suits her argument.  The Keller study, while interesting, did not control for the impact of neuroticism, the “negative” personality type which is largely genetically determined and is independently associated with a higher mortality [3-9].  It does not prove that thinking about your stress in a better way makes you live longer.

Dr Leaf went on to claim that “the researchers estimated that the 18,200 people who died, died from the belief that stress is bad for you—that is more than two thousand deaths a year.”  Even here, Dr Leaf manages to get her facts wrong.  The authors actually wrote, “Using these cumulative hazards at the end of the study follow-up period under the assumption of causality, it was estimated that the excess deaths attributable to this combination of stress measures over the study period was 182,079 (controlling for all other covariates), or about 20,231 deaths per year (over 9 years).”

Dr Leaf can’t even get her vexatious arguments right.  Not that the number really matters, because notice how the authors described the magic number as an “assumption of causality”.  Basically the authors said, ‘Well, IF this was the cause of death, then these would be the numbers of deaths attributable.’  They NEVER said that anyone actually died because of their beliefs about stress.  Indeed, the results showed that just believing that stress was bad didn’t make any difference to the mortality rate as Dr Leaf suggested – it was the interaction of high stress AND the belief it was bad that was associated with a higher mortality.  But why let pesky issues like methodological rigour get in the way of sensationalist hyperbole.

Then in the penultimate paragraph, Dr Leaf suddenly decides to throw sugar into the mix.  Somehow without justification, stress is bad and therefore sugar is also bad, and they both throw the hypothalamus and the rest of the body into toxicity.

Dr Caroline Leaf is promoted, by herself and by many in the Christian church, as a Biblical and scientific expert, but in one short promotional essay, Dr Leaf makes multiple critical scientific and exegetical errors.  In other words, her errors in discussing scientific findings and basic Biblical text are so massive that they are incongruent with her claim to be an expert.

Something needs to change – either Dr Leaf revises her knowledge and improves her accuracy, or she needs to stop misleading people from pulpits, both virtual and real.

References

[1]        McEwen BS. Stressed or stressed out: what is the difference? Journal of psychiatry & neuroscience : JPN 2005 Sep;30(5):315-8.
[2]        Keller A, Litzelman K, Wisk LE, et al. Does the perception that stress affects health matter? The association with health and mortality. Health Psychol 2012 Sep;31(5):677-84
[3]        Okbay A, Baselmans BM, De Neve JE, et al. Genetic variants associated with subjective well-being, depressive symptoms, and neuroticism identified through genome-wide analyses. Nature genetics 2016 Apr 18.
[4]        Servaas MN, Riese H, Renken RJ, et al. The effect of criticism on functional brain connectivity and associations with neuroticism. PloS one 2013;8(7):e69606.
[5]        Hansell NK, Wright MJ, Medland SE, et al. Genetic co-morbidity between neuroticism, anxiety/depression and somatic distress in a population sample of adolescent and young adult twins. Psychological medicine 2012 Jun;42(6):1249-60.
[6]        Koelsch S, Enge J, Jentschke S. Cardiac signatures of personality. PloS one 2012;7(2):e31441.
[7]        Vinkhuyzen AA, Pedersen NL, Yang J, et al. Common SNPs explain some of the variation in the personality dimensions of neuroticism and extraversion. Translational psychiatry 2012;2:e102.
[8]        Gonda X, Fountoulakis KN, Juhasz G, et al. Association of the s allele of the 5-HTTLPR with neuroticism-related traits and temperaments in a psychiatrically healthy population. Eur Arch Psychiatry Clin Neurosci 2009 Mar;259(2):106-13.
[9]        Lahey BB. Public health significance of neuroticism. Am Psychol 2009 May-Jun;64(4):241-56.

Dr Caroline Leaf – Not a mental health expert

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Dr Caroline Leaf is a communication pathologist and self-titled cognitive neuroscientist.  She wrote a PhD on a learning program developed for an educational setting.  She is not a medical doctor.  She is not a psychologist.  She has no experience or training in the diagnosis and management of mental illness.  She is no more qualified to give advice on mental illness than my hairdresser is.

And it shows in her latest social media post: “Lets really start loving as a church- true unconditional non judgmental love – pushing people away and locking them up and drugging them against their will is not the solution to the the problems of life.”

Her statements is a nonsense, nothing more than a scarecrow fallacy.  Yes, pushing people away and locking them up and drugging them against their will is not the solution to the problems of life, that’s why no one does it.  If people were locked up or drugged against their will because of “the problems of life” then we’d all be locked up and drugged.

The only people that are forcibly treated are those with the most serious of mental illnesses whose condition has deprived them of the insight they need to make the decision for themselves.  Even then, the consent for treatment is given by the next of kin, and if no next of kin can provide consent, then the consent is usually made by a independent statutory body so there’s no conflict of interest.

That Dr Leaf continues to make such inane statements about mental illness confirms that she is not fit to give the church, or anyone else for that matter, any advice on mental health.  She may have a PhD in communication pathology but that is a highly specialised field that doesn’t even begin to cross over to clinical knowledge of mental illness.

Dr Leaf has chosen to fill her vacuum of mental health experience with the opinions of Mad In America, a group that’s irrationally biased against modern mental health care.  She regurgitates their creed almost verbatim – mental illness is over diagnosed, psychiatric medications are useless and dangerous, and Dr Leaf also claims that psychiatric medications are only prescribed to bring the cabal of the American Psychiatric Association and the pharmaceutical companies more power and money.

Psychiatric medications are more helpful than harmful (Leucht et al, 2012, Torniainen et al, 2015).  I’ve discussed this in blog posts in the past.  Yes, they’re not without their side effects, and they’re not for every patient, but they have their place in psychiatric care.  That Dr Leaf can’t or won’t review this evidence is just another indictment against her ministry.  That she actively promotes the idea that pharmaceutical companies and the APA are actively attempting to harm people for their own power and riches is scandalous.

If Dr Leaf was serious about promoting good mental health through the church, she should stop promoting baseless anti-psychiatric propaganda, and start encouraging Christians with mental illness to seek the best treatment available, whether that be medications or counselling or both.  She should also start teaching the church the truth about mental illness … That mental illness isn’t caused by poor choices or toxic thoughts, but because of genetic abnormalities that make the affected persons brain more vulnerable to external stress.

Because to stop turning pain and trauma into shame, anger, fear and then hate, people need correct information to allow them to offer real loving understanding and nonjudgmental support to move through the pain.  At the moment, Dr Leaf isn’t offering the church anything even close to that.

References

Leucht S, Tardy M, Komossa K, et al. Antipsychotic drugs versus placebo for relapse prevention in schizophrenia: a systematic review and meta-analysis. Lancet 2012 Jun 2;379(9831):2063-71.
Torniainen M, Mittendorfer-Rutz E, Tanskanen A, et al. Antipsychotic treatment and mortality in schizophrenia. Schizophrenia bulletin 2015 May;41(3):656-63.

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.

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.