Psychology and 'Alternative Medicine'

[Diane]

Psychology and 'Alternative Medicine': Social and Judgmental Biases That Make Inert Treatments Seem to Work, by Barry Beyerstein, 1999.

This is quite old, but nothing much has changed, so it's still relevant.

Excerpt:

For users who choose CAM on ideological grounds, their fondness for these practices is rooted in a much larger network of social and metaphysical assumptions. Needless to say, their cosmological outlook differs substantially from the rationalist-empiricist worldview that underlies scientific biomedicine. Because these adversaries enter the fray with so few shared axioms and rules of evidence, it is not surprising that a consensus is rarely reached. Proponents of CAM disagree with their detractors, not only about the basic constituents of the universe and the nature of the forces that govern them, but also at the epistemological level-i.e., they cannot even agree about what are valid methods for settling such disputes. [7] Health being such a basic human concern, it is to be expected that differing opinions about the causes and remedies for disease would form a integral part of these two incommensurate worldviews-one objective, materialistic, and mechanistic, the other subjective, animistic, and morally driven. Because our views on health and disease are so enmeshed with our beliefs about the nature and meaning of life itself, not to mention the underpinnings of our moral precepts and our fundamental conceptions of reality, to attack someone's belief in unorthodox healing is to threaten this entire mutually supportive system of bedrock beliefs. Not surprisingly, such attacks will be resisted with strong emotion.

Social and cultural reasons for the popularity of unproven therapies

• Nostalgia
• The Low Level of Scientific Literacy among the Public at Large
• An Increase in Anti-intellectualism and Antiscientific Attitudes Riding on the Coattails of New Age Mysticism
• Vigorous Marketing of Extravagant Claims by the "Alternative" Medical Community
• Inadequate Media Scrutiny and Attacking Critics
• Increasing Social Malaise and Mistrust of Traditional Authority Figures - the Antidoctor Backlash
• Dislike of the Delivery Methods of Scientific Biomedicine
• Safety and Side Effects

Psychological Reasons for the Popularity of Alternative Therapies

• The Will to Believe
• Logical Errors and Lack of a Control Group
• Judgmental Shortcomings
• Psychological Distortion of Reality
• Self-serving Biases and Demand Characteristics

Why Therapists and Their Clients Erroneously Conclude That Inert Therapies Work

• The Disease May Have Run Its Natural Course
• Many Diseases Are Cyclical
• Spontaneous Remission
• The Placebo Effect and the Need for Randomized, Double-blind Assessments
• Some Allegedly Cured Symptoms Were Probably Psychosomatic to Begin With
• Symptomatic Relief versus Cure
• Many Consumers of Alternative Therapies Hedge Their Bets
• Misdiagnosis by Self or by a Physician
• Derivative Benefits

[BB]

Because our views on health and disease are so enmeshed with our beliefs about the nature and meaning of life itself, not to mention the underpinnings of our moral precepts and our fundamental conceptions of reality, to attack someone's belief in unorthodox healing is to threaten this entire mutually supportive system of bedrock beliefs. Not surprisingly, such attacks will be resisted with strong emotion.

This is what is scary about the current trend of infiltration. It is so very invasive. Some practitioners might even threaten legal action for questioning these assumptions...or so I've heard.

Anybody have any experiences they can share on a positive outcome of confronting these beliefs?

[nari]

In our paper today I came across an article on superstition and ritual beliefs.
A study has been published in the current edition of the journal Science (no authors quoted!!) by a group at Northwestern University; they confirm the suspicion that people take up alternative or bizarre beliefs when they feel out of control, such as post-9/11.

If someone else can provide a convincing 'reason' that fills holes of uncertainty amongst anxious people with poor filtering systems, then any sort of 'reasoning' becomes comforting.
The same could apply to those who try dozens of diets, or wander from one CAM practioner (or other health practitioner) to another looking for solutions to fill gaps in their feelings of inadequacy and lack of control over their lives.


Nari

[Jon Newman]

CAM of the gaps?

Edit: Darn. I thought I made that one up but I probably read it before (like here)

[Diane]

The bits that appear in the quote boxes below constitute just one tiny bit of the whole article, but it seems like a good place to begin:

An Increase in Anti-intellectualism and Antiscientific Attitudes Riding on the Coattails of New Age Mysticism

As a major plank in the New Age platform, CAM is permeated with the movement's magical and subjective view of the universe, epitomized in its catchphrase, "You create your own reality." [12] In advocating emotional over empirical and logical criteria for deciding what to believe, New Age medical gurus such as Andrew Weil and Deepak Chopra have fostered the attitude that "anything goes." [13] Even in elite academic institutions, there are strong proponents of the notion that objectivity is an illusion and how you feel about something determines its truth value. [14,15]

We see this happening to PT at U. of Miami.

To the extent that this has led many people to devalue the need for empirical verification in general, it has enlarged the potential following for those who sell magical and pseudoscientific health products. [16,17,18,19,20]

Mind-body dualism permeates New Age thought, not least of all in its alternative medicine wing. Ironically, it is the New Age supporters of CAM who accuse their scientific critics of being dualists. [21,22] However, it is the CAM afficionados who are the real dualists, as evidenced by their constant appeal to undetectable spiritual interveners in matters of health.

One would have hoped that by now the huge neurobiologic expansion of knowledge base would have crowded out dualism. But it would seem people are determined to retain "spiritual", "energetic, "karmic" explanations of effects, even fight for them.

They need this obfuscation in order to support the oft-heard canard that scientific medicine undervalues the effects of mental processes on health. [23] The confusion this has spread in the public mind has paved the way for a resurgence of many variants of "the mind cure" so popular in past centuries; i.e., the belief that the real causes and cures for almost all disease lie in the mind, conceived by New Agers as coextensive with the immaterial soul.[24]

...Which gives the "mind" (and by extension, a perceptual illusion of the brain known as conscious awareness, which manifests the illusion that "we" exist separately from our own brains) tremendous illusory powers it simply does not possess. The only power "we" have, as the "conscious awareness" module of our brains, is the power to inhibit our own nonconscious ruminating, be skeptical, be curious, read and learn and understand. And create means by which ideas can be tested for external validity.

It is easy to understand the appeal of such beliefs among those who have elevated wishful thinking to a virtue. Wouldn't it be nice if laughter and thinking optimistic thoughts would keep us healthy, prayer could rid us of diseases, or imagining little Samurais in the bloodstream attacking malignant cells would purge the body of cancer? Admittedly, there is evidence for psychological effects on one's health, but the size of these effects has been blown out of all proportion by CAM promoters such as Herbert Benson. [25] Several good critiques of the errors, experimental confounds, and artifacts that permeate the literature on spiritual beliefs and health have appeared recently. [26,27,28]

A related and troubling supposition common to New Age health propaganda is that one's moral standing can alter how forces in the natural world will affect us. In accepting this anthropocentric and animistic worldview, alternative healers are reverting to the prescientific notion that health and disease are tied to one's personal worthiness, rather than to naturalistic causes. This has fostered the return of an endless variety of long since discredited practices that purport to make patients "deserve wellness," rather than attacking the cellular bases of their diseases. Often, this merely leads to blaming the victim, for, implicitly, the patient must have done something despicable to "deserve" his or her affliction. And if the treatment fails, as it so often does, sufferers feel worse yet, for they must have been undeserving of a cure.

Stinkin' thinkin', the phrase made popular by AA - in this case however, the addiction was to the memeplex, the "dopameme," the feel-good thinking instead of rational thinking.

Vancouver is absolutely full of people treating people who uphold every kind of anti- and a-rational thinking you could list. I imagine other cities are not much different. It really does seem to be anti-intellectualism and anti-scientific. (Maybe I even stand out as a red zebra in my work.) Most of the time I stay disengaged from discussing anything, stay polite. But once in awhile I treat somebody - the last one was a massage therapist - with whom I end up arguing. She was big into visceral treatment and, since she asked me what I thought about it, I told her. :angel: Mistake, I suppose - I must have grievously offended her or something because she did not return, but c'est la vie. Some mountains you just can't climb.

Being a red zebra hasn't really bothered my practice much overall ... probably it's lucky that most of the time the anti-rationals and general public also pride themselves on being truly inclusive of everyone, including even a poor, spiritually handicapped atheist individual such as myself who can't see any point in trying to develop my own "spiritual" side. They take me as I am, and tolerate my POV on what I think is happening (more than I do theirs) ... well, I can, unless they ask for confirmation. Then, they find out I do have a boundary and that it excludes their particular bundles of thinking.

Most people enjoy learning something new about their physicality.

[Diane]

Seems to me that the job of countering anti-scientific thinking will never be accomplished in that people will just go ahead and make up new stuff until the days humans go extinct. Not that countering it shouldn't be done, continuously, same as housekeeping, another way of combatting 'entropy' at the mental level, as opposed to the personal surroundings level... just that it's a big job and few seem willing to take it on.

I've just found this paper, which you can read here, and is discussed here, or listen to an interview with the researcher here. It's that all-too-human need to control that creates these strange mental byways in us.

The tendency for people to come up with pattern recognition of something that has no basis in reality seems to be particularly prevalent in those who have no control over some sort of complex situation. Like trying to help other human primates in pain perhaps.. we get the development of ortho constructs.
Or MFR constructs.
Or worse.

[nari]

This is the paper I was referring to in my last post - thanks Diane.

Nari

[Jono]

I love the expression “dopameme” by the way.

Not really sure if I can express this clearly but…I think the tension in health care is that we try and discover scientific, mechanistic, treatments for people who don’t experience their bodies as being machines. We experience our bodies as being vitalistic, integrated, holistic. So I think that when people hear CAM practitioners use these sorts of words they think that they have a truer understanding of peoples bodies than more scientific methods.

The tension I find is educating patients in an honest, scientific way and at the same time entering into their subjective world-view enough that they feel understood.

I guess CAM practitioners don't have that tension because they can talk however they want.

[nari]

Jono, I think you have made an important point.

People like to be treated holistically because that touches what they are feeling. Mechanistic approaches that deal with anatomy and the body in general may not 'reach' the person in a way he or she would prefer, despite a friendly, non-threatening attitude.
Also many CAM practitioners do not demand that the person does homework in the same way other practitioners do; many people want a passive solution to their problems.

PTs are becoming more 'holistic' but it is a slow process.

Nari

[Diane]

What could be more "holistic", I wonder, than to make clear from the start that a person's nervous system includes "them"?
I think that any other kind of "holistic" notion merely supports dualism, i.e., the idea that some non-tangible essence of them is indestructible and immortal (as long as they behave themselves). But this is a heavy responsibility, as was pointed out by Beyerstein - If dualism is the mode of thought, then it only takes one wrong thought and a person's whole existence becomes burdened by a dread disease or something. Too much guilt! Too much work!

Better, in my opinion, to encourage the idea that existence is nice and also arbitrary, one's sense of self is part of the same system that has physicality and this enormous need for O2, and that the "person" inside, is innocent as the day they were born, pretty much. Nature just keeps on unfolding, and they are part of it. Enjoy the ride... Yes there are things one can do to avoid unwelcome genetic expression to a certain extent, like avoiding unbearable stress, but basically, we're only here for awhile, and when the system that holds our function all together in a coherent manner is done, so are we.

[gilbert]

whoa Diane....
You're wandering off into some pretty deep philosophical waters there about the nature of human existence. I'd be willing to argue with you but I'm sure that would violate some rule of SS. Maybe we'd better stick with physiotherapy, or at least with things that you can prove?
-Gilbert

[Diane]

Quite right Gilbert. Consider me reined in.

[Mary C]

:thumbs_up Gilbert

[Diane]

I'm back. I certainly do not want to press points with dualists, but this IS the forum for skeptical and critical thinking, so adding some of that to the mix is not entirely out of bounds. If Ramachandran says out loud that he is a neutral monist, (and he does), then so will I.

[gilbert]

thanks Diane
(Oh darn, I lost my chance for a really fun argument)

I totally agree with the damaging effects of people who are vulnerable and looking anywhere and everywhere for help getting sucked in by CAM practitioners. (I should know, they are my main competition. A nearby town has no physiotherapist, but 7 or 8 "practitioners" including massage, naturopathy, chiropractic etc.)