There is something very wrong with modern psychotherapy.
But before we talk about that, let's first talk about why seeing a psychologist might be good for you:
It’s been well-researched that talk therapy alleviates stress and provides clarity. (If you have hesitations about pouring your heart out to a total stranger, writing in a diary works just as well)
You like the idea of paying for a friend you can only see once a week
You hate money or have a strong urge to give a lot of it away
Okay, now that's out of the way, let's continue.
Before I begin my gratuitous rant, I want to pose a question about a phenomenon I find incredibly fascinating. I will attempt to answer this at the end of this post. The question is this:
In 2015, a Stanford anthropological study revealed that most schizophrenics living in India and Ghana experience positive auditory hallucinations. Such individuals heard imaginary voices offering soothing guidance or productive commands. They described these as divine and positive interactions.
This is in stark contrast to schizophrenic sufferers living in the United States, most of whom report auditory hallucinations of a disturbing nature: voices degrading them or commanding violent acts.
How is the mechanism of the “disorder” the same, but the manifestation so different?
How can one thing make Ghanaians so happy, yet make Americans so miserable?
WHY THE CURRENT PSYCHOLOGICAL PARADIGM CAN BE HARMFUL
The three most harmful aspects of psychology, I think, are:
Iatrogenesis in psychiatry diagnoses.
Iatrogenesis means “physician-induced disorder”. It is a term used to describe any unintended effect caused by a doctor during a medical intervention.
Although this is not universal, for many, sometimes simply the act of being diagnosed with a mental illness can cause or intensify the mental illness. The intensification of the ill-effect is directly proportionate to the suggestibility and mental instability of the patient.
Psychological iatrogenesis a documented phenomenon. For instance, there have been many cases of people suffering from nonepileptic seizures that are psychogenic in nature rather than neurological. For more information, google “Psychiatry Iatrogenesis”.
That's crazy. That means we might be creating our own misery through belief alone.
The phenomenon of iatrogenesis is STRONGLY related to the nocebo effect. The nocebo effect, as the opposite of the placebo effect, is when inert substances cause harm simply because one expects it to. If a sugar pill can make people drowsy just because it’s blue rather than red, through the power of expectation alone, it’s not hard to believe that a diagnosis of depression can literally make one more depressed.
I also believe chronic fatigue disorder is also psychogenic, especially if there isn’t any evidence of a neural correlate.
I came to this conclusion on my own a few years ago. I went to the doctor because I was tired all the time. He suggested that it was a symptom of depression and tried to prescribe me antidepressants on the spot. I was not depressed but it certainly planted some sort of seed in me. In later sessions, I asked if he was sponsored by a pharmaceutical company. He told me there’s nothing wrong with accepting a free lunch every once in a while.
2. Victim Mentality.
Psychological diagnoses sometimes has the paradoxical effect of inducing learned helplessness.
It is the same whether the patient blames nature (“I have a chemical imbalance in my brain”) or nurture (“I am worthless because of my childhood upbringing or parents”). The problem is that they are blaming external circumstances and thus severing themselves from existential agency and personal responsibility.
This can be seen clearly in anyone who attempts to justify an immoral act by blaming their personality disorder. “It’s okay I cheated and stole, but I’m depressed, I couldn’t help it!”
3. The pathologisation any kind of discomfort. Which leads me to my next point...
WHY DEPRESSIVE AND ANXIETY EPISODES CAN BE GREAT
Depression and anxiety feel like shit. But there’s a great reason for that.
Every human being has a certain set of needs that have to be met. It’s different for everyone depending on their individual set of values, but generally most people desire significance, growth, and connection.
When these needs aren’t met, the body intuitively responds in one of two ways: depression, or anxiety.
Depression is a down-regulative force. (Hence the name “depression” literally meaning “pressed down, lowered in force”.)
Anxiety is an up-regulative force. Anxiety kicks the body into action. Look at the physiological manifestations of anxiety – a heart beating fast enough to explode, incredible sensory alertness, intense restlessness, rapid breathing. Your body is preparing you for battle.
Have you ever noticed the correlation between chronic anxiety and stomach problems? When someone is in a constant state of anxiety, their body is constantly in fight mode, which means all their energy is partitioned to physiological processes that help them fight to survive. Digestion is not one of them, and so this results in gastrointestinal malfunctioning.
To put this all in more neutral language:
Depression is rest.
Anxiety is energy.
It is so so important to look at this neutrally. Why? Because it is neutral. Anxiety at the physiological level is simply just arousal. It is neither inherently positive or negative. It is only positive or negative if it is applied in a meaningful or non-meaningful way, respectively.
Since it is just physiological arousal, to the body, anxiety and excitement is the same thing. So if you are anxious for no reason, just reframe it in your mind as excitement. Your body won’t really know the difference.
Even if this stimulating sensation is uncomfortable, sometimes it’s apropos to the situation. There exists a phenomenon of “optimal anxiety” – where just the right amount of arousal maximises performance. This is illustrated by a Yerkes-Dodson Curve:
(Image sourced from wikicommons)
Okay Kari, so what about that end of the bell curve where anxiety is high and I’m hyperventilating for no reason?
SO WHAT'S HAPPENING? WHY AM I SUCH AN ETERNAL FAILURE?
There seems to be two main sources of psychological pathology:
YOU ARE TRYING TO SURVIVE - Overactive animal brain (overactive limbic system)
YOU ARE CONDITIONING YOURSELF - Conditioned negativity at the neurological level
Let’s go into these two sources in more detail.
YOU ARE TRYING TO SURVIVE
The brain is the powerhouse for human self-preservation. Evolution via natural selection has fine-tuned it to keep us alive and functioning at optimal levels. Our animal brain, the subcortex which lies below the cortex, houses the limbic system, which in turn houses the hypothalamus. The hypothalamus is concerned with homeostasis or the maintenance of a stable internal environment. When we feel the urge of our particular brand of addiction or pathological behaviour, it is because our subcortical brain has somehow come to believe that this behaviour is necessary for survival or the maintenance of a stable internal environment (homeostasis).
When your needs aren’t met – another way to put it, your homeostatic stability is disturbed – your body compels you to act to restore stability.
This explains addiction super well.
Imagine there’s a guy. His name is Jake. Jake works an unfulfilling job. The job makes him tense and on-edge with an avalanche of stress. One way to counteract the stimulating effects of stress is to apply the depressive effects of alcohol. Over time, Jake develops alcoholism because it restores his internal equilibrium in some way. Nice one, Jake.
Before you become an alcoholic just yet, let me just say that substance abuse disturbs equilibrium in the body in other ways. It also doesn’t help you treat your life problem – in fact it represses it. So now we know that there are healthy and unhealthy ways to cope. Drinking your worries away isn’t the best strategy. (No shit kari)
Now imagine this girl. Her name is Jenny. Jenny wants to lose weight. She thinks the best way to do this is to embark on a 3 month-long cleanse where she eats & drinks nothing but diluted grapefruit juice and cayenne pepper. She probably believes in other crap like homeopathy but that’s besides the point. After about 2 months of starvation, her body compels her to binge eat everything in sight. Binge eating after a long period of strict dieting is the body’s attempt to restore energy equilibrium. However, if the binge eating becomes too intense, then the body will attempt to purge to restore balance again. This is why a lot of women & men that suffer from bulimia have a history of dietary restriction, binge eating, and purging behaviour, in that order exactly.
So sometimes if you are in pain, sit back and think about it. Think about if you have any needs that are unmet. Think about what unhealthy behaviours you are indulging in that might compel your body to act seemingly beyond your control. Maybe your body is trying to help you survive in the best way it can. It’s locked all the way down in the basement of your brain - the subcortex - and doesn’t have a full understanding of the problem, so maybe it’s a little flawed in the way it’s trying to help. But be grateful that it’s trying.
2. YOU ARE CONDITIONING YOURSELF TO BE DEPRESSED
One of the greatest scientific discoveries is that of the neuroplasticity of the brain. We now understand that the human brain is highly malleable. You can rewire your brain just by thinking and behaving differently on a habitual basis.
This was not always thought to be the case -- before the 1950s, the scientific dogma stated that the brain stopped growing or changing after the age of 25. New scientific studies show the contrary – neurogenesis (the proliferation of new neurons) can occur at any stage of life. You can still induce neurogenesis in elderly populations with curcumin and blueberry supplementation!
This means that personality is not innate, congenital, or fixed. A personality is simply a set of automatized thoughts and behaviours, conditioned over a series of days, months, or years. You can change your personality by programming different thoughts into your brain, and behaving differently, over and over again.
What does neuroplasticity look like at the neurological level? What is the mechanism of brain change?
There are three important processes: Neurogenesis, Synaptic Plasticity, and Myelination.
THREE FORMS OF NEUROPLASTICITY
Neurogenesis, as the name suggests, is the generation of new neurons. As I wrote earlier, we now know that new neurons can form in adult mammalian brains, contrary to the archaic idea that the brain stops growing after a certain age.
What does this mean? By manipulating your behaviour on a consistent basis, you may stimulate neuronal growth in two main areas of the brain: the dentate gyrus of the olfactory bulb and the hippocampus. The hippocampus is the seat of memory and emotion, so neurogenesis in this area leads to improved memory recall and learning aptitude in the individual. The last I read, neurogenesis in the dentate gyrus lead to a significant increase in prosocial attitudes. It made people more social and good-natured!
Here are some activities that induce hippocampal neurogenesis:
Exercise, especially endurance/stable-state cardio
Intermittent fasting (with an 8-10 hour eating window)
Curcumin supplements, the active component of turmeric
Omega 3 fatty acids, in the form of high quality fish oil and walnuts
Ingesting blueberries – studies show that this has a protective effect against neurodegenerative conditions such as dementia
Environmental and social enrichment – novel stimulation in one’s environment
In the past I’ve conducted lil “experiments” on myself where I would practise as many things as possible on the list above every day for 6+ weeks. In the future I would like to do this again, but take a reputable spatial awareness IQ test before and after to see if there are any raw score differences. Next time I would try for 6+ months since rewiring takes some time. I still do intermittent fasting and cold showers every day, just for fun.
Part of mental hygiene & staying away from the depression trap means engaging with as many of these neuro-protective behaviours as possible.
2. Synaptic Plasticity
The human brain is a complex network of neurons. Synapses are the junctions between connecting neurons, where electrical and chemical signals are transmitted.
The strength of a synaptic transmission between neurons is contingent on how often these neurons are fired together.
When we learn, certain connections between neurons (via the synapses) strengthen. When we stop learning, connections between neurons (via synapses) are pruned.
Thus, synaptic plasticity refers to how the brain is constantly forming new connections in neuronal networks by learning and unlearning different things. The brain is constantly changing. This is closely related with myelination, which, speak of the devil…
Myelination, in my opinion, is the most important and exciting part of neuroplasticity!
Have you ever heard of the brain being made up of grey matter and white matter?
Grey matter refers to neurons, dendrites, synapses in the brain, which have a grey-pink hue.
White matter refers to a substance in the brain called myelin. Myelin is a white fatty substance formed around the axons of neurons.
I drew a lil diagram so you can understand better:
See how a neuron is connected to another neuron via synapses? And see how each neuron has a long tail kind of thing going on? Those tails are called axons. Electrical signals travel down the axon to the next neuron. Axons are coated by sheaths of myelin, which speeds up the transmission of these electrical signals.
Myelination is the process of myelin formation. (This is also called myelinogenesis, and like the name suggests, refers to the generation of new myelin).
So how do you increase myelin growth? How can you make the transmission of nerve signals faster and stronger?
Every time a neuron is fired and the axon is activated, certain cells are triggered to add a new layer of myelin onto the axon. The more the neuronal pathway is activated >>> the more it becomes myelinated >>> the faster the signals are transmitted >>> which leads to the ease of the pathway being activated again. This becomes a positive feedback loop.
THIS IS HOW HABITS FORM.
Myelination is the neurological mechanism of habit formation.
We perform certain behaviours with great dexterity and ease because we have myelinated the correlated neuronal pathways. The more we practise something, the easier it gets.
There is no such thing as congenital, innate, or inherent talent. Everything is learned and conditioned via myelination.
Which leads me to my main point – just like talent and skill is myelination-driven habit, pathological, chronic negative thinking is also a myelination-driven habit.
Negative thoughts and sensations, in the avatar of depression and anxiety, can be quite a beneficial thing. They help the organism survive in tough times. But once the tough times pass, it is not healthy for negative thoughts to remain. The more you engage in such thinking, the greater you condition your brain to think negatively.
Let me give an example.
Say you experience some kind of trauma – you lose your job. Your body reacts accordingly – by causing depressive thoughts (this is your body telling you hey! Something is wrong here) and anxious sensations (this is your body telling you to do something to rectify the situation). These are your survival instincts kicking in.
Eventually you manage to find a job. The stressor is gone. But the stress remains. You still have a persistent negative mood. This is because you have conditioned your brain to be negative. Every time you validate that negative thought, that correlated neuron fires and myelinates the axons that improves the connection of learned depression.
Mental abnormality is stress in the absence of a stressor.
Now imagine the alternate situation. After months of gruelling interviewing, you find a job. The stressor is gone. But at times, you still feel depressed “for no reason” (the actual reason is that your neurons are used to being fired in a certain way). But you know this feeling is meaningless, so you dissociate it from it. You don’t subscribe any meaning to it at all. When you keep doing this, eventually it goes away.
Just as depression can be learned, so can happiness. I honestly believe in this. Happiness is totally a choice if you want to take it. The sure-fire way to do this is by practising gratitude utilising the reticulating activation system. That’s another blog post though
NEUROGENESIS INCREASES GREY MATTER.
MYELINOGENESIS INCREASES WHITE MATTER.
SYNAPTIC FORMATION DETERMINES THE STRENGTH OF COMMUNICATION IN NEURONAL NETWORKS.
>>> All these create changes in the brain.
YOU CAN INCITE THESE CHANGES, FOR BETTER OR WORSE. I don't know about you but for me this was an insane revelation.
WHY YOU ARE NOT YOUR DIAGNOSIS
One of the best ideas of French existentialist philosophy is the notion of “bad faith”. There are heaps of amazing ideas, but I love playing with this one the best.
Bad Faith, as proposed by the great philosopher Jean-Paul Sartre, is the self-deception of subsuming values into your life that aren’t your own. They could be other people’s values, societal values, or the values of a movement or tradition at large. By doing so, you severely limit your existential freedom. Bad faith is the act of compromising your autonomy and authenticity.
Good Faith, then, is to act according to your own intrinsic values.
I honestly believe that taking on a diagnosis of depression, anxiety (and most anything else in the holy bible of mental disease that is the DSM) is an act of Bad Faith. For sure, look at the construct and see how it can help you figure out what’s happening in your life, but please do not subsume a diagnosis into your identity. These are external values, not yours.
If you are puzzled over my concern over the DSM, please let me just say this: In 1952, the DSM listed homosexuality as a sociopathic personality disturbance. Psychological paradigms change all the time. Sometimes the dogma is wrong.
I strongly believe that most psychological afflictions can be treated by looking at the two causes (survival and conditioning), & promoting personal responsibility and agency.
At the beginning of the post, I posed a question about Indian and Ghanaian schizophrenics experiencing positive hallucinations. It is because our western psychological frameworks are largely secular and non-spiritual. Modern psychology is procrustean insofar as it dismisses anything unscientific as abnormal. The American Schizophrenic thinks, why the hell am I hearing voices, what is wrong with me? The Ghanaian Schizophrenic thinks, how am I so lucky to be able to hear the voice of God?
You might be thinking: "Pfft. I'd rather be unhappy and rational than happy and delusional."
I would say, how can you be certain that you aren't unhappy and delusional?
Your beliefs colour your identity, which in turn create the artwork of your reality.
This doesn’t mean that everyone should just abandon scientific disciplines and go back to freaken witchdoctors and magical incantations. It just means that maybe something very human is missing in the militant idealisation of science, especially the rigid scientific study of something as humanistic as the psychology of human behaviour.