Dubious Claims in Psychotherapy for Youth, Part II: Internalizing Issues

Stephen Hupp, Amy Tuteur, Britt M. Hermes, Caleb W. Lack, Carol E. Colaninno, Michael Marshall, Stuart Vyse

This is the second installment of a three-part series that shares the sidebars from the book Pseudoscience in Child and Adolescent Psychotherapy (edited by Stephen Hupp, Cambridge University Press, 2019). Contributors for this installment include a former naturopathic doctor, a clinical psychologist, an anthropologist, a behavioral scientist, an obstetrician gynecologist, and an investigator and conference organizer. Topics covered include symptoms related to psychosis, the bipolar spectrum, depression, phobias, obsessive compulsive disorder, and attachment.

 


Mania: Does Naturopathic Medicine Help Treat Bipolar Disorder?

Britt M. Hermes

Naturopathic doctors (NDs) are complementary and alternative medicine (CAM) practitioners who claim they are trained similarly to physicians. It’s critical to understand the education and philosophy behind naturopathy, as patients of any kind are likely to encounter NDs.

NDs believe the body has a mystical energy force called the vis that can be harnessed to heal through magical options. NDs passionately advertise that their therapies work, but no naturopathic treatment has been clinically proven to be safe and effective for bipolar disorder or any other condition. NDs attend four-year programs in which students take abbreviated versions of medical courses and study a plethora of CAM practices that include homeopathy, acupuncture, high-dose vitamins, and “functional medicine,” the pseudoscientific use of excessive laboratory tests to prescribe supplements. The ND curriculum relies on the trappings of science and is accredited by a naturopathic council.

NDs can become licensed to practice in twenty U.S. states and Washington, D.C., and are regulated by naturopathic boards. NDs have lobbied aggressively for these markers of legitimacy and have been successful by exploiting the public’s scientific illiteracy and proclivity for natural solutions. Lay naturopaths, on the other hand, do not attend accredited programs and are not regulated. The two professions, however, share the same health philosophy and use the same methods. Because NDs attach “doctor” to their name, patients perceive them as medically competent practitioners capable of diagnosing and treating disease. This misperception makes NDs uniquely dangerous (for more information see Hermes 2015a; Hermes 2015b).

 

Depression: Is Psychoanalytic Dream Interpretation Useful?

Caleb W. Lack

People have attempted to make sense of dreams for the entirety of recorded history, from the Sumerian Epic of Gilgamesh to Freud’s Die Traumdeutung. But is there anything to dream analysis? Most modern dream analysis flows from the psychoanalytic ideas of Freud, which posit that the content of dreams, if properly understood, can allow us to understand the true roots of our mental health problems. This insight would then lead us to become more mentally healthy. In particular, Freud believed that dreams were wish fulfillments and that what happened in them was the true expression of (often repressed) desires. However, modern research has poked huge holes in Freud’s assumptions and the overall idea of the usefulness of dream interpretation.

First, most of our dreams don’t have hidden, secret meanings but instead are about our daily lives. While there are certainly oddities that occur in REM dreams in particular, even those can often be traced back to what you were talking about, seeing, reading, or playing on a given day. Second, most emotionally charged dreams are negative rather than being positive or enjoyable. For instance, less than 10 percent of our dreams involve sexual activity, which Freud considered the most common type of desire that would manifest in dreams. Third, given well-understood problems with human memory and recall, it’s quite likely that most of the dreams we can remember bear only a passing resemblance to the actual dream we experienced. How accurate could an interpretation of such even be?

Finally, and of the most relevance to most readers here, there is no evidence at all that understanding or interpreting dreams has a positive impact on one’s mental health. Assessing sleep length and quality is crucial for the child clinician, but dwelling on dream content or searching for hidden meanings only wastes everyone’s time. For an in depth critique, see Domhoff 2000. 

 

Anxiety: Should Children Be Afraid of Bigfoot?

Carol E. Colaninno

Throughout history, children have feared many types of monsters, often thought to be hiding under the bed, in the deep, dark forest, or in murky, muddy waters. The fear of monsters can have profound impacts on children and even adults. One “monster” receiving recent publicity and causing both children and their parents to fear the forest is Bigfoot. The pursuit of documenting the existence of this hairy, human-like giant with big feet is the subject of headlines, blogs, and even television series and documentaries. But does the scientific community have evidence for children to be wary? The short answer is: well, not really. There is little empirical evidence to support claims that Bigfoot exists. The evidence we do have suggests our imaginations have morphed creatures of the past and present into a harmless, mythical monster.

In the very recent past before human civilization, creatures that resembled Bigfoot existed. Known as Gigantopithecus, this now-extinct genus of apes, most closely related to present-day orangutans, is estimated to have stood nine feet tall and weighed over 1,000 pounds (Ciochon 1991). This giant primate roamed the forests of present-day China, India, and Vietnam. Gigantopithecus did coexist with our human-like ancestors, Homo erectus (Ciochon et al. 1996), but even then, our ancestors had little reason to fear them. Scientists studying the fossilized teeth of Gigantopithecus have concluded that members of this genus ate fibrous vegetation, mostly bamboo with some seeds and fruit (Ciochon 1991), not children! It is also safe to say that Gigantopithecus went extinct during the last ice age (Pleistocene) when many very large mammals suffered mass extinction due to global climate change.

So, millions and thousands of years ago, there was an animal that was Bigfoot-like, but there is no evidence that any similar creature roams the earth today. Under the framework of the scientific method, we are able to disprove those explanations not consistent with evidence. As great as this method is, we cannot disprove the existence of something we have no evidence for, in this case, Bigfoot. We can merely say that there is no evidence to support its existence. Although many have used this limitation of the scientific method to profit off the search for this mythical monster, the scientific community can safely say there is no evidence to support fears of Bigfoot.

Obsessions and Compulsions: Do Superstitious Rituals Help Cope with Anxiety?

Stuart Vyse

If you were a school-aged child in England of the 1930s and you saw an ambulance go by, you would likely grab your collar and quickly recite:

Touch your collar, Touch your toes.
Never go in one of those.
Touch your knee, Touch your chin
Never let the burglar in.

The rhyme might vary depending upon your area of the country, and in some cases the ritual required that you maintain a grip on your collar until you had seen a dog or another four-legged animal (Opie and Opie 1959). In England during that era, children spent more time outside than they do today, and there were lucky or unlucky omens associated with seeing nuns, trains, oil patches, people with wooden legs, and a variety of animals, including white horses, crows, ladybirds, and magpies.

Many typically developing children show magical beliefs and rituals beginning at approximately the age of two and continuing throughout childhood (Evans et al. 2002). Often these rituals center around common early fears, and although they appear similar in shape to the compulsive rituals of Obsessive Compulsive Disorder (OCD), there is little understanding of the relationship, if any, between typical childhood rituals and the more pathological patterns of behavior shown in OCD (Evans et al. 1997). Indeed, early superstitious rituals are considered adaptive responses to anxiety, in contrast to the nonfunctional compulsions of OCD. Furthermore, many adults employ rituals to manage the stress of loss and to prepare for important performances (e.g., in sports and the theater), and there is now growing evidence that rituals can help adults manage anxiety, which in turn can improve performance at a skilled activity (e.g., a timed math test; Brooks et al. 2016). Rituals are not magical incantations, but, in both children and adults, performing a ritual can have psychological benefits. However, it’s important to note that the ritual can be helpful even without any attached superstition (for a more detailed discussion, see Vyse 2018). 

 

Trauma and Attachment: Does Attachment Parenting Promote Attachment?

Amy Tuteur

Attachment parenting is the dominant parenting ideology of early twenty-first-century America, yet it has no basis in science. It contains the word attachment, yet its fundamental principle is at odds with attachment theory. It claims to recapitulate successful parenting in prehistory, yet prehistory was populated by multiple different parenting cultures that changed over many centuries. Simply put, it’s a philosophical viewpoint masquerading as science.

Attachment parenting was created from whole cloth by William and Martha Sears, a pediatrician and nurse, respectively. The fundamental principle of attachment parenting, never clearly articulated, is that mother-infant attachment is problematic and uncertain, contingent on specific mothering behaviors, including unmedicated childbirth, extended breastfeeding, and, above all, continuous physical proximity between mother and child (Sears and Sears 1997). This is precisely opposite of the insights of John Bowlby (Bretherton 1992), H.F. Harlow (1958), and other founders of attachment theory. They discovered that attachment occurs spontaneously between caregivers and babies so long as the caregivers can be depended upon to reliably respond to the infants’ most important physical and emotional needs. While attachment theory tells us that children only need a “good enough” mother (Winnicott 1971), attachment parenting insists that children need a perfectly giving, always available mother.

Attachment parenting reflects a longing for the past—but it’s a past that never existed.

 

Psychosis: Is Homeopathy Effective for Schizophrenia?

Michael Marshall

Homeopathy is promoted for all manner of ailments, including physical conditions ranging from hay fever to cancer. Its promotion for psychological issues is equally broad-ranging—with homeopaths promoting their treatment for most mental health issues, including schizophrenia (Fountainhead Clinic N.d.).

The breadth of therapeutic indications claimed by homeopaths runs contrary to the strength of its evidence base. While it is hard to find a single condition not treated by one homeopath or another, it’s equally hard to find any credible and replicable evidence that the treatment is effective. In fact, based on a review of the research, the National Health and Medical Research Council (NHMRC) in Australia concluded that “there are no health conditions for which there is reliable evidence that homeopathy is effective” (NHMRC 2015, 1).

The reason for this inefficacy lies in a central tenet of homeopathy, “The Law of Infinitesimals.” Homeopathy is based on the misguided principle that liquid or powdered solutions get stronger the more they are diluted, with the strongest remedies diluted far past the point where any trace of the original active ingredient can still be found, even with the most accurate measuring equipment. As such, most homeopathic remedies contain nothing but water (see The 10:23 Campaign N.d.) and the sugar that makes up the blank pill. It is therefore no surprise when a chemically inert pill fails to be effective for any condition.

 


Note

1. The authors are listed in the order that their work appears in the book. Authors were only involved in their own sidebar and were not involved in writing or editing the other sidebars.


References

  • Bretherton, I. 1992. The origins of attachment theory: John Bowlby and Mary Ainsworth. Developmental Psychology 28(5): 759–775.
  • Brooks, A.W., J. Schroeder, J.L. Risen, et al. 2016. Don’t stop believing: Rituals improve performance by decreasing anxiety. Organizational Behavior and Human Decision Processes 137: 71–85.
  • Ciochon, R.L. 1991. The ape that was. Natural History 100(11): 54.
  • Ciochon, R., V.T. Long, R. Larick, et al. 1996. Dated co-occurrence of Homo erectus and Gigantopithecus from Tham Khuyen care, Vietnam. Proceedings of the National Academy of Sciences 93(7): 3016–3020.
  • Domhoff, G.W. 2000. Moving Dream Theory Beyond Freud and Jung. Paper presented to the symposium “Beyond Freud and Jung?,” Graduate Theological Union, Berkeley, CA, September 23.
  • Evans, D.W., M.E. Milanak, B. Medeiros, et al. 2002. Magical beliefs and rituals in young children. Child Psychiatry and Human Development 33(1): 43–58.
  • Evans, D.W., J.F. Leckman, E. Carter, et al. 1997. Ritual, habit, and perfectionism: The prevalence and development of compulsivelike behavior in normal young children. Child Development 68(1): 58–68.
  • Fountainhead Clinic. N.d. Naturopathic treatment of schizophrenia. Available online at http://fountainheadclinic.com/schizophrenia/.
  • Harlow, H. F. 1958. The nature of love. American Psychologist 13(12): 673–685.
  • Hermes, B. 2015a. ND Confession, Part I: Clinical training inside and out. Available online at https://sciencebasedmedicine.org/nd-confession-part-1-clinical-training-inside-and-out/.
  • ———. 2015b ND Confession, Part II: The accreditation of naturopathic “medical” education. Available online at https://sciencebasedmedicine.org/nd-confession-part-ii-the-accreditation-of-naturopathic-medical-education/.
  • National Health and Medical Research Council. 2015. Statement on homeopathy. Available online at https://www.nhmrc.gov.au/about-us/publications/homeopathy.
  • Opie, I., and P. Opie. 1959. The Language and Lore of School Children. Oxford: Oxford University Press.
  • Sears, W., and M. Sears. 1997. The Complete Book of Christian Parenting and Child Care: A Medical and Moral Guide to Raising Happy Healthy Children. Nashville: B& H Books.
  • The 10:23 Campaign. N.d. What is homeopathy? Available online at http://www.1023.org.uk/what-is-homeopathy.php.
  • Vyse, S. 2018. Do superstitious rituals work? Skeptical Inquirer 42(2): 32–34.
  • Winnicott, D.W. 1971. The Child, the Family and the Outside World. Harmondsworth: Penguin Books.

Stephen Hupp

Stephen Hupp, PhD, is a psychology professor at Southern Illinois University Edwardsville. He is editor of Pseudoscience in Child and Adolescent Psychotherapy (reviewed in our September/October 2019 issue) and coauthor of the books Great Myths of Child Development, Great Myths of Adolescence, and Thinking Critically about Child Development4th Edition. He also currently holds the Guinness World Record for the “longest line of books.” On Twitter he is @StephenHupp.

Amy Tuteur

Amy Tuteur, MD, is an obstetrician gynecologist. She is author of the book Push Back: Guilt in the Age of Natural Parenting (2016). She is @ATuteur on Twitter.

Britt M. Hermes

Britt M. Hermes is a writer, scientist, and a former naturopathic doctor. She practiced as a licensed naturopath in the United States for three years and then left the profession after realizing naturopathy is pseudoscience. Her work focuses on the deceptions naturopathic practitioners employ to scam patients and contrive legitimacy in political arenas. Hermes’s writings can be found at Forbes, Science 2.0, KevinMD, and Science-Based Medicine. She spoke on this topic at CSICon 2019. She hopes her stories will protect patients from the false beliefs and bogus treatments sold by alternative medicine practitioners.

Carol E. Colaninno

Carol E. Colaninno, PhD, is an anthropologist specializing in archeology and assistant research professor for the STEM Center at Southern Illinois University Edwardsville.

Stuart Vyse

Stuart Vyse is a psychologist and author of Believing in Magic: The Psychology of Superstition, which won the William James Book Award of the American Psychological Association. He is also author of Going Broke: Why American’s Can’t Hold on to Their Money. As an expert on irrational behavior, he is frequently quoted in the press and has made appearances on CNN International, the PBS NewsHour, and NPR’s Science Friday. He can be found on Twitter at @stuartvyse.