There are hints of autumn in the weather now, but still some warm and sunny spells. It’s nice to sit in the sunshine, to take your shoes and socks off and wiggle your toes.
Phew! Those socks are a bit smelly. I fling them as far away as possible, which turns out not to be very far. I never liked those socks. They’re a nasty not-quite-grey yet not-quite-green colour. That’s what I get for buying a value pack of five pairs — there’s always one pair that’s a horrible colour.
One of them lands on the grass, and the other several feet away from it on the driveway. The funny thing is, the one that’s landed on the grass looks OK:
While the one that’s landed on the asphalt driveway looks much worse, even though it’s exactly the same colour in reality. Is there something wrong with my eyes, with my brain perhaps?
“Aha!” the psychologists amongst you will be muttering. That’s completely normal.
Our perception does not measure absolute qualities like colour. It measures by comparison with the background. Change the background, and the perceived colour of the sock changes.
Tea and peas
That’s not the only strange thing that has happened to me recently. I made a mug of tea, but I hadn’t drunk it. Then I remembered that I wanted to get some peas out of the freezer.
Well, the freezer is completely full as it has been such a good year for fruit. It took me ages to sort it out and find the peas. I thought my mug of tea would have gone cold meanwhile.
But when I lifted the mug, it seemed hotter than when I left it! How can that happen?
“Aha!” the psychologists amongst you will be muttering once again. That’s completely normal too.
Our perception does not measure absolute temperature either. It measures the temperature of anything you hold in your hand by comparing it with skin temperature. If you put your hands in the freezer for a while, anything you touch seems hotter by comparison.
Now I’m reading some about some research project, a randomized controlled trial in which patients who had some treatment or other showed significant improvement compared to ‘treatment as usual’.
The thing is, I just don’t believe in the treatment. It doesn’t make sense to me from a therapist’s point of view. Is it just that I’m a grumpy old fart who doesn’t like new treatments? Does the fact that it was a randomized controlled trial mean that I have to accept the results as valid?
Aha! Aha! Aha!
“Aha!” the psychologists amongst you will be muttering yet again. The research study used a standard questionnaire to assess whether the patients had improved. It measured the patients’ own perception of how severe their illness was.
But perception measures things by comparison with the background. The background for the treated group was that they attended treatment sessions twice a week. The background for the control group was that they just carried on trying to lead their normal lives — ‘treatment as usual’ in the NHS means no treatment at all.
So the treated group were exposed to an environment in which being ill was the norm. By comparison with that environment, their perceived symptoms would have seemed less severe. (Just like the background of green grass made the green in my sock seem less severe.)
It is to be expected that the treatment environment would change perceptions, whether or not the treatment itself actually did anything. So the outcome of the research study is meaningless.
A pervasive problem
Standard methods of assessment that rely on patients’ perceptions of their own condition are pervasive in mental health research. All these methods are invalidated by exposing patients to an environment where their illness is acceptable or commonplace.
Patients who attend group treatments are likely to be particularly badly affected, because the group creates a social environment in which there is a powerful message that it is ‘normal’ to be ill.
Worst affected are in-patients, because they are isolated from ordinary life. All their social encounters in corridors and common rooms reinforce the background, and they typically attend intensive group therapy too.
This smells as bad as old socks on a hot day. The people who design and carry out research like this are almost without exception people who have studied psychology. They know perfectly well that backgrounds change perception. They have sat through lectures on the subject and written essays about it.
For them to pass off research like this as valid smells of deliberate scientific fraud.
When you read about scientific studies of treatment methods, ask yourself whether the treatment group and the control group were exposed to exactly the same environment against which to form their perceptions of how ill they were, or whether the treatment group alone were deliberately exposed to an environment that would change their perceptions of their symptoms.
When you read about long-term follow-up studies, ask yourself whether the participants were deliberately re-exposed to a clinical environment in order to level-set their perceptions again.
Hat-tip to Lola Snow for her chilling description of a follow-up study that seems to be doing exactly that: Shattered