It’s weird to discover that developments in psychotherapy and an apparently unrelated field are connected. It makes me wonder what, or who, is behind it. Only for a moment, though. Actually, and sadly, we all know who is behind it.
This chilling article in the US political magazine American Spectator caught my eye: Doing Security the Israeli Way It describes how airport security in Israel manages to be much more sophisticated than airport security in the US (or here in the UK, for that matter). The secret is in the technology they use:
The heart of the Israeli strategy is the idea that the most sophisticated scanner in the world is an intelligent, alert human being and that the most important terrorist behavior database is the shared assumptions, memories and life learning we call “common sense.”
The author, Stephanie Gutmann, also writes in The Daily Telegraph, (mainly about Israel and climate change, it seems). She is scathing about the approach to airline security taken by the US Transportation Security Administration (TSA), and the UK is no better:
When Richard Reid climbed aboard a trans-Atlantic flight with a British passport issued in Belgium, no luggage, a one-way ticket and a bomb in his shoe, we made everybody take off their shoes. Now that Umar Farouk Abdulmutallab has gotten past security with no luggage, a one-way ticket and a bomb in his underpants, we’re going to check everybody’s underpants with body scanners. But no scanner ever invented can look into another person’s mind. Only when we start talking to passengers will be able to get into their heads.
An increasingly checklist-based approach threatens mental health services in the same way that it threatens airline security. The attraction to bureaucrats is clear. Highly skilled people are expensive and opinionated. It’s much cheaper and easier to employ unskilled personnel armed with checklists.
In this way, mental health services are gradually becoming de-skilled. There are now very senior clinicians who have never personally made a diagnosis or formulation. They have interpreted symptom lists and test scores, yes, but they have never developed clinical judgement.
As a consequence, increasing numbers of patients are floating around the system without any solidly-based diagnosis, and therefore without any solidly-based treatment. Hit-and-miss approaches to treatment eventually help some of these patients to recover, but hitting and missing can take years for conditions that could have been treated in months by skilled clinicians. The amount of money wasted over the course of these years is staggering.
Take the quiz
For particularly glaring examples of the checklist mentality, you only have to search the Internet for tests that pretend to diagnose personality disorders. Disclaimers on these sites almost always try to wriggle around the word ‘diagnose’, but the reality is that these quizzes invite you to attach a label to yourself based on your answers to the quiz. The notion that you can recognize a disease by its signs and symptoms is exactly the dictionary definition of ‘diagnose‘.
A personality disorder is essentially a disorder of interpersonal relationships. These disorders are usually pretty obvious to experienced professionals after only a few face-to-face meetings.
Online, though, it looks like you can simply tick boxes to find out whether you have a personality disorder. This is completely daft. When you are ticking boxes online you are not interacting with another person at all, not even with an unskilled one. An online test could never reliably detect a personality disorder.
For example, consider this question in the Personality Disorder Test at 4degrees (“an interactive community for teenagers and twenty-somethings”):
Do you have difficulty trusting people? ◯ Yes
If you have a personality disorder, you don’t know the answer, you only think you do. The term ‘personality disorder’ means that your own judgement of your interpersonal relationships doesn’t work properly. You might think it works, and you might answer the question confidently one way or the other, but if you really do have a personality disorder your answer might not represent reality.
(Hat-tip to Susie, who took this test and blogged about what the results might mean.)
Even though bureaucratic state-controlled systems seem to be increasingly mechanistic in their dealings with people, perhaps moving towards an ideal world where everyone is microchipped, GPS-tracked, and flowcharted through life, there are small signs of a backlash.
Perhaps in a generation the pendulum will swing the other way, as we gradually learn to choose a different kind of bureaucrats, those who understand that dealings with people require skilled people, and handling people as if we are things is pants.