Normal healthy men of the world - you still need to be enhanced

These machines are all over the place. It's a fair assumption that every man in the UK will see a machine, selling a product like this, at some point (when they have to pee).

What I find especially disappointing about this example is that young men in particular are being given the messages:

Sex is about "performance"
You need to be "enhanced"

.... again, the inference is that normality just won't do. What you bring to your sexual encounters, i.e. "you", with the body you have, the sexuality you have developed, as an individual who can be good enough for a partner, is NOT good enough.

.... see also Menhancer and Sorry, Bernie

Nick Clegg's "boost" to mental heath services

I've come out of my blogging hibernation, to have a rant about deputy PM Nick Clegg's cash-injection into mental health services.
 
Clegg is promising that people with mental health issues will be seen more quickly. There will be a target waiting time of 18 weeks, he says, promising an extra £120 million of government funding.

The first thing that strikes me is that there is no mention of standards - no suggestion that the £120m will be spent on good quality psychotherapy. My guess is that much of the cash may be pumped into the already heavily-criticised IAPT programme. This thought saddens me deeply. I don't share the enthusiasm of (for instance) ReThink, who said “This is a watershed moment for everyone affected by mental illness and has the potential to improve the lives of millions.”. (... aren't ReThink one of the organizations who would stand to earn a chunk of the £120m??)

As other commentators such as Andrew Samuels have intimated, I think the £120m will largely be spent on expensive training for poorly-qualified practitioners, who will then deliver manualized psuedo-therapy.

One more thought... perhaps readers will remember what happened when Accident and Emergency waiting targets were introduced in the UK.  All kinds of amazingly creative tactics have been used to keep the figures down. In my town of Colchester, people are still waiting for hours in an ambulance outside the hospital - such is the need to massage the figures.
How can we expect anything different to happen in mental health services? I await with dread the horror stories to come, of patients who have been sidelined in ever-more demeaning ways, and their suffering made worse.

We need to do better.

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Normal, Healthy Men of the World: Your Penises Still Aren't Good Enough

.... see also "Two Steps Forward, One Step Back"

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The Sale of Certainty

This morning I heard health expert Dame Prof Sally Davis, on BBC radio 4, talking about the health of UK children. (It seems that cases of rickets are on the rise. She suggested the introduction of vitamin supplements for all kids).
During the interview (which you can listen to here, at approx 2h 39min), she was also called upon to comment on mental health issues in family life, and their treatment.
How disappointing it was to hear the same old line trotting out once again, like a soundbite, or one of those management-speak buzzwords that seems to be infectious in the meeting-room spreading from one employee to another. It goes something like this:
 (a lot of mental health problems) "will respond to.... Cognitive Behavioural Therapy... talking therapies..... "

The words used here are telling. They show a lack of understanding about the therapy world; its different modalities, and their potential use in the wide range of mental health issues. The words also show a willingness to endorse, publicly, a particular form of treatment.

I have previously drawn attention to this advertising of the CBT 'brand' here.

Dame Sally makes it very clear to us exactly why she wears this logo on her T-shirt. She says "I believe that we should only offer treatments that are evidence-based."
What she's saying, then, is that she only values treatments (and that includes therapies) which offer a statistical probability of "success" based on "outcome measures", and perhaps therapies which lend themselves to a widely-accessible "treatment protocol".
(For a deliciously sarcastic take on this kind of approach, see my friend Jason Mihalko's blog here).

Dame Sally is, of course, coming from her own training and heritage. She is steeped in the politics of medicine; a world of ever-increasing tension between public treatment needs and public costs. She values 'evidence-based' therapies, because, perhaps rightly, it would be hard to advocate the spending of public cash on therapies that aren't shown to be 'cost-effective'. The taxpayer deserves value for money, of course.

Evidence-based treatments are useful because, in the medical world, they offer the best assurance that a certain drug/intervention will work. The science tells us that in (n) cases, (x) show a measurable improvement compared to a control group who haven't been given this intervention. Therefore, the chances of your symptoms improving with this treatment are predictable to a certain level of probability.
Evidence-based treatments are also seductive, because they offer us a sense of safety and hope for a particular outcome that we are invested in.
We invest psychologically as patients, because we all want our symptoms to improve.
We also - as Dame Sally illustrates - invest financially. This, on a political level, has huge consequences, because government will clearly be much happier to offer therapy that offers clear, predictable outcomes.

Easy, then, to be fooled into thinking that therapies offering statistically-supported outcomes are the 'best'.
Sure, if you have the type of problem that fits neatly into the standardized diagnostic boxes that NICE and the APA prefer. But the problems of our life and our world are, to my mind, mostly in a different category than this.

How many times, for instance, have you lost a night's sleep because of a meeting, interview, or other event the next day that you are uncertain about?
We have all become stressed and irritable, maybe felt depressed, because of an ongoing issue in life that we can't control or predict.
Maybe you have thought about making a major decision in your life but have been held back for some time, because of the fear of the unknown. "If I knew I could get more work over there, I'd leave this job for good. But how do I know...?"

If only there were an assured, statistically-supported outcome, that you could be certain of....!

I don't believe I'm in the business of offering people assured or certain outcomes. Because in lots of ways, I don't believe there are many to be found. However, the selling of empirically-supported therapy is popular because it fits with an economic and medicalized model of human suffering. The natural human needs for self-exploration, mutual discovery and understanding, and psycho-spiritual development, are not necessarily part of the 'treatment plan'.....

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