Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Thursday, July 12, 2012

If You See Something, Say Something, But Don't Expect to Be Thanked


Since 9/11, we’ve been cautioned repeatedly with respect to potentially criminal or terrorist acts: If you see something, say something. And very wise this is, because there are many more eyes of ordinary citizens to see problems than there are of “authorities”.

More recently, I’ve seen that catch-phrase used with respect to the Sandusky child molestation case. According to trial testimony, Sandusky was seen molesting boys, but the people who saw him didn’t mention it, or spoke only to others who in turn failed to report the facts to anyone who might have intervened. Now various sports journalists are trying to encourage those who see evidence of child abuse to take their observations to someone in a position to enforce the law.

This is all good advice, but it fails to take into account the retaliation of those whose plans are disturbed by a report of “something seen”. (And of course some of those people may be completely innocent of any wrongdoing.) While that retaliation may not go as far as the anti-snitch culture in which you can get shot for reporting, nevertheless it is severe enough that even whistleblower-protection laws are not perfectly effective.

“If you see something” is also at odds with the cultures of mental health and social services professionals, as I mentioned at http://childmyths.blogspot.com/2012/06/mental-health-mantras-versus-evidence.html. Most of those professionals would not dream of failing to report child abuse (although as the Barahona case showed, being friendly with parents may make caseworkers too comfortable with missed observations and appointments), but they are most reluctant to offer criticisms of other professionals’ work or belief systems. It’s not nice, especially if the criticism is offered in a public way. Ethics guidelines for both psychologists and social workers recommend that any concern about a colleague should be taken privately to that person and worked out, with complaints to a state organization or licensing board reserved for desperate problems. My own experience, in reporting a mental health professional whose online advertising was not truthful and who had attempted to self-plagiarize in a professional publication, was that the problems were said not to meet the threshold for an ethics complaint--  even though the lack of truth in advertising was misleading to clients. One blog, at www.goodtherapy.org, contains repeated complaints of therapy clients whose therapists have failed to provide appropriate services and who have been turned away when they filed complaints. (For full disclosure, by the way, this blog kicked me off several years ago when I criticized the claims of a therapist who was at that time a major player on the blog!)

A recent case of retaliation against a professional critic is told at http://jamescoynequickthoughts.posterous.com. Jim Coyne, a clinical psychologist and professor in the University of Pennsylvania Department of Psychiatry, wrote a post for his Psychology Today blog that questioned the research of pharmaceutical companies on antidepressants used to make cancer patients feel more comfortable psychologically during treatment. In short order, he found that his post and his picture were taken down by Psychology Today and his post was replaced with a new title. He was also told that in future his posts would need preapproval. This experience with Psychology Today echoes my own story at http://childmyths.blogspot.com/2010/12/federici-v-mercer-story-behind-lawsuit.html. Interestingly, in both cases, the criticism had not been directed against Psychology Today itself, but the retaliation was by the magazine, presumably in preemptive strike against litigation or removal of advertising. The intention, wherever it was framed, was clearly to have a chilling effect on professional criticism and to uphold marketing strategies.

In an article published some years ago (Kennedy, Mercer, Mohr, & Huffine [2002]. Snake oil, ethics, and the First Amendment: What’s a profession to do? American Journal of Orthopsychiatry, 72, 5-15), some colleagues and I argued that professional ethics, as well as personal ones, should require us to say something if we see something. In the personal arena, we would be concerned with  individuals or small groups harming others. In the professional area, our obligation should be to speak up when we see what we consider to be systematic professional errors; this does not mean jumping on every colleague who makes a mistake, but it does mean responding to genuine misrepresentation or clearly misguided treatment strategies.

Between the pressures of the marketplace and the cultural demands of mental health and social services professions, few of those who see something now feel ready to say something. This means that much that needs saying is going unsaid—in the professional world as well as in reporting of child abuse.  Isn’t it time that we stood up against the anti-snitch culture? If enough of us do it, we may be able to create a culture of responsible criticism.

I’ll say “thank you” to anyone who stands up--   but at this point very few other people will, unless our criticisms speak to their personal conditions.  



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