Concerned About Unconventional Mental Health Interventions?

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

Friday, December 12, 2014

Mistaken Attachment Beliefs, Persuasion, and "Trojan Horses"

I’ve been trying to figure out a name for a persuasive technique. Here’s an example: at www.imt.ie/clinical/2014/12/attachment-disorder-children.html, the authors Arshad and FitzGerald provide a good deal of well-substantiated information about children’s emotional attachment to their parents. They describe different qualities of attachment and refer to stages of attachment as they occur in the course of early development.

But now the trouble begins. Forgetting or ignoring the fact that insecure attachment is perhaps not ideal, but is within the normal range rather than pathological, these authors make the following statements: “Reactive attachment disorder is a severe form of insecure attachment, with symptoms of emotional dysregulation, anger, guilt, impulsive [sic], disinhibition, aggression, hostility, reactive [sic], proactive [sic], impulsiveness, stealing, hypervigilance, aggressive, withdrawn, destructive, temper outbursts, demanding, clinging, sleep problems, enuresis, overfamiliarity with strangers, oppositional, fidgety, poor hygiene, learned helplessness, abnormal eating habits, lack of eye contact, can’t keep friends, blames others for mistakes, mistrustful, manipulative, lack of remorse, irritable, fussy, swears, diffuse boundaries, and jealousy.” Rather than being supported by systematic research evidence, or drawn from any of the DSM discussions of Reactive Attachment Disorder, this symptom list is characteristic of websites like www.reactiveattachmentdisordertreatment.com.

The same technique is evident at www.attachmentnetwork.com and at www.radzebra.org. The latter has separate pages, one with material from DSM-IV and the other with a list of “symptoms” that are certainly concerning (like “fascination with blood and gore”--  by the way, is gore different from blood?) but that are not associated with disorders of attachment. These notional symptoms seem to have been drawn from the non-evidence-based 1996 article by Keith Reber which I discussed recently on this blog.

In the pages and documents I just mentioned, we have several examples of a persuasive technique. Trying to persuade people is not in itself a problem--  that’s something I am doing here, and even a simple presentation of well-founded statements is an effort at persuasion. However, persuasive devices are problematic when the goal is to convince readers that claims are correct, when they are not. It does not really matter whether the persuader is a true believer, has financial goals that depend on persuasion, or sees persuasion as a path to glory. Getting people to think that something is true when it is not is never really the right thing to do. In “wars of propaganda”, like World War II there may be short-term goals of persuasion that can lead to improved long-term outcomes, but even that use of persuasive devices may be based only on a guess as to what a good outcome may be. (Jane Austen’s novel Persuasion gives a good example of the difficulties here).

But what is the particular persuasive device seen in the examples above? It mingles true and false statements, apparently setting up an appeal to the authority of the true statements in order to “spread” that authority to cover the false statements as well. As I have tried to find a name for this device, I’ve found nothing among lists of fallacies or errors of critical thinking that might lead to persuasion in this way. There is such a thing as the fallacy of composition, which is the mistake of assuming that something true of a part of a whole must also be true of the whole, but that doesn’t seem to be exactly what’s going on here. I have found references to the method under the rubric of “disinformation” or intentional spreading of confusion about facts and logic, but no specific label to describe this technique as opposed to other disinformative methods.

Can any reader provide me with a name for a method that mixes true and false claims with the purpose of gaining belief for the false ones? In the absence of any other name known to me, I’m going to call this a “Trojan horse” technique. Presenting the reader with some well-established information, the “Trojan horse” user suggests the verity of ill-founded statements that have the potential to harm those who accept them. That’s certainly what appears to be happening in the examples given earlier, where accepting mistaken beliefs about attachment can lead to mistaken--  in fact, dangerous--  choices about treatment of children.






16 comments:

  1. I'd call it "intelligent-design-like".

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    Also, I don't get what's so very wrong with kids liking stories of blood/gore... I was raised on the original (not watered down, Disney-fied) Grimm & Andersen fairy tales; spent most of grades 2\3 on a Stephen King reading kick, and; getting my parents to sneak me into "Pet Sematary" in 2nd grade is among my fondest memories of childhood.

    (It took a good week of begging - my parents eventually conceded that a kid who merrily read 300+ pages of gory novel was unlikely to be traumatized by seeing the movie adaptation).

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  2. Good name!

    As for the other,I honestly don't know what they mean by "fascinated" and I don't suppose they do either.

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  3. More lies about RAD:
    http://johnmsimmons.com/rad-manipulation-reactive-attachment-disorder/

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  4. Thanks so much, I hadn't seen this one. And the man is making a career of the whole thing!

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  5. Is there a drop of legitimacy in any "Conversion Therapy," like the one in part perhaps responsible for Leelah Alcorn's recent suicide?

    In any case, why don't we regulate therapies with the same scrutiny that we regulate pharmaceuticals for mental health treatment?

    Currently, we hope that the profession will regulate itself, which does not seem to be working.

    What can we do? Specifically, in this situation, to prevent more under-age transgender youth from being subjected to this atrocity named "therapy"?

    Please consider signing the petition at Change.org, as I did, and explaining why "Conversion Therapy" should be banned:
    "Children in distress should have access to professional *RESEARCH*-based therapies to help them with their depression and/or other mental health issues. Conversion Therapy is quackery at best. Torture under the name of "therapy" at worst. It should be banned, as should all other therapies applied to under-age children, until supported by research. We control substances that treat mental health through the FDA. Why shouldn't other treatments be effectively regulated?"

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    1. Hi Marianne-- nice to hear from you, even though it's about a topic we wish didn't need to be discussed!

      To begin with your first question, I do not believe that there is a single drop of legitimacy in Conversion Therapy. As far as I can see from reading Richard Cohen's book, C.T. is based on a variety of incorrect assumptions about sexual orientation and about attachment. Attraction to same-sex individuals is interpreted as resulting from poor attachment to one's same-sex parent, a situation that is claimed to cause longing for a same-sex emotional connection. This is of course not current scientific thinking about same-sex attraction, which is thought to be largely genetic in origin.

      In addition to making this mistake about same-sex attraction, Cohen fell for the idea that attachment could be caused to happen by reenactment of certain experiences which typically take place early in life-- especially the experience of being held, nurtured, but also restrained by an older person. This idea he got from and attributed to the American psychiatrist Martha Welch . However,there is no reason to think that when a person of any age is held by an older person, the younger one develops an attachment parallel to that usually seen in toddlers' attitudes toward familiar caregivers.

      So, C.T. proponents are mistaken both in their attribution of same-sex attraction to attachment issues and in their belief that a ritual causes attachment to occur. C.T.is not only without an evidence basis but implausible in its lack of congruence with well-understood aspects of development. (Actually,all you have to do is to try to figure out where trans individuals fit into the C.T. theory, to see th lack of logic.)

      Why don't we regulate psychotherapies? I agree strongly that we should do so, but I see many reasons why this has not happened. One is that the general population is divided between those who think that no psychotherapy accomplishes anything and those who believe that all therapies are beneficent. In addition, just as the medical profession has always resisted regulation from outsiders, mental health professionals of all disciplines have fought against any regulation more specific than requirements for licensure, and their national organizations have invested heavily in determining licensure requirements and board certification exams. APA, NASW, and similar groups play strong roles as supervisors of guilds; this is not to say that members are indifferent to the effects of treatments, but there is at least as strong a concern with whether a decision is "good for psychology" or "good for social work". These professional groups also have cultures that deplore any kind of public criticism of anyone in the field.

      I testified at the New Jersey assembly discussion of prohibition of C.T., and I was one of only two people who tried to bring up the absence of an evidence basis for the method. Most witnesses either spoke movingly of their own suffering when their families did not accept their orientation, or on the other hand argued that C.T.prohibition interfered with religious rights.

      In my opinion, the N.J. law was passed because the LGBT witnesses were very well organized and politically savvy. The evidence for or against C.T. was not a salient topic,it seemed. Because of that, I believe that the political power of LGBT groups and individuals is what must be brought to bear on C.T. in order to prohibit by law the use of the method on minors. BUT-- I must point out that the laws as they exist only forbid C.T. by mental health professionals. Members of the clergy may continue the practice, although they may be prosecuted if they harm someone directly-- driving them to suicide probably will not count. How to deal with the activity of clergypersons is a much more difficult matter.

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    2. Unfortunately, I think the Change.org petition's wording opens some difficult cans of worms. I understand that the authors wanted to make the petition's appeal as broad as possible by referring to unsupported treatments other than C.T. as well as to C.T. However, by failing to define what is meant by being "supported by research", the petition seems to ask for prohibition of treatments that are still in an experimental stage and ignores the real difficulty of establishing evidence for treatments of unusual problems. The petition also fails to recognize that most psychotherapies for childhood mental health issues need to be directed in part or whole toward the adult caregivers of the children with concerning behaviors. This is a complicated situation and quite a bit different from FDA regulation of pharmaceuticals that are given to the person who seems to need the treatment.

      I absolutely agree with the goals of the petition, but I don't think it will be easy to reach them. Although state organizations supported passage of the anti-C.T. laws, I would be very surprised if any of the national mental health-related organizations supported the petition's position, and I honestly believe that it will be the LGBT community that succeeds in making the needed legal changes. As for stopping members of the clergy from doing C.T.-- I have no idea how to address this-- do you?

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    3. Thanks, as always, for your work and your insights. Jean.

      No, I have not considered the role of clergy in doing "therapy." Eeks -- that's a huge loophole, isn't it, in trying to ban conversion therapies?

      I suppose it would be too much to ask for clergy to follow professional therapists' lead? If they ever got there and renounced (or regulated out of existence) Conversion Therapy themselves, that is.

      By the way, the comments about the petition were mine, not the organizer's. Sorry I didn't make that clear. The call for redress in the petition is very straightforward (and didn't get tied up by the complexities of research and evidence bases, as I did).

      So far, about 250,000 people have signed the petition, which I hope is only a small percentage of folks who support people who choose to live out their lives in the gender they feel themselves to be, even if it's not the one they were born into (or born into thoroughly, in the case of intersex people).

      The petition can be found at: https://www.change.org/p/president-of-the-united-states-enact-leelah-s-law-to-ban-transgender-conversion-therapy

      Here's the text that accompanies the petition:
      On Sunday, December 27, 2014, Leelah Alcorn a 17 year old transgender youth wrote a suicide note, posted it on Tumblr and then walked out to a highway and out in front of a semi-truck tragically ending her life. In her last post, Leelah explained how her parents had forced her to attend conversion therapy, pulled her out of school and isolated her in an attempt to change her gender identity. One of the last things Leelah wrote is as follows:

      "My death needs to be counted in the number of transgender people who commit suicide this year. I want someone to look at that number and say “that’s fucked up” and fix it. Fix society. Please.“ -Leelah Alcorn

      In the pursuit of honoring Leelah's last request we the petitioners call upon the President of the United State- Barack Obama, and the Leadership of the House and Senate to immediately seek a pathway for banning the practice known as 'transgender conversion therapy'. We ask that you name the bill in memory of Leelah as the Leelah's Alcorn Law and protect the lives of transgender youth.

      'Conversion therapies' have been documented to cause great harms and in this case, Leelah's death. Therapists that engage in the attempt to brainwash or reverse any child's gender identity are seriously unethical and legislation is needed to end such practices immediately. Transgender youth have one of the highest suicide rates in the nation. We must not allow therapists to increase those rates with therapy methodologies that have been demonstrated in harming transgender youth.

      All major psychological associations speak to the heart of harms that can happen to transgender youth when attempting to discriminate and change their gender identity. ...

      [continued at Change.org]

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    4. Oh dear,this is my fault for being too lazy to look back at the petition and just copying what you said, Marianne! Thanks for the correction.

      The clergy issue is really difficult. What I would like to see, to begin with,is legislation that would prohibit anyone from doing physical-contact treatment unless they were trained in an area like physical therapy. That could apply to clergy,social workers, etc. Of course, even without the physical aspects of CT, there is still the whole issue of hassling and tormenting someone to make an impossible change-- a change equivalent to demanding that a "straight" person be attracted to the same sex!

      In the NJ discussion of legislation, I was interested to see that the clergy present were not satisfied with the idea that they could continue doing CT, but wanted psychologists also to be allowed to do it "for severe problems".

      Of course, only a small proportion of clergypersons want to do CT or even countenance it. This creates the problem for legislation of appearing to attack specific belief systems. In my opinion we are looking at a culture war equivalent to the one about creationism but with more immediate and obvious harm done by one side. I am at a loss as to how to fight this and still maintain a tolerant and multicultural society-- there's a sort of parallel here to the statement about how "they came for the Jews, but I wasn't a Jew so I didn't say anything." How do we tolerate intolerance at some acceptable level? Any ideas?

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    5. I edited the other post to reflect what Change.org said and what you said.

      It will be interesting to see whether APA will sign onto the proposal for legislation. Their task force already rejected CT, but it's so unusual to ask for a federal law about this kind of thing that I would think it would be kicked back to state legislatures and state psychological associations.

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  6. The self-proclaimed trauma mamas to supposed RAD/FASD kids are seriously, seriously making stuff up:

    http://monkeypajamas.net/2015/01/05/navigating-the-minefield/

    This adoptive mommy blogger is, like so many others, convinced that her adopted, mentally ill (with RAD), plus a borderline IQ (mild intellectual disability) & FASD (memory & executive function issues) somehow lacks the ability to connect cause with effect yet is able to manipulate adults (many of whom have degrees/graduate degrees and plenty of experience working with kids, e.g. therapists, principals, special ed teachers, clergy, etc).

    Which makes no sense. Because to manipulate a grownup (particularly, say, a principal who is used accustomed to the usual kid shenanigans) requires a VERY sophisticated understanding of cause and effect!


    "Save the other families who live in this world, we are alone. Many of our kids are master manipulators and we deal with an ever shrinking circle as those within it buy into the performance and become convinced that we are either lying or crazy. The concept of mental illness in children is so disturbing that we’d rather call it anything else and blame the caregiver. I rarely talk about any of this to anyone but her therapist because I really can’t handle the empty future projections or judgement.

    My daughter’s personality is so fractured that she can become a completely different person with a change in audience. She is the master of doe-eyed feigned helplessness in the presence of other adults, a controlling bully with her peers, and wildly extroverted and sassy with older kids/young adults. A favorite behavior of hers is to follow me around at a gathering making repeated requests for me to get her food. After the fourth or fifth time when I tell her “no more” she’ll wait for an audience and ask again so she can appear to be the victim of the heartless mother who won’t feed her.

    This was especially delightful when at a recent gathering round the fire, she stood to make sure she had everyone’s attention and said in her best polite innocent voice, “Mommy, may I have a kiss?” She was talking about a Hershey’s chocolate kiss and had already been told “no more” after several servings, but the shocked response was palpable when I told her to sit down. I gotta admit, it was a pretty clever tactic and we all had a chuckle when I explained. Later, at the same event, I had to physically move her after she nestled up next to an adult male friend."

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    1. Of course, the rest of us don't act different when with different people... do we? Ouch, I must have fractured my personality.

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  7. And yet more posts about non-existent attachment disorders from otherwise sane & educated adopters!
    http://emergingmama.com/attachment-disorder-spectrum/
    http://letunfold.com/2015/01/17/is-attachment-disorder-real/

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  8. Oh man... this is so discouraging. You're right, these people are in a general sense educated, but apparently only to the point where they can look things up on the Internet and swallow them whole. Is this what people are calling neoliberalism in parenting?

    "A little learning is a dangerous thing; Drink deep, or taste not the Pierian spring. These shallow drafts intoxicate the brain, and drinking largely sobers us again."

    Time for these folks to sober up!

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    1. Sadly, yes.

      The Let Unfold blogger brags about having spent $60k (!!) in 2014 to "successfully" treat her daughter's non-existent attachment disorder.

      Scary!

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    2. It would be interesting to know who "earned" all that money.

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