By David Tuller, DrPH
Oonagh Cousins, a world-class rower who once dreamed of representing Great Britain in the Olympics, got sick early in the pandemic and has been suffering from Long Covid ever since. Her story was first covered by the BBC in November, 2020. A BBC article last year covered how her condition had “crushed her Olympic dream.” Earlier this year, a BBC investigation of the woo-woo intervention called the Lightning Process also featured Cousins, who had tried it and believed it was “exploiting people,” as she told the reporters. I wanted to hear a bit more about Cousins’ experiences as well as what she’s up to now. We spoke earlier this week.
My main concern is the risk of iatrogenic harm when doctors prescribe or recommend psychological therapies as treatment without knowing or explaining to patients the many harms – both direct and indirect – that could potentially arise from them. I don’t think psychological therapies should be considered as a risk-free or low-risk option but it seems to me that this is a widespread view amongst the medical community. If parity of esteem for mental health means anything, I think the potency of psychological therapies should be properly recognized and with that, (as with any medical treatment), their potential for harming as well as benefiting patients should be acknowledged. Doctors should be warned that such therapies could cause considerable iatrogenic harm if applied in the wrong situations.
In our everyday lives, there are countless ideas, services and products on offer to us for free or at cost and we all have to make our own judgements on the risks we’re prepared to take according to the information we’re given and what we seek out (whether that’s related to diet or exercise regimes, politics, religion, self-help advice or whatever). But when we, as vulnerable patients, access healthcare from registered medical practitioners, I think we should be able to rely on them to be knowledgeable about the iatrogenic harm that therapies could cause and to advise us on the risks attached to the investigations and treatments that they’re recommending …. and that should apply to mental health investigations, therapies and drug treatments as much as it does to physical health interventions. I see little evidence that it does. I’d say that it’s high time that the potential risks of psychological therapies were taken seriously.
So what might those risks be? Here are a few off the top of my head:
> direct risks – that the therapy plants ideas and thoughts that encourage or nudge the patient to take decisions and actions they otherwise wouldn’t take that could damage their health, relationships or other aspects of their lives (e.g. career) – i.e. a range of potential biopsychosocial harms
– that having psychological treatment could make key people in their lives less sympathetic/empathetic towards their predicament and less supportive towards them at a time when they may well need more rather than less support.
>indirect risks – that the patient suffers medical neglect and a deteriorating biopsychosocial situation due to time wasted through not getting the diagnosis and treatment that they need.
– that if the patient doesn’t improve through psychological therapy then the therapist/doctor may persist with the notion that that patient has psychological/psychiatric issues but that they now need a different approach and so recommend/dish out inappropriate drugs that have the potential to cause additional iatrogenic harm rather than admit that they delivered/prescribed the wrong treatment to them in the first place.
I suspect there are more.
I did the LP in 2010 for ME. We weren’t asked to sign anything binding and no pressure was put on us to push through our energy barriers, in fact the emphasis was on relaxation and positivity. The whole formula was pretty simple and based on NLP. It certainly wasn’t a cult! Although it was sold as a cure. It helped me a lot for about 4 months and then I gradually relapsed. But I still do the process sometimes when I need to have a (relatively) active day and can then feel better for 3 or so hours.
I agree in principle about toxic positivity and making the illness psychiatric. However, it did help me, and I don’t know why. It’s the only thing that ever has, but I still have ME at 80.