CBT doesn't really work much and science in mental health

Lynch, D, 2010, Cognitive behavioural therapy for major psychiatricdisorder: does it really work? A meta-analytical review of well-controlled trials, Psychological Medicine
http://journals.cambridge.org/download.php?file=/PSM/PSM40_01/S003329170900590Xa.pdf&code=b62ffa4b898268608a9e7b504bdd5319

Cognitive behavioural therapy - changing the way people think and behave by using talking techniques from therapists - doesn't really work according to this high quality review.The review uses a different inclusion criteria to the 'mega-analysis' which is often used to show that CBT really does work.
Butler, A. et al. 2006, The empirical status of cognitive-behavioral therapy: A review of meta-analyses, Clinical Psychology Review
http://www.sciencedirect.com/science/article/pii/S0272735805001005

So which one is true? The massive review (the 2006 one) which includes loads of papers but has a weaker inclusion criteria and, if I remember right, doesn't include a funnel plot or the smaller review of higher quality trials (the 2009 one at the top of the page)?

I'm afraid it's the one of controlled trials. At least based on the current paradigm of evidence based medicine. Blindness is so important.

The double blind randomised controlled trial gained success when it showed insulin shock or insulin coma therapy to be as effective as other treatments at the toime for...think it was schizophrenia. At the time
the insulin treatment was considered best practice around the world but the introduction of random assignment to the control or active treatment group showed that, in fact, it wasn't the best treatment.

Time and again it's the reviews that select the highest quality trials which show treatments thought to work suddenly don't. The recent noteable example is electro-convulsive therapy or ECT. This barbaric
treatment is what I hope is the last in the line of psychiatric treatments which induce seizures. The history of inducing seizures to treat mental disorder can be traced back to the work of Hippocrates who
notices paitents who had malaria seizures also had behavioural changes. The recent Bentall and Read review on ECT picked high quality trials with long term follow. This treatment of last resort was shown to be as
effective on follow up as sham ECT (where no electricity is used to shock a person into a seizure) and slightly more effective during treatment.
http://www.mindfreedom.org/kb/mental-health-abuse/electroshock/ect-review-2010-read-bentall.pdf/view
(Link to paper at the bottom of the page.)

Many, many people have died because of this treatment. Some people who've had it done are major advocates of the treatment. This presentation on TED is an example.
http://www.ted.com/talks/sherwin_nuland_on_electroshock_therapy.html

The speaker may have gotten the same benefit from sham ECT and less damage to his brain.

And so back to CBT. The controls in the trials are as effective as this new dogma of treatment for all but depression where the evidence for it's effect is small. The effect size is far below what got the Improve
Access to Psychological Therapies scheme approved.then factoring in publication bias...that demon of good
research....which is the effect of trials with negative results being hidden...well it knows off about a third of the effect size of CBT studies.
http://bjp.rcpsych.org/content/196/3/173.full

In a sense it's saddening that there's few effective cures for mental disorder. Perhaps it's all the hedonic treadmill.
http://en.wikipedia.org/wiki/Hedonic_treadmill

Or perhaps it's the operational cluster of symptoms approach doesn't provide a good way to assign treatment to diagnosis?

An anthem for those resilient to misery

Hard knock life by Jay-Z

http://www.youtube.com/watch?v=ekomM8aobQo

That's the thing about misery. After a while you just get used to it. It's just life.

I just don't want anyone else to have a hard knock life. Not like mine.

An emoticon for the mask

:'-)

Untreated depression seen through my self-harm scars

There's a really big scar from one of my self-harm attempts while I was going through hellish psychosis. It's a really big one that's described in an earlier blog post.

The scar is huge because it was untreated. I didn't know how to stitch it myself. I could have worked it out and done it but I'm not Rambo. I didn't think to take a needle and thread and DIY it.

There's an old study that shows that 85% of people recover from depression in a year without treatment. The study didn't really say enough about the actual outcomes.

Has my lack of treatment created a huge scar that will heal but leaves a big and permanent gash on my psyche and life? Yeah. Probably. C'est la vie.

So I rang services on Saturday morning

It was something of a mistake. It was alcohol depression that made me desperate and I stupidly revealed myself as suicidal, self-harming and paranoid (or not).

The saddest thing is that I can't kill myself.

I've been reading some things this evening by Schneidman to try and help me.

He says that there are two questions to ask people who are suicidal (from this blog).

• Where do you hurt?
• How may I help you?

I don't know the answer to the first question. I just want consciousness to end. It's not about the fight for the greater good or whatever bullshit I use to justify my existence. It's not about my broken heart. It's not even about contemplating losing that which I really love: skunk. Or the feeling that I have no friends. Really. I'm so used to those. Betrayal is the hardest thing but I suspect that I deserve it for having done it to someone else.

"All I do is suffer"

It's the text from someone else's suicide note (from the book linked to below). It resonates with me though it's not truly how I feel. I have thought those words before and recovered.

"I beg you to celebrate for me that I can be free of pain." is a plea for understanding and forgiveness I hope the reader remembers when my time comes. "don't feel you've failed" is the absolution I'd offer.

The second one question about what help I want is much easier to answer though. Kill me, please. I can't do it myself or it's going to take a lot more effort to do which I just don't have. My pathetic half-arsed attempts just make me look more the pathetic loser.

I think there might be some people who would like me to die because in my bad phases, when I get socially destructive and self-destructive, I turn into a monster (or reveal my true being).

There's a part of me that sees what I did as a self-death anyway. I've opened myself up for forced medication and not the fun drugs like antidepressants. I would guess that antipsychotics are on the cards if I'm not careful but I really don't care anymore. I'm so useless because of what or who I am and how I behave. Those along with my "self", psyche and personality could all be changed. I could no longer be and the "dead man walking" (as I felt like when I was on medication) can return. That thing at least was useful for work. The deranged, demented psycho isn't.

I've slept all day yesterday after that or as much as I could, and last night and a lot of today too. In the last few hours I've eaten something and I've started using my mum's laptop to read up on Shneidman's works to see if he can at least offer something and in one of what may be his last books I'm finding a sense of normality in his case study of Arthur. (Please don't follow the link if you don't have resilience to academic language).

Yeah. I know this is depression. I haven't even reached for St John's Wort or omega-3 fish oils. I took 1 vitamin pill on Friday because I wanted to feel better. I'd even showered two days in a row on Friday.

I don't know what tomorrow brings but I don't care.

I'm not planning to kill myself. Don't worry about that. I've not been successful in killing myself on so many of the weak, pathetic attempts I've made. The scars on my arm are minor and it's just something for people to tell each other about to show just how much of a freak I am (don't worry...I forgive those people who revealed my darkest secret to other people in the office and in the pub). I can handle the paranoia though this week has cost me my laptop and, I think, wrecked all my camera equipment. More for people to laugh at me about.

Ever the freak. Ever the failure. And, worst of all, still alive.