The final part of our discussion of mental illness is treatment for mental illness or therapy. I'm going to go through this fairly quickly, just because there's so much to say, I can hardly give it justice. I just want to give a feeling for the sorts of therapies that exists and then end with some general observations about their efficacy and how they work. If people are interested in pursuing there's many other sources, both for people who are interested in more of the theory of how to treat mental disorders. But also as I mentioned at the onset, many of you suffer from problems yourself, or people you love suffer from problems, and there are many excellent resources online or otherwise on how to deal with these problems. I often get email from people who see my course from different countries, and they talk about issues that they are suffering from. My first response always is to see a therapist. It's to see somebody often at your campus or workplace, and talk it through. It may not help, you may need to do something else or see a different person but it rarely hurts, and it's always a good step. Now, there are many different forms of therapy. One sort of classic form of therapy is psychodynamic therapy, it's built at ideas of Freud. The idea of psychodynamic therapy is that the problems that people struggle with that bring them to the therapist's office are symptoms. You should focus instead on underlying causes. Classical Freudian Psychoanalysis is a lengthy process, often going on for years, involving many sessions a week, and involves techniques like free association, the therapist might say some words and the patient will say something back, and dream analysis, where dreams are explored in order to give insight into what the mental problem is. There's behavior therapy, motivated directly by ideas of B.F. Skinner. One example of this is in psychiatric hospitals or token economies, where people, the techniques of operant conditioning are used to reinforce good behaviors and diminish bad behaviors. But as a less extreme example, many of the treatments of phobia use the techniques of classical conditioning, where objects that would frighten you, instead of being associated with fear, you learned to associate them with relaxation and calm. I said before that the behaviors theory of the origin of phobias does not seem pretty well-founded, but interestingly enough the techniques for getting rid of phobias developed through behavior therapy do work pretty well. The most common form of therapy these days, at least in United States, is cognitive therapy, where the idea is you talk with your therapist, and you try to identify incorrect distorted ways of thinking. You might for instance think that you're a failure, and that a small catastrophe will ruin your life. But when you talk it over, and you realize that typically we're exaggerating how important things are, how permanant problems are, which often over-attribute them to ourselves. I'm dividing these up right now, as if they are sees bright lines, Freudian Skinnerian behaviorist, and cognitive. But typically a good therapists run summed together. A very common mode of treatment is what's called CBT; Cognitive Behavioral Therapy, which brings together the techniques to work under distorted thoughts, along with techniques, and being trained to improve your behaviors. There is of course, Medical Interventions Medications. These include antipsychotics for schizophrenics, anti-anxiety drugs for people with anxiety disorders like obsessive compulsive disorder, and of course antidepressants which are very common. There's also different sorts of interventions like electroconvulsive therapy or ECT in which electric current is run through your brain. This has had a horrible reputation in movies and popular media but in fact, when it comes to severe depression, it is quite efficacious. It's nobodies first resort, but if talk therapy and medication fails, electroconvulsive therapy can often save people's lives. Recently, there's a lot of interest in transcranial magnetic stimulation, it's a very new technology involving also running highly directed pulses of electrical energy into the brain, and it has some promise in treating disorders like depression. Again, I'm talking about these separately, but they tend to run together. So, you might meet a therapist, and talk to your problems of him or her. But at the same time, if the therapist is a psychiatrist, he or she might prescribe a Zoloft or Wellbutruin, or some other medication for your problems. So, does any of this work? Well, people do report feeling better after therapy, but that doesn't tell you that much, because maybe they would have gotten better anyway. There's something statisticians call regression to the mean. So, people's moods like everything else, just tends to go up and down more or less randomly often as sort of directional trends, but they go up and down. A point at which you enter therapy is often when you're at your worst. Well, there's one thing about when things are at their worst, they typically get better. So, the getting better after therapy might just be the normal ebb and flow of one's moods or ones behaviors, or one's happiness. This no doubt plays a role, but the people interested in therapy are very conscious of this problem, and sort of experiments in the typically use control groups, a good study for instance when you have about 100 people who are looking to get some sort of therapy, they all sign up for therapy, and 50 of them get treatment, and 50 of them are put on a waiting list. It turns out typically, almost regardless of the therapy, people who get the therapy do better than people who didn't. Maybe they both improve, but they improve more after under therapy. So, in general, there is some conclusions you can make, the first is what I just said, people in treatment do better than those who are not in treatment. We know some sorts of therapies work better for specific problems, so if you have a major depression, you might do well with Cognitive Behavioral Therapy, CBT, along with some medication, while if you have bipolar disorder, medication is extremely efficient for that. We also know, and this is perhaps no surprise, that some therapists are better than others. Finally, there's what you could call nonspecific factors in therapy's effectiveness. Nonspecific, meaning they're not related to the specific principles, the logic of Freudian therapy or cognitive therapy and the like, but they do play a role in the therapy success. These are general features of all forms of therapy share. One is support. You're dealing with a person who accepts you, who feels empathy for you, who encourages you, who guides you, somebody who is on your side. Finally, there's hope. When you go into therapy there's some sense of faith that this will work. You're taking a shot at it, but you wouldn't be there if you didn't think it had some chances of success. This sort of hope could be a self-fulfilling prophecy. Believing something will work is often an excellent first step to making it work. This is yet another reason why therapy is often a powerful mechanism for improving people's lives.
