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Some random topics on my mind, today...
Apr. 3rd, 2013 07:57 pm1.) People who are vehemently against EMDR therapy for PTSD, and insist it is quackery, really frustrate me. Yes, I understand the controversies, the relative newness, and the problems with existing data. Here is some info, though, taken from sources cited by naysayers:
-EMDR has been proven through well controlled, academically sound research to be more effective for PTSD than no treatment, or supportive counseling (regular "talk therapy").
-Well controlled, respectable research has also shown it to be as effective - which skeptics like to call "no more effective than" - cognitive behavioral therapy with anxiety provoking stimuli (the standard, APA endorsed PTSD treatment).
-Case studies of EMDR, which are less reliable as a data source, are consistently overwhelmingly positive.
-And, individuals who have had it often say it was life changing, hugely helpful, etc, which basically nobody cares about, because anecdata. Articles seeking to "debunk" EMDR have enormous comment threads filled with PTSD sufferers swearing by it and practitioners who go on and on about how it's helped their clients like nothing they've ever seen.
-The main problem areas surrounding EMDR are that some of the success may be a placebo effect, and nobody can conclusively prove the eye movement part specifically is actually doing anything. Thus; pseudoscience!
-EMDR is recognized by the APA as a type of therapy, but they neither approve nor disapprove of it...although they do also offer a certification in it O_o
Ok! So, PTSD is something that is generally understood as a "chronic and debilitating condition that tends to respond poorly to most interventions" (Scott O. Lilienfeld, Ph.D.) and the only non-EMDR treatment on the table has traditionally been 20 or more 2 hour sessions of extremely heightened anxiety as you re-experience your traumas until your triggers hopefully, eventually trigger you less. Even that is acknowledged as not always working; some experts have thought at times that it could actually make things worse.
OR! EMDR works as well ("no better than") that torture... WITHOUT HAVING TO GO THROUGH THE TORTURE. I'm not sure people without PTSD can understand what dealing with triggers is really like for people who have it, but if the data is actually telling me that there's an option that does not involve 40 hours of adrenaline and sobbing...yeah. Bring it. I don't give one fuck if the eye movement part hasn't been proven. I don't care if it's silly as hell and done by someone with a crystal ball who's wearing a kercheif and lots of dangly jewelry - we have clinical proof of benefits!
Skeptics say that EMDR might just be effective since it also (like cognitive behavioral therapy) involves some re-imagining of traumas - which it does, you can't process anything without going there, and I remember EMDR sessions as being emotionally gruelling - but EMDR is not FORTY INTENSE HOURS OF PURPOSEFUL TRIGGERING. I can imagine plenty of people, particularly combat veterans, avoiding treatment altogether if it's the anxiety provoking stimuli but going in to give EMDR a chance. And if they do, and it works better than nothing or talk therapy, and as good as much more arduous options...what the hell is the problem with that?
If people with PTSD are somehow managing to "placebo" the process of EMDR into fixing them, LET THEM DO THAT. Because PTSD sucks, and the alternative to the placebo is often horrible. NO research has ever shown that EMDR wasn't at least somewhat helpful, let alone that it could hurt. Many people who have had it, swear by it - I personally have never read a single account anywhere of a person who went through EMDR and had bad things to say (although I'm sure there are some out there somewhere, and it depends on your practicioner, and your own willingness, like any counseling). My own experience of EMDR in 2008 took me from being a barely functioning wreck to being someone who lives a basically normal life, but has some triggers. It was huge for me.
It's not like we have a ton of really awesome options that are always effective for treating PTSD, that are being ignored in favor of something that does nothing! But that is kinda how skeptics of EMDR treat it - like people are just insisting on choosing snake oil over chemotherapy. More studies? Open access to information? Proposed experiments with tweaking the therapy itself based on results? Sure! But what is up with the people who shoot it down angrily anytime it's mentioned anywhere as having helped someone?
I've talked about this before.
2.) I dislike our cultural aversion to acknowledging the risks of accepted practices, or the way that we blow up and then fixate on the risks of activities outside the norm. The first example that pops into my mind is veganism: when someone hears that a person has gone vegan they immediately start in asking questions like, "But what about protein? How will you get enough B vitamins? ANEMIA!!" Nobody asks people who eat fast food every day whether they have any nutrient deficiencies. I've had moms who do hot dogs, ramen and kool-aid all the time ask me how I can keep Ananda healthy, if she's a vegetarian. There is also an automatic suspicion involved with finding out someone has made any dietary change - "Who TOLD YOU you have a corn problem? What do you think is actually wrong with refined sugar?" People go off about self-diagnosing sensitivities, as though it's somehow harmful to eat differently and see if it changes the way you feel. Like it's a major personal threat to them, if you get results. I don't see this level of stigma when people decide to keep their desks stocked with candy or when they live on microwaved frozen meals. Why? Because that doesn't go against the grain (haha, grain...gluten....not funny). End tangent.
Back to assessing risk - I've been asked how I can know I'm teaching my kids everything they need to know, as a homeschooler, dozens of times. The answer is: I can't! Do you think schools are teaching kids everything they need to know? There are flaws in every diet, holes in every educational system, but somehow rather than honestly evaluating choices we overlook the risks we're used to and worry over the ones we're unfamiliar with.
Birth choices are a huge relevant area. People really jump straight to "endangering the baby's life" when a mother says, "homebirth." But you are treated like an alarmist weirdo if you tell people TRUE RISKS, actual facts, about birthing in a hospital! Or cite studies about the great (low risk pregnancy) outcomes in homebirths, here and abroad. I'm treated like what I'm saying is "true, but..." when I talk about my own actual, personal experiences with hospital birthing risks - that I had a healthy infant who caught a superbug from the hospital and ended up in quarantine on vancomycin, that I had a spinal hematoma from anesthesia and a retained surgical instrument that almost killed me. None of that would have been possible, in a homebirth - they're risks of birthing in a hospital, along with many others. That isn't me saying hospitals are killers and home is always safe; both have risks and benefits that vary by case. They're worth evaluating. I just don't understand the unwillingness to honestly evaluate risk, apart from familiarity. Over and over, I hear midwives I know talk about the hell they catch if they have to transfer from a homebirth and the baby ends up in the NICU. Hospital staff act as though their NICUs aren't comprised of 99% babies whose mothers labored and birthed right down the hall, yet still had complications. Comfort levels =/= actual safety.
This thought process started because a friend tagged me in a facebook post about homemade infant formula that's vastly superior to standard, manufactured formula (better nutrition and gut protection, no corn syrup, less allergens, etc). I immediately said, "Yeah, that's probably better, but just wait til that baby gets any normal sickness and the mother tries to explain to a pediatrician or nurse that she makes her own formula in the blender out of ingredients they've never even heard of." It's a fast track to a CPS case worker and mandatory nutrition classes where they'll tell her all sorts of mainstream, untrue things from the old food pyramid - like that we all need 6-11 servings per day from the "bread, cereals, rice and pasta group" to live.
I think a lot of this stems from the assumption that most people are stupid, and thus we need protocols and systems for everything to save us from ourselves. Doctors, news anchors, governments andbusybodies so forth do not trust people to do things like take necessary supplements while vegan, do their homework to make a complete baby formula carefully - I doubt many doctors believe midwives can recognize problems during labor or that women can truly cope with the pain at home. We lay people don't trust each other with these sorts of decisions, either. Everyone wants to know if your doctor will "let" you do this or that. I've been asked many times about things like homeschooling and co-sleeping, "Is that even legal?"
I saw someone on tv years ago saying that 100% fruit juice is pretty good for you (debatable, go with it), but when they tell parents that, parents buy "juice," meaning dyed corn syrup and water, and so since they can't trust anyone to actually read labels they just put a blanket AAP no-no on all juice. Like how they do the vaccinations in big clumps of 10 at once or something, and cram them all into a few months, because otherwise nobody comes back to finish the sets and get everything they need. There has to be some kind of societal taboo on doing things in a "weird" way to keep parents from piercing their children's ears with rusty nails and staple guns - thus, people act like anyone ordering safe, sterile home piercing kits for ears that are far superior to a mall gun must be a CRAZY PSYCHO.
The problems with this model are that, 1. people do not address problems with existing protocols and systems because they don't even understand that there are alternatives out there, and 2. people who do dig deeper and go for alternative lifestyles - even objectively superior ones - are marginalized for it.
There is probably also a fear of blame at work here; it's hard and scary to step out on a limb and do things differently, especially against the advice of "experts." The risk is all on YOU, then, if/when you screw up somehow. Nobody faults parents whose kids are shortchanged in schools; everyone looks for things to fault homeschooling parents for. I don't understand this mentality at all. Isaac's school sends home hand-outs with wonky layouts and typos all the time, but when I make grammar mistakes on the internet people immediately jump to "and she HOMESCHOOLS her CHILDREN? :(" A preschool teacher I was in college with last year didn't know what several words I wanted to use in our group essay meant, but she still questioned how I could be qualified to homeschool my own kids.
For me, the personal liability aspect of going out on a limb is neither here nor there, and that could just be because I, for whatever reason, feel the same sense of guilt and responsibility for trusting to norms when I shouldn't as I do for stepping out on a limb when I shouldn't. Meaning: it was really fucked up of me to listen to my OB and go for an early c/s with Isaac. I was so sick to death of that ultra hard pregnancy that I swept my own judgement and research under the rug and went along with medical advice based on my platelets and this and that, and then it turned out they weren't right about my dates or the level of platelet urgency. Next stop: newborn intubation and transport. By contrast, with Jake, I took a supplement for my platelets and carried him safely to 42 weeks (and later ended up writing about that for Midwifery Today). Right vs wrong can be subjective or even on a gradient, but whatever "wrong" is, it's "wrong" regardless of whether you are wrong with the rest of society or wrong out there on your own. I was wrong assuming everything was fine during the first hours of my labor with Elise, and maybe would have avoided all the problems she had if we'd had the damn repeat c/s weeks earlier like doctors told me I should. Or maybe some other thing would have went wrong! The point is, everyone tries to tell me I was totally justified listening to the doctor, with Isaac, and many (mostly anonymous) people have told me I was dead wrong NOT listening to doctors, with Elise... and that doesn't make any sense. I was actually doing the best I had with available information, with Elise, who suffered a rare anomaly nobody could have predicted; with Isaac, I was being selfish. Understandably selfish in some ways, but it is what it is.
Thus concludes my rambling for today; this dinner ain't gonna cook itself. I really forgot how spaced out and choppy trying to write an entry during the daytime can be.
-EMDR has been proven through well controlled, academically sound research to be more effective for PTSD than no treatment, or supportive counseling (regular "talk therapy").
-Well controlled, respectable research has also shown it to be as effective - which skeptics like to call "no more effective than" - cognitive behavioral therapy with anxiety provoking stimuli (the standard, APA endorsed PTSD treatment).
-Case studies of EMDR, which are less reliable as a data source, are consistently overwhelmingly positive.
-And, individuals who have had it often say it was life changing, hugely helpful, etc, which basically nobody cares about, because anecdata. Articles seeking to "debunk" EMDR have enormous comment threads filled with PTSD sufferers swearing by it and practitioners who go on and on about how it's helped their clients like nothing they've ever seen.
-The main problem areas surrounding EMDR are that some of the success may be a placebo effect, and nobody can conclusively prove the eye movement part specifically is actually doing anything. Thus; pseudoscience!
-EMDR is recognized by the APA as a type of therapy, but they neither approve nor disapprove of it...although they do also offer a certification in it O_o
Ok! So, PTSD is something that is generally understood as a "chronic and debilitating condition that tends to respond poorly to most interventions" (Scott O. Lilienfeld, Ph.D.) and the only non-EMDR treatment on the table has traditionally been 20 or more 2 hour sessions of extremely heightened anxiety as you re-experience your traumas until your triggers hopefully, eventually trigger you less. Even that is acknowledged as not always working; some experts have thought at times that it could actually make things worse.
OR! EMDR works as well ("no better than") that torture... WITHOUT HAVING TO GO THROUGH THE TORTURE. I'm not sure people without PTSD can understand what dealing with triggers is really like for people who have it, but if the data is actually telling me that there's an option that does not involve 40 hours of adrenaline and sobbing...yeah. Bring it. I don't give one fuck if the eye movement part hasn't been proven. I don't care if it's silly as hell and done by someone with a crystal ball who's wearing a kercheif and lots of dangly jewelry - we have clinical proof of benefits!
Skeptics say that EMDR might just be effective since it also (like cognitive behavioral therapy) involves some re-imagining of traumas - which it does, you can't process anything without going there, and I remember EMDR sessions as being emotionally gruelling - but EMDR is not FORTY INTENSE HOURS OF PURPOSEFUL TRIGGERING. I can imagine plenty of people, particularly combat veterans, avoiding treatment altogether if it's the anxiety provoking stimuli but going in to give EMDR a chance. And if they do, and it works better than nothing or talk therapy, and as good as much more arduous options...what the hell is the problem with that?
If people with PTSD are somehow managing to "placebo" the process of EMDR into fixing them, LET THEM DO THAT. Because PTSD sucks, and the alternative to the placebo is often horrible. NO research has ever shown that EMDR wasn't at least somewhat helpful, let alone that it could hurt. Many people who have had it, swear by it - I personally have never read a single account anywhere of a person who went through EMDR and had bad things to say (although I'm sure there are some out there somewhere, and it depends on your practicioner, and your own willingness, like any counseling). My own experience of EMDR in 2008 took me from being a barely functioning wreck to being someone who lives a basically normal life, but has some triggers. It was huge for me.
It's not like we have a ton of really awesome options that are always effective for treating PTSD, that are being ignored in favor of something that does nothing! But that is kinda how skeptics of EMDR treat it - like people are just insisting on choosing snake oil over chemotherapy. More studies? Open access to information? Proposed experiments with tweaking the therapy itself based on results? Sure! But what is up with the people who shoot it down angrily anytime it's mentioned anywhere as having helped someone?
I've talked about this before.
2.) I dislike our cultural aversion to acknowledging the risks of accepted practices, or the way that we blow up and then fixate on the risks of activities outside the norm. The first example that pops into my mind is veganism: when someone hears that a person has gone vegan they immediately start in asking questions like, "But what about protein? How will you get enough B vitamins? ANEMIA!!" Nobody asks people who eat fast food every day whether they have any nutrient deficiencies. I've had moms who do hot dogs, ramen and kool-aid all the time ask me how I can keep Ananda healthy, if she's a vegetarian. There is also an automatic suspicion involved with finding out someone has made any dietary change - "Who TOLD YOU you have a corn problem? What do you think is actually wrong with refined sugar?" People go off about self-diagnosing sensitivities, as though it's somehow harmful to eat differently and see if it changes the way you feel. Like it's a major personal threat to them, if you get results. I don't see this level of stigma when people decide to keep their desks stocked with candy or when they live on microwaved frozen meals. Why? Because that doesn't go against the grain (haha, grain...gluten....not funny). End tangent.
Back to assessing risk - I've been asked how I can know I'm teaching my kids everything they need to know, as a homeschooler, dozens of times. The answer is: I can't! Do you think schools are teaching kids everything they need to know? There are flaws in every diet, holes in every educational system, but somehow rather than honestly evaluating choices we overlook the risks we're used to and worry over the ones we're unfamiliar with.
Birth choices are a huge relevant area. People really jump straight to "endangering the baby's life" when a mother says, "homebirth." But you are treated like an alarmist weirdo if you tell people TRUE RISKS, actual facts, about birthing in a hospital! Or cite studies about the great (low risk pregnancy) outcomes in homebirths, here and abroad. I'm treated like what I'm saying is "true, but..." when I talk about my own actual, personal experiences with hospital birthing risks - that I had a healthy infant who caught a superbug from the hospital and ended up in quarantine on vancomycin, that I had a spinal hematoma from anesthesia and a retained surgical instrument that almost killed me. None of that would have been possible, in a homebirth - they're risks of birthing in a hospital, along with many others. That isn't me saying hospitals are killers and home is always safe; both have risks and benefits that vary by case. They're worth evaluating. I just don't understand the unwillingness to honestly evaluate risk, apart from familiarity. Over and over, I hear midwives I know talk about the hell they catch if they have to transfer from a homebirth and the baby ends up in the NICU. Hospital staff act as though their NICUs aren't comprised of 99% babies whose mothers labored and birthed right down the hall, yet still had complications. Comfort levels =/= actual safety.
This thought process started because a friend tagged me in a facebook post about homemade infant formula that's vastly superior to standard, manufactured formula (better nutrition and gut protection, no corn syrup, less allergens, etc). I immediately said, "Yeah, that's probably better, but just wait til that baby gets any normal sickness and the mother tries to explain to a pediatrician or nurse that she makes her own formula in the blender out of ingredients they've never even heard of." It's a fast track to a CPS case worker and mandatory nutrition classes where they'll tell her all sorts of mainstream, untrue things from the old food pyramid - like that we all need 6-11 servings per day from the "bread, cereals, rice and pasta group" to live.
I think a lot of this stems from the assumption that most people are stupid, and thus we need protocols and systems for everything to save us from ourselves. Doctors, news anchors, governments and
I saw someone on tv years ago saying that 100% fruit juice is pretty good for you (debatable, go with it), but when they tell parents that, parents buy "juice," meaning dyed corn syrup and water, and so since they can't trust anyone to actually read labels they just put a blanket AAP no-no on all juice. Like how they do the vaccinations in big clumps of 10 at once or something, and cram them all into a few months, because otherwise nobody comes back to finish the sets and get everything they need. There has to be some kind of societal taboo on doing things in a "weird" way to keep parents from piercing their children's ears with rusty nails and staple guns - thus, people act like anyone ordering safe, sterile home piercing kits for ears that are far superior to a mall gun must be a CRAZY PSYCHO.
The problems with this model are that, 1. people do not address problems with existing protocols and systems because they don't even understand that there are alternatives out there, and 2. people who do dig deeper and go for alternative lifestyles - even objectively superior ones - are marginalized for it.
There is probably also a fear of blame at work here; it's hard and scary to step out on a limb and do things differently, especially against the advice of "experts." The risk is all on YOU, then, if/when you screw up somehow. Nobody faults parents whose kids are shortchanged in schools; everyone looks for things to fault homeschooling parents for. I don't understand this mentality at all. Isaac's school sends home hand-outs with wonky layouts and typos all the time, but when I make grammar mistakes on the internet people immediately jump to "and she HOMESCHOOLS her CHILDREN? :(" A preschool teacher I was in college with last year didn't know what several words I wanted to use in our group essay meant, but she still questioned how I could be qualified to homeschool my own kids.
For me, the personal liability aspect of going out on a limb is neither here nor there, and that could just be because I, for whatever reason, feel the same sense of guilt and responsibility for trusting to norms when I shouldn't as I do for stepping out on a limb when I shouldn't. Meaning: it was really fucked up of me to listen to my OB and go for an early c/s with Isaac. I was so sick to death of that ultra hard pregnancy that I swept my own judgement and research under the rug and went along with medical advice based on my platelets and this and that, and then it turned out they weren't right about my dates or the level of platelet urgency. Next stop: newborn intubation and transport. By contrast, with Jake, I took a supplement for my platelets and carried him safely to 42 weeks (and later ended up writing about that for Midwifery Today). Right vs wrong can be subjective or even on a gradient, but whatever "wrong" is, it's "wrong" regardless of whether you are wrong with the rest of society or wrong out there on your own. I was wrong assuming everything was fine during the first hours of my labor with Elise, and maybe would have avoided all the problems she had if we'd had the damn repeat c/s weeks earlier like doctors told me I should. Or maybe some other thing would have went wrong! The point is, everyone tries to tell me I was totally justified listening to the doctor, with Isaac, and many (mostly anonymous) people have told me I was dead wrong NOT listening to doctors, with Elise... and that doesn't make any sense. I was actually doing the best I had with available information, with Elise, who suffered a rare anomaly nobody could have predicted; with Isaac, I was being selfish. Understandably selfish in some ways, but it is what it is.
Thus concludes my rambling for today; this dinner ain't gonna cook itself. I really forgot how spaced out and choppy trying to write an entry during the daytime can be.
