Tomi Gomory

Is Graduate Social Work Education Promoting a Critical Approach to Mental Health Practice

A sample of 71 psychopathology course syllabi from 58 different graduate schools of social work was analyzed to determine whether different viewpoints and the concomitant empirical evidence were presented regarding 4 significant mental health topics: concepts of mental disorder, reliability and validity of psychiatric diagnoses, biological etiology, and drug treatment. There is little evidence that graduate psychopathology courses cover viewpoints other than the most conventional and institutional—that of biomedical psychiatry. A small handful of secondary (textbooks) rather than primary (research articles) sources provide the majority of the mental health content in these courses. Implications are discussed. The article includes an overview of both the relevant conventional and critical literature.

A Fallibilistic Response to Thyer’s Theory of Theory-Free Empirical Research in Social Work Practice

Empirical clinical social work practice (one of the current scientific paradigms of the profession) has too narrow an understanding of how science is done. That perspective maintains that science is an inductive, positivist, often atheoretical process, which can lead to credible, justified knowledge. By reviewing Bruce Thyers article, “The Role of Theory in Research on Social Work Practice,” through a Popperian falsificationist lens the difficulties of that approach are highlighted. An alternate approach, “Critical Rationalism,” a fallibilistic noninductive trial-and-error testing of conjectured theories and methods, is described. It is contentded that this approach better advances professional knowledge and resolves the problems unresolved by the current methodology.

CRITICAL RATIONALISM (GOMORY'S BLURRY THEORY) OR POSITIVISM (THYER'S THEORETICAL MYOPIA): WHICH IS THE PRESCRIPTION FOR SOCIAL WORK RESEARCH?

This article is the last of four in a debate between a critical rationalist (falsificationist) and a positivist (justificationist) about the value and utility of theory in social work. The critical rationalist position and its criticism of the positivist approach to theory and the pursuit of science in social work are reviewed and explained in seven theses and a little commentary. Some criticisms about how critical rationalists choose among theories and interventions are answered. Finally, the use and misuse of quasi-experimental research in social work are addressed briefly.

The Limits of Evidence Based Medicine and Its Application to Mental Health Evidence-Based Practice. (Part One)

The present article outlines the major limitations of evidence-based medicine (EBM) and through a close review demonstrates that the three component EBM process model is a pseudoscientific tool. Its “objective” component is the collection, systematic analysis, and listing of “effective” treatments applying a research hierarchy from most rigorous (systematic reviews of randomized controlled trials [RCTs]) to least rigorous (expert opinion). Its two subjective components are the clinical judgment of helping professionals about which “evidence-based” treatment to select and the specific and unique relevant personal preferences of the potential recipients regarding treatment. This procedural mishmash provides no more rigor in choosing “best practice” than has been provided by good clinical practitioners in the past because both turn out to be subjective and authority based. The article also discusses EBM’s further methodological dilution in the National Institute of Mental Health (NIMH) endorsed Evidence-Based Mental Health Practice (EBP) movement. In EBP, the allegedly rigorous EBM protocol is altered. Instead of systematic expert protocol-driven EBM reviews of RCTs, NIMH sanctioned expert consensus panels decide “evidence-based practices.” This further problematizes the development of best practices in mental health by converting it to a political process. The article concludes with some observations on these issues. In a second article (part two) forthcoming, assertive community treatment (ACT) is examined as an example of an EBP that fails as a scientifically effective treatment despite its EBP certification and general popularity among practitioners.

Sexual Prejudice Among Barbadian University Students

The level of sexual prejudice on university campuses has implications for the health and well-being of gay and lesbian students, and research on sexual prejudice in the Eastern Caribbean is extremely limited. This study assesses the individual attitudes of 251 Barbadian students toward lesbian and gay people using two psychometric inventories. It also examines differences in attitudes as a function of demographic variables including gender, religiosity, and personal acquaintance with lesbian or gay people. The Barbadian students evidenced diverse attitudes, with the average student displaying a moderate amount of sexual prejudice toward lesbian and gay people. Religiosity predicted more negative attitudes toward both lesbians and gay men. Being male predicted more sexual prejudice against gay men, but not against lesbians. Finally, personal acquaintance with a gay or lesbian person did not have a statistically significant relationship with sexual prejudice. This study is among the first of its kind and may serve as a guide to other researchers seeking to further explore attitudes toward lesbian and gay people among Eastern Caribbean students or among Barbadians in general.

Coercion: The Only Constant In Psychiatric Practice?

In the Western world, since at least the 15th century, state-sanctioned force has been employed to control those who disturb others by their violent or existentially destabilizing behaviors such as threatening or inflicting self-harm.

The Limits of Evidence-Based Medicine and Its Application to Mental Health Evidence- Based Practice (Part Two): Assertive Community Treatment Assertively Reviewed

This article is the second of two published in Ethical Psychology and Psychiatry; the first appeared in Volume 15, Number 1. The first article argued the very serious limitations of evidence-based medicine (EBM) and its very popular mental health offshoot evidence-based practice (EBP; Gomory, 2013). This article is meant to be a consolidation and update of a 1999 analysis of Assertive Community Treatment (ACT), the best “validated” mental health EBP according the National Institute of Mental Health (NIMH) and academic researchers. This analysis reconfirms the failure of ACT as a treatment modality and a platform for successfully reducing hospitalization; its touted consistent effect except when ACT can apply administrative coercion to keep its clients out of the hospital or quickly discharge them. When ACT fails to have such administrative coercive control, it does no better than other community mental health delivery systems. The use of ACT coercion begun over 40 years ago, the article further argues, set the table for conventionalizing psychiatric coercion as evidence-based best practice.

DSM-5: The Delayed Demise of Descriptive Diagnosis

In 1980, DSM-III adopted a descriptive approach to psychiatric diagnosis, creating checklists of unwanted behaviors to define and use as required criteria when posing each of several hundred diagnoses. The objective of this novel approach was to validate psychiatry as a scientifically legitimate branch of medicine, by enabling research into hopefully homogeneous groups of patients to pinpoint the implicit hypothesized physiological causes of the disorders the patients were presumably sharing. In each subsequent revision of the DSM including the DSM-5, however, no physiological criteria of any sort are included for any diagnosis, confirming the empirical failure of this attempt to substantiate the medical model of madness. The futile endeavor to validate countless human faults and suffering as medical diseases explains most of the “scientific” conundrums and controversies surrounding the release of DSM-5, including whether to include or exclude diagnoses, where to draw boundaries for each, and why clinicians still fail to agree on which diagnosis they should apply in a given case. Despite DSM-5’s insolvency, the essentially moral project of descriptive psychiatric diagnosis has today vast socio-economic ramifications that help to preserve it.

The Solving Problems in Everyday Living Model: Toward a Demedicalized, Education-Based Approach to “Mental Health”

We argue that human existential pain and threat may usefully be helped by a noncoercive educational approach that also resonates with many interpersonally focused psychological approaches, rather than by the widely touted current medical model of “mental health” treatment (using psychoactive drugs and supportive psychotherapy). First, the “progress” leading to the latest Diagnostic and Statistical Manual of Mental Disorders is briefly reviewed, highlighting the scientific limitations of the medical model. Next, an educational model of self-understanding and change, based on Popper’s fallibilism, Freire’s critical pedagogy, and Miller’s feedback-informed treatment is explicated. Finally, some options for funding and testing the model are discussed. We hope this offers mental health clinicians another important alternative to conceptualize the helping encounter to ameliorate personal problems in living.

Letters to the Editor: The Role of Theory in Social Work Research

the totality of our knowledge ... is a man-made fabric which impinges on experience only at the edges . . .. Total science is like a field of force, whose boundary conditions are experience . . . . But the total field is so undetermined by its boundary conditions, experie nce, that there is much latitude of choice as to what statements to re-evaluate in light of any single contrary experience . (pp. 3940)