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

By Gomory, Tomi | Ethical Human Psychology and Psychiatry, April 1, 2013 | Go to article overview

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


Gomory, Tomi, Ethical Human Psychology and Psychiatry


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 Insti- tute 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.

Keywords: clinical practice; evidence-based medicine; evidence-based practice; mental health; social work

No profession is free of dogmatic clowns.

-Jacobsen, 2009, p. 19

The relatively recent phenomena of evidence-based practice (EBP) in mental health is derived analogically from the dramatic growth and resulting assertion of legitimacy of its parent movement, evidence-based medicine (EBM). Mental health EBP as a result depends on the concept of disease as the target of amelioration and presumes its validity in understanding and responding to the complex human existential travails that are the problems addressed in mental health. As Thomas Insel (2007), the director of the National Institute of Mental Health (NIMH), tells us, "as [mental health] research during the Decade of the Brain ( 1990-2000) forged the bridge between the mind and die brain, research in die current decade is helping us to understand mental illnesses as brain disorders" (p. 757). In 2010, the NIMH budget was $1.5 billion, most of it ear- marked for research on the severely mentally ill (SMI) and their treatments. Almost a third of the funding, about $400 million, was spent on brain and basic behavioral research (NIMH, n.d.) designed to verify NIMH's institutional assumption that mental illnesses are brain diseases.

This bald-faced declaration by the director of the NIMH, the institution that disburses the overwhelming majority of mental health research dollars and outlines the direction of all acceptable mental health research programs in the United States, in die absence of any physiological markers or identified lesions that would be diagnostic of even a single currently listed mental disorder within the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 2000) seems to be putting the cart well before the horse but has not disturbed the mental health helping professions and their EBP (Gomory, Wong, Cohen, & Laçasse, 2011).

This article will first briefly describe EBM and dien identify its problems. Then it will describe its reworked version as EBP applied to mental healdi in die United States and discuss its problems. Anodier article (part two) forthcoming in this journal will provide a specific example of how it can all go wrong by reviewing assertive community treatment (ACT) perhaps the most well documented EBP certified by die NIMH that has been around for more than 40 years. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

The Limits of Evidence-Based Medicine and Its Application to Mental Health Evidence-Based Practice: Part One
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Author Advanced search

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.