'The talking cure' and other psychology myths

Does the "talking cure" really work? Photo / Getty Images

Many of psychology's concepts and terms have, in recent decades, entered our vernacular. Political pundits speak casually of "confirmation bias" - the way people focus selectively on evidence that backs up their existing beliefs - and many lay people know the purported role of serotonin in producing a sense of well-being. Psychological discoveries continue to sharpen and refine our understanding of human suffering and of the human condition more broadly. Nonetheless, many myths about psychology persist.

Myth No. 1: We only use 10 per cent of our brains.

Perhaps no psychological misperception is more widespread than the idea that vast swaths of the brain lie perpetually dormant. Psychologist William James may have unwittingly originated the idea by speculating in 1907 that "we are making use of only a small part of our possible mental and physical resources." In 1936, writer Lowell Thomas recklessly paraphrased James, claiming that "the average man develops only ten per cent of his latent mental ability." Today, a science fiction trope - as in the Luc Besson film "Lucy," or the Bradley Cooper vehicle "Limitless" - involves awakening more than 10 per cent of someone's brain and gaping as remarkable new cognitive abilities emerge.

But neuroscience offers no support for the sci-fi fantasy. The brain is a glutton for energy - accounting for about 20 per cent of calorie expenditure, despite making up only 2 per cent of body mass - and has little tolerance for waste or excess. All 86 billion neurons are programmed to self-destruct if they fail to wire up properly to active, useful circuits. Because such "neural pruning" is relentless and ubiquitous, anyone who used only 10 per cent of their neurons would be found in an autopsy to have a dramatically shrivelled brain. (Such cerebral shrinkage is not commonly observed.)

It is now clear that every part of the brain is always on active duty. The typical neuron fires about once every second. And no part of the brain can withstand more than trivial damage without a loss of neurocognitive function.

Myth No. 2: Talking about your problems helps.

Just over a century ago, Sigmund Freud popularised the notion of a "talking cure," known now as psychotherapy. Freud said we all have an unhealthful tendency to repress upsetting thoughts and feelings. This belief endures. As the editors of Reach Out, an online mental health resource, put it: "If you or someone you know is going through a tough time, talking to someone ... really is one of the best possible things you/they can do." A therapist writing for Psychology Today elaborates: "Give your pain a voice, and let someone listen. You will be amazed at how much weight will be lifted off your shoulders."

Talking about painful experiences, however, is not guaranteed to be helpful. Consider "critical incident stress debriefing," a group-counselling protocol for people who have witnessed traumatic events. A meta-analysis of all published CISD trials did not find any beneficial effects of the intervention. Some studies have even linked the treatment with worse outcomes, perhaps because it forces some people to face painful memories before they're ready.

In an important 2007 paper, "Psychological Treatments That Cause Harm," Emory University professor Scott Lillienfeld highlighted a growing body of evidence that talk therapy - although helpful for many - can sometimes backfire. About 10 per cent of psychotherapy patients get worse during treatment, and only about half get better. One reason: Many therapists do not use evidence-based techniques and procedures shown to be effective in clinical trials.

Myth No. 3: OCD manifests as hyper-organisation.

"Neat freaks" and their fastidious fellow travelers are commonly described in popular culture as having obsessive-compulsive disorder. Jayma Mays, reflecting on the "OCD" that typified her germophobic character, Emma, on "Glee," observed parallels in her own life: She arranges her spices in alphabetical order, and she "was constantly cleaning and organising things" as a child. Likewise, fans often describe Monica Geller of "Friends" (played by Courteney Cox) as a paragon of OCD-ness: She vacuums her vacuum cleaner and owns 11 categories of towels, each with a precise function.

But OCD has little to do with neatness, and most sufferers are not particularly tidy or uptight. Instead, they're plagued by a cascade of unbidden, disturbing thoughts, often in the form of harrowing images that they may feel compelled to ward off with time-consuming rituals. It's a serious mental illness that typically causes great distress and functional impairment. Someone with OCD, for instance, might be tormented by intrusive images of running people over with her car. After hitting a bump or a pothole while driving, she might spend the next hour ritualistically combing the area for signs of an injured pedestrian, despite a near-certainty that none existed. (I have worked with such a patient.)

A small minority of OCD sufferers really do have compulsive hand-washing rituals. But excessive cleaning is just one possibility in a broad universe of OCD symptoms. (Adding to the confusion: A similar-sounding diagnosis, obsessive-compulsive personality disorder,truly is characterised by a need to have things well-ordered and "just so.")

Myth No. 4: Mood swings are the hallmark of bipolar disorder.

Formerly known as manic depression, bipolar disorder is a source of increasing public fascination, and some high-profile celebrities have been diagnosed with the condition, including Catherine Zeta-Jones, Russell Brand, Mariah Carey and the late Carrie Fisher. It's widely believed that volatile emotions are central to the disorder. The popular website VeryWellMind, for example, says that "rapid and often extreme, fluctuations in one's emotional state" are "one of the classic symptoms." MayoClinic.org describes bipolar illness as "a mental health condition that causes extreme mood swings."

But mood swings are nowhere to be found among the disorder's official diagnostic criteria. Yes, bipolar individuals experience the devastating lows of depression and the extreme highs of mania (or, in some cases, the milder elevation known as hypomania), but such profoundly altered states typically last for weeks or months at a time. They rarely turn on a dime. And "mood" isn't always the most serious concern. Bouts of depression commonly bring on crushing fatigue, impenetrable brain fog and searing mental anguish. Mania can induce wildly impulsive, erratic behaviours - reckless promiscuity, disastrous spending sprees, even physical altercations - with suffering and functional impairment in their wake. According to a recent study, most married bipolar patients eventually end up divorced, and more than a third are unable to hold down a steady job. Bipolar disorder is a far more serious condition than the "mood swings" of popular imagination might suggest.

Myth No. 5: Medication is the way to fix a chemical imbalance.

Drug companies besiege consumers with the message that "chemical imbalances" are the ultimate drivers of mental illness - and that they must be fixed with their pills. "Research suggests an important link between depression and an imbalance in some of the brain's chemical messengers,"explain the makers of Effexor, an antidepressant. Anad for Paxil suggested that "a chemical imbalance" contributes to generalised anxiety, and that "Paxil works to correct this imbalance."

Such ads present a gross oversimplification. Depression, for instance, involves a dizzying array of brain perturbations, including neuroinflammation, impaired glucose utilisation, runaway stress signaling, faulty circadian rhythms, altered sleep patterns, decreased neuroplasticity and impaired hormone regulation. Worse, the "chemical imbalance" framing leads many to conclude that taking medication - ingesting chemicals - is the only effective means of treating psychological disorders.

Medicines have a place in the armamentarium of psychiatric treatments, but there are many other ways of changing the brain's neurochemical profile. Regular exercise boosts signaling in brain circuits that utilise dopamine and serotonin - neurotransmitters commonly targeted by psychiatric drugs. Exercise also increases neuroplasticity, improves cerebral glucose metabolism and leads to better sleep. What we eat also alters the brain's "chemical balance." Nutrition-based interventions - boosting omega-3 fats, magnesium, zinc, or soluble plant fiber - have been found to lift symptoms of depression, anxiety and even ADHD. And numerous studies show that psychotherapy, too, can alter brain function for the better.