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Sex abuse article missing content?

I’ve just been reading my Summer 2012 edition of New Zealand Skeptic, but I think there is a piece missing from my version.

On page 15-17 there is an article by Gordon Waugh that is missing both a chunk of text and his references. There is clearly a gap between the first section which ends with “it caused mental injury” and the next which starts with “Do sexually assaulted people exhibit …”. In the later section he talks at length about the lack of a defined ‘syndrome’ caused by sexual abuses. This doesn’t make any sense unless there is a paragraph on why the ‘mental injury’ should be a ‘syndrome’ in order to be real. There’s no specific ‘falling off a ladder’ syndrome, either, but I wouldn’t argue that that means people aren’t injured in falls. Without Mr Waugh’s explanation of why he is using this narrow definition of ‘mental injury’ his argument becomes ridiculous.

I’m also concerned that his references have been lost. He talks about what counsellors believe and think, but the survey or research that backs this up is missing. I find it hard to believe an author calling for ACC to demand testable evidence in relation to sexual abuse cases would fail to provide the evidence to back up his own assertions. He also talks only about counsellors, and I assume that the section of his article that deals with what it means to be an ACC registered counsellor is also missing. Without it, it looks as though anybody can can set themselves up and start referring patients for claims. This is obviously absurd and without the missing section Mr Waugh’s credibility takes a serious knock.

Perhaps these could be printed alongside part two of this article, which I assume will be covering the legislative aspects. Mr Waugh refers twice to laws that are being broken, but never actually sets out which statutes these are. He also calls for the criminalisation of ACC claims that fail to provide “proper evidence” of sexual abuse and I assume he will talk more about how “proper evidence” is defined and how it would be collected. And how its collection will be consistent with the evidence required by other types of injury.

Renee Maunder

Peppering is back

Not possums … rabbits!

I was horrified to see a Country Calendar this morning (made in 2011) where the increase in rabbits was being discussed. One of the farmers said he had been told to shoot a rabbit, skin it, burn the skin, and scatter the ash in order to have the desired effect. He just hoped the rabbits would go elsewhere! He admitted his other farmer friends were doubtful but were waiting to see what happened. He said he was four weeks into the trial but that positive results might not show up until at least six weeks.

Well, this might work if he shot lots of rabbits to get the skins to burn … shooting would remove a few.

Else I have this mental picture of hundreds of little bunnies all sitting in Easter baskets and madly paddling away back to England…

Louette McInnes
Christchurch

Deconstructing Sex Abuse Industry Claims

ACC’s best-practice guidelines for identifying cases of sexual abuse are not credible.

Twenty years ago, New Zealand had a mere handful of people who claimed to be ‘counsellors’. Now they number in their thousands. The phrase, “victims were offered counselling”, has become commonplace, yet the only practical intervention they can make is to talk.

How did we suddenly produce so many wise folk who can provide counselling and therapy to so many? Is counselling science-based or evidence-free ideology? What did we do before we had counsellors?

Despite lofty claims of being trained health professionals, counselling is not registered under the Health Practitioners Competence Assurance Act 2003. Nor is it regulated by Government or any public process. It requires no specific or mandatory training, public examination, knowledge or skills. Selling counselling services to the public can be done by anyone, without control or accountability, much like psychics, spirit guides and mediums.

My particular concern here is sex abuse counselling, the industry it spawned and the part ACC plays. An ACC press release of 16 October 2009 advised that “[b]y law, ACC can only accept sensitive claims from those diagnosed with a mental injury resulting from the sexual abuse they’ve suffered.” There are two parts to this; firstly, sexual abuse must have occurred, and secondly, it caused a mental injury.

A Sexual Abuse Syndrome?

Do sexually assaulted people exhibit predictable behavioural characteristics that can accurately be profiled? The term ‘syndrome’ is defined in the New Shorter Oxford English Dictionary as a “group of symptoms or pathological signs which consistently occur together, especially with an (originally) unknown cause”. There is yet no reliable scientific evidence that sexual abuse is a cause of any specific psychiatric, psychological or behavioural condition. Reactions to sexual abuse are generally idiosyncratic and therefore unpredictable.

The existence of a sexual abuse syndrome would mean the “(originally( unknown cause” could be determined from client behaviour alone. Police would have a field day! No such syndrome has yet been identified, making it impossible to properly conclude from client behaviour alone whether a sexual abuse event was experienced.

Science – and evidence-based diagnosis – should always precede treatment decisions and methods. To ensure correct treatment is given to sexual abuse victims, it is also necessary to define what behaviours are not indicative of sexual abuse, but that has not been achieved. If the possibility of sexual crimes arise, then it is essential to find the facts from other forms of evidence.

Counselling

A recent president of the NZ Association of Counsellors declared that counsellors are not ideologically driven people – they are trained health professionals with high ethical standards who are not required to investigate crimes. Sexual abuse is a serious crime. But counsellors lack the skills, resources or authority to conduct external investigation of client claims.

To help it survive and grow, the industry created ideological myths and beliefs about abuse, amongst others, the fantasies of recovered memories, multiple personality disorder and satanic ritual abuse, and then invented scores of ‘counselling modalities’ to treat the claimed effects.

Counsellors believe that sexual abuse can be detected, confirmed or diagnosed from client behaviour.They created extensive lists of ‘effects’ and believe that clients presenting with a ‘cluster’of these ‘effects’ must have been sexually abused. In reality, the causes of those ‘effects’ are myriad. Test it for yourself – how many causes of (eg) ‘depression’ can you name?

The three glaring flaws in most sex abuse counselling cases are a lack of credible evidence that the client was in fact sexually abused, inability of counsellors to separate the effects of sexual abuse (if any) from the effects of other trauma in the client’s life, and a penchant to make treatment decisions on the basis that inevitable detrimental consequences arise from sexual abuse.

To them, allegations of abuse are proof of abuse, but absent externally corroborated evidence or other reliable markers of sexual abuse, a counsellor cannot know whether a client was in fact abused.

ACC’s Best-Practice Guidelines

There is much misguided and ill-informed thinking underscoring this vexed topic, as shown by ACC’s document Sexual Abuse and Mental Injury: Practice Guidelines for Aotearoa New Zealand, March 2008 (generally called the Massey Guidelines(.

It was developed for ACC by a research team from Massey University’s School of Psychology (Turitea Campus( and purports to describe best-practice guidelines for professionals from all disciplines providing therapeutic services to people who have experienced sexual abuse.

ACC’s October 2009 press release said, “[t]hese guidelines represent a significant landmark in the treatment of mental injury resulting from sexual abuse, because they’re developed by New Zealanders for New Zealanders; are evidence-based; and the product of four years’ extensive research and consultation.”

The Massey Guidelines declare that over 700 effects of sexual abuse have been identified, which are believed by counsellors to be reliable indicators of sexual abuse. The document states :

“No single effect can be seen as a trustworthy indicator of sexual abuse. Since effects never occur in isolation, it is useful to consider them in terms of what effects are more likely to co-occur.”

‘Effects’ present as ‘clusters’. If ‘pairs of effects’ had been specified, it would mean sets of two. However, the term ‘clusters’ means a group of three or more.

How skilled would counsellors need to be, to be able to determine retrospectively from ‘clusters of effects’ whether the client experienced sexual abuse? A reliable test would be to calculate the permutations to establish how big the task might be.

In the Massey Guidelines, no required order of choice of any single ‘effect’ is evident, and repeatability of any item is allowed (for example,’depression’ could appear in none, any, many or all clusters(. Under these conditions, the permutation formula to calculate the number of clusters is nPr, where n = 700 and r = 3, 4, 5…x, depending on how many effects make up a ‘cluster’.

Suppose any four effects are simultaneously presented as a cluster, then r = 4. The number of different ‘clusters’ able to be presented by a single client, and which the counsellor must be able to recognise, is therefore 7004 raised to the power of 4. That is, 238,047,385,800 possible clusters.

Full knowledge and awareness of that vast number of clusters is beyond ordinary human capacity. Counsellors would also need the ability, resources and authority to externally investigate each cluster and its individual components to ensure – before making treatment decisions – that the sole causewas in fact sexual abuse and not some other event or trauma in the client’s life.

The Guidelines say that for practical purposes in writing the document, the number of effects was conveniently reduced to 200! The number of possible clusters is consequently reduced. With just 200 effects presented in random clusters of four, a mere 1,552,438,800 clusters could exist.

Belief in the utility and reliability of these ‘clusters’ allows counsellors to assert that virtually any human behaviour is caused directly by sexual abuse, and conveniently removes the need for any other form of evidence of abuse.

Debate about the sex abuse industry is one about belief vs evidence. ACC supports the quaint notion of 700 ‘effects’ and believes mental injury is caused by sexual abuse which can be diagnosed from client behaviour alone. But no syndrome yet exists. Besides, counsellors and ACC fail to demand testable evidence of claimed sexual abuse.

I conclude the sex abuse industry is an ideological house of cards, based on myth, assumption and belief, and that ACC and sex abuse counsellors fail to meet legislative obligations. Moreover, every sexual abuse claim submitted to ACC without proper evidence of abuse and mental injury, constitutes a case of improperly using a document to obtain money, services and/or advantage.

Gordon Waugh is a retired Air Force officer with over 30 years of electronics engineering experience. He was a foundation and executive member of Casualties Of Sexual Allegations (COSA), a national organisation dedicated to helping men and their families damaged by false allegations of sexual abuse.

Hokum Locum

Debunking debriefing

It has become a cliché that whenever something bad happens, a horde of counsellors descend on the survivors to make their lives a misery. It’s true. Counselling does make you more sick compared to doing nothing.

A child is run over and killed. Instead of teachers and parents rallying around and doing what they have done for hundreds of years, ‘professionals’ are now called in to make things worse. In a study, survivors were randomly allocated to “emotional ventilation debriefing” (whatever that is), educational debriefing or nothing and were followed up at two weeks, six weeks and six months. The only difference in outcome was that at six months the first group had significantly more emotional distress.

Not only are these forms of counselling useless they are harmful and the relevant authorities should face up to this by not inflicting it on people. People have always coped with death and disaster and feelings naturally settle with time. Ordinary people underestimate their own ability to just be there for their friends and family and support them. No fancy talk is necessary. bjp.rcpsych.org/cgi/content/abstract/189/2/150

More on Placebos

It can easily be argued that the history of complementary and alternative medicine (CAM) is intimately involved with the history of the placebo effect. The placebo effect is also intimately involved with the practice of medicine although attempts are made to control for it.

The placebo effect is poorly understood, even by doctors, and if you interview specialists they generally discount the placebo effect in their own specialty and attribute it to their colleagues in other specialties. Orthopaedic surgery is rife with placebo procedures such as arthroscopic washout of arthritic knees. At least two good trials have shown that it is worthless yet orthopaedic surgeons continue to inflict this useless procedure on their patients. I confronted one such specialist and he argued that “in my experience it makes the knee feel better.” This is the typical feeble appeal to authority which is the lowest and most contemptible form of evidence. This refusal to accept the evidence is not unusual and in the past other placebo operations have been performed for years until such time as there is a critical mass of peers crying stop.

With respect to homeopathy, there are wide variations in the results of placebo controlled trials because, as someone put it, not all placebos are equal. One wag suggested that “double strength placebos” were needed.

In an interesting study subjects were given placebo analgesia and subjected to painful stimuli. The painful stimuli were then surreptitiously reduced to make the analgesia appear even more effective. This enhanced learned response lasted up to seven days and the authors concluded that this effect “may explain the large variability of the placebo responses that is found in many studies.”

My conclusion from all of this is that my own profession fails to use the placebo effect in a positive way. It is viewed instead as a nuisance to be controlled or minimised. The CAM industry has shown no such reluctance and the placebo effect is behind most of these treatments. Perhaps this explains the public fascination with quackery?

www.chaser.com.au/index.php?option=com_content&task=view&id=1182&Itemid=26

Medical Journal of Australia Vol 179 18 Aug 2003

Pain Vol 24 Issues 1-2, Sep 2005 Pg126-133

Traditional Chinese Medicine (TCM)

Advocates of TCM argue that it cannot be evaluated by clinical trials because TCM has a different philosophical basis to western medicine. This is a typical argument known as the ‘plea for special dispensation’ and is a hallmark of quackery.

TCM evolved in China in the same manner as western medicine under the teachings of Galen. Authoritative teachings were gospel and anyone who dissented was criticised. In many respects this process has some of the features of a religion where beliefs are more important than scientific facts.

Galen solved the problem of the circulation of the blood by proposing that blood got from one side of the heart to the other through tiny pores in the heart. No one was ever able to demonstrate these pores but it was taken as fact. When Harvey described what actually happened in the circulation of the blood (ie arteries to capillaries to veins and back again) based on his anatomical studies he was treated as a heretic. TCM is a placebo-based philosophy and every time there is a scandal such as herbs adulterated with western drugs, for example Viagra and steroids, this strengthens the argument that such products and practices should be banned as being consumer fraud.

Occupational Health Delusions

Unhappy people in boring jobs can escape their stressful situation by attributing some mythical illness to the workplace. This entitles them to compensation from ACC. Many such people become extremely litigious and unpleasant if there is any suggestion that their illness is psychosomatic. Complaints and symptoms are out of all proportion to any evidence of an actual injury.

A recurring theme in the occupational health literature is the statement that “psychological factors might be important.” There is seldom any suggestion that a condition has nothing to do with work. Conditions such as railway spine and miners’ nystagmus were compensated when we now know that these conditions were a delusion, a folie a deux between plaintiffs and their gullible doctors.

Sick building syndrome (SBS) is a modern example of this delusional thinking. I recall an earlier study where symptoms bore no relationship with building ventilation. This experiment involved varying the ventilation rate without the workers’ knowledge. If the air was being changed at a very high rate there should have been a corresponding drop in symptoms.

Another recent study has found “symptoms of SBS are more strongly associated with job demands, workload, social stressors, and support at work than with the physical environment.” Occupational and Environmental Medicine 2006;63:283-289

More on Goji Juice

I revisited the goji juice site www.best-goji-juice.com and decided to investigate Dr Earl Mindell. He has a legitimate Bachelor’s degree from the University of North Dakota and a PhD from a diploma mill, the University of Beverly Hills. Quackwatch has some good information about his vitamin industry and the goji juice industry is a good example of multilevel marketing similar to Amway. Has anybody tried the stuff? I would be interested to hear.

The ideal marriage?

Consider an iridologist married to a reflexologist. The iridologist can look into her partner’s eyes and tell him what’s wrong with his feet. The reflexologist can look at her feet and tell her what’s wrong with her eyes. Many thanks to whoever it was who passed that on at the conference and thanks to Dr Keith Davidson for passing on a half page advertisement devoted to reflexology from the Christchurch Press, 26 September. It’s clearly a growth industry with their own website www.reflexology.org.nz. You can train at a reflexology school or even gain a diploma from the Canterbury College of Natural Medicine.

“Treatment” for suffering just creates the disease

For those of us who learnt of the tragedy through the media, the anguish and grief of the family who lost their two youngest children in the icy depths of Lake Wakatipu is painful even to imagine. We know their lives will never be the same again. So it was comforting to read that the people of Glenorchy are doing what close-knit communities always do in times of adversity.

“The 111 call on Friday night, made by the children’s father, Stefan Poplawski, brought not just the emergency services to Greenstone Elfin Bay Station, but scores of local residents – by boat, car and helicopter. Some came to assist the commercial divers attempting to retrieve the lost children … others came to give whatever comfort they could.”

A police officer reported that the community had rallied protectively around the family, so we can be confident that the sensible, good-hearted people of Glenorchy are giving the bereaved family the comfort and practical assistance they need. The school mates of the Poplawski children are not so lucky. They’re being offered counselling.

Why? Sure, the accident was a terrible tragedy, but tragedies are nothing new and neither is the suffering they cause.

Throughout human history, people – both adults and children – have shown themselves to be remarkably resilient. Whenever and wherever tragedy strikes there is always strength and solace to be found in adversity. What is new in our modern world is the propensity of mental health practitioners to pathologise ordinary human suffering. These so-called experts want us to believe that suffering is no longer part of the human condition; these days suffering is a disease in need of treatment. A whole industry has grown up around this belief. Now, when adversity strikes, ACC-funded trauma counsellors descend on the unfortunate community in droves. And here’s the rub: trauma counselling doesn’t work. In fact, trauma counselling does more harm than good.

There have now been over a dozen controlled trials in which people involved in accidents and other traumas were randomly allocated to receive or not receive counselling. The results showed conclusively that counselling immediately after a traumatic event does not work. Those who received it were no better emotionally than those who did not. Worse, the better studies with longer follow-ups showed that receiving such counselling increased the rate of later psychological problems. The group that seemed to be harmed most by this were those who were particularly upset at the time – exactly those who you might think ought to be treated. So immediate post-trauma counselling may help us feel that something is being done, but it doesn’t help those who receive it. The fundamental problem with trauma counselling seems to be that asking anyone to talk to a complete stranger about their feelings while they are still raw with pain just makes things worse.

For most mentally healthy people – including the children of Glenorchy – not talking about it is often the most appropriate immediate response to a disaster. No doubt, in their own good time, the kids will talk about the tragedy as little or as much as they want with their family and friends and teachers, for these are the people who know them best, and who know best what support they need and when they need it. Of course they will be anxious for a while, and in need of comfort. But, as always, there will be chores to be done, lessons to be learned, sports to be played. Day by day, life does indeed go on. These children don’t need counselling. As they learn to cope with adversity they’ve already got the best role models any child could have – the courageous and compassionate adults in their own community.

Originally published in the Otago Daily Times, 15 September 2005.