Philosophy and Core Values
THE NEEDS OF THE CLIENT COME FIRST
The Illawarra Anxiety Clinic adopts the values of the Mayo Clinic where Dr. Deacon trained as a postdoctoral fellow. Chief among these is "the needs of the client come first.” He emphasises respect, autonomy, collaboration, transparency, and a commitment to offer clients the most effective approach available for their issues in an environment of shared decision-making. His approach is active, present-focused, straightforward, efficient, practical, and emphasises behaviour change. He believes in "doing therapy," not just "talking therapy." Dr. Deacon views psychological problems like depression and anxiety as able to be fully overcome, not chronic illnesses to be managed over the long-term, and works with clients to become their own therapist and acquire the knowledge, skills, and confidence to overcome their struggles and reach their full potential.
MENTAL HEALTH PRACTICE SHOULD BE SCIENCE-BASED
Dr. Deacon has strong scientific values. His rigorous training, years of experience as a professor and practitioner, and extensive scientific knowledge enable him to provide the most effective therapy available to his clients in a manner informed by current best-practice science-based guidelines. In addition, Dr. Deacon is critical of pseudoscientific ideas and practices that can harm clients; waste their time, money, and effort; and reduce the credibility of mental health professions including clinical psychology. Dr. Deacon's clients can rest assured that they will receive scientifically credible therapy and will not be exposed to the potential harms of pseudoscientific practices which, unfortunately, are commonplace in the mental health system.
PROBLEMS OF THINKING, FEELING, AND BEHAVING ARE NOT MEDICAL DISEASES
Dr. Deacon rejects the idea that problems of thinking, feeling, and behaving are medical illnesses or diseases. Although biological factors like genes and brain structure and function play an important role in our psychological experience, there is no reliable scientific evidence that biological abnormalities are a major cause of "mental disorders" like major depression, schizophrenia, bipolar disorder, anxiety disorders, ADHD, eating disorders, or addictions. There are many biological correlates of mental health diagnoses, which is not surprising because all psychological phenomena are associated with biological processes (i.e., the mind and brain are connected). However, no disorder of body structure or function has been shown to cause any "mental disorder," or to even be specifically correlated with any mental health problem to a degree that is useful in making a diagnosis. That is why psychological problems are diagnosed with questions and subjective judgment rather than medical tests as with physical diseases.
On occasion, a psychological problem turns out to be caused by physical pathology such as a bacterial infection or genetic mutation. In such cases, the problem is understood to be a medical disease and is no longer classified as a "mental disorder" or treated by mental health professionals. It makes no sense, and is frankly insulting, to diagnose a bona fide medical disease as a "mental disorder."
In summary, there is no known biological pathology for any mental health diagnosis. Popular claims that "mental disorders" are caused by physical pathology, such as the claim depression is caused by a "chemical imbalance in the brain" and the claim that psychiatric drugs "work by rebalancing chemicals in the brain," are scientific myths that can harm those who believe them. It is important for clients to understand this so they are able to make informed choices about their care based on accurate information.
Unfortunately, accurate information can be hard to come by as misleading claims that psychological problems are medical diseases caused by a chemical imbalance are common, even from leading experts, professional organisations, and government agencies. Indeed, such misinformation is often promoted in high-profile "mental health literacy" and "anti-stigma" campaigns. A 10-year study of 3000 people in South Australia found that those with high "mental health literacy," in other words who believed Beyondblue's message that depression is a real medical illness caused by a chemical imbalance, were much more likely to become clinically depressed during the study than those who rejected this view. Ironically, having "poor mental health literacy" appears good for your mental health.
If "mental disorders" are not medical diseases, what are they? In reality, mental health diagnoses like "obsessive-compulsive disorder" and "major depressive disorder" are simply descriptive labels for types of psychological problems. They do not explain the cause of such problems, unlike real medical diseases caused by physical pathology which by definition explain why people experience symptoms. Mental health diagnoses like "social anxiety disorder" are concepts, whereas physical diseases can be directly observed and diagnosed with medical tests. It is thus a mistake to think of "mental disorders" as real biological entities ("things" that people "have," like a cancerous tumour), no different than medical diseases like diabetes, that cause symptoms. Mental health diagnoses don't cause psychological problems, they are psychological problems. A diagnosis of "major depressive disorder" does not explain why a client feels depressed, it simply describes the fact the client feels depressed. This is very different from a diagnosis of diabetes which explains, through a well-understood pathological biological process, why a person has symptoms like weakness and fatigue. Thus, it is easy to see that the popular claim "mental illness is a disease like any other" is both misleading and harmful.
There is no scientific justification for assuming, in the absence of direct medical evidence, that people who experience psychological problems or are diagnosed with a "mental disorder" are medically ill, have a "broken brain" or chemical imbalance," or that their thoughts, feelings, and behaviours are "symptoms" of a literal disease from which they suffer. This is important to understand because people who believe their psychological problems are medical diseases are more pessimistic about improvement, feel like they have less control over their own lives, make less effort to control their behaviour, and believe therapy will be less effective than psychiatric drugs even in cases where science-based therapies are the best available approach. And psychologists and psychiatrists who believe psychological problems are medical diseases have less empathy for their clients and are more pessimistic about the benefits of psychological therapy. People dealing with psychological issues are not sick with a broken brain, their experiences are not symptoms, and they are not fundamentally different from anyone else because psychological struggles are part of the human condition. This reality is empowering to those who accept it, including both clients and therapists.
Moreover, if clients do not have a "broken brain" or "chemical imbalance," they may not necessarily need to take psychiatric drugs to fix it. Drugs can be helpful for some clients, but they do not correct physical pathology (because none exists) and are therefore not necessary in the way insulin is for a person with diabetes. The choice to take a psychiatric drug, as with any intervention, should be based on fully informed consent about its risks and benefits, both alone and relative to alternative evidence-based interventions. Individuals who have been misled by their healthcare provider to believe they need to take psychiatric drugs to correct a chemical imbalance are unable to provide informed consent, cannot engage in shared decision-making about their care, and are at risk for undergoing treatment that may not be in their best interests. Doctors who tell clients that their psychological problems are caused by a chemical imbalance in the brain, and that they need to take psychiatric drugs to correct it, are engaging in unethical practice.
Dr. Deacon is careful to avoid language, causal explanations, and therapeutic approaches that might cause clients to view themselves as abnormal or defective, reduce agency, lower self-efficacy, and cause pessimism about improvement. He has met many clients whose experience in the mental health system tragically transformed what might have been a temporary stress-related period of distress into a chronic and disabling psychological struggle. Often, such individuals were told they have a chemical imbalance in their brain, were taught to view their unwanted thoughts and feelings as "symptoms" of "mental illness" that must be controlled or eliminated, were given diagnoses that altered their identity and invited stigma and discrimination, and were prescribed experimental psychiatric drug cocktails that worsened their psychological wellbeing and physical health. Although such practices are common in the mental health system, a compelling body of scientific research demonstrates that they routinely make clients worse in the longer-term. The Illawarra Anxiety Clinic strives to protect clients from the potential harms of this pseudoscientific biomedical approach. In doing so, we strive to follow the most important ethical principle for healthcare providers: "First, do no harm."
To learn more, check out this special issue of the Behavior Therapist Dr. Deacon commissioned on this topic.
FROM PHILOSOPHY AND VALUES TO OUR THERAPY APPROACH
Along with contemporary psychological theory and science, our philosophy and core values are the basis for our approach to therapy. This collaborative approach emphasises empowering clients with accurate information and useful strategies, an emphasis on fully overcoming and not simply "coping" with anxiety problems, accepting the reality that anxious thoughts and feelings are a universal and inevitable part of life, and making helpful behaviour changes that promote learning valuable lessons and living a more rich and fulfilling life. Learn more..