The Shocking Truth About Pseudoscience in Therapy | Cara Santa Maria

Abhijit: Hey everybody. Welcome back to Rationable conversations. Today we have a very special guest for whom I have been waiting for over two years now we are gonna be talking about the pseudoscience in mental health and therapy.

And a lot more as well. I have a lot to uncover.

Abhijit: Today we have with us Cara Santa maria. Hi. How do you pronounce your name first?

Cara Santa Maria: So I, here in the US I say Cara but I always give a pass to folks for whom Cara is awkward in their languages. So a lot of my British friends, my Australian friends, they might call me Cara.

I have a friend from Rwanda who I think I'm Kira to him

Abhijit: oh, that's a little weird. But yeah, with me, my name is Abhijit and the whole world pronounces it in many different ways, so I know exactly how that is. So Cara it is. Thank you so much for joining us.

Cara Santa Maria: Thanks

Abhijit: And I really wanted to jump in and first, ask you what, you have been up to over the last couple of years. You've been getting your PhD tell us what you've been up to.

Cara Santa Maria: Yeah, so when you first reached out to me when I couldn't join you, it's because I was finishing my PhD in clinical psychology, which means I would've been in my internship year, which is a full-time placement where you're doing the work of a psychologist, but you're doing it under a psychologist's license 'cause you don't yet have your doctorate and you're not yet licensed.

So I would've been in my internship year and also defending my dissertation at the same time. They really like to stick it to you with a PhD in psychology. And then after that, I would've been completing a postdoc or a fellowship. Different places used different terminology, and as soon as I finished that, which was this last march, then it was the process of getting my license.

Steps to take the exams that are necessary to submit all of the paperwork. now I'm in this funny place where I'm waiting to start my new job. I'm going through the credentialing process at the hospital. Where I'll be coming on as a licensed, finally clinical psychologist.

working in a cancer center

Abhijit: That is so amazing. And I've been listening to you and you are one of the rogues on the skeptics Guide to the Universe. And you've been on there for like over a decade now.

Cara Santa Maria: Yeah, I've been doing my show. I've been doing Talk Nerdy, which is my podcast for one year longer, and I think we're in our 11th, maybe even into our 12th year now for talk Nerdy, so made 11 or close to 11 for SGU.

Abhijit: So I'm gonna be including links of course, in the description for both of these podcasts. They are fantastic. In fact, I've been listening to the SGU since around 2010.

Cara Santa Maria: And

Abhijit: I started listening to your,

Cara Santa Maria: they've been around since 2004. They're one of the first podcasts.

Abhijit: Yeah. I was, listening to a lot of their stuff and catching up on it over the years, and it was so amazing.

Cara Santa Maria: I met you. I met Evan, I met Jay. So it's just it's been an absolutely, this last cyclone that I came to was fantastic, and I think it's probably one of the last that will happen, and definitely one of the last that I'll attend. There's a lot of controversy over there, of course, We'll see what happens there. I misspoke before they started in 2005it's 2025 now. They've been on the air for 20 years.

Abhijit: It's insane. Amazing. Absolutely amazing. I have been really going in depth into the topic of mental health because a couple of years ago, I think in 2023, I got diagnosed with A DHD.

And and I'm like 40. I was 43 at the time, and it blew my mind. It completely changed my entire perspective on life. with that profound realization came a passion for looking into mental healthcare and seeing how it's being addressed in India. It is an absolutely abysmal situation. There's nowhere close to enough care for the population that we have, which is significant.

It's over almost one and a half billion people now. I've been wanting to talk to you as a skeptic in general because you've been a science communicator for most of your career. I'm just starting out, but I really wanted to get into the mental health side of things with you a couple of weeks ago in the last episode of my podcast, I interviewed Jonathan Steer from Calgary.

Oh yeah. have you met him or worked with him

Cara Santa Maria: Yeah. and I think he wrote, a blurb for the book that I co-edited with Steven Hupp. I know that they worked together quite a lot and I may have done a blurb on Jonathan's book too, I can't remember. But yeah, we all run.

Similar professional circles for sure.

Abhijit: Yeah. So that was a fantastic conversation that he had, so I want to lead off from there. it doesn't matter that you haven't listened to it, it's fine. I had a fantastic conversation and I'm listening to his audiobook right now, as I'm driving into the mountains.

So I wanted to start off with, first of all, I've been looking at a summarization of your book in a way. Thanks to chat GPT. It's not plagiarism if it's chat GPT. So there's something there's a term that he, that it used called brain spotting. What exactly is that?

Cara Santa Maria: When do they talk about brain spotting?

Abhijit: I don't have much context because I was looking at a,

Cara Santa Maria: and you're talking about the pseudoscience book?

Abhijit: Yes. pseudoscience in therapy.

Cara Santa Maria: Yeah. That's a tough one. just to clarify, Stephen Hup, who is a psychologist and I, co-edited this book, we invited a bunch of subject matter experts to write chapters for their. Different areas, and then we clarified things, cleaned them up and put them together in a volume that we thought would make sense and the way that we chose to do the order of the chapters. tracks a little bit with the DSM, so we were interested in talking about different clusters of diagnoses.

So there's a depression chapter, there's a bipolar chapter, there's an obsessions and compulsions chapter. Chapter on pain, Trauma, a chapter on sleep disorders personality ticks, inattention, and hyperactivity. So there's a whole chapter right there for you. But I wrote the intro chapter called thinking Critically about Therapy, and I think Stephen might've done, yeah, he did a post script that includes skepticism resources.

Abhijit: And while you're looking that up, I always plug this whenever I possibly can. I wrote a book a couple of years ago. Ghost wrote though. It's under somebody else's name. It's on Amazon called what was it, In Your Corner.

So it was basically, it's 10 short stories that I wrote on. Teenagers who have been going through mental health difficulties and issues like depression. A DHD obsessive compulsive, and a variety of others including anxiety, self-harm, stuff like that. And did a lot of research and also got a lot of.

Try to bust as many myths as possible in the process But it was so insightful and the research completely fired me up. this all kind of started around 2023 when I was getting into this stuff and I love it.

Cara Santa Maria: Yeah, so brain spot. See, this is why when it comes to pseudoscience, everything is reshared repackaged.

Some new person will discover or invent it, slap a trademark on it and then make a bunch of money. this is a pseudoscience promoted by a psychotherapist named David Grand. He was engaging in EMDR, which is problematic in its own right.

When he was engaging in EMDR, he claimed that the patient when moving their eyes back and forth, would stick their eyes in one location. he asked that patient to keep her gaze there and in doing so, helped her to release her trauma.

later she was better at sports or something like that.

Abhijit: so what is EMDR for me?

Cara Santa Maria: EMDR. So that's a whole other thing. EMDR is eye movement desensitization and reprocessing the. Frustrating thing about EMDR is that it is considered evidence-based by the American Psychological Association, very often people can go to a psychologist or psychotherapist and engage in EMDR, usually for post-traumatic stress disorder, but now it's used for other things.

their insurance might pay for it, or they may not understand that there's very low quality evidence. this is a situation where, yes, EMDR has been tested, but it hasn't really been tested against the standard of care. there's actually, a whole chapter on EMDR in the book.

Gerald Rosen, along with some of his graduate students wrote this chapter on trauma and writes at length about EMDR because it's a hot, trauma therapy Basically, he calls it a purple Hat therapy.

Abhijit: I've heard of those.

Cara Santa Maria: you've heard of it? Okay. Yeah. So the idea would be. Let's say that you were, and this is not the therapy, this is an analogy. Let's say that you were really afraid of driving over a bridge. Like you had a pretty intense phobia that anytime you drove on a bridge, like over water, that the bridge was gonna break and you were gonna fall in.

And so I worked with you at length doing all sorts of evidence-based therapeutic techniques to get you to a place where you started to feel more and more comfortable driving over a bridge. And eventually you were able to do it without your anxiety going through the roof. And then let's say I handed you a purple hat and I said, if you wear this purple hat, you'll be safe when you go over the bridge and then you drove over the bridge and you are safe.

EMDR is like saying that the purple hat is the reason that you went over the bridge without anxiety and not all of the therapy that you did. Because very often, when people engage in eye movement, desensitization and reprocessing, they're moving their eyes back and forth.

But they're doing it while they're engaging in trauma-informed therapy. Okay.

the claim is that moving your eyes helps the brain process these memories and reduce their emotional intensity.

But really, any form of distraction might help you talk about something difficult without focusing all of your energy and attention on it.

there's nothing special about moving your eyes back and forth really quick. the main ingredient, right? The thing that is actually helping people who engage in EMDR therapy is the therapy itself. It's talking about their trauma with their psychotherapist and learning how to talk about it without re-experiencing it.

Abhijit: So in a way it's like giving a homeopathic medicine along with a real medicine.

Cara Santa Maria: Yeah. And I think that's why it's been so hard to tease it apart. It's been, not that it's been hard to debunk, it is pretty well debunked, but I think the reason it sticks around so much is because if somebody was getting better with their real medicine.

And they were also doing their homeopathy. They very often might fall into some cognitive biases that tell them, oh, just to be safe, I should keep doing this.

Abhijit: Absolutely.

Cara Santa Maria: That's the real problem, right? It's when people take the real medicine, but then they also do the folk remedies and give all of the credit to the folk remedy when really it was the medicine that helped them.

Abhijit: Absolutely. I have plenty of family members and friends who swear by homeopathy, even though they've been taking regular medication or therapy They always give all the credit to the alternative medicine. Somehow and they Oh yeah.

Swear that it's made work. That it's works. It's it's quite interesting. And that it's also happening in mental health. I see a lot too.

Cara Santa Maria: Yeah, it does. And I see it a lot too, with things that resolve on their own. Like my favorite example is a ty. it's like a little pimple almost on your eyelid.

Abhijit: Yeah.

Cara Santa Maria: And when people get sty, there are all sorts of folk remedies, right? Put a tea bag on it, put a gold ring over your eye. And when you ask people. What does that do? Like why would you do that? They're like, I swear I had a sty. I put a tea bag over it and in five, six days it was gone.

And I'm like, 'cause that's how long it takes for one to just go away on own.

Abhijit: Exactly. It's like the whole cold thing. If you don't take medicine, it might take seven days to go away, but you take medication and it'll just take a week.

Cara Santa Maria: That's so good. so back to brain spotting. apparently this is just like an even narrower focus.

I found a good quote online actually in a science-based medicine article that Steve Novella wrote earlier this year.

Abhijit: Yeah.

Cara Santa Maria: Brain spotting makes use of this natural phenomenon through its use of relevant eye positions. This helps the brain spotted therapist locate. Focus process and release a wide range of emotionally and bodily based conditions.

Brain spotting is also a brain-based tool to support the therapy relationship. We believe that brain spotting taps into and harnesses the body's natural self scanning, self-healing ability. When a brain spot is stimulated, the deep brain appears to reflexively signal the therapist that the source of the problem has been found.

But here's the thing, when you just stare into a particular direction, there's no anatomical link between your eye gaze and like some. Part of your brain where trauma is low. This is like phonology.

Abhijit: Exactly. And it sounds for people like us and you especially, you've been in the skeptical movement for a very long period

we can tell these little terms that they use that put up little red flags. It's so subliminal now that, yeah, I'm trying to figure out what exactly where the words were, but yeah, it doesn't sound like it's really a real thing, I can understand why people would be drawn into it and giving it some form of credit for working, or at least wanting to try it out.

Cara Santa Maria: Yeah. It uses all the right words. It talks about, neural processing and plasticity. And sometimes it's hard for people to accept that, when we're dealing with mental health issues, there are some diagnoses for which medication is a boon, right? For which medication can be night or day for some patients.

I myself have been diagnosed with. major depressive disorder, but more likely persistent depressive disorder. I think that's a better fit for my diagnosis. which used to be called dysthymia, and I take Prozac every day before I took Prozac, I just white knuckled this.

And after Prozac. It's incredibly different. my depression is really well managed. That said, I still speak to a therapist and I myself am always working to learn my own tools. I am a therapist now as well but therapists need therapists too, On developing my own tools to help manage my depression and to help with emotion regulation and coping.

I think it's hard for a lot of people to accept that talking to somebody. and engaging in evidence-based Therapeutic approaches is incredibly healing. There are a lot of tools that we can learn By talking, we can learn them by listening. We can learn them by doing homework, engaging in different sort of cognitive behavioral approaches.

I think a lot of times people want there to be a quick fix or they want there to be a sheen to the therapy, right? Like a program that you can pay for or kind of fancy words that make it sound more legitimate. When actually, the irony is that those drummed up and fancy approaches that sound really legitimate are often less legitimate than the ones that don't require.

The verbiage.

Abhijit: Yeah, exactly. speaking of therapy and psychotherapy, I was speaking to Jonathan Sta and we were discussing all the things in the wellness industry, which try to hijack mental health issues. and get patients away from therapy and into their industry.

But I was wondering, since I haven't read your book, because I have ADHD, sorry. are these any forms of pseudoscience that are prevalent between the therapist and the patient?

Cara Santa Maria: I think EMDR is a great example. It's accepted by the A PA.

A lot of trauma informed therapists use EMDR. But it's a problematic approach because it doesn't work. And most of the studies that show that it does work are low quality studies where they don't have controls. that opens up another conversation about how we test mental health treatments.

A lot of people expect mental health, treatment science to be as robust as drug trials, and it's very hard to do that. So you often end up with gold standard treatments in psychology or in the mental health field being the treatments that just happen to be the easiest ones to test. there is a lot between the therapist and the client that is both art and science.

And I often hear physicians say the same thing. Like medicine. Very similar to psychotherapy is evidence based, right? If you're going to be dispensing a medication, you're going to want to make sure that the dosages are within the appropriate range for your patients. That the drug interactions have been well researched and vetted, and that you're treating a appropriate.

Let's say disorder or diagnosis based on the symptoms that tell you that you have that diagnosis, right? And all those things are similar in psychotherapy as well. But then there is the art component, right? Some people react differently to different drugs or do I wanna start this person on a lower dose and ramp up?

Or is this person based on these things that they're telling me their fear gonna get in the way? Are they treatment resistant? Are they good about taking their medications Some patients aren't ready to dive into certain approaches right at the beginning.

Some patients require a lot more validation than other patients, but there are some central ingredients that pretty much all therapists agree is necessary for psychotherapy to work. And there are ethical principles that guide that as well. Whether somebody is using pseudoscience within the therapeutic context I'm sure it happens all the time.

And sadly, because psychotherapy is different than psycho pharmacy, right? It's, it is talk therapy. There's a lot more room for that, a lot more latitude.

Abhijit: Yeah. I've heard aboutthese things being seriously discussed. let's do a quick. Rapid fire around and then we can dive deeper into each one if necessary.

I'm just gonna name a few of these interventions and you can let me know if they're okay. Fake or real? scientific fiction. We'll see if I know. Alright hypnosis.

Cara Santa Maria: Hypnosis is fake. I think there are aspects of relaxation therapy that are real, but hypnosis the way that you and I would think of it, like you're getting very sleepy and now you're gonna bark like a dog.

that's totally fake.

Abhijit: but there's a lot of hypnosis that's used, to combat addiction behavior and addiction disorders, et cetera.

Cara Santa Maria: I wish that there was another term that some of those practitioners would use, Like relaxation therapy for addiction.

Because I think if there's a claim that somebody is getting into your subconscious and helping you or causing you to no longer be a smoker because they're sending you subliminal messages, that's abject pseudoscience, There is some pretty good evidence that, whether we're talking about mindfulness, meditation, or just relaxation, can be exceedingly beneficial for emotion regulation and for helping people combat things like cravings and for helping people gain insight into why they choose the behaviors that they choose.

depending on the addiction, whether there's a strong physiologic addiction or whether the addiction has more psychological components. I think some people could quit, smoking for example.

Abhijit: If

Cara Santa Maria: they engage in relaxation therapy with a psychotherapist, that helps them dig deep into, why they're still smoking when they don't want to be.

But no, you're not gonna be in some half awake state where I send you subliminal messages. Move a clock in front of your eyes and when you wake up you just move up craving something, you'll not anymore.

Abhijit: Yeah, that's

Cara Santa Maria: not real.

Abhijit: that leads into my next one, which is meditation.

Cara Santa Maria: meditation is a tough one.

Like on the Skeptics Guide podcast, you might hear Steve and I have nuanced conversations about meditation. part of the problem with meditation is that it's just a broad term and it's not a regulated term. And so there are mindfulness-based meditation techniques that are utilized in psychotherapy

different orientations of psychotherapy claim them differently. cognitive behavioral therapists might say we developed mindfulness based meditation. Like existentialists will be like no. We use it all the time. And depending on how it's done, and depending on the desired outcomes, it can be incredibly.

there are good quality studies showing positive outcomes with very narrow focuses of mindfulness based meditation. The neuroscience is really interesting because it does seem to quiet the default mode network, which is activated when our minds wander.

expert meditators or people who have been meditating for a long time, especially mindfulness based meditation in an FMRI scanner, their default mode networks are much quieter and they can quiet them much more quickly.

So that shows that they are less apt to distraction and to mind wandering. They're able to bring in their focus more quickly. Now that's a really interesting finding, right? Does that mean that if you meditate, it's gonna help you with your trauma? Not necessarily. And actually, I find that mindfulness-based meditation that focuses on the breath is.

Deeply calming for me. But I have friends and patients who have anxiety and when they feel panicky, their breath becomes a trigger point for them. Thinking about their breathing makes them panic more, and so I would never recommend engaging in that type of meditation for somebody who is triggered by focusing on their breath.

Abhijit: I remember one of the conversations that was happening on the SGU where Steven said meditation is anything that you're doing with attention, focusing on one thing. So it could be gaming, reading, certain forms of exercise as well, which could be meditative in their effect.

do you think that's true?

Cara Santa Maria: I think that can be meditative, but I also agree with him because the definitions are wiggly. This is an operational definition problem. I think gaming can be meditative.

I think that, coloring can be meditative, and I think that all of those things can be deeply beneficial. I love knitting. It helps me focus on something and it gives my hand something to do, and I find it's very good for anxiety reduction a lot of peoplesay they like to engage in very focused activities for that reason.

I think that. One of the active ingredients in mindfulness-based meditation, which is not elicited in, let's say gaming or even knitting, is the intentionality that comes when you recognize that your mind has started to wander and you bring it back to your anchor point. that's the practice of mindfulness based meditation.

It's sitting quietly. Thinking about your breathing in and out, or thinking about a tone a bell, whatever it is, it's having an anchor point and then doing what human beings do, which is. Your mind starts to water it. It always happens, right? Yeah, exactly. The goal is to not think. The goal is to recognize when you start thinking about other things and redirect your attention back, and then it's gonna happen again and redirect it back, and that's a very specific.

Practice that's not elicited in those other approaches. And that's why I disagree with him as well. When he says a lot of the studies show that it's no different than just relaxation. yes, that is true, but you have to ask yourself what are the independent and what are the dependent variables in those studies?

A lot of people are gonna feel calmer after any type of relaxation experience, whether it's mindfulness based meditation. sitting in a quiet room getting a massage or listening to soothing music. Yeah, it's gonna help all of us calm down, and it might help us with our anxiety and the numbers might look the same, but when we're specifically looking for the outcomes that come from mindfulness based meditation, very often it has more to do with attention and regulation.

So in that one narrow way, I do think that mindfulness based meditation is different from what we might just generically call meditating.

Abhijit: That is very interesting. In fact, I first understood meditation thanks to Sam Harris in his book Waking Up. as part of the promotion for the book, he released two MP three files of him guiding you through a meditation.

One, I think was like nine minutes long. One was about 20 minutes long, and I used those to meditate and it helped me tremendously. when my therapist started telling me to start meditating, I was like, yeah, I can do that. now I find that I don't meditate all the time, but when I'm having trouble getting to sleep, I first try my breath, and if that doesn't work, I use white noise as the anchor point.

And I'm out in five minutes.

Cara Santa Maria: .That's great. it is important, for a lot of people when they first start engaging in mindfulness meditation, listening to a guided practice can be really helpful.

Abhijit: Yeah.

Cara Santa Maria: then the hope would be that eventually you might be able to get to an unguided practice where you are just focusing on the breath within a certain amount of time.

But really anything. I keep mentioning the breath. That's not the only way to meditate. Basically anything that involves focusing on the present moment and not judging yourself, right? Being very aware of right now and every time your brain does what it tends to do, which is wander and think about other things.

Bringing it back to the present, whatever your anchor point is in the present, and doing it in a really non-judgmental kind way. It's important because it translates to many. Other aspects of self care being kind to yourself and being able to be present. 'cause for many people when they're struggling with anxiety and depression and some of the other symptoms of mental illness that are not in the severe mental illness kind of bracket, like anti-psychotic mental illnesses very often when we're dealing with depression, anxiety, even trauma. What's happening is that we're having a hard time staying present in the moment, and we're either ruminating about the past, we're replaying things that happened and go, why did I say that? Oh my God, I sounded so stupid if only I had done something differently. If only I had made a different choice.

Or we are catastrophizing about the future. Oh my God, this thing's coming up. Am I gonna be ready? How am I ever gonna get through this? And when we can get

Abhijit: how is preparing for this interview?

Cara Santa Maria: Again, this is a normal human experience, but for folks who struggle with anxiety or depression, sometimes that's turned up to 11 and it becomes so debilitating that it interferes with their everyday lives.

It interferes with your ability to maintain a healthy relationship or get through your work or school. It maybe gets in the way of you sleeping at night. There are a lot of different ways to check the boxes in how we diagnose. mindfulness meditation can be a huge part of helping people manage their anxiety and depression symptoms.

Abhijit: And this kind of leads into another thing I wanted to talk to you about, I was talking to a friend of mine the other day

we've spoken about therapy and going to therapy for, a variety of different things. she told me that she kept mentioning another word along with therapist I think she mentioned energy therapist, spiritual therapist or something of that sort.

Cara Santa Maria: That sounds intense.

Abhijit: I dug deep into that a couple of days ago because I wanted to understand her perspective before I spoke to you about this. She goes to a person who she does breath work with. along with the breath work, there is a long conversation that happens and she counts that as therapy.

firstly, I wanna understand, have you explored at all the implications of breath work in mental health and therapy?

Cara Santa Maria: No, not in a super deep dive way, but I think one of the things implicit in this, question or discussion, is what is the breath work?

What does that actually do? Is it evidence-based? Is it pseudoscientific or is it an appropriate treatment for something? Yeah. The other is this word therapy. The word therapy is not a regulated term, chemotherapy is a type of therapy.

Psychotherapy is a type of therapy and perhaps energy therapy is a type of therapy. All a therapy is a treatment, intended to heal something relieve something or make you feel better. So massage therapy is a type of therapy, but very often if I'm going to a spa to get a massage, I have no expectation that massage.

Is going to heal a mental or physical disorder or injury that I have. I'm going there for relaxation my form of self care because it makes me feel good. And there's nothing wrong with that. The thing where things get dangerous is when people promote different types of therapies as bonafide or evidence-based.

Medical or psychological treatments.

Abhijit: Yeah.

Cara Santa Maria: breath work therapy or energy therapy or reiki therapy is not a bonafide psychotherapeutic treatment. So I never learned about it in school. It's not listed on any evidence-based treatments list.

it doesn't seem to have a mechanism of action. That said, learning how to breathe, and focusing on your breath in meditation can be beneficial. when I work with folks Who have panic disorder,

Learning how to breathe is hugely beneficial, right? I do teach breathing techniques. How do you bring your breath low into your belly, diaphragmatic breathing so you're not breathing shallow in your chest and blowing off too much carbon dioxide and making you lightheaded.

We don't want that when we're feeling anxious. People learn how to breathe in such a way that it doesn't spin their anxiety out of control. But I think that's really different than what most people are claiming when they talk about doing quote breath work.

Abhijit: Because this comes with a term like spiritual response therapy.

Cara Santa Maria: Yeah.

Abhijit: Which kind yeah.

Cara Santa Maria: The minute you start getting into the metaphysical, it can't be scientific anymore, right? by definition, things that are metaphysical don't exist in the natural world, which means we can't use the tools of the natural world to study them. So it's not science anymore.

It is a form of pseudoscience. when I say something is a form of pseudoscience, that doesn't necessarily mean that it's not. Beneficial in some form or another. Pseudoscience just means, it has been proven not to work. And those are the things that we love to focus on.

Books like this one, because why would you engage in something if we've done the research and we know it just doesn't work, but it also includes this. Kind of category of things that have not been proven to work. If we've proven that something doesn't work, it's very different than we just haven't proven that it does work.

some of those things are because that are unethical or difficult to test, and others are because they're not testable. Whether you are actually, I don't know, communing with spirits when you close your eyes. I can't test that. By definition that's, I can't do science with that, so I'm never gonna be able to talk about it scientifically.

And for me, I am an evidence-based practitioner. I'm not interested in engaging with my patients and things that are outside of the realm of of what I would considerreasonable approaches to mental health treatment.

Abhijit: The thing is the mind, even thoughI think of the mind as a part of the brain, emergent property of the brain.

Yeah. And I feel that, but I feel that the differences between physical physical health and ailments is fundamentally different for mental ailments. In the manner that there can be a lot of placebo like effects that can actually be effective in helping regulate someone's mood. For example, with this friend of mine who is going for this breath work and doing spiritual response therapy, and she goes for foot reflexology which is like an acupressure thing. I wonder if those things, are no better than placebo, they are relaxing. would you count that as still beneficial in some way

Cara Santa Maria: It may be beneficial for her mental health, and I think that's why there's a big difference between talking about mental health and talking about mental illness, right?

If somebody is feeling stressed, run down. If they're having a hard time grappling with a decision that they might be making about work or about their family and then they want to engage in spiritual practices yeah, that could be great for their mental health. Is it going to treat a mental illness?

Probably not. It may be something that helps them holistically, feel more well-rounded, feel better about themselves. It may bring them community, it may bring them a sense of purpose. All of those things can promote mental health, I guess I would encourage a conversation around what a placebo actually is, because I do think that we misuse the term placebo a lot.

We love to throw around the term placebo effect, but there actually is no such thing as a placebo effect. What there are specific effects and non-specific effects. So anytime a treatment is given, there are aspects of the outcome variable that are explained by the manipulated variable.

So I give you a drug, you get better. It's very likely that some percentage of your betterness can be explained by the drug I gave you, but it's not gonna be a hundred percent. Some percentage is gonna be the fact that you came to the doctor to get that drug and that you got up and got in the car and you drove and that you saw other people and you spoke to people and you smiled and shook a hand and you maybe started to feel motivated to do other things to improve your, health and wellness.

The drug would account for a bit of that variance, but there will always be a percentage not explained by the drug itself. We don't always have the tools to divvy up all that variance and say 1% is from the twinkle in the doctor's eye and 3% is from the sun shining that day. we can't measure that

When it comes to mental health, the variance is usually a smaller portion that can be explained by the psychotherapeutic treatment because it's not drug therapy, And it's not as straightforward. But there's always some variance, which is why when you take group A and you give them the treatment and you take group B and you give them.

The same treatment, but without the active ingredient, A, a certain percentage of group B feels better. a lot of people try to say that's the placebo effect. That's you willing yourself to be better.

Abhijit: Yeah.

Cara Santa Maria: I think it's better to think about it that is all of the nonspecific effects that work.

We just don't necessarily know how to measure them or even put a name to them sometimes.

Interesting. But it's all those same things I mentioned being enrolled in a study. Having hope showing up. maybe you're eating a little bit better, maybe you're going to sleep earlier at night because you wanna make sure you're refreshed for when you go in for that appointment.

There are all sorts of non-specific effects that could be contributed to your health and wellness, but I think this is one of the best ways to think about it from an ethical perspective. It is illegal and highly unethical. To give somebody a placebo and not tell them, a placebo, or sugar pill, is a drug that doesn't have the active ingredient in it. if you gave that to somebody and said, you're taking a drug that's gonna make you feel better, and then they started to feel better. We know it's because of the non-specific effects, and it's unethical to tell them it's because of a drug.

We're withholding real medicine from them when we do that. it's a huge no-no. in clinical trials. The people who are taking the placebo versus the people who are taking the active ingredient. don't know who is who, and neither do the scientists or physicians who are giving them the drugs because they might act slightly differently and affect the outcome.

Abhijit: Ah,

Cara Santa Maria: we can't say you're getting the drug All we can say is we don't know if this is the drug or the placebo.

Abhijit: Yeah. in some countries we are now having part of the government, knowingly giving people the wrong treatments and expecting things to get better

So you've got RFK Junior. And we've got our Ministry of AYUSH, which is a part of the government. devoted to promoting pseudoscientific treatments. Including naturopathy. Yeah. Yoga, Ayurveda, homeopathy. Unani, which is a Middle Eastern. It's not Middle Eastern.

It's actually Greek, a Greek form of herbal medicine. And Sid, which is a South Indian form of herbal medicine.

Cara Santa Maria: Yeah. And isn't it amazing how much those actions by these individuals in power can be. A bit inscrutable. Why would they wanna be promoting these treatments that we either know don't work, or we don't have good enough evidence to show that they do work?

Why would they be promoting this either instead of, or sometimes parallel with evidence-based treatments? And I believe that a fair amount of explanatory power comes from. Pure unfettered nationalism. It comes from pride in one's nationalistic culture.

Abhijit: Yeah.

Cara Santa Maria: And I think we see this both in the USA, and we see this in India. We invented this thing, this is our way, we are gonna do it different. And because we're doing it that way, we're doing it better. And I think you saw the same thing during the horrible era of Lysenkoism.

Abhijit: Yeah.

Cara Santa Maria: the USSR.

Abhijit: Thousands of people dying. definitely thousands to tens of thousands

Cara Santa Maria: Yeah, because it affected food crop. Like it affected so many things. Let's see how many deaths is Lysenkoism responsible for?

Abhijit: And of course there was,

Cara Santa Maria: probably pretty hard to measure, obviously anything could be an estimation there. Yeah. But massive famine. some people are arguing, the famines themselves, 7 million plus people. Huh.

Abhijit: My God.

Cara Santa Maria: And there were scientists that were executed.

There were indirect deaths. Some people think 15 to 55 million people starved in China. It's, yeah, it's pretty bad. 'cause they adopt a lot of the, those same Lysenko policies. Actually a lot of folks would argue that the great Chinese famine from 59 to 62 was due to Lysenko policies.

Abhijit: And more recently there was this huge famine of sorts, which happened in Sri Lanka. And in fact, I want to talk to Kevin Foer about that. And I first heard Kevin Foer on your show Talk Nerdy. So I'm actually mailing him and we are in touch and trying to figure out case.

Cara Santa Maria: Yeah, he's a great interview and he is really knowledgeable because this is his research and he's in it all day every day.

Abhijit: absolutely fascinating. But unfortunately we have run out of time. I had so much more to ask you. we really need to do part two if you have the time

one thing I do want to touch on before we go which I've been very intrigued about is animal therapy and music therapy. How do animals and music have beneficial effects on people who are going through stuff and who have mental health elements?

Cara Santa Maria: That's the thing again, where there's that art and there's that science. And I think we get into trouble when we try to take the art and push it into the science and do a one size fits all label for everybody. I've seen this when I am. In an academic program, students really interested in engaging in studies around animal therapy, animal assisted therapy, or music therapy or art therapy, for example.

There's not very strong evidence that show that if I sat down with, I don't know a piano. And played music for every single person struggling with OCD, that it would have any impact on their OCD. But I can damn well tell you that I have patience for whom music is exceedingly healing for them.

And I have patience for whom music doesn't really do much. And I think that's the important thing to remember, that a lot of these things, which could be like. additional benefits to individuals on top of their bonafide treatment. They're great. But as a psychologist, I'm not gonna be engaging.

I might recommend you love music. Music helps you relax. Do the things that you love, engage with the things that make you feel calm, that give you a sense of purpose, that help you. Sleep at night that promote all of the aspects of wellness that we know are gonna improve your mental health overall.

But I'm not gonna write a one size fits all prescription and say, everybody needs to go ride a horse today because riding a horse is gonna help you with your autism. it just doesn't work that way. It would be great if it did, and I think a lot of people promote it like it does work that way, but it just doesn't.

Abhijit: They go, because I've got three cats and I've got five bass guitar. But I also go to therapy, right? I also go to therapy and I have a psychiatrist. I'm on medication. Yeah.

Cara Santa Maria: Don't just get yourself another bass. Another cat is not gonna fix all your problems.

Abhijit: That's what I keep about, there's no dose

Cara Santa Maria: response curve

Abhijit: That's what I keep telling myself. But thank you so much. This has been such an intriguing conversation and honestly, this hour has just flown by. we do have to cut it short, but hopefully we can do a part two at some point and we'll coordinate for that. In the meantime, thank you Cara, so much for joining us on the Rationable conversations.

Cara Santa Maria: Thanks for having me.

Abhijit: And thank you everyone for listening. If you like this conversation, please give it a do subscribe to this channel or this podcast. Read it on an Apple. On a on Apple podcasts or whatever platform you're listening to. we are on Patreon at Rationable as well, if you want to support the show in other ways.

thank you all for listening, and thank you so much, Cara, for joining us. Until next time, stay Rationable.