Non-strategic ignorance
Considering the potential for a paradigm shift in evidence-based mental health
Bibliographic Data
| ID | 4217986 |
|---|---|
| Authors | Susan Mcpherson (0000-0002-9478-9932, University of Essex, corresponding author), Felicitas Rost (0000-0002-7250-9434, The Tavistock and Portman NHS Foundation Trust), Sukhjit Sidhu (University of Essex), Maxine Dennis (The Tavistock and Portman NHS Foundation Trust) |
| Year | 2020 |
| Volume | 24 |
| Issue | 1 |
| Pages | 3-20 |
| Publication date | 2020-01-01 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Health An Interdisciplinary Journal for the Social Study of Health Illness and Medicine (JOURNAL) |
| Journal identifiers | ISSN: 1363-4593 • E-ISSN: 1461-7196 |
| Publisher | SAGE Publications Inc (PUBLISHER) |
| DOI | 10.1177/1363459318785720 |
| PMID | 29972085 |
| OpenAlex | W2810581443 |
| Language | EN |
| Citations received | 4 |
| References cited | 22 |
Randomised controlled trials form a central building block within the prevailing evidence-based mental health paradigm. Both methodology and paradigm have been widely problematised since their emergence in the mid-late twentieth century. We draw on the concept of 'strategic ignorance' to understand why the paradigm still prevails. We present focus group data gathered from 37 participants (service users, public, carers, general practitioners, commissioners) concerning the way they made sense of a randomised controlled trial of psychotherapy for treatment-resistant depression. Thematic analysis of the findings revealed an overall critique of randomised controlled trial methods which we refer to as 'non-strategic ignorance'. Specifically, participants problematised the construct of depression, unseating the premise of the randomised controlled trial; they were sceptical about the purpose and highlighted its failure to show how therapy works or who might benefit; the randomised controlled trial was seen as inadequate for informing decisions about how to select a therapy. Participants assumed the treatment would be cost-effective given the client group and nature of the therapy, irrespective of any randomised controlled trial findings. Each area of lay ('non-strategic') critique has an analogous form within the methodological expert domain. We argue that 'expert' critiques have generally failed to have paradigmatic impact because they represent strategic ignorance. Yet parallel non-strategic critiques have common sense appeal, highlighting the potential power of lay voices. The discussion considers whether the evidence-based mental health paradigm is faced with epistemological problems of such complexity that the conditions exist for a new paradigm in which service user views are central and randomised controlled trials peripheral
Epistemology · Ignorance · Mental health · Paradigm shift · Political science · Premise · Psychotherapist · Qualitative research · Randomized controlled trial · Skepticism · Social science · Sociology · Thematic analysis · Law · Medicine · Mental Health and Patient Involvement · Mental Health and Psychiatry · Psychology · Schizophrenia research and treatment · Social Psychology · Surgery
Initial Severity and Antidepressant Benefits
Comparative Studies of Psychotherapies
The place of clinical trials in the development of psychopharmacology
Beware Zombies and Unicorns
Profitable failure
Using thematic analysis in psychology
We Have Never Been Modern
A meta-analysis of outcome studies comparing bona fide psychotherapies
| Unique citing works | 4 |
|---|---|
| Citations per year | 1.33 |
| Citation span | 2023 - 2026 (4) |
| Citation velocity | current |
| Highly cited | No |
| Citation types | Neutral: 2 |