Insomnia, Mental Illness and Logical Fallacies

As an individual that has studied in the STEM fields and actually work in the field, I've always found psychology as a field of study to be underdeveloped as a scientific discipline.  What I mean by this is that, for as long as the field of psychology has been around, it should have more of a solid intellectual and factual foundation that we often see in STEM fields such as physics, chemistry and biology.  Factual foundations that are well proven and supported by evidence often result in the development of technologies and knowledge that actually improve the quality of our lives.  But we don't see this in psychology. Much of psychology is mired in wishful thinking, logical fallacies and unsubstantiated claims.  In itself, this isn't too bad.  New fields of study often have very little information to work with and researchers have to invent ways to investigate poorly understood phenomena, so there's bound to be missteps and lines of investigation that bare no fruit.  It's when such underdeveloped fields are used to influence and dictate policy, which in turn directs the course of research in that field, resulting in the self-perpetuating cycle of the ignorance that I see in psychology that is such a serious problem.  Since psychology has this impact on our lives, we mistakenly treat it as a mature science on the level of STEM fields when it clearly isn't.

This has been a recurring thought for me for many years and a recent article in The Conversation has compelled me to write about where I see the field of psychology going wrong.  The Conversation intends to describe the link between insomnia and mental disorders, even though the cause still isn't clear, and I currently see no way that they can get much closer to the truth because of several logical fallacies being committed.

Questionable Cause (aka: cum hoc ergo propter hoc)

The logical fallacy of questionable cause occurs when somebody concludes that one event causes another event simply because they typically happen or exist together.  As an example, one might look outside and see dark clouds in the sky and rain.  When considering these two events occurring simultaneously, one might conclude that the rain is causing dark clouds to appear. Such a conclusion is obviously absurd.  The phenomenon is understood well enough that even uneducated people know that it's actually the dark clouds causing the rain and not vice versa. Or one fails to consider that both the rain and the dark clouds can share the same root cause (oversaturation of moisture in the air).

It's when the phenomenon isn't well understood, such as depression and insomnia, that we can inadvertently commit the questionable cause fallacy.  In this case, it's has been assumed for decades that insomnia is a symptom of depression and other mental disorders.  Nobody, as far as I can determine, had seriously considered that insomnia might be causing mental illness.

Literature often describes insomnia being comorbid with other mental conditions such as depression, anxiety, attention deficit hyperactivity disorder (ADHD),  post traumatic stress disorder (PTSD) and even bipolar disorder. Also, according to the article:

The relationship between insomnia and mental illness is bidirectional: about 50% of adults with insomnia have a mental health problem, while up to 90% of adults with depression experience sleep problems.

If insomnia is comorbid with mental illness in at least half of the cases, then concluding that mental illness is causing the insomnia, is a textbook case of Questionable Cause.  I can understand the leap in logic.  We often see patients with chronic conditions such as arthritis or acid reflux having difficulty sleeping.  Normal sleep patterns return when the condition is effectively treated or managed.  So I can see that some people might assume that this pattern holds in the case of mental illness.  Except, nobody has ever proved this!  Psychologists assumed that this was true for mental illness as well and ran with it.

It was only until recently that psychologists have begun to question the assumption that insomnia is merely a symptom of mental illness.  According to "The Good Night Study" (Gosling, et al):

The relationship between insomnia and depression has received considerable attention in the past decade. Focus has shifted from the view that insomnia is a symptom, or sequala, of depression to one in which it is conceptualised as a related but not totally dependent phenomenon. Supporting this, insomnia is commonly unresponsive to otherwise successful treatment for depression, being the most common residual symptom following completion of either pharmacological or psychological depression treatment, and the timing of insomnia onset more often than not precedes the onset of a depressive episode.

 As someone who is standing outside looking in, this idea seems obvious to me.  If insomnia is comorbid with other mental disorders, then it's possible that mental illness might be caused by insomnia or that they share a root cause.  This possibility should have been investigated a lot sooner!  Also, consider that we've been raised from the time we were wearing diapers that getting a good night sleep is crucial to good health and well-being--including mental well-being.  Yet, psychology hasn't considered that insomnia could be causing mental disorders until only a decade ago??  Better late than never, I guess, but it shows how the Fallacy of Questionable Cause could allow a paradigm to be established that ends up derailing research in a field that is still seeking good models for mental function.

Appeal to Popularity (aka: Argumentum ad Populum)

The logical fallacy, Appeal to Popularity, is known under several different names--Appeal to Belief, Appeal to Consensus, Appeal to the Masses and the Bandwagon Fallacy.  All of these labels refer to the idea that something must be true because a lot of people say or believe that it's true.

The textbook example of this fallacy was that everybody "knew" that the Earth was the center of the universe and that the sun, the other planets and the stars all orbited the Earth, which was fixed and motionless.  This was known as the Ptolemaic Model of the universe and this model of the universe endured for over a thousand years.  You would think that this was an awfully long time for an idea to endure that was so obviously wrong!  How backwards they must have been!

Except that the wrongness of the Ptolemaic model wasn't obvious at all!  The people that lived in the past didn't arbitrarily pick a theory and threaten all dissenters with death if they disagreed. The model was very successful at making accurate predictions of movements of the sun, moon and planets in the sky for over a millenia.  Rest assured, these predictions were often a matter of life and death.  Older societies often took cues when to sow and harvest their crops based on the locations of the stars, moons and planets.  This model also informed religions about when they should observe certain holidays and holy days.  The Ptolemaic model worked very well as a celestial model and was quite comprehensive for it's time.  There was only one problem: It was wrong! 

The Ptolemaic model of the universe represents a textbook example of a theory that many people believed in because it apparently explained so much about our world, but it still ended up being wrong.  So we can't necessarily assume that a theory is correct based upon its explanatory power. Later, more accurate and precise heliocentric models of the universe faced much resistance exactly because so many people believed in the Ptolemaic model.  For me, the Ptolemaic model is a textbook example of how strong of a headwind the appeal to popularity can have on the advancement of science.

Don't mistakenly assume that the science of today has shrugged off such a prejudice past.  It's hard to believe that with technology making our lives easier and our easy access to information that we still may not understand much about the world.  This is very apparent in the field of psychology. Even today, the mind is very poorly understood beyond the gross anatomy.  It's very much a black box--we don't know how it works beyond receiving and reacting to stimuli and information.  Black boxes should worry any researcher because it becomes too easy to assert a hypothesis as truth and build a whole field of study based on something that hasn't been proven--much like the Ptolemaic model.  It's too easy to commit the Fallacy of Questionable Cause, and yet, this is what the field of psychology has done and it's going to take decades to undo the damage.

The idea that mental illness is causing insomnia and not vice versa isn't just a minority opinion, it's actually dictating the standards of care in the practice of psychology. Recent research attempted to determine if cognitive behavior therapy conducted over the internet (CBT-I) was effective in reducing insomnia and had observed that patients' moods improved according to a recent research article on PubMed:

"If providing an online CBT-I intervention for patients with both insomnia and a comorbid psychological condition can yield improvements in sleep, as well as improvements in mood, this suggests that patients can initiate treatment for insomnia, even in the presence of psychological symptoms of depression or anxiety. That is, patients may not have to wait to seek help for insomnia until their psychological distress is fully resolved. This is of importance given that some clinicians believe patients with insomnia and comorbid psychological symptoms cannot benefit from insomnia treatment until the psychological issue is resolved, particularly if that intervention is conducted online. "

The passage makes it quite clear that the field of psychology regards insomnia as a symptom of mental illness and that it seems to be standard practice--or the practice of a large portion of practicing psychologists--to delay treatment of insomnia in favor of treating the psychological distress.  What justified this approach besides the prejudices of psychologists?

Now that the idea that insomnia can cause mental illness has been raised, the field will start to reevaluate how mental illness is studied and treated, right?

You wish!

Let's consider another logical fallacy.

Appealing to Authority (aka: Argumentum ad Veracundia)

The logical fallacy, Appeal to Authority, refers to an argument that must be true because somebody in authority has said it is true.  This argument is persuasive because people in authority are assumed to have access to knowledge that the rest of us don't have.  Also, many authority figures can be charming and persuasive as well as skilled in their practice.  It's one reason they became authorities to begin with.

When it comes to science, it's important to note that legitimate authorities (not crackpots pretending to be authorities) often are more knowledgeable then the general population in the subjects that they study, practice and do research in, so opinions of authorities in psychology should carry some weight in discussions about the practice of psychology and it's social and political implications. But how can one tell who the authorities are?  One would think that a psychologist is an authority in psychology, right?

Here's an experiment you can try: The next time you visit your doctor, ask him what's the last research article he or she has read and when?  He doesn't have to be a psychologist, he could be another specialist or even your general physician.  Don't even ask him what the article is about.  Just ask him to tell you the title!!!  I'd say 9 out of ten times he wouldn't be able to give you an answer.  It is likely to have been years since he's read any research, assuming he ever did in the first place!!!

This isn't to say that he isn't a legitimate authority on health and medicine.  He still knows more than you.  But he's practicing with knowledge that he acquired during medical school and his residency which may be years to decades out of date!  Of course he's required to take continuing education where he can glean some information on modern developments, but it isn't nearly as rigorous as medical school.  Left to his own devices he may be practicing medicine using science that has been obsolete for decades.

So who is reading all that research and using it to dictate evaluations, diagnosis and treatments?  Well, the authorities are!  Who are they?  They're the different medical associations and government agencies.  They're the ones  that actually evaluate research and create standards of care within their respective fields based on it.

So your doctor isn't getting his knowledge from research journals, he's getting his knowledge from authorities above him (or the reps that are selling drugs or medical devices).  Your doctor is just following a flowchart and using checklists.  He may be very competent at doing this and may even have knowledge of the underlying causes of your problem, but when he's diagnosing and treating you, he's following a flowchart.  Anybody questioning the checklist and standards of care will be greeted with Appeals to Authority.  It's assumed that the authorities are reading all the research and incorporating it into policy and standards of care.  "We treat the mental illness instead of the insomnia, Dr. Smith, because the ABC Association and XYZ Agency recommends it."

So current discoveries in the doctor's specialty won't impact how he practices until the research is evaluated by the authorities above him and enshrined as policy.  That seems to be a pretty straight-forward method of correction except this is where new ideas meet resistance in much the same way as the heliocentric model of the universe encountered resistance from people who had an investment into the Ptolemaic model. And it happens for several different reasons ranging from no-need-to-fix-what-isn't-broken to people thinking that the new paradigm somehow undermines their authority on the subject and end up resisting it solely on principle. 

This resistance is encountered in any field and often explains the observation that science advances one funeral at a time.

Even if a psychologist does read research journals and keep up on current findings, while still finding time to perform his other duties and responsibilities, it's not going to matter much. He must still follow the standard of care set up by the authorities.  So in the case of insomnia and mental illness, he must regard insomnia as the symptom  (it will be specified as such in his checklist for diagnosis) and not a cause, and then select a treatment from a list of approved or recommended treatments by the same authorities to manage a mental disorder that isn't insomnia.  Deviating from these standards too much could be the quickest way to lose his license or get sued for malpractice.  If the worst comes to pass, he can at least say that he followed the standards of care and let the bureaucrats argue about whether it's the right thing to do.

The best scenario in such cases would be for a psychologist to read the research and realize that both cost and the risk of adverse side effects are quite low and try to treat the insomnia in his patient with cognitive behavioral therapy (CBT) in the hope that the symptoms of his mental illness subside.  Then he will concurrently treat the mental illness with the appropriate recommended therapy to keep the authorities happy.  But if the treatment for insomnia does resolve the comorbid disorder, he will have a difficult time convincing anybody of the efficacy of treating insomnia.  "Of course his condition improved, Dr. Smith.  You treated his depression with the recommended therapy and his sleep problems abated."

This is just one example how Appeal to Authority can be detrimental to advances in psychology.  This isn't as much of a problem in other medical and STEM fields (although it can still happen) because outcomes are more easily measurable and the results tend to speak for themselves.  But it's easy to see how logical fallacies can be institutionalized in the field of psychology and retard further advances precisely because so little is known about the brain and the mind.

So what's the point?

We all know that failing or neglecting to treat a condition often makes the condition worse when given enough time.  Perhaps many cases of mental disorders is simply insomnia that has persisted untreated for too long.  Too many of us are living stressful lives.  We check Facebook or play Candy Crush in bed instead of going to sleep.  And it's always rush, rush, RUSH during our waking hours! How long can the mind function normally in the absence of adequate sleep before degradation occurs?  I know that if I miss only a day or two of good sleep, I start getting easily irritated, I lose my temper more easily, I feel disconnected from relationships with other people and my work, I lose hand and eye coordination, etc.  Imagine the state of mind when going months to years without a good night sleep!

Also, let's not forget how this can influence policy when politics get involved.  Consider this:  A child of about grade school age has difficulty sleeping at night for a variety of different reasons.  He wakes up and always comes to school tired.  It becomes difficult for him to pay attention in class.  He's sluggish in recess.  Other children don't want to play with him.  He gets easily agitated and loses his temper over minor things.  He won't sit still. He has emotional outbursts. He fidgets and daydreams.  His grades suffer and the teachers are at the end of their wits.

The child gets referred to a counselor by a school principle or administrator that has incentives from the government to identify children with disabilities so they can petition for government aid.  The child is brought to his first appointment with the counselor by his parents who also have a vested interest in a diagnosis for a mental disability so they can convince themselves that their divorce isn't what's screwing up little Timmy.  The counselor, who is on the government dole, has an incentive to find some type of disorder or disability for the sake of job security.

After an hour meeting with little Timmy, the counselor comes up with a diagnosis of ADHD.  How?  Did the counselor do a brain scan?  A blood test?  No, no.  He used a checklist!!!  It's very probable that all little Timmy needed was a good night sleep!!  But no.  We have a huge bureaucracy with incentives to find things wrong with people, being advised by another group of people that refused to consider insomnia as a cause of mental or behavioral disorders because of the logical fallacies that I've described above.

Has anybody noticed that parents don't seem to be putting their children to bed at reasonable hours like they used to?  I'm seeing parents with toddlers and infants in malls, theaters and restaurants at 9, 10 even 11 o'clock at night, even on weekdays!  Meanwhile, diagnosis of behavioral disorders are skyrocketing, especially among children.  Is this just correlation or something more?


In the meantime little Timmy simply gets diagnosed with ADHD.  Nobody seems to consider that Timmy just needs sleep.  At best, the counselor may decide that Timmy needs therapy.  I'm also a big fan of therapy, especially CBT.  It has the potential to help a lot of people.  The catch is that you need patience and time.  The patient needs to develop new habits and new engrams that become reinforced cognitively.  It could take from months to years to see results.  This time frame won't be good enough for Timmy's teachers or parents.  They want a solution, NOW!

So the counselor refers Timmy to a psychiatrist to prescribe ritalin--A STIMULANT!!

I would call this government sanctioned malpractice and encourage everyone else to think twice before insisting that the government should manage our healthcare!


I can already here you mommy bloggers huffing and puffing about how your child is different and he really does have this phantom disorder.

I only have one question, "Where's his father?"  

"But it's in the genes, you know!"

Yes, I know, I know.  A scatter-brained, easily distracted mother ends up raising a scatter-brained, easily distracted child.  Color me shocked!

According to Sleepdex:

• Schizophrenia (2.2 million in US) — often co-morbid with sleep disorders.
• Anxiety disorders including posttraumatic stress disorder, generalized anxiety disorder, and social phobia. (40 million in US each year) — often co-morbid with sleep disorders
• Schizoaffective Disorder (under a million in US) — often co-morbid with sleep disorders
• Dissociative Disorders (under a million in US) — often co-morbid with sleep disorders
• Panic disorders (6 million in US each year) — often co-morbid with sleep disorders

Insomnia may not cause only ADHD, but can possibly be the cause of a variety of mental disorders ranging from panic disorders to schizophrenia!  Yes, this is a hypothesis, but if psychology and psychiatry are still grappling with root causes to mental disorders, then I might as well toss this idea out there and see who runs with it.  All these disorders that are being treated as individual and distinct disorders might simply be symptoms of the same underlying disorder--that disorder being insomnia!  This isn't a far fetched idea considering that medical disorders can exhibit different symptoms and complications in different people.  Consider diabetes as an example. The list of symptoms for diabetes is quite broad and varies on an individual basis. We may treat the different symptoms and complications in diabetics but we also give much attention to persuading all diabetics to adopt a much more healthier lifestyle as well as encouraging other people to live healthy lifestyles to avoid diabetes and its health complications in the future.  We must start to think the same way about mental disorders.