‘Bad Therapy’ II
Every generation has concerns about the next one and for some time now, concerns about the young have centred around mental health. That’s new, that hasn’t happened before: earlier generations worried about Teddy boys, Hippies, Punks, Rave culture but they didn’t worry that their children were sinking into a slump of anxiety and depression. And there are certainly statistics available to justify concern. Hyper-sensitivity, lack of resilience, entitlement; these are the Snowflakes generation(s), with unprecedented levels of economic inactivity and reported mental health issues.[1]
Commentators have found causes where they wanted to find them: an unprecedented confluence of societal problems embodied in neo-liberal capitalism,[2] the ‘coddling’ of the young,[3] an anxiety fuelled Selfie culture[4] and, invariably, the malign influence of tech and social media.
Bad Therapy tracks the problems to a different source and it’s quite a significant development: the publication of a book in the mainstream non-fiction market with an explicit message that mental healthcare is, itself, making things worse.
It’s clear from the degree of media coverage the book has attracted that the author, Abigail Shrier, is expressing a concern shared by a lot of people that doesn’t normally get heard. And it doesn’t normally get heard because, generally, people don’t read or write about mental illness unless they have a vested interest (mental healthcare professionals, specialist journalists, sufferers and their families) and, generally, those people aren’t keen on saying it’s making things worse.
But, more than that, viewed from within the perspective of mental health as a subject of study and learning, looking at what psychology knows about the underlying phenomenology and cognition and the aetiology of mental illness, what she’s saying is completely logical and credible.
The cause of mental illness is too much difficulty meeting the world around you half-way, which generates enormous amounts of anxiety and aggression and self-hatred. That impinges further on people’s ability to function competently in the world around them and that compounds their negative emotions. Sufferers’ relationships with other people are laced with disappointment, frustration, insecurity, resentment and grievance. It’s a misery sentence, it’s happening a great deal more and its roots are in self-centredness.
Therapy is an inherently self-centred activity but one of the ways it’s perspective has developed over the last 50 years has been an ever increasing focus on the self. Forget about CBT, that's just a manualised technique that people might (or might not) encounter in the consulting room (and the results for which suggest it’s not very effective in helping people to recover from anxiety or depression), the ideas and values from mental healthcare which have come to permeate society and had real impact on you and your children and your neighbours and your work colleagues and your children’s schools and the papers and the books you read and the films you watch, the music you listen to and the social media you use, come from another school of therapy called person-centred. That is an extraordinarily and explicitly self-centred view of the world (the ‘person’ in person-centred is always ‘me’).
People, especially the young (who have never known anything else and have been brought up by parents who have themselves been immersed in these ideas), have become increasingly liable to become ill because their perspectives on the world are too self-defeatingly, self-centred. It’s ideas that have been exported out of the world of therapy that have made them like that and when they're ill (and excruciatingly unhappy) we expose them to more ideas from therapy.[5]
In retrospect this all seems entirely predictable, and it was predicted but those concerns were written off as discredited and outmoded. And because psychology doesn't function properly as a science (at least for now) in the context of mental health, nothing can ever be proven so the arguments were always entirely ideological.
Belief is plastic, ideas take on their own life, people can be persuaded of anything: history is just a sequence of conflicts between different things people have been led to believe in the past. At the moment, people have come to believe, passionately, that it’s correct to hold beliefs that have come out of person-centred psychotherapy.
It was probably always inevitable that our mental healthcare system would become dominated by ideas around subjectivity, vulnerability and appetite for care. If medicine can’t demonstrate a capacity to cure, its going to end up being guided by the sufferers. That would be true for cancer too if oncologists couldn’t show that they knew what cancer was and could make people better, but extreme subjectivity, a heightened sense of vulnerability and an insatiable appetite for care are hallmarks of mental illness (in a way that they aren’t for cancer).
But it could have stayed there; hermetically sealed in the world of psychotherapy and clinical psychology (like chemotherapy in oncology). The fact that it didn’t, and these ideas have come to dominate all our lives as much as they have, says something about the rest of us (and it’s not particularly flattering).
Last week I wrote a piece saying that Shrier’s book wasn’t going to change anything but maybe that was overly pessimistic. Ideas do shift and maybe the publication of a book like that is itself evidence of a change in how people feel. Maybe, just maybe, after 50 years of exposure to these ideas, we’re seeing the beginnings of an adjustment?
For a long time, this stuff didn’t seem to matter much – just roll your eyes and let the people who seemed to care so much about it have their way; what harm could it do? Perhaps we’ve had enough time now to see how wrong that was. Perhaps there is increasing openness to the idea that this is serious, something has caused real harm, and increasing openness to look for explanations beyond causes which we can conveniently locate outside ourselves, like Big Tech.
Because it is worse than that. The problem is our own bad ideas about ourselves and the world around us, ideas that don’t work in terms of mental health, ideas that make people ill, ideas that came to us from, of all places, mental healthcare.
We get the newspapers we deserve; we get the politicians we deserve, and we’ll get the mental healthcare system we deserve. There’s a lot of people invested in current ideas about mental health: mental healthcare professionals, sufferers, their families. And anyone who has acquired ‘expert’ status: specialist journalists, influencers, celebrities, or your kids’ primary school teacher (she’s had training, she ‘knows’). But there’s no evidence for them: they’ve been selected because they were in the personal (self-centred) interests of the people closest to the subject.
If these ideas never felt right, don’t just grumble to friends in your kitchen. Otherwise, we’re all going to have to go on living with the consequences.
[1] https://commonslibrary.parliament.uk/why-are-young-people-leaving-the-labour-market/
[2] https://www.amazon.co.uk/Sedated-Modern-Capitalism-Created-Mental/dp/1786499843
[3] https://www.amazon.co.uk/Coddling-American-Mind-Intentions-Generation/dp/0735224897
[4] https://www.amazon.co.uk/Selfie-Became-Self-Obsessed-What-Doing/dp/1447283651
[5] I’m not suggesting therapy is never helpful to the individual as a clinical intervention (I was a therapist), though the evidence suggests that’s much rarer than we would like to think. There are different therapies and there are different therapists. There is a world of difference between experience in the room with a Kleinian psychotherapist and a Rogerian counsellor but, in terms of how therapy has impacted society, Rogers has won hands down, and his values have become the dominant one’s people encounter around mental healthcare (even around the Kleinian commandos)