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August 28, 2006

Comments

dearieme

I like "deskilled": you get ill from being tied to your desk. Sounds about right.

james higham

...a state of concentration so focused that it amounts to complete absorption in an activity and results in the achievement of a perfect state of happiness...

This is so e.g. getting carried away with blogging but personal spirituality must also be taken into account and this is where the economist often struggles. This X factor can't be quantified and yet it exists.

Metatone

I think people are being a little loaded in their interpretation of Layard's proposals.

To my reading he is trying to make politically feasible proposals that can make for real improvements in the short to medium term. We'd all prefer to totally re-engineer our societies to be based on happiness (which Moloney correctly connects to inequality) but just who is going to vote for that instead of "more tax cuts"? And more importantly, who is going to buy out Rupert Murdoch so we have a real campaign for that?

Give this and the widespread evidence of mental health difficulties across our society, why not try to improve mental health provision. As for the criticism of CBT, well, as far as I can tell from the literature, the profession is split and it's hard to see Moloney as massively more credible than the CBT supporters. Sometimes you have to give something a go...

James Hamilton

Chris, Maloney isn't good on this, not at all.
I was just looking over my diary for the last six months, and I can see that I treated people for compulsive eating, heavy drinking, phobias of blushing, dogs, lifts, planes and public speaking, panic attacks, depression, agitated depressions, generalised anxiety disorder and a variety of other less easily defined problems. And regarding all of them I'd say, OF COURSE social conditions played some part. Less in some, more than others, and I meet people whom I am forced to tell that they aren't suffering from any kind of disorder - they're just not happy where they are and their next step is theirs, not mine*.Maloney's article is very short, and I wouldn't say it's a thorough treatment of the subject, but from its tone I'd say he was missing a few things.

I share his misgivings about Layard's influence in government. This is partly on philosophical grounds - Layard's book shows no interest in defining the "happiness" the surveys he draws from claim to measure, and no interest in the very real philosophical problems that accompany any term of that kind. These are both definitive weaknesses and, in my opinion, undermine the book entirely.

Michael Marmot's work on the health implications of inequality avoids these pitfalls - partly because he's aware of them, and discusses them in his papers. It's a good thing he too has the ear of government. I hope he gets more of it.

Maloney's right, I think, to query the likely impact of an big expansion in the provision of CBT in the UK. There's no army of potential talented therapists out there waiting for the funds to work or train. And CBT isn't for everyone - it's very demanding on the client, and needs a degree of intellectual strength, stable personality and commitment that is far from universal amongst people experiencing mental distress. Nor does it enjoy any real scientific underpinning - CBT, as Maloney says, runs contrary to current neuroscientific research. But Maloney doesn't seem to understand what CBT actually is or what it tries to do - it's certainly not "based upon an assumption that rational insight will lead, magically, to beneficial change". I've worked with CBT, and don't recognise the therapy in that description at all.

If Maloney's really going to suggest that social conditions are the crucial (his article implies, sole) element in mental health - then he needs to explain his rejection of genetic inheritance, physical causes, accident, and the roles of upbringing, other life experience, and the individual's thoughts and beliefs. It's not enough to suggest that researchers who think those other things important do so because they want to return us to cutthroat capitalism. It's scarcely fair of him to accuse the goverment of trying to avoid social expenditure, either.

He, like Layard, treats the idea (that mental distress and illness is all to do with society) as though it's new. It's not. R.D. Laing wrote about it forty years ago, and some of what he was in favour of (the breaking up of the family unit, free sexual expression, freedom from the tyranny of work) are now regarded, by the people who are in Laing's place today, as the cause of all the trouble. In forty years's time, views will have shifted again. Laing would have regarded Maloney as a Conservative with a large "C".

That illustrates the core of the problem. There is no agreement in "psychology" or "psychotherapy" as to which aspects of the social environment are specifically to blame (Marmot's aware of this problem and discusses it). Even if there were, it doesn't follow that we know what to do about it, or how to control what we do : there's no awareness here of unforseen consequences, or any acknowledgement that individuals differ and react in separate ways to the same circumstances.

Nor is it ever considered that a change in the social environment for one group in society that improves things won't create distress in others. The Maloneys might do well to reflect on some of the demarcation and pay differentials disputes of the '70s and ponder. If they're serious, of course, in what they're saying.

All that said, it's impossible to escape the feeling that this isn't a psychological argument, but a political one. My first field was history, and the problem there is the same - how to minimise the influence on your research of your own political views, how to prevent your assumptions distorting what the evidence is trying to tell you. History at least had Herbert Butterfield, and since 9/11 I've wished journalism had had him as well. There's no equivalent of Butterfield in psychology, and the problem he highlighted is one few psychological researchers are aware of, let alone seeking to avoid. I would argue that the majority of psychological research papers have their results implicit in the questions they ask. And for a large number of researchers, the idea that their research should produce results that contradict their political beliefs is unthinkable - a whole layer of consciousness away from the idea merely being unattractive.

No one works in psychotherapy and escapes the impact of social circumstances and environment on mental health. Bad housing, lack of social contacts, poor work or no work - of course these things are involved, and of course these things should be combatted. But they aren't all that's involved - so are other factors. To suggest otherwise is politicised fantasy that helps no one. To suggest that government policy should be driven by that suggestion is also fantasy, of a more dangerous kind.


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