The state of ethics in psychology, in Australia, at least, is lamentably primitive, and the politics of psychological practice virtually unspoken. If psychology is presumed a science, after all, how can it be political, any more than the laws of thermodynamics, or quadratic equations? Ethics is taught as a subject to psychology students, but it amounts to little more than a few strictures and prohibitions – do not fleece patients, do not maintain conflicts of interest, no sexual relationships, etc. By themselves, these prohibitions are perfectly reasonable, but they hardly constitute a level of ethical discourse beyond that which the average five-year old might grasp. The continuities between the biopolitics of the clinic and those of the factory, the school, and the prison are invisible. Foucault, Laing, Szasz and others go unread and misunderstood; ‘anti-psychiatry’ is even used as a term of abuse, as if criticism of this or that diagnostic system was tantamount to nihilism. If academic psychology avoids direct confrontation with complex ethical questions, the same can be said of regulators, at least in Australia. The regulators certainly enforce prohibitions and punish violators, and there is plenty of evidence that they are rapidly escalating regulatory requirements (and, of course, fees). None of this gets to the heart of the matter. The more important question, generally evaded by the discipline, is what is it that is happening, ethically and politically speaking, when one does psychology? And when one does CBT, in particular?
In every epoch, the ideas of the ruling class are the ruling ideas. This was true of neoclassical economics in the pre-GFC era and of Lysenkoism in Soviet times. Thus, we should not be surprised to see the Lysenkoism of psychology, CBT, as the vanguard in psy-intervention, with its explicit aim of ‘mastery’, to use Beck’s own term. The patient, in CBT, is pathological as a result of his or her thoughts and behaviour. The cure is for these to be submitted to discipline and surveillance, ultimately by the patient’s own initiative, but in the first instance by an expert, who directly instructs the patient on how to think and act. Let nobody object that ‘empathic’ CBT practitioners are outside of this dialectic of mastery; if anything, empathy probably makes their coercive labours all the more efficient.
Can a clinician really be an expert who coaches others in how to think (or, more precisely, in how to speak)? As we have seen, there are solid theoretical grounds for answering in the negative. My position is that there are also strong ethical and political grounds, in short, because subjecting a patient to a regimen of mastery, even if they ask for it, is to use psy-technology to perpetuate inequality and subjugation. It is not for nothing that one of the few philosophers the CBT have read is Epictetus, their poster-boy, who was, after all, a slave. CBT is a doctrine that, at root, encourages its victims to think ‘positively’ (or ‘realistically’, or whatever) about their slavery. In short, it is perfectly suited to the political and economic situation of the developed, Anglophone world at the present time.
Let us examine this in more detail. A person may, in the context of their history and circumstances, have very good reason for expressing ideas that some ‘expert’ or other finds ‘distorted’, or threatening. This is not a reason, in itself, to eradicate such ideas. In certain versions of Islamic law, in Saudi Arabia or Iran, for instance, a thief can be punished by severing his hand. In Australia, there is sometimes populist outcry for sex offenders to be castrated, chemically or otherwise. Is not the practice of CBT performing exactly the same function, albeit, at the level of the psyche rather than the body? Is it not an attempt to destroy and prevent alleged ‘distortions’ of thought (of which having the idea of stealing might be an example), thus performing its role in social control in a manner every bit as sinister as that of the Saudi system, albeit, more subtle and insidious? When faced with totalitarian regimes, psychoanalysis, for instance, has always been banned. Not so CBT and its prototypes – as Darian Leader pointed out in his book on depression, CBT-style practices were perfectly at home in China’s Cultural Revolution. Unhappy thinking is irrational thinking, and must be remedied. In this sense, CBT is less a psychological practice than a biopolitical one, entirely akin to the ‘rehabilitation’ programs to which prisoners are sentenced. This remains the case even if CBT’s subjects present voluntarily, since the overt aim of the intervention is to inculcate self-governance and self-restraint. Viewed in an historical light, it is not difficult to discern the function of CBT. Lobotomy was once commonplace as a treatment for various disorders, and ‘effective’, from a narrow point of view. It was superseded by neuroleptic medications which, whilst ostensibly less brutal than lobotomy, had roughly the same effect. CBT is the latest heir to this tradition, and whilst it is more subtle and refined again than the neuroleptics, we should not mistake its purported ‘effectiveness’ as anything other than a mutilation of subjectivity, a debilitation of the mind’s creativity. It is, like the lobotomies of old, a technocratic exercise in making people docile, and it goes far beyond the mere ‘suggestion’ that Freud warned of so long ago.
All of the indoctrination in CBT hinges upon an appeal to reason (free of cognitive distortions) which, as we have seen, is entirely untenable. Well over 100 years ago, Nietzsche debunked the (allegedly) Socratic equation that reason=virtue=happiness. Despite the obvious absurdity of this moralising formula, it exists virtually unchanged in CBT, notwithstanding the two and half millennia of philosophical thought that have intervened in the meantime. One irony of this bizarre notion of ‘reason’ is that, if taken literally, it is not reasonable at all, but something perverse and Sadean. It is as if CBT is an elaborate attempt to have the clinician and ‘reason’ stand in as a kind of superego for the patient, against which all discourse (reduced to propositional statements) must be scrutinised, moralised, judged. The patient must be calibrated to norms imposed by the clinician (under the aegis of ‘reason’), their wrong thoughts (and by extension, their subjectivity) ‘corrected’ with Panglossian zeal.
Seen in this light, Beck’s decision to abandon the unconscious and embrace Behaviourism is not merely an epistemological failure, but a colossal ethical one. It was Skinner, after all, who pronounced that the purpose of his psychology was to ‘predict and control’, and CBT has taken up these baleful imperatives with gusto. Skinner dismissed ‘fear of control’ by his techniques as irrational, despite saying elsewhere, quite openly, that he thought he could ‘produce’ specific behaviour in those subjected to his methods. If the same ‘techniques’ were to occur in virtually any other setting, without the imprimatur of the phony science that CBT has constructed, it would be quickly denounced as a confidence trick, at best, and as cult-like indoctrination, or an abusive relationship at worst. It is all the more striking that, unlike in psychoanalysis, nobody who practices CBT need undertake any course of treatment of their own. CBT’s clinicians are generally not so irrational as to practice their own self-mutilation.
It should be said that in all of this, there is no need to impute bad faith or corruption to CBT’s practitioners. Beck need not be paid off by Walmart or by the Tea Party to produce an ideology compatible with them, just as psychiatrists need not necessarily be in the pocket of Big Pharma to nevertheless perpetuate drug dependence and bioreductionism. At the heart of psychology and – why not? – medical practice in toto, is a gaping anxiety in the face of subjective suffering. The clinician wants to do something, give something, anything, and the more literal this something is – a prescription, a take-home ‘strategy’ – the better. Well-intentioned as such practices may be, we should have no illusions about the fact that they are designed to alleviate the clinician’s own suffering (in the form of anxiety), and only secondarily, the patient’s. Patients themselves recognise this, and frequently complain of their experiences with CBT. One of the first questions I am regularly asked in practice is ‘You don’t practice CBT, do you?’.
Not only is CBT an ethical failure, but it unarguably practices politics of the most retrograde sort. You can practice CBT, or you can be politically progressive, but in no way can you do both. For political progressivism is incompatible with a doctrine that preaches to the abused and exploited of society that their dissatisfaction is borne merely of their own wrong thinking, which is something to therefore be dismissed or corrected. It is incompatible with a creed that openly ‘subjectifies’ (in Foucault’s sense) rather than subjectivises (in Lacan’s sense). It is incompatible with an ideology in which human subjects are reduced to countable objects, to ‘human resources’, to be apprehended through the alienation of discredited systems (such as psychometrics, and the DSM) and from whom the clinician’s aim is to extract as much productivity and compliance as possible.
Indeed, it is difficult to not see in the ‘strategies’ of CBT a kind of Taylorist micromanagement of a subject’s ideology. For all of the appeal to reason, it is evident that CBT has nothing to do with any kind of ethic of truth, since the latter is by no means guaranteed to be pleasant, ‘realistic’ or pacifying. Sagacity and melancholia have a history together far longer and profounder than CBT’s glib platitudes and thought-policing. CBT – and psychology, at large – is a practice in power, or, more generally, a whole complement of micro-strategies for exerting power over bodies and minds. This link with power – the micro-regulated self – is why academic psychology is no mere nosological reverie. Psychology as academic discipline supports practices of power and coercion (like CBT) just as positivist criminology supported ‘rehabilitation’, and just as, for Edward Said, Orientalism was the ideological complement to European colonial brutality. CBT makes no attempt to hide this – criminality (such as sex offending, for instance), is held to be the by-product of faulty thinking. As ever, university discourse masks a will to mastery, and here psychological ‘science’ does the ideological heavy-lifting for practices that would otherwise be acknowledged as forms of oppression and conformism. Can one but chortle when reading of the ‘strategies’ of CBT, such as ‘pleasant activity scheduling’?* Clearly, it is yet another managerial device, modelled on the insipid corporate picnic, and based on the notion that a human unit needs leisure and health, not for their own sake, but precisely in order to be of greater utility.
Even if the epistemology and theory of CBT could be regarded as valid, it would nonetheless remain a doctrine that must be rejected on ethical and political grounds as a kind of casuistry (in the worst sense), and a manipulative attempt to induce submission and conformism (to norms) in those who fall prey to it.
*Leaving aside, of course, that the actions of human drives – sex, to be ‘off one’s face’, seeking excess – seldom have anything whatsoever to do with ‘pleasantness’, as such.
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Ethics and CBT… part of a series..