Here are some responses to points/questions that recently arose on twitter, in longer than 140 characters:
What do CBT and Mindfulness™ have to do with austerity and coercion? The practice manuals that list how to implement these techniques mention ‘collaboration’ and nice stuff like that.
Austerity is not only the state cutting mental health services, but the services themselves internalising the prerogatives of the state. Hence the proliferation of short-term treatments, technique over transference, cheap online ‘educational’ content, standardisation, state-corporate ideals of ‘wellness’, and directive and authoritarian approaches.
That ‘collaboration’ is invoked in the above approaches is not only not surprising, but entirely consistent with neoliberal austerity. The ‘collaboration’ in question here is that discussed by Foucault, in which the ‘client’ is called upon to become the principle of his own subjection. Buzzwords such as ‘collaboration’ and ‘client-focused’ also assist practitioners in suspending their own ethical and political judgements. Consequently, if you believe, as many practitioners do, that austerity worsens psychological welfare, it follows that short-term, reductionist approaches such as CBT are not a cure but an obstacle to mental health. And whenever we hear a word like ‘collaboration’ used as the handmaiden of power, we should not forget the more sinister meaning this term acquired in the middle of the 20th Century.
But #notallCBT and mindfulness is coercive. And besides, mindfulness isn’t just about getting people to accept everything.
Perhaps not. It is difficult for any generalisation to be universally true, and besides, in the case of CBT in particular, the term is frequently just a Trojan horse used by practitioners and researchers to make their work appear officially acceptable. Whatever is supportive or directed toward maintenance of the transference in ‘CBT’ treatment is non-standardised and, by definition, not CBT. Thus, there will always be some slipperiness of definitions and semantics when it comes to non-self-identical concepts.
But in some cases, at least, mindfulness, CBT, ‘positive psychology’ and the like are not about getting people to accept ‘everything’, but getting them to accept bad things. And often, it isn’t merely ‘acceptance’ of the bad thing that is aimed at, but affirmation of it. A case in point is Martin Seligman’s ‘spiritual fitness’ program in the US military, in which the exhausted soldier is ‘rehabilitated’ into ‘reframing’ an odious order into a personal compliment. Another case is that of workfare in the UK and Australia, in which mere compliance by ‘clients’ is insufficient, and a more marketable ‘positivity’ is directed. One doesn’t just tolerate Big Brother, but is obliged to love him also.
We could regard it as mere coincidence that the same kinds of directive psychological treatments are put to abusive ends, but that would be a little disingenuous, wouldn’t it?
Isn’t mindfulness like physical exercise, namely, generally beneficial, or perhaps both good and bad, depending on the circumstances?
Maybe – but beneficial for whom? ‘Wellness’ as it is generally conceived, is for the boss, just as rest is encouraged in workers so that they can be more productive for their employers. If situated within a Masters or University discourse or for this sort of ‘wellness’, the ‘benefit’ is measured directly in terms of compliance with the Other.
The idea that mindfulness (and other) techniques can be variously good or bad, depending on their uses, recalls the familiar ‘Guns don’t kill’ argument, in which tools and technologies are wrongly construed as ethically and politically ‘neutral’. Since the same psychological technologies and ideologies keep turning up in coercive practices, we have no reason to assume these technologies and ideologies are ‘neutral’.
We should also consider how paradigms deal with coercive or unethical behaviour. When psychoanalyst Masud Khan came to sessions drunk, and had sex with patients, he eventually lost his status as a training analyst. Today, no analyst would consider his behaviour to be acceptable. By way of contrast, Martin Seligman and followers can torture dogs in the lab, and manipulate soldiers in the military, without ever being called into question from within their own paradigm. Indeed, such manipulations are widely praised, and handsomely rewarded. In CBT and Mindfulness, the coercion and manipulation is so systematic within the paradigm as to be largely invisible to its adherents.
Finally, peddling hints and tips for ‘wellness’, whatever the discourse or intention, is a bizarre and inept method of practicing psychotherapy. I recall, a few years ago, attending a presentation for mental health practitioners, in which a guest speaker who, among numerous other suggestions (including one about not providing treatment to anybody who used drugs) extolled the virtues of giving patients dietary advice on salmon and vitamins. Now, to be clear, I don’t doubt that salmon has nutritional value, and that it is a fine fish in culinary terms. But salmon is not psychology. If you went to university for 7 years in order to hand out generic fact sheets on diet to all your patients, you probably did the wrong course. You are treating the ‘client’ like an idiot, and becoming one yourself in the process.
What about the voluntary nature of CBT or mindfulness? Don’t clients have agency?
The short answer is that the unified subject naively presupposed by CBT and mindfulness simply does not exist. Consequently, it makes no sense to attribute agency to such a subject and then to consider this fictitious ‘agency’ a proof of a treatment’s legitimacy.
We should also recall the near-identical similarity between these arguments from ‘consent’ and, for instance, libertarian apologias of sweatshop labour. Any exploitation or danger to a worker can be justified on the basis that the worker contracts to do it freely. But ‘freedom’ and ‘consent’ require more than the ability to submit, but also the ability to refuse.
This ability to refuse is often minimal or non-existent in the application of CBT and ‘positive psychology’ techniques. First, whenever psychological treatment is being applied in an involuntary setting – be it forensic, forced hospital admission, workfare, etc – the ‘treatment’ is almost always CBT and its cognates. Again, this is not a coincidence, but a direct result of the sorts of problems these techniques are designed to treat.
Second, in Australia and certain other places, free or low-cost treatment seldom involves anything other than CBT or mindfulness, or some other short-term, didactic, directive approach. A person who is suffering with one problem or another may find themselves unable to access any treatment at all unless they can finance it. In Australia, this problem is notable in all places, but especially severe in rural areas. Since cheap short-term treatments may be the only ones funded by bureaucrats and insurance companies, the ability for a patient to refuse is very limited. It isn’t a matter of CBT vs proper therapy, but of CBT vs no therapy, or dubious medications.
But even assuming that a patient could ‘freely’ and knowledgably choose CBT/mindfulness, would there not be a question here as to why anybody would want a self-proclaimed expert to correct their distorted thoughts, or to accept their own suffering as caused by a lack of pseudo-spiritual pacification? What sorts or ideological and fantasmatic props are necessary for such ‘therapy’ to be possible? To be sure, we could see ‘voluntary’ subjugation to power as a triumph of free enterprise, but of course, this is far from being the only possible interpretation.