CBT is Aristotle with Facebook brain – A note on paranoia as an epistemic ideal

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In Cognitive Behaviour Therapy (CBT) discourse is reduced to data, and this data is further submitted to the Aristotlesque requirement of non-contradiction, albeit, without any Aristotelian depth of intellect.

Consequently, cognitivism and CBT affirm the existence of an unconscious, but this unconscious is entirely continuous with the conscious. It’s more of the same, more or less. Contrast this with the Freudo-Lacanian unconscious, which is disruptive, punctual, discontinuous, and structurally incapable of completion.

It’s no coincidence that CBT first arose when cognitivism was displacing the increasingly-discredited behaviourism from the laboratory (though not yet the clinic, in the Anglosphere at least). This was the age of Festinger’s cognitive dissonance, in which, like good Aristotelians, the subject abhors contradiction. Since contemporary CBT reaffirms a data-based, continuous unconscious, Festinger’s ideas fester still. Show the subject that his suffering arises from the faulty conviction that he always bungles his relationships/work/studies – show him the contrary evidence, the errors in his logic – and he will be obliged, by way of contradiction, to renounce his conviction, and thereby eliminate his suffering.

It was not until the era of neoliberalism that these Aristotelian outtakes reigned supreme over the clinic, for reasons that I have attempted to explicate elsewhere, but which are largely economic and biopolitical in character.

At the heart of the adventures of Freud and Lacan is the proposition that, in at least a thousand different ways, human subjects, divided as they are, exist in permanent, structural contradiction. There are so many examples of this in the centuries that preceded them that I would say that Freud and Lacan merely articulated and formalised, rather than discovered this fact. My experience is that it is common knowledge amongst the uneducated, and that perhaps the educated have some catching-up to do.

The clinical work of psychoanalysis cannot, on this basis, be oriented toward either completeness or consistency, if one means by this the overcoming of contradiction. Repression, disavowal, denial, foreclosure, the law of the exception, the law of the not-all are but some of the psychoanalytically-articulated responses to contradiction. After Gödel,he who trades consistency for completeness deserves neither.

But let us suppose that the psychoanalytic premises are wrong, and that the cognitivists are really as evidence-based as they say. In principle, the latter would be able to work with a subject to produce an image of perfect consistency, with the offending data eliminated. The outcome would resemble nothing so much as the most brittle paranoid delusion. The subject attains an image of coherence with all that is unassimilated sent packing, much line a refugee ship at Australia’s borders. This is the best case scenario for treatment by CBT principles, and we need only look at the outcome of excessive Facebook consumption to see what befalls those who cannot live in contradiction.

Science’s man does not exist: Psychoanalysis, scientism, and the structuralist project.

Here is my latest, from the journal Psychoanalysis Lacan, to be found here.

On the Crisis of Reproducibility in Psychology

As we might expect, most results in psychology are not reproducible. As the authors who obtained these results say, ‘reproducibility is a defining feature of science’. From this, we could conclude, as have many in the field, that the answer is more experiments, tweaked statistics, metholodogical tinkering and the like. Or, we could make a point that is not so much epistemically radical as it is blatantly obvious, and that is that psychology is not a science at all. It does not resemble science except in the most superficial of respects. It isn’t just the failure of replication documented here, but the complete impossibility of findings in psychology ever being abstracted into formulae for precise prediction.

Language and Diagnosis

 

The BPS has been tackling some important issues in mental health. In 2014, this involved publishing the ‘Understanding Psychosis’ report, and more recently, the BPS has published guidelines on ‘functional’ diagnostic nomenclature,  in which clinical conditions and treatments are articulated in non-medical language. In both cases, the BPS has identified an area of difficulty – perhaps even crisis – in mental health. Psychosis is poorly conceptualised and haphazardly treated. Diagnostic language in psychiatry was never ‘scientific’, and the farcical DSM-5 has eliminated any last vestige of credibility from these sorts of conceptual systems. There can be no doubt that the BPS has the best interests of what it calls ‘service users’ at heart when it attempts to tackle these problems and devise workable solutions to them.

Longer Chains and Bigger Cages

A reply to Peter Kinderman:

 

For me, a psychologist is bound to run into problems if s/he wishes to jump paradigms without proper consideration of epistemology, or if s/he wishes to consider the ethics of forensic intervention whilst completely ignoring Foucault (among others). This article exemplifies such an approach.

Paradigms across psychiatry, psychology and psychoanalysis

The dominant  paradigms within psychology and psychiatry, whilst far from being internally homogenous, nonetheless have more similarities than differences. Notwithstanding the division of labour between psychiatrists and psychologists in hospital settings (for instance), the two disciplines have a largely overlapping epistemic basis. Even psychology’s supposedly unique contributions – a body of knowledge about general, non-pathological psychological functioning – have been largely absorbed into psychiatry.

Against the ‘understanding’ of psychosis…

I may say that in the last teaching, Lacan is very close to saying that all of the symbolic order is a delusion, including his own construction of the symbolic order.

Paradigm Shifts after the Decline of the Medical Model

‘Neuroenhancement’ in its various forms, whether applied to cognitive tasks, or social functioning, looks initially like one more medical intervention. This, however, is misleading. For all of its flaws, the medical model is relatively simple and static. The idea is to identify pathology or malfunction, and to remedy it. Where the pathology in question is a positive symptom or syndrome, medical intervention is relatively free of controversy.

The Problem with Randomised Controlled Trials (RCTs)

I have recently been debating the merits and problems of objective, quantitative research in mental health. (One of my interlocutors has posted a lengthy response here, arguing in favour of ‘objectivism’). RCTs are a methodological device introduced into mental health from general medicine. Whilst they are merely problematic in the latter, they are outright misleading in the former.

Love, technology, ideology and ethics: A critique of “neuroenhancement”.

“The medicalization of love”[1] is one of a series of papers[2][3] in which Earp, Savulescu and others explore the ethical ramifications of administering neurochemical interventions to address problems of love. The authors rightly observe that love is, in many ways, already ‘medicalized’, and anticipate some ethical objections to neurochemical interventions in human relationships. Specifically, the authors reject charges of neural reductionism, and disagree that neurochemical interventions need necessarily increase “pathologization” and the expansion of medical-social control. I wish to argue that these conclusions are, from many points of view, misleading, to say the least.