Review of CBT: The Cognitive Behavioural Tsunami, by Farhad Dalal

Back in 2014, I posted a series of essays critiquing cognitive behaviour therapy (CBT) in terms of its philosophical and ethical problems. The idea that I had at the time was to provide a rebuttal of CBT that was not from within the parameters of its own assumptions, but which examined CBT from first principles, and also in terms of its political positions. The data may supposedly be in support of CBT, I reasoned, but such data was largely irrelevant if it pertained to incoherent theories and concepts, and was used to prop up a series of coercive and unethical practices. There were many critiques of my articles, on Reddit, for instance (here is an example), though practically none of them attempted to defend the theory of CBT. Few people seem to seriously uphold CBT concepts, even among advocates of this approach. Rather, the main objection to an a priori critique of CBT was ‘evidence’, which clearly proves CBT to be the ‘industry gold standard’, at least for now. Since CBT ‘works’, principles – first, or otherwise – simply do not matter.

Theses on Mental Health Reform in Australia

 

The Federal Government of Australia commissioned a detailed review of the country’s mental health system. (It subsequently tried to suppress the review for 12 months, and has since abandoned some of its recommendations). Now, as Australia recovers from a Federal election cempaign, discourse of mental health policy has been dominated by a small, recurring number of self-proclaimed advocates, as well as their respective research institutes. The proposal that the present Government is implementing is to expand the bureaucratic structure of GP’s Primary Health Networks (PHNs) to allow for a division between ‘complex’ and ‘low-intensity’ treatments. The former will have treatments administered and rationed by the PHNs; the latter will be diverted to self-management apps. The Headspace model, which, other than isolated, localised successes, has been a miserable and costly failure, will be retained, albeit with some minor trimming down of administrative functions. The advocates – and the most prominent are Patrick McGorry, Ian Hickie, and John Mendoza – want the app approach to be expanded at the direct expense of the existing Medicare system, which they say needs ‘reform’ (i.e. severe cuts or abolition). Meanwhile, the advocates are silent on the perilous and worsening state of public mental health systems, and the $11 billion per year that the Government spends on subsidised ‘private’ health insurance. The aim of the theses here is to provide an alternative to the dominant discourses and speakers which purport to speak for the mental health system and those who use it.

Notes on mental health and neoliberalism

I recently read a couple of Foucault’s later lectures, namely Security, Territory, Population (1977-1978) and The Birth of Biopolitics (1978-1979). In this latter set of lectures, Foucault made a rare foray into contemporary economics, analysing various currents of neoliberalism (especially German and US varieties) and their relation to new forms of governmentality. I thought it beneficial, if only for me, to jot down a few notes on Foucault’s reconstruction of neoliberal thought, because I think it particularly pertinent in understanding contemporary knowledge and practice in mental health. I have a paper forthcoming in an academic journal on this topic, and perhaps after this post, I can move onto other things in 2016.

Dismal Sciences: Anti-welfarism and Secondary Gain

There are a variety of contemporary ideological positions used to justify whittling down the welfare state, including market libertarianism, Reaganomics, Randism, Blairite ‘meritocracy’, and so forth. Some of these positions seek recourse to dubious economic ‘science’ (such as the Laffer Curve), whilst others are based on the distorted readings of Nietzsche or Darwin by adolescents. What all tend to have in common, however, is the notion that for the state to assist those in a position of weakness is, in essence, to encourage weakness. The rhetoric of neoliberalism does not pose attacks on the welfare state as the economic elites having won the class war and having their way with political economy, but rather, tries to argue that such attacks are for the benefit of the poor as well. These arguments, and the policies that they support, are often reviled as discredited nonsense, but they persist, nonetheless.

Drone Psychology: A Profession Digging Its own Grave

The following reflections were inspired by a Facebook thread, responding to this article. The article gushes that, according to some corporate consultants, mental health services in Australia could be delivered for $9.70 annually, saving on the inefficiency of training psychologists for face-to-face clinical work. People suffering with problems could anonymously read fact sheets, and undertake generic courses in CBT.

Reductio ad traumatum

In 1933, two servant girls in Le Mans, France, Christine and Léa Papin, murdered two of their employers.(1) Madame Lancelin and her adult daughter were bludgeoned and knived repeatedly, to the point of unrecognisability. Each had their eyes gouged out. The Papin sisters had spent much of their young lives in institutional care. Their family had a history of incestuous abuse, and at least one of their relatives had died by suicide.

2666

 

Who is killing the women of Santa Teresa? Or, to give the city its proper name, Ciudad Juarez? The short answer is –  the men. In Bolaño’s novel, and in Juarez since the 1990s, about 30% of the hundreds of women killed were murdered by somebody whom they knew, most often partners. One cannot seek recourse to the metaphor of a ‘war’ between the sexes, when in this context, it is more or less one sex doing all of the killing. The authorities are at best, callously indifferent, and at worst, implicated in the killings There is a lengthy scene is which the very police who are investigating the killings pass the time by telling a series of viciously misogynist jokes.

I was reminded of Bolaño’s posthumous novel, which I read only this year, by this article, on a man creating portraits of the victims of femicidio in Juarez.  That piece, by way of free association and some cursory googling, led me in turn to this piece, putting Mexico’s cartel wars in the context of 21^st global capitalism. This is precisely the context that Bolaño puts them, also, as he frequently reminds the reader that the deceased (or her kin) work at the local maquiladoras, or sweatshops, the managers of whom have little sympathy for those looking for their missing loved ones. I do not know enough of Mexican culture to know whether the grim imperative for women to work in sweatshops runs against the ideals of Marianismo, but it would not be surprising. Whilst the specific nature of the horrors occurring in Santa Teresa/Ciudad Juarez may be unique, the underlying economic conditions are not, and an inventory of sweatshop horrors could be compiled, including the worker suicides of China, and the collapse of a factory building in Bangladesh. These are the modern day equivalents of Blake’s ‘satanic mills’, or of Marx’s cotton manufacturers in Capital, but, unlike in the 19^th Century, the global economy implicates everybody who benefits – the Europeans, New Worlders (like Australians, and the norteamericanos), and the local elites. Indeed, some of the alleged serial killers reflect this culpability, involving a German (Haas) and a wealthy Mexican family (the Uribe family, whose name may not be incidental).

The other factor hinted at throughout the book (and more than hinted at in any recent account of Juarez) is the presence of the narcos. They are central to the economy, to law and order, such as it is, and to the city itself. Some – libertarians, perhaps – might imagine that prohibition is the root of all evil here. It is not. Organised crime, when it is well-organised, has a habit of infiltrating everything, prohibited or not. A fine book by journalist Oscar Martinez, recently translated into English, illustrated this well. The cartels of Mexico control not only the narcotics industry, supplying drugs to North Americans and Europeans, but also the coyotes (people smugglers),  the protection industry, and human trafficking. In some respects, this latter may be the most profitable of all. A gram of coke or marijuana can be consumed but once; a sex slave, under threat of death and torture, can be used over and over again.

One of the threads of 2666 is violence. There is extreme but transient grotesquery, such as the vengeances enacted in the Santa Teresa prison, gruesome as they are. Yet there are also the enormous violences of the 20^th Century, such as WWI, Stalin’s Terror and gulags, and the Holocaust. The logic of 2666 – and I believe that logic is what we are dealing with here – is to situate Juarez as the heir of this violence. After all, the Mexican cartel wars seem to have killed far more civilians than the Afghan war (since 2001). Perhaps both wars have been complementary – neo-conservatism in the military politics of Afghanistan and Iraq, neoliberalism in the economy of Mexico (and elsewhere). It is fitting that the frontier of this violence should be situated on the border between Mexico and the US. Bolaño’s violence, I should hasten to add, is entirely different to that of, say, Cormac McCarthy, in Blood Meridian. Bolaño’s killers employ the full repertoire of criminality to finish their victims, and 2666 could function as a catalogue of modern slaughter. It has an unmistakable cumulative effect, as one discerns styles, patterns, typologies.These slaughters include squalid domestic murders, to horrifically sadistic tortures, to utilitarian style of executions and drive-by shootings. Yet Bolaño almost never depicts the murder itself – there is no jouissance of torture and killing in Bolaño – but the heart-rending after-effects. The nameless victim to whom investigators are indifferent, tossed into an unmarked grave. The missing adolescent, searched-for desperately by loved ones around the rubbish dumps and maquiladoras. Crime fiction is genre fiction, to be sure, but with the best of its authors – Bolaño, or another favourite of mine, Sciasca – there is nothing b-grade about it. And why should there be, when there is no neat distinction between criminality and law and the rest of life?

Finally, there is something fundamentally psychoanalytic about Bolaño’s 2666. As with his other works, dreams are of some significance, and are described at length throughout the novel.  To a lesser extent, this is true of memory, in all its fallibility. The figure of the detective – his enjoyments, labyrinthine journeys and crises – constitute one of Bolaño’s most important pieces of symbolism, from his poetry, to The Savage Detectives, to 2666. A detective, in Bolaño’s world, is never some mere proceduralist, a bureaucrat with a badge and a gun, but somebody searching for the answer to the riddles of life in life’s contingencies, obscenities, unfinished clues, cryptic symbols and horrors. If this is not psychoanalytic, then I do not know what is.