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.

Melancholia & Depression

One of the finest new journals of Lacanian Psychoanalysis is this one, in which I have a piece discussing melancholia and what is now called depression.

‘Changing Minds’: An unintentional satire of the mental health industry

In recent years, there has been an annual commemoration of ‘Mental Health Week’, a period in which Australians are subjected to ‘awareness campaigns’ by various media organisations. We tend to receive a familiar style of ‘messaging’, namely, tokenism (‘Are You Ok Day?’), advocacy for more bureaucracy, and censorship of views that do not conform to simplistic biomedical paradigms. It is in this context that the national broadcaster screened ‘Changing Minds’, a series which ‘journeys with mentally ill patients on their road to recovery, from breaking point to breakthrough.’ The setting for the doco is a hospital in Sydney, and patients and staff apparently consented to the footage being made public.

“There is no Us and Them”

Further to a Twitter discussion from today – there is a gulf between patient and clinician, between administrator and administered that cannot be wished away with the language of facile humanism. I have tried to touch on this point before, but as always, others say it better.

The Leftist Defense of Psychiatry

This article raises some typical points in service of a leftist defense of psychiatry. (NB: the post I am citing summarises rather than advocates for these positions). This defense hinges on the claim that if mental illness is held to be ‘socially constructed’, this conception may lead to a denial of the existence of certain forms of suffering. This denial is something that can then be exploited by contemporary governments increasingly eager to implement spending cuts and austerity measures. One person cited in the article was Tad Tietze, for whom ‘the logic of Szasz would empty hospitals and put the same people in prison’.

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.

The problem with diagnosis is not diagnosis, but discourse

In the UK and elsewhere, there is a growing movement to abolish diagnosis in psychiatry and clinical psychiatry. Leading the movement are a group of clinical psychologists and a range of critics of mental health practice. I would like, once more, to revisit the question of diagnosis from a psychoanalytic perspective, in the hope that it may shed some light to those without an analytic approach.

One of Freud’s Asides

I recently had occasion to re-read Freud’s case of the Ratman, and was struck by a passage in which Freud attempts to educate his obsessional neurotic patient in the underlying principles of psychoanalysis:

On ‘deep-brain stimulation’ for depression

 

A response to this post:

I think the author of this post is quite right to ask questions about the nature of evidence of these radically invasive, bio-reductionists ‘treatments’ for depression.

More on psychosis: Subjective structure and incompleteness

 

I am not going to be exhaustive here. The aim is to present a little exegesis and a little analogy.The above chart – taken from Lacan’s Seminar X, on anxiety – may help to illustrate a couple of things at the very least, concerning the entry into subjecthood, and the separation of neurosis and psychosis.