Last week, as yet more errors were piled on the statin comedy, and antibiotics got it in the neck from Red Dave, another it’s time we put-it-in/took-it-out of the water story caught Dr No’s eye. An economist – economists seem to get all the top health slots these days – and a psychologist – he was on the Today programme, sounding worryingly like Peter Cook’s classic amiable psychiatrist – want Cognitive Behavioural Therapy (CBT) to be much more widely available to treat mental health problems. It is what airheads call a no-brainer. As Bush Lite might have said, CBT is where wings take dream (it works), and it makes the pie higher (it more than pays for itself: lower healthcare costs and folks back at work). Yet not just folks but our government have misunderestimated the power of CBT. NHS provision has increased in recent years, but from a very low base, and still only one patient in eight who might benefit gets the therapy. That’s one helluva misunderprovision for something that has if not wings then legs.
CBT works by evaluating and retraining the patient’s thought patterns. The central tenet is that what we think (cognition) affect what we feel and do (behaviour). It has a great advantage over pills: given a little ongoing practice, the new thought patterns can be used indefinitely at no extra cost – the main reason why it is so cost-effective. The patient doesn’t have to keep taking the medicine, just keep up with practice. This way, a depressed patient – a condition in which CBT is often effective – becomes ‘psychologically immunised’ against depression. Another advantage over pills is the lack of side effects; yet another is the absence of drug withdrawal syndromes. Although no magic bullet – nothing is – by and large, CBT is safe, effective and affordable. What’s, as they say, not to like? Or, as Siobhan Sharpe might say, let’s juice this lemon.
Which leads Dr No, via a typically deranged knight’s move thought, to the question: could CBT turn out to be another sort of lemon, not in the way of zest, but in being a dud? Others certainly think so, notably in the Guardian, which has from time to time aired views that – to summarise – CBT is at best patronising junk, at worst a con, a sort of cognitive lobotomy that tricks patients into thinking they are better when they are nothing of the sort. Life is still shit, but the CBT victim is now moronically happy in their pile of shit. Such moral cynicism must surely exist, but then equally we could reply we are all in the gutter, and is it not better that we look at the stars, rather than circle the drains?
So, by and large, Dr No remains in favour of CBT for patients. Where he gets uneasy is when he hears talk of wider use. The unnamed economist in the first paragraph is in fact none other than the one time Happiness Tsar, the Leader of the Dream Team, one Richard Layard, and Layard is On a Happiness Mission. The recent media activity arose from the publication of the alarmingly up-beat-or-else titled book ‘Thrive’, co-written by Layard and his soothing psychology buddy David Clark. It makes a compelling case that CBT works, is cost-effective, and must be more widely available, yah-da-dah. So far, so good.
But – and here we see the outline of a fly in the happiness ointment – Layard is an economist, not a doctor. Proper doctors (public health doctors, who we all know are nuts, tend to be the exception) concern themselves with ill health in individuals. Being an economist, Layard sees things in economic terms, on an economic scale, only his particular fancy leans more towards the Gross Happiness Quotient instead of the more usual GDP. While most economists focus on wealth, Layard zooms in on health. Instead of wanting us to be wealthier, he wants us all to be healthier, in short, to be Happier.
At this point, some realists are wont to put paper bags over their heads, to save time reaching for one when the time comes to throw up. Dr No doesn’t necessarily have his paper bag on yet, but his here-we-go-again detector is certainly crackling away. He sees clear potential for diagnostic and so therapeutic creep. Flown by the Happiness Tsar, the more CBT airbus loaded with extra therapists has, like one of those NASA airplanes with piggy-backed shuttle, another payload, a payload that on this occasion could threatens us all. If CBT improves clinical depression, then why shouldn’t it help ordinary unhappiness? Discontents and malcontents alike could be cognitively lobotomised to a condition of moronic delusional happiness. It would certainly be what the Incredible Dement once called, as he watched Smedley can himself, ‘a result’. Indeed, it would be more than that, ‘a result’ on a mass scale, a populace of happy morons all watched over by behaviourists of cognitive grace.
At which point, Dr No’s paper bag went pop.
Note: the title and some of the ideas in this post are derived from the 2011 BBC2 TV Series ‘All Watched Over by Machines of Loving Grace’ (a title itself taken from a poem by Richard Brautigan), an excellent look at another Dream Team’s doomed attempt to liberate humanity from itself. Well worth seeing if it is broadcast again.