Thursday, March 23, 2023

Comments by Topher

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  • please, please, please either get an in depth interview with Professor of Social Work, William M Epstein or review his three key books relating to psychotherapy and its research base. The three key books are the illusion of psychotherapy, psychotherapy as religion and psychotherapy and the social clinic in the united states, soothing fictions. Across these books he takes the research apart on methodological grounds and what he demonstrates is fascinating – how this house of cards persists is yet more evidence of a self interested cultural disorder.

  • Its criminal, the drug companies have known about this for decades and carried on peddling this highly profitable drugs to millions of people. Just as they did with barbiturates, benzodiazepines, sleeping tablets, and no doubt the drugs used for ‘adhd’ and everything else. How does the same criminal activity happen year in year out? These companies have been fined billions for their criminal activity but its a fraction of the profits they make so is just part of their business model. This is beyond nuts and is only made possible by thousands of people just doing their jobs, following the guidlines. The guidlines corrupted by drug company influence and the regulator also captured and corrupted by drug companies – read Whitaker and Cosgrove’s Psychiatry under the influence.

  • I would recommend an interview with William M Epstein on his three key books pertaining to psychotherapy, the illusion of psychotherapy, psychotherapy as religion and psychotherapy and the social clinic soothing fictions – across these works and others he takes apart the research base for psychotherapy and demonstrates none of it has any credible evidence supporting it and it can and does cause harm. The commenter above talking about EMDR working on a biological level is laughable – The REM sleep idea is just an idea among many for its supposed action.

  • We know the answer from industry and the deluded mental ill health system – Drug Em! and or send them for psychological therapy that itself has no credible evidence supporting it – keeps the eye off the ball, therapists in jobs and the status quo intact. Oh and massive and growing harm to millions and kids and when they are bent out of shape into adulthood, well then, the industry has more harmful nonsense for you, step right up.

  • From my reading and experience there seems to be three main camps on the claimed effectiveness for any from of psychotherapy and we know the drugs don’t work. We have a range of cultural disorders not personal ones.

    One camp is occupied by the main players in each modality or therapeutic school. They are all competing in a market place of ideas, for power and status – most of the research is done by therapists themselves, so those with the most to gain from their approach coming out on top. It also seems that the approaches that are elevated over others are those that are a best fit for the broader political, economic and cultural zeitgeist. Given the research is done mostly by those with the most to gain its horribly biased and therefore of little merit

    Another camp is also occupied by those with the most to gain and the research is done mostly by therapists – however this camp eg Bruce Wampold in the great psychotherapy debate etc – are at least attempting to get us closer to truth by looking in greater detail at the research.

    This camp assumes therapy is efficacious and they they are interested in what bits of therapy make it useful – dismantling studies and other forms of research have been carried out to try and understand what is it that actually helps in any therapy. What they have shown is the following.

    The most important, indeed key factor in any psychotherapy’s success is absolutely nothing to do with psychotherapy – The most important factor is all about the individuals resources coming into therapy – resources in the broadest sense, finances, health, family, friends, meaning, purpose etc.

    Next most important is placebo, then how comfortable the person feels with the therapist or the pseudo relationship, then comes shared goals/hope and right at the bottom is modality/theoretical orientation/techniques.

    Then we have a third camp, also made up of therapists and people in related fields – these people are even more interested in getting us closer to truth and they assess psychotherapy in relation to its cultural position. There are many authors here but William M Epstein over several books including The Illusion of Psychotherapy, Psychotherapy as Religion and Psychotherapy and the Social Clinic, Soothing fictions has taken the best of the research apart and analysed it on methodological grounds. What he demonstrates is there is no evidence for any psychotherapy being effective and it can be harmful.

    It’s really incredible that a field with such terrible research and routine poor outcomes and clearly making absolutely next to no difference to human wellbeing as evidenced by the ever rising numbers of people suffering manages to maintain any sort of cultural power position.

    This brings us back to psychotherapies usefulness to power and maintaining the status quo by obfuscating the real causes of so much distress in myriad cultural disorders. As David Smail highlighted it then loads individuals with responsibility to somehow adjust to ever worsening conditions. This constantly and falsely advertised transcendent heroic individualism or delusion is also picked apart by David Smail and William M Epstein.

    In my own experience working in the sector most of the people I know and come across aren’t aware of the critics of the research literature and simply carry on like it doesn’t exist even when its pointed out.

    Peter states ‘Most of the problems patients face are caused by maladaptive emotion regulation’

    really? seems to me that most of the problems are caused by myriad cultural disorders dressed up as personal disorder.

    It seems so often the case that the road to hell is paved with good intentions.

  • I wish people commenting on psychotherapy would read and understand the work of William M Epstein and especially his three books the illusion of psychotherapy, psychotherapy as religion and psychotherapy and the social clinic, soothing fictions.

    In these and other books he takes apart the research literature including the so called foundational texts smith and glass etc, in addition to the psychometric measures (tick boxes) and assesses the industry in relation to the culture. What he demonstrates is that the industry and its research is as bad if not worse than the drugs industry and the research and has no real evidence supporting it and just like the drug industry it can harm.

    The problems and the solutions are mostly located in myriad cultural disorders, not personal ones.

  • Each generation looks back at the one before with horror and wonders how could they have done such awful things in the name of ‘treatment’ while thinking rather smugly that our own generation has it right and its all science backed – then of course history repeats over and over in this self interested, corporate greed fest. At least in previous generations when someone came at you with an icepick you had an idea this might go badly wrong.

    Now we’re all so thoroughly conditioned into a pill for every ill we think surely those pretty little things surely are science backed? surely the regulators like the MHRA are not nearly completely (87%ish) funded and staffed by industry people? surely thats just a conspiracy theory, right?

    Meanwhile bodies and brains are damaged left and right, lives are ruined and way more harm is being done than ever before. Somehow everyone is an armchair psychiatrist or DSM zombie labelling themselves and their friends like its a game and encouraging people to go to mental (ill) health services.

    DSM disordering leads to scraps from the table – reasonable adjustments in the disordered school, or reasonable adjustments in the disordered work place or welfare benefits – all useful for the individual while obfuscating and maintaining the multifaceted cultural disorders for us all and turning more and more people into psychiatric consumers.

  • I am not sure power and the status quo would want to abandon something that serves its interests? maintaining the illusion of broken brains or faulty thinking, attitudes and beliefs locates the issues and solutions inside the individual. As people have pointed out this de-contextualises and de-politicises distress. People accessing services have come to believe in the myth of psychotherapy. i don’t think Smail or Epstein would suggest human care and compassion can’t be useful and is not needed

    These human qualities just don’t require a cultural power player known as a therapist to offer it with psychobabble aplenty- most therapists, myself included, have no more a clue as to what is going on or how to live beyond the resources I’m/we’re lucky enough to have than anyone else does.

    Psychotherapy can also be very harmful – consider the illusion we represent and what we can get people to think about and disclose in a session – this can be horribly re- traumatising and de-stablising yet when people drop out, likely much worse most of the time zero follow up is offered – so again we get to delude ourselves because we simply don’t get to see the harms done – the care stops when they leave the office/wage space – we simply have not a clue as to what life is like for anyone we see its all done on our terms in our offices – illusion on illusion.

  • From my reading and experience there seems to be three main camps on the claimed effectiveness for any from of psychotherapy.

    One camp is occupied by the main players in each modality or therapeutic school. They are all competing in a market place of ideas, for power and status – most of the research is done by therapists themselves, so those with the most to gain from their approach coming out on top. It also seems that the approaches that are elevated over others are those that are a best fit for the broader political, economic and cultural zeitgeist. Given the research is done mostly by those with the most to gain its horribly biased and therefore of little merit

    Another camp is also occupied by those with the most to gain and the research is done mostly by therapists – however this camp eg Bruce Wampold in the great psychotherapy debate etc – are at least attempting to get us closer to truth by looking in greater detail at the research.

    This camp assumes therapy is efficacious and they they are interested in what bits of therapy make it useful – dismantling studies and other forms of research have been carried out to try and understand what is it that actually helps in any therapy. What they have shown is the following.

    The most important, indeed key factor in any psychotherapy’s success is absolutely nothing to do with psychotherapy – The most important factor is all about the individuals resources coming into therapy – resources in the broadest sense, finances, health, family, friends, meaning, purpose etc.

    Next most important is placebo, then how comfortable the person feels with the therapist or the pseudo relationship, then comes shared goals/hope and right at the bottom is modality/theoretical orientation/techniques.

    Then we have a third camp, also made up of therapists and people in related fields – these people are even more interested in getting us closer to truth and they assess psychotherapy in relation to its cultural position. There are many authors here but William M Epstein over several books including The Illusion of Psychotherapy, Psychotherapy as Religion and Psychotherapy and the Social Clinic, Soothing fictions has taken the best of the research apart and analysed it on methodological grounds. What he demonstrates is there is no evidence for any psychotherapy being effective and it can be harmful.

    It’s really incredible that a field with such terrible research and routine poor outcomes and clearly making absolutely no difference to human wellbeing as evidenced by the ever rising numbers of people suffering manages to maintain any sort of cultural power position.

    This brings us back to psychotherapies usefulness to power and maintaining the status quo by obfuscating the real causes of so much distress in myriad cultural disorders. As David Smail highlighted it then loads individuals with responsibility to somehow adjust to ever worsening conditions. This constantly and falsely advertised transcendent heroic individualism or delusion is also picked apart by David Smail and William M Epstein.

    In my own experience working in the sector most of the people I know and come across aren’t aware of the critics of the research literature and simply carry on like it doesn’t exist even when its pointed out.

    It seems so often the case that the road to hell is paved with good intentions.

    some of these ideas are also laid out here

  • Consider how utterly vacuous and meaningless ‘recovery’ is conceptualised within the worlds largest and most expensive revolving door known as IAPT- Increasing Access to Psychological Therapies service. Here the personal, nuanced and changeable concept of recovery is largely based on two drug company funded tick box questionnaires the PHQ9 and GAD7.

    These questionnaires have also led to massive gaming of the data, by manipulating clients to reduce their scores or by therapists themselves filling them in. So the well advertised and claimed 50% recovery rate is a multifaceted fantasy.

    Most people that work in IAPT are aware of this, yet carry on as if it’s something to celebrate. This is understandable considering management have made it so it is beyond criticism and woe betide any therapist that doesn’t reach the 50% fantasy, for this person will risk being managed out of a job and or bullied.

    This is partly why staff are overwhelmed and burning out left and right.

    Imagine that mental health services destroying the mental health of its workers and doing nothing but produce empty data.

    Another cultural disorder made possible by the hard work and ignorance of thousands.

  • The school system is toxic for millions of young people and families are chronically stressed in myriad ways making home life painful too. These are all shaped and influenced by power, politics and economic decisions. CBT tells us the issues are within the individual in faulty thinking, beliefs and behaviours. McMindfulness is about accepting what is and getting on with it. If you read William M Epstein’s analysis of the psychotherapy research and others they tell us none of it has any evidence of efficacy and can be harmful.

    We need to address our many and varied cultural disorders and stop making it about the individual, these are political and economic disorders. The mental health industry by and large helps to maintain the status quo by obfuscating the real causes of suffering in the world.

  • what do we mean by ‘outcomes’ using tick box questionnaires often funded by drug companies is not an outcome.

    Can someone define outcome please?

    Surely self report by the individual on the receiving end of ‘therapy’ is all we really have?

    We also know how thankful people are for just being offered warmth and kindness, not to mention the highly prevalent people pleasing and low self esteem subservience we see all around us.

    Why do we need some culturally sanctioned power player called a therapist to offer warmth and kindness to people?

    Is it not time to de-professionalise and democratise care and compassion?

    To do away with the ‘soothing fictions’ of professional therapy?

    Wampold and others research has already demonstrated the most important factor in therapy and its nothing to do with therapy – its all about the resources the person has, resources in the broadest sense.

    Most therapists I know including me have no more clue as to what is going on or how to live than anyone else does. Mental health ‘professionals’ in the UK across primary and secondary care are being burned out by overwhelming work loads, targets and toxic work cultures – while at the same time offering ‘clients’ ‘treatments’ on low self esteem and asserting ones self in a not ironic way.

    Mental health services destroying the wellbeing of staff – ‘clients’ caught in service revolving doors, being offered almost nothing, consistently being educated to see themselves as disordered, labelled, drugged and around and around it all goes. Suffering increasing, suicide increasing, prescribed drugs increasing, iatrogenic harm increasing, early onset dementia doubled in the last 8 years.

    Millions of people work extremely hard every day to ensure these cultural disorders are maintained.

    Need the promotion, the training, the certificate, the certainty, the status, the money, the power, the soothing fictions.

    The road to hell is always paved with good intentions, along with political and economic systems that bring out the worst in human beings.

  • Hi Mike,

    I wonder if we would expect people to question an assessment done by someone in a powerful position no doubt presenting what they/we do as evidenced based? all legitimised by therapies broader context in terms of its cultural position and sanctioning?

    In my experience people are desperate for any sort of help. I’d say one of the most common responses from people about past therapy is that it was helpful at the time.

    When pressed people often suggest it was helpful to be able to talk about things or have someone listen. Some might be able to half remember some technique but there current situation is one of great suffering.

    Yet when you look back at the notes you would think a major successful treatment has been carried out.

    We know from the common factors material that the most important element in any successful therapy is nothing to do with therapy, its all about the persons resources, the the relationship then some idea of shared goals and placebo trumping much of this. Then if you read critics like William M Epstein he pulls apart of the best of the evidence and states none of it has any evidence and it can be harmful. It also does’t seem to matter about training or supervision lay people with compassion have been shown to be no different from the eminently qualified.

    Surely in reality there are few people with adequate resources enabling them a freedom of change unavailable to most people?. Is it not cruel then to blankety offer therapy to anyone when for most it is the suffocation of limited resources and systemic cultural disorders that are causing so much distress?

    you might find this ladies work useful around IAPT

  • IAPT is already horribly medicalised, decontextualising and generally frames distress in terms of ‘symptoms’ ‘disorders’ ‘treatment’s etc. I think I would have to leave if this was further cemented by adopting structured interviews to then subjectively apply some disorder label and then some ‘disorder specific’ model.

    As if we can just take treatments off a shelf and apply them to people as if they are broken records. CBT makes the assumption that the world is okay and the problem lies within your disordered thinking, behaviours and attitudes. The world is acknowledged but is then reduced to a mere trigger again for your own personal disorder. It then attempts to adjust people to what are really myriad cultural disorders – It also fails to do this just like most therapy fails and can be harmful. Read William M Epstein’s books for a take down of the research literature. The Illusion of Psychotherapy, Psychotherapy as Religion and Psychotherapy and the social clinic soothing fictions.

    What impact does this have on the culture at large and people’s thinking? Does it give people the idea that they can just apply some technique or simply sift the data, think rationally and be different to how they have been, probably for most of their lives?

    The illusion of the quick fix and radical individual transformation is everywhere – We also seem to be losing the ability to think of ourselves outside of medicalised language, we’re all mentally ill now it seems.

    This also seems to be useful for power because it de-contextualises and depoliticises distress.Why bother making the world fit for human thriving when its all between your ears.

    Most IAPT services offer almost nothing and once you subtract the time for endless box ticking and empty notions of ‘recovery’ you get low CBT is 3 hours, intermediate CBT 5 hours and high intensity 8 hours.

    In my experience most people in these services are just incapable or unable to think critically about this multi billion pound monster – seems we are back to the cultural disorder of self interest.

    and then what of free will not not?

  • id encourage everyone to read the critics of the therapy research and realise its not evidenced based at all – sad to read a therapist on here waffling about ‘neuroscience-informed model’ all sounds so scientific and so settled when its simply self serving waffle.

    These resources might help
    Read all of David Smail’s books – they are older but still very relevant – why therapy doesn’t work, The origins of unhappiness, Power interest and Psychology etc

    Read all of William M Epstein’s books – they can be expensive but do come on sale occasionally, The Illusion of Psychotherapy, Psychotherapy as religion, Psychotherapy and the social clinical etc.

    The Therapy Industry by Paul Maloney

  • I wonder have you read any of the critics of the research literature Mike? I would urge you to read all of William M Epstein’s books – Over most of them he takes the best of the best research and takes it apart – what he presents is not at all what is advertised – The titles everyone in therapy ought to read are The illusion of Psychotherapy, Psychotherapy and the Social Clinic in the United States, Psychotherapy as Religion The Civil Devine in America. Consider the broader disaster that is Psychology research and

  • The reductionist, internalising, stigmatising language of ‘disorder’ is everywhere in IAPT. It is unavoidable and most everyone uses it. It is also all over the IAPTus digital system.

    Furthermore it is not just PWP’s that offer screenings to people. Services are structured slightly differently across the UK. In many there are 3 levels of brief support PWP, Intermediate and High Intensity. All three offer screenings and all three have to label someone as disordered in order to have completed the digital system.

    I find it thoroughly saddening that I am literally forced to use the reductionist, stigmatising, internalising language of disorder at every turn. We need less not more of this I know what I am ‘treating’ its a human being right in front of me and i’ve no illusions any talking and listening that I do will make much of a difference over the long term.

    As someone that used to work in secondary care and have sat in on hundreds of psychiatric assessments leading to diagnosis I can tell you its dangerous unscientific nonsense. Mike suggests diagnosis is a ‘convenient, imperfect taxonomy of problems’ convenient for who? These are powerful stories that people take to be real malfunctions within themselves so they become self limiting self full-filling prophesies and everyone around them can also often see the person as mentally ill – all behaviour becomes viewed in this way.

    The problems that cause us to suffer are most often in the world and yet diagnosis reduces this complexity down to a ‘trigger’ again for your own personal disorder and it is YOU that must be adjusted to simply get on with it.

    As the critics have pointed out NO psychotherapy has ANY robust evidence supporting it whatsoever read William Epstein’s works, Farhad Dalal, The Therapy Industry by Paul Maloney, David Smail and many others.

    Therapy itself is the abject failure and of course it has to be because we are diagnosing the treating the wrong thing – what we have are myriad cultural disorders that must be changed if we are ever to realise human wellbeing.

  • The mental (ill) health system is a dangerous disgrace and needs to be exposed as such and dismantled as soon as possible. It seems once a cultural disorder is powered through self interest, self deception and ignorance it is unstoppable. This is especially the case when a cultural disorder is useful to power and maintaining the status quo. it then continues on crashing through the culture like a Tsunami with a diamond encrusted smile.

    There is so much ignorance in mental health services that we need something written, produced and recorded that lays it out for workers to grasp. However sadly in my experience once people are invested in delusion its all too easy to reinsert ones head in the sand. It is also necessary because people have mortgages etc to service. Amazing how a vast bureaucracy with feedback and self interest is the most all powerful way of controlling people because we get to do it to ourselves for a wage. We’re all digging our own graves and throwing each other into them but its all so normal just so accepted just the way it is. until it is not.

  • We need a deep dive book or article on all aspects of the regulators, history, staff, finances etc. In the UK the MHRA is split into two parts, medical devices and pharmaceuticals – the latter is wholly funded by drug companies and for most of its history headed up by ex pharma management. I understand the FDA’s funding is about 70% drug company money. The regulators are paid for and staffed by the very industry is meant to regulate – what could possibly go wrong?

    I can find this from 2004 and you can be sure its even worse now

  • I have met countless people over the years labelled ‘autistic’ or ‘asd’ and they are all individuals with little recognisable similarities in terms of what determined the label. Except for some folks i’d say shyness can be a present but not always. Look at the long list of celebrities whose lives are often all about clear communication and interaction. Consider Elon Musk although I must say I wonder if his ‘autism’ label was more a marketing tool for selling his neuralink tech.

    I always wonder what is meant by neuorotypical or neurodiverse – surely EVERYONE is the latter and the former an illusion?

    The DSM mindset is saturated right through our cultures.

  • de-pressed by employment
    relative poverty due to employment and political and economic policy/ideology
    chronic ‘insert response here’ caused by political and economic policy/ideology
    suffering due to class position
    suffering due to school system
    suffering from taking excessive responsibility for cultural disorders
    suffering compacted and entrenched due to the medicalised mental health system
    suffering caused by commuting, debt, awful housing
    suffering due to no community
    suffering due to consumerism and credit
    suffering due to myriad cultural disorders turned into personal disorders

  • I think mumbo jumbo seems quite apt – I trained in EMDR about a decade ago and I was initially swept up with the enthusiasm of colleagues and what seemed like people benefiting from it. However when I really began to reflect on what I was seeing and doing it made less sense.

    There can be something helpful, dare I say healing, in supportive compassionate encounters with trusted others – spaces where people can speak out what is in can help.

    I think this is all EMDR really is, especially around the ‘processing’ phase its a chance to speak it out or just have someone sit alongside – the psychobabble that goes along with it especially about the brain and the endless computer metaphors ‘installing resources’ etc is just fluff or stagecraft. However fluff in therapy does seem to help generate a little more placebo so perhaps its needed. I do wonder if we included the extraction of a white trauma dove from a seemingly empty bag might also get much the same results?

    Of course having people speak out what is in can also be very harmful, overwhelming etc . I find the resource installation and grounding ideas particularly uncomfortable because we are not computers – we cannot simply wave our fingers, follow a light or hand taps and be in possession of ‘resources’. Being able to ground self or engage in guided imagery etc if workable at all involves dedicated practice and the life resources to make such endeavours practicable and manageable. It cannot be done in brief therapy without considerable self delusion by both parties.

    We also know that nearly all ‘therapy’ is done on our terms, in the clinic devoid of context and full of people largely conformist and people pleasing, with no long term follow up or taking into account the myriad of factors that might also be helping outside of the therapy room, yet all benefit is linked to what seems the most obvious.

    After working in the industry for a long time it seems full of people I think of as ‘believers’ well meaning people often kind hearted but also very self interested and excellent and self promotion and believing in what they do and their curative powers. This would be all well and good if it really worked but we all know therapy is completely oversold yet many believers will simply refuse to engage with the critics, heads firmly in the quite lucrative and safe sand. This is a helpful book for a take down of the ‘evidence’ for therapy etc

  • people feel better when sitting talking with a kind compassionate person but once the brief encounter is over we often go back to how we were especially if the causes of our distress remain unchanged – we’re in a sick situation were therapists are attempting to adjust people to cultural disorders and we mistake panic reactions for ‘panic disorders’ square pegs round holes.

  • Really interesting and useful article as is the entire series, thank you Sami.

    One thing to make absolutely clear is what ‘recovery’ actually means in the IAPT context.
    It refers to nothing more than how people score on two main tick box questionnaires the PHQ9 and GAD7. Score below ‘clinical’ on these and it matters not if your lived experience/context is a disaster zone you are now in ‘recovery’ and the revolving door awaits.

    Once caught in the revolving door it is easy for people to start believing there is something fundamentally wrong with them and they come to associate whatever labels the different therapists ignorantly and freely assign to them as facts so its becomes ‘its my’ ………….insert one or more reductionist, stigmatising, decontextualising labels here.

    Therapists are also under enormous pressure to ensure at least 50% of people ‘recover’ and if they don’t manage this they will be managed out of the service – so of course no gaming ever happens…

    Both IAPT and secondary care not only do almost nothing for the people they are tasked to help but these services likely cause much harm by internalising and ‘treating’ individuals – if they have time to factor in context at all it is reduced to a trigger for your personal disorder.

    Staff up and down the country work incredibly hard under immense stress and so many staff are teetering on the edge of their own waiting lists, prescribed drugs and ‘diagnosis’ and functional substance abuse.

    Sadly the ‘professional’ training courses do not give any real time or even acknowledge the critics of the research literature and its all presented with such clear certainly so ‘scientific’ This means therapists take this illusion into the world and make it stronger, often looking down on other therapists they deem inferior or without an ‘evidence base’

    Services have also been whittled down to a shell of support, more like a production line broken people in recovered people out. In some services people are lucky to get 6 to 10 x 50 minute sessions, often working with people with complex issues and awful contexts.

    People are expected to open up to a therapist about such profoundly painful experiences super quick and when it gets too much and they drop out zero follow up is done in most cases. Imagine how much worse this could make someone, how much more desperate. I think these harms are more likely for people opening up about profound trauma and the techniques to ‘contain’ this unimaginable hell, ‘safe place’, ‘grounding’ etc are more for the therapists benefit than anything of real benefit to the suffering person.

    The system is sick and self interest and precarity keeps the entire thing bumbling along.

  • Love this – thank you for your darkly hilarious testimony – and well done fella you lived to tell the tale! This is like surviving a shark attack in emerald waters.

    If this were a song i’d call it the Culture Disorder Blues.

  • A question I ask is what is actually helpful is it ‘psychotherapy’ or human compassion and care? It seems to me the latter is intrinsic to many of us but it has been professionalised, making it seem like only this group of paid trained people can help. When in reality mutual aid could be provided by anyone with the time and resources to care – the trouble is our systems don’t give us much time or resources to care and the values support and promote self interest above everything else.

  • I would advise reading William Epstein’s latest book Psychotherapy and the social clinic in the united states soothing fictions and his older book the illusion of psychotherapy.

    There is no credible evidence for the effectiveness of any psychotherapy whether face to face computer or whatever – the research system is corrupt the research shockingly poor but the advertising and self interest machine is all powerful.

  • Some thoughts – I was once enthusiastic about these tools and I still see they could have a place but not if we do nothing to change the causes of our suffering that lie mostly in myriad cultural disorders.

    I am also concerned by the inevitable over promotion and advertising and grand claims (in fact the entire piece strikes me as advertising) for something that only has ‘Theories of Why Psychedelics May Work’ sounds familiar right? ‘anti depressant’ etc theories of action and here we are with massive and sustained over prescribing and more harms being discovered daily. Releasing these things into the greed filled profit wilds of out current system seems dangerous and seems to further add to the ‘mental illness’ internalising of distress narrative.

    ‘Mental illness keeps a person separate and alone’

    suffering doesn’t land on our heads from the abyss – it comes to us in myriad ways and for myriad reasons – cultural disorders abound, most jobs, debt, the media, economy, political systems, class, junk values and much more shape us all in multiple ways – quite often bending people out of shape and distorting us leading to suffering. We have an epidemic of loneliness not because of mental illness but because of the way our living systems are constructed – we have cultural disorders in need of treatment.

    ‘We are also working to ensure that therapeutic treatment for patients takes place in medically supervised environments, without losing the essence of the transcendental which underpin their healing potential’

    I bet you are – roll up roll up and get your latest professional sounding waffle and you only need a maintenance dose every 6 months for the rest of your life – Is Huxley’s Soma coming closer into view?

    How about we provide medical supervision but roll this out to ordinary people in local communities – medicine men and women don’t tend to wear white coats and make millions out of assisting their fellow travellers its a need deep within many often suffocated in the cult of the individual and the professionalising of care.

    ‘In a therapeutic setting, psychedelics may produce profound personal or existential insights, feelings of empathy and self-compassion, and a sense of connection or unity with other people, things and the world in general. Research shows that these characteristics are correlated to therapeutic outcomes and that patients regard these experiences among the most meaningful of their lives’.

    Ever been to a rave? festival? sat in the grass with a small group of trusted others? Therapeutic setting? Yes of course these tools can produce these profound experiences and it can certainly be amazing and Changes you – BUT when the dust settles and the shine diminishes we see the insights illuminate a world/system cultural disorders lacking in empathy, compassion and full of disconnection and disunity – whoosh what a come down hey – no no just come for your maintenance dose and forget about changing the world, its just your silly negative perceptions, always remember there is nothing good or bad but thinking makes it so – you are really swimming in waves of bliss not about to start that soul destroying body breaking, relationship crushing nightshift so you can continue to live like a sophisticated rat in a slightly bigger cage.

    ‘Another important area to be well versed in professionally before working with psychedelics is trauma. It’s critical to be experienced in somatic practices, as well as understanding and being comfortable with transference and projection. This level of comfort comes from both training in the subject matter and doing your own inner work. Processing one’s own non-ordinary states of consciousness can help others do the same’.

    If you are a human Being living in the actual world then this means you are already likely well versed in trauma – no training or special certificates needed, just a life lived – perhaps some guidance for sitting and being with distress could be useful for those drawn to their inner healer and to be in service to others – but please lets not professionalise and profiteer ordinary human care and compassion – yes do your own inner work – go experience a psychedelic experience of your own. In the UK before lockdown the UK Psychedelic society was doing guided group truffle sessions in the Netherlands. I am sure there are many more examples.

    ‘To achieve this, we need practitioners who are trained to provide psychedelic-assisted therapies in medically controlled environments. Aspiring professionals need to learn the different therapy modalities that will inform their work with “non-ordinary states of consciousness.” They also need to be very capable of “holding space” for a period of hours, which is unlike the normal one to two-hour sessions usually deliverer’.

    Again do we need more professionalising and profiteering of human care and compassion and the medicalising of non ordinary states? many millions of human beings have experienced non ordinary states since time began and are doing so daily.

    I hear people sometimes say things like, think of all the changed people newly inspired to face and change the world after these sessions – perhaps this will happen for a minority but like the rest of the therapy industry, it will be used to keep people keeping on with what is – consider in the UK recent school guidance forbids teachers from even discussing anti capitalist ideas in class, welcome to the machine, just a micro dose a day keeps those changing the system thoughts away.

  • It is always helpful for people to be clear about the DSM and the pills it inevitably leads to BUT please can we have some humility and honesty about psychotherapy and its equally limited ability to help people.

    This is just massive and shameful overselling -makes me cringe – i’m just imagining a drug company style video that goes along with this sort of waffle.

    ‘Once the psychological injuries are mapped out, treatment can address them. And only psychotherapy is specifically designed to address emotional wounds. Only therapy is focused on uncovering and refuting the negative self-talk that scrolls through the minds of people who have been emotionally abused. Only therapy can heal the distorted images of self and body that people carry who have had their sexuality violated’.

  • There are many worrying things about the current situation – more and more people are educated to self identify with a disorder or four – the so called anti stigma and mental health awareness advocates appear to be promoting not mental health but self identifying with mental illness narratives – Daily I meet people that describe a huge amount of suffering as those I listed above and yet they seem to miss the obviousness of their situation and tell me I think i’m OCD, or my last therapist told me I have GAD or whatever label you care to choose.

    Mental health services in general seem to be locked into a business model of creating customers and completely overselling their wares – the services I work in proclaims 6-10 sessions of a brief talk therapy will furnish the suffering with the skills to be their own therapist! I mean talk about false advertising and besides most of the therapists I know, myself included have no more ability to cope with life than anyone else does – if life brings suffering into being suffer we will just like everyone else.

    The entire IAPT model is hinged on the PHQ9 and GAD7 – two subjective questionnaires that can tell us almost nothing except someones best guess at how they may or may not be feeling in a given moment of time – yet these measures are god almighty – continued services funding, micro management, massive staff burnout and empty notions of recovery are all bound up with how someone scores on those measures and this is all anyone seems to care about – a persons life could be in pieces but as long as enough people pleasing, placebo and subtle manipulation can be generated and the person scores ‘below clinical’ well now they are suddenly in ‘recovery’ it is really beyond a joke – this experience has taught me about the power of institutions and ideology tied to self interest and how harmful things can become very quickly

  • ‘The categorization of the DSM obfuscates the impact of trauma and stressors (such as poverty and isolation) on human wellbeing. Even for PTSD, it implies that the response (avoidance, nightmares, etc.) to intense, life-threatening trauma is “disordered.” The researchers write’,

    perhaps we can start naming cultural disorders like – (such as poverty and isolation) yes and there’s so much more to ‘choose’ from
    most jobs
    few communities
    crushing routines
    miles of endless miles of traffic jams
    people crammed onto trains
    glaring florescent tubes
    mental health services causing huge amounts of staff to suffer while making it almost impossible for them to offer a humane attempt at care
    habit forming cultural disorders lurk everywhere
    algorithm mania
    click bait tick disorder
    sugar with my everything disorder
    day time television or having the DTTees.
    frantic typing disorder
    persistent micromanagement disorder
    phq9 and gad7 partial delusion pickle lobes
    psychobabble courgettes
    professionals in denial disorder
    professional babble my way out of a brown formulation disorder
    registered nincompoop production line of suffering disorder
    standing in long queues for years of my life compulsive disorder
    will work for food disorder
    anyone care to join in?

  • good luck to the team in making such important changes – how mad to think power is more of less missing from the picture – I’ve worked in the mental (ill) health system for years and its deeply frustrating to daily hear the language of disorder pouring out from just about everyone – I think in the land of psychological therapy especially with the dominance of CBT this language has exploded and it always seems to me that many therapists actually like the language – I think the language helps provide some with a sense of professionalism and expertise when it is anything but.

  • I agree that some sort of indicator regarding the lack of validity and reliability about such constructs would be useful.

    I think for people just lifting the veil on what they have been educated to believe about human suffering reading headlines asserting this or that mental illness can be very confusing.

    I would also really like to see a collaborative piece written by suffering people and professionals discussing or listing all of the harms hinted at in his article and to include what benefits there are.

    One of the benefits or perverse incentives at least here in the UK is to identify yourself as mentally ill because in an age of austerity, cut backs, and a public humiliation system otherwise knows as the benefits system, it actually pays to self identify as mentally ill – how utterly twisted of the powers that be to create a system whereby people need such harmful illness labels in order to cling to what little social support they can with the threat of it being taken away always with them.

  • What a crazy world – work places are the cause of stress and burnout of broken marriages, families, broken bodies, boredom and essentially turning people into robots set to repeat the same old tasks over and over again for the best years of our lives – but hey lets not diagnose the work place as being ill and disordered and seek to change the work place or work ethic…NO let us always and forever pathologise the individual and make it his or her responsibility to change through the magic of ‘research recommends healthy boundaries, seeking support, mindfulness, and psychoanalysis’.

    We even have mental (ill) health services causing massive harm to staff – anyone worked in secondary (anti) care in the UK? many staff are hanging by a thread quite often functional substance dependent riddled with anxiety and low mood – or perhaps in the UK governments ‘flag ship’ IAPT service? again a service that is nationally burning its staff out on mass with its relentless drive to service targets targets targets – targets by the way that are meaningless and freakish distortions of what ‘recovery’ is meant to be – score ‘below clinical’ on the phq9 and we have a winner – congratulations you are now in recovery

    At the same time as its causing direct suffering to its staff on mass IAPT management is also tightening its sickness policies so now people are on final stage warnings for having minor issues like heart attacks, bereavements, major accidents and of course for burn out BUT you can always go have some of your own CBT to change your pesky NATS, unhelpful beliefs attitudes and behaviors and get with the program.

    a sick system doing little to help those its tasked to help and causing great suffering to its staff – in a word MENTAL.

  • wow such a powerful piece and amazing your son survived and is thriving.

    It is beyond belief that we are drugging our children and labeling them as mentally ill and sending them for ‘treatment’. The labeling and drugging of adults is also now completely out of control with ‘mental health awareness’ campaigns actively encouraging people to self identify as mentally ill and seek ‘treatment’ Never to look outside of themselves as the cultural disorders causing our suffering always within at your own faulty/disordered brain, thoughts, beliefs, attitudes and behaviour.

    My own journey was also dramatic and I went from being naturally sad and distressed because of an awful job and a relationship breakdown with estrangement from my dear daughter. I was started on 20mgs Citalopram and went from being sad and distressed to completely emotionally numb and suicidal within two-three weeks.

    I cannot recall writing the note that I left that simply said my name followed by the words ‘is dead’. The idea to kill myself and the actions following it felt so automatic like I was a robot ‘I’ had gone.

    The plan, buy alcohol drive somewhere remote, drink it all and drive head first into a wall. I drank half of it and fell asleep from exhaustion . Thankfully when I woke many hours later the urge to die had dissipated so I drove home to find the police waiting to ask me about the note.

    I have heard this story of profound emotional numbing and suicidal behavior from countless people over many years while working in the mental (ill) health system. I say ill health because it can can do little for those its tasked to help, often causes harm not only to those its meant to help but also to the staff through targets driven burnout.

    We have mental (ill) health services harming mental health – truly crazy.

  • The drugs marketed as anti depressants and many others are so easy to get prescribed and as the article states prescriptions rise year in year out.

    We’ve had a century or more of clinical psychology and now hundreds of talk therapies, dozens of drugs and an ever increasing deluge of harmful,stigmatizing limiting diagnostic labels also easily caught by word of mouth.

    Surely by now with the focus on the individual and our alleged imbalances, faulty genes, disordered thinking, behavior, attitude and beliefs we are moving towards better well-being or improving well-being – NO its the exact opposite – the therapy industry can do little to help those suffering and it actually causes huge amounts of suffering for the staff it employs at least in the UK within IAPT and secondary care services with ever increasing burnout and other manifestations of suffering caused by human beings caught in toxic or disordered elements of the culture, targets and empty notions of recovery.

    Surely we need to move away from this myopic, harmful, individualistic, decontextualizing mental (ill) health system and its clearly unhelpful but well meaning raft of ‘therapies’ and seek to identify and treat the cultural disorders we are all stuck with.

  • 2019 and this is a question without answer? really what about in the broken hearts and minds both adult and child – we need no study to know our own suffering all we need do is look at it, touch it, feel it. My school experience was nothing but anxiety – the constant shifting sands and shenanigans the mayhem and fear, the bored indifference forced to endure the sitting the standing the lumps of chalk flying heads bounced off desks dad would like to hurt the Geography teacher for hurting his son – send him for anger management CBT him so he can see not reality but only his perception of reality molded and shaped to locate the problems inside of broken you, sure education hurt but at least i’ve got my job and all the freedom it takes away from me and pays me it back in drips and drabs annual leave and burnout attempts at helping the blind leading the blind the kindness shines inside of us and its trying to make more light blighted by targets and business models mental illnesses and bogus treatments fear and self assessments tick box bollox ‘caseness’ and crassness the deserving and the shirkers narrative swinging monkeys singing in the digital trees I want to be like you oooo a lying politician too oooo so I can learn to be anti human too 0000

  • I really appreciate the interview and the paper its based on – I work in the industry and have of course suffered myself and still do. My own suffering is entirely down be being over worked in a targets driven relentless service that is entirely focused on moving suffering people into ‘recovery’ via symptom reduction.

    This is essentially a meaningless paper recovery based on the administering of two self assessment measures the PHQ9 and GAD7 two measures that tell us absolutely nothing of someones complex life context and history. Even more bonkers is the fact that these two measures are also fundamental to continued service funding and ever increasing micro management. So everyone is pressured to focus on the reduction of the scores as the goal.

    Most therapies reduce the complexity of the world/context to mere ‘triggers’ for some hypothesized internal disorder and seek through insight and will power to change ‘unhelpful’ or ‘disordered’ (in reality utterly normal and expected) thoughts, beliefs, attitudes, behaviors into more ‘rational’ or balanced modes of being – ultimately services seen to be mostly about helping people simply get on with it to accept the unacceptable.

    Perhaps an approach based on helping us develop what David Smail called ‘outsight’ would be better because this would help us connect with and understand how the culture through power is causing our suffering from top down from politics, economy, ideology, media, education, jobs, debt, broken communities, alienation, fear, food systems, advertising, food banks and on and on.

    Mental Health Services in the UK such as IAPT are causing huge levels of staff suffering through burnout, due to targets and this production line of suffering model we currently have.

  • A a study for this?

    its hard to maintain any sort of exercise regime when you are feeling relatively well given all the competing demands on time and energy – exercise or any sort of behavioural activation is the opposite of what it means to be depressed – add in the side effects of various prescribed drugs, a job that sucks the life force out of you, zero community, relative poverty etc and really is it surprising that its hard?

    surely ‘treating depression’ is just focusing on a set of symptoms while leaving the causes and many others besides lurking.

    I wonder has anyone had any experience with the power threat meaning framework? seems to be an attempt to recontextualise people after all the so called treatments seek to reduce the irreducible to an internal issue amenable to change via will power

  • apologies if some of what I said last night seemed a little annoying Shaun – note to self don’t engage in online discussion after more than 2 drinks.

    I agree with you that few people now would feel able to share with trusted friends and family and neither would many people feel they had time or confidence to simply listen and be present. However this is not because of some lack of relevant expertise but more a product of the cultural disorders that we live with – what did people do before ‘services’ and look at the evidence we’ve had 100 yearsish of clinical psychology, longer with psychiatry and we have dozens of drugs – hundreds of talk therapies – and yet things are clearly getting worse, suffering increases year in year out – much like hysteria at the turn of last century was the common cold of the age now depression is meant to be – you have a better chance of recovery from psychosis or so called schizophrenia in the third world than in the first – how can this possibly be?

    we have all been trained to give our power away to the experts – oddly at the same time many people when consulting other experts in medicine for example we might well have done some homework and come with informed questions – mostly not so with psychotherapy – its mysterious, maybe this is all to do with how embedded and revered its become within the culture – or normalized – at least in the west – and now the talk of ‘evidenced based’

    There are plenty of cultures that would see talking to a stranger outside of the community/family as nuts, and others still that would feel talking it over and ‘expressing and reliving trauma’ also unhelpful and possibly harmful.

    it seems the massive efforts over the years from the west to go help in disaster zones say the Indonesian Tsunami likely cause more harm than good- Ethan Watters outlined this well in his book Crazy like us – he documents the arrogance of western therapists and therapy agencies descending on the country bringing their supposed modern scientific tools and techniques to enlighten the indigenous people- sure some of this was done with genuine care but so much was also seen as an experimental zone whereby self interest was the main interest to study and try out their wares on a disaster zone. most could mot speak the language or had any clue to the local customs and cultural norms and assumptions that were utterly different to their own – individualism over collectivism, the language of trauma etc but they dove in anyway so sure of themselves.

    It just seems to me that we’ve got many cultural disorders that are left largely in the dark by therapy because we are all looking at personal disorder or in some way just helping the person to adjust to their situations – not see beyond into the powers shaping and controlling us all and reposition the limitations of the individual in this context – while perhaps at the same time exploring how collective change happen, the history of grass roots movements to bring us what we take for granted today – at least in the services I know this would never be touched beyond the superficial because we’re all educated in personal disorder ‘ I have depression’ etc – ‘I need help’ so in this way services consciously or not reinforce these cultural assumptions of individual fault and personal responsibility to change self, to adjust

    the mantra of the modern worker seems to be ‘you’ve just got to get on with it’ and while we all struggle to get on with it, suffering increases year in year out.

    so me and you Shaun are part of a system that helps to maintain not change the status quo so we’re all vulnerable to more harm than is needed.

    self interest ties us all to this toxicity – i’m a ‘consumer’ have a mortgage, have wants and desires constantly stimulated by cultural disorders etc.

  • I see what you mean Shaun and its probably a bias from me to listen only to respond – do tell me about your experiences with EMDR? just before if even some of these are right then its a wonder we can communicate at all

    I have also had experiences – some telling experiences are when i’ve got a sense of a good alliance I will ask for honesty from the person about their open views about what we did – I recall asking this of a person at the end processing ‘installation of future template’ etc this session would have looked like a text book treatment success, suds gradually lowering, emotional soothing, narrative moving from anxious stress to distant, calmer not as bothering etc.

    This person explained they thought it did nothing at all but what they did find useful was the chance to speak some truth to someone deeply curious and caring for them in a relatively safe space. This could be done by family, friends, the broader community – if we had communities and time to engage each other more compassionately in cultural possibilities that created better conditions for trust and cooperation to flourish.

    I think David Smail had it right when he said all any therapy can offer is some comfort, clarification and encouragement but these are all transient and suffering can heighten once the talking and listening, waving your arms around stops – and yes for some lost souls this can be a life and death connection but on the whole are we helping to placate and mystify, minimize and emphasize according to our models and formulations rather than help with expanding outsight into the political and class awareness, media studies and ideologies, the way mental health industries shape the cultural narrative about what is and is not mad or abnormal – this from a largely white middle class american mans view – already throughly biased and blinded by the cult of the individual the super hero the self starter, biased to extroversion and social Darwinism, Benny Hinn putting fire on pastors, just access your deep well of will power and force your will on the immensity of all that is .

    now I wonder if you had heard these words spoken in the context of a first therapy encounter – what model might you use to treat me?

  • are these the words of a believer ,’I can say that I’ve seen people quickly start feeling better about their trauma and/or themselves after doing as little as one session with a light bar. I think EMDR out of all the interventions I’ve learned is the most promising for delivering on it’s promises of long-term symptom relief.’
    imagine that ‘one session with a light bar’
    did you train with the real Yoda?
    I’ve a friend that swears bruises have materialised and dematerialized during processing – I love the benny hinn side kick = fire on ya! ‘tapping in resources’ thats right you can just tap em in – well I can do it for you cheers me right up

    hail from which star system have you traveled?
    we’ve got trauma creep, in fact we’ve got the insatiable creeping psychiatry defining he landscape we haven’t imagined yet

  • Hi Shaun – yes sadly it does seem that in our alienated fear filled world that therapy for some people might be useful some of the time in some ways depending on the context and what is on offer.

    Alas its mostly at least in my experience short term therapy and I think sometimes it might cause more harm than good – take for example those suffering as you have suffered with childhood trauma – this might have been multifaceted and the persons current circumstances might also be horribly harmful to them and so they are referred to IAPT for say counselling, EMDR, CBT, EFT etc. These suffering people often with decades of trauma and ongoing major stress will be offered around 10 x 50 minute sessions. less than half a day in someones life to address a lifetimes suffering.

    is this not unethical? dangerous? gross false advertising?

    people are often just beginning to feel that they can say more than they may have said to anyone before and its time to leave – we’re told by management that people can re refer and they often do and the cycle continues.

    I also don’t think it necessarily takes a profound trauma to crush esteem because many people if not most of us are suffering what I think of as millions of paper cut trauma’s – family lives being witness to parents being broken down by their awful jobs, ships passing in the night, financial battering, poor housing, a school system that cares not a jot about each person’s possibility but only in targets, image and feeding our young through the sausage machine of the system soaked with comparisons, pressure and stress. zero community life, lack of meaning, loss of contact with nature, self and others, constant and relentless advertising and consumer culture with its illusions and manipulations and images of happiness and success. The cult of the individual and delusion of the hero the self made man the me me me mantra.

    Then when crushed and confused send us to therapy, drug us, label us – all focused on the individuals supposed maladaptive self – no one has time to take a wide angle zoomed out approach helping the person place their tiny lives in this broader cultural disorder context soaked through with powers so vast its hard to comprehend – so its all about the persons disorder and how we experts can somehow help them and delude ourselves to get on with it.

    When can we start to diagnose and treat the many cultural disorders all around us?, to see more clearly that if we take a beautiful flower and place its roots in turds, its leaves in pitch dark then pour feed on it we are not really helping except maybe helping to maintain the status quo and the killing of possibility.

  • Thank Steve i’ll check the book.

    This idea of insight is interesting. it seems to be at the centre of most therapeutic approaches, the desire to invoke in someone the all important ‘ah ha moment’ as if this can somehow make change happen or follows from it.

    When I reflect on my own experiences and the years of working with many others insight seems a mystery-Observing my own life and the glimpses of the lives of the people I see, it seems clear that we often have clear awareness or insight into an issue of great harm, be it a relationship, attitude, behaviour, belief, situation etc – we can also reflect on it, talk about it, describe it to others,sing songs about it and yet continue with predictable certainty to repeat it – until somehow it changes – once change (if change happens at all) happens our minds automatically populate a story for the change, often a story about something we have done, an act of will, but is it?

    or is it more that things, happenings (life) happen to and through us but are not directed by us at all – the age old free will conundrum seems to be leaning more towards determinism – I sometimes see life and what happens to us as seeming random and mostly luck – ‘I’ appear to be here to bare witness to what is.

    reminds me of some couples conselling I had many years ago that I partially remember.

    I used to think an insight I gained during this therapy was key in what seemed like my decision to end the marriage – but when I step back from this and consider the massive complexity of influences external and internal most of which is completely and utterly beyond my awareness I wonder how can it be? – I recall the therapist accurately paraphrasing my words back to me and this seeming to me like an ‘ah ah moment’ and a decision made to walk away. While it of course influenced me, given the weight of all other influences was it not insignificant? but maybe the esteem I had for therapy at the time imbued it with meaning and power and the cultural reverence for therapy created a story for me.

    who knows hey.

  • agreed the more human and connected the better – and yes connections and or the lack of connections is the major theme of Johann Hari’s last book titled lost connections and I think its certainly a major issue – we have such potential and if our needs for connections currently missing were met would we really need a mental health industry?

    I wonder have you any book recommendations Steve that helped in your journey to change? or is there a recommended books section on the site?

    these have all helped me

    By David Smail – Power, Interest and Psychology: Elements of a Social Materialist Understanding of Distress

    The Origins of Unhappiness: A New Understanding of Personal Distress

    By Paul Maloney The Therapy Industry: The Irresistible Rise of the Talking Cure, and Why It Doesn’t Work

    By James Davies Cracked

    by Ethan Watters Crazy Like Us: The Globalization of the Western Mind

    be well

  • Hi Steve, thanks but I wish it wasn’t so! Buying into the entire industry/ system is hard not to do – I must admit when I first began reading the critical perspectives and reflecting critically on my own work it was really hard to do. However once my head was lifted from the deep sand of training and constant association with believers I could not put it back.

    Its quite a lonely place to be because I often share articles and ideas from this site and other places at work and hardly anyone is willing or has the time to engage in a discussion. Reminds me of a quote, something about it being difficult to get people to understand something when your wage depends on not understanding it. I actually had one supervisor some years ago tell me he is pleased there’s such a thing as ‘mental illness’ because it keeps him in a job.

    It seems many mechanisms like self interest and the power of conformity ties us to so much cultural toxicity its staggering to me – i’m pleased you managed to escape it Steve.

    I do what little I can to help those I see but I stress its so very little – The thank you cards and letters I get from people while appreciated serve to remind me of just how disordered the culture is.

    I think it is sad that so many people can be so thankful for so little and time and time again people minimize their own prolonged hidden heroic courage in the face of overwhelming adversity that would have crushed me to pulp. Instead they are full of thanks for something they believe I have done.

    The cultural esteem and powerful story of talk therapy and the industries drugs and labels serves to help in this personal minimization by creating a narrative or a sort of dot to dot picture to colour in- the culturally induced crushing of self esteem ensures these stories are often believed in – while many people have no one they can turn to for trusted solidarity many people do but feel unable to share because they understand that those family members and friends are also suffering.

    So we are encouraged to turn instead to we ‘mental health professionals’ we ‘experts’ ‘therapists’ ‘traumatologists’ ‘psychotherapists’ ‘counselors’ it all sounds so reassuring so certain and technical.

    yet behind the welcoming smile of the expert is a human being, someone probably suffering or soon to be suffering and just as lost and in need of support, solidarity and compassion as everyone else.

  • I have thoroughly enjoyed reading the various discussions at the end of this article – while at times some of it has seemed a little confrontational I think its mostly been quite respectful and shows a range of feelings and perspectives.

    I have worked for many years across various mental (ill) heath services in various roles including my current role as a therapist although personally speaking I dislike the title therapist and think of what I do more as a temporary compassionate helper – I also think that if we had cultures whereby human wellbeing was front and centre, with people actually having time to care and share with each other these roles would be a thing of the past.

    Long before clinical psychology spawned the hundreds of ‘talk therapies’ we now have we had human beings harming and helping each other, its just what we do, if we have the time/energy to care that is.

    Caring like almost everything else has been turned into commodity to be bought and sold, someones job – Jobs cause huge harms to the majority but where is the debate on these harms? – the massive Gallup poll done a few years ago covering hundreds of countries and millions of peoples attitude to working life revealed that only 13% of people are enjoying their work – for the rest they say are ‘sleep walking’ through their days disengaged, bored understimulated, numb others still actively hate their daily grind. Not that we needed such a poll, its quite obvious if you just allow yourself to reflect on your own work history and listen to what others say about work.

    it seems to me that it is quite easy for people within services/roles that have been elevated to relatively respectful if not revered positions to also inflate what they believe they can achieve through talking/listening to someone. Training, supervision and associating with other therapists just reinforces these beliefs and I’ve met many a therapist with almost god like beliefs in what they do – after all we are constantly told to ‘trust the model’ and ‘sell’ what we do with absolute belief that it works – ‘research says’ ‘NICE guidelines say’ etc.

    Therapy as an activity usually takes place within a consulting room model devoid of context beyond the persons own limited story of self/world, biased and blinded by culture and a therapeutic industry that essentially tells us its not the world but our interpretation of the world that is at fault and all you need to do is harness some will power to change.

    Furthermore most of the mental (ill) health workers I know are themselves suffering with various levels of burnout and major stress because services are more like production lines of suffering – especially in the UK with IAPT.

    All anyone cares about in IAPT is ‘outcome measures’ meaningless scores on two self assessment measures the PHQ9 and GAD7- no matter if you are crushed by the culture if enough people pleasing can be stimulated in session and you score below ‘clinical’ then we have winner and you are now in ‘recovery’ another empty term, for how can you recover from the cultural disorders that impact us all to differing degrees throughout our lives.

    Its also worth remembering that therapists themselves are no better equipped than anyone else to cope with life stress and cultural disorder – get the right or wrong conditions in life and we also suffer just the same as anyone else and no prior knowledge of theory or techniques will help us much.

    This stress is clearly evident in services daily – spend just a few moments listening to therapists and you will often hear judgments that this or that person has a personality disorder or comments like how do they expect to get better if they aren’t doing their homework or taking their medications etc.

    That word medications is something I think we really need to stop using along with anti depressants and anti psychotics -and the disgusting personality disorder label – it seems whenever we use these terms we perpetuate a harmful myth and contribute to free advertising for drug companies and personal pathology – they are drugs, that sometimes help and it seems to me more often than not hinder and harm.

  • how can the study demonstrate that any personal practice can prevent depression? has it found the cure for human greed, ego, power abuses? the unintended consequences of planned government policy? for media bias and control? for crushing school systems? for jobs and work that crushes daily, people into to a shadow of themselves, to mass debt? to poisoning food systems? to advertising….

  • ‘expectable responses to distressing life events that signal a need for rethinking one’s life and recalibrating one’s self-perceptions and emotions’.
    just like baking a cake?
    what harms are associated with individual therapy ?
    does it pacify people?
    does it redirect legitimate anger?
    does it mystify and obfuscate the causes of distress?
    does it have time to explore the ‘unintended consequences of political, economical, class, ideological, media policies?
    does is pathologise the individual?
    do some ‘therapies’ actually encourage the person to seek out prescription drugs
    does it help normalize, and reduce the irreducible and therefore help them and us to accept the unacceptable
    does it often involve a therapist suffering just like most everyone else does but having to paste the face on just like a clients narrative tells of their own exhaustion with their own social facade
    does it conspire with the government to get people off benefits and back to a job that will slowly or quickly harm them in many ways
    psycho-compulsion anyone? harm or help? explain
    does it reduce human distress down to a set of pointless scores on self assessment measures?
    luckily for us as long as you score below clinical it matters not that you’re life experience with cultural disorder is crushing you, apparently you’re in recovery. you’re welcome.

  • Thanks Shaun, I used to consider those aspects you mention be the merits of therapy and perhaps that does happen for some people some of the time but short term quick fixes are in my experience completely and utterly oversold in the culture. It seems to me any gains are apparent while you have someone (hopefully) compassionately listening to you but once this is over things quickly return to normal – unless the person has adequate access to resources and power and these are usually the people that need therapy least of all.
    take care

  • Hi Shaun – I agree we must be able to ask questions of ourselves but changing ourselves significantly is another matter and requires access to resources and power.

    I suspect if we were to really delve into the reasons for the examples you gave such as road rage or mass shootings we would see much more clearly that it is not individual malfunction, such as disordered thoughts or attitudes that somehow just need evaluating and correcting but would highlight instead a systems failure within the culture – we need to take an outside in approach and zoom out of our lives to help us see beyond the obvious and into the hidden – people are suffering in a multitude of ways sometimes obvious quite often not obvious but suffering in the form of many paper cut harms that accumulate over time and we often ignore, distract or dissociate from and therapy hides us from.

    for me its not about blaming society but looking at how it shapes us all.

    Going back to the ideas of CBT and its assertion that there are these things called ‘common thinking errors or distortions’ surely we need to be asking what is influencing such ‘common’ conflicts and seek to change the causes in the culture or at least be honest about them, not heap the stressed person with responsibility to bend themselves into some fantasy rational self monitoring selector of correct cognitions and attitudes after we tell they they are suffering with ‘depression, OCD, GAD, PD’ and on and on.

    I would love to know what forces in the culture, family life, the economy, political philosophy, ideology, media, class are contributing to the development of these interactive expressions of suffering.

    a little like offering drugs to people drugs that might subdue, suppress or make you less bothered about things previously bothering but do nothing to confront the problem but instead helps to hide it – Being bothered about what bothers us is precisely what we need to do in solidarity with others if we are ever to create a world that meets human needs.

    Be Well Shaun

  • Hi Shaun – these are interesting aspects about us as human beings and our conduct that you bring up.

    When I read your words and the language of ‘responsibility’ and ‘not accepting reality’ etc I am reminded of the age old and unresolved debate regarding free will. After listening to thousands of stories over the years and observing myself living alone for around a decade I often wonder about this.

    When I consider the vast array of influences and powers shaping me and the world around me (most of which are out of my awareness) I am often left wondering just where does this ‘free will’ emerge from?

    My conscious thoughts are utterly out of my control, my behaviors very often feel automatic as does my speech and even this conversation we are having. however it feels like I am driving this but is it more that I can observe, reflect and think about it all and while this seems to give me some element of control its mostly just happening to and through me – I don’t know?

    When I look within there is no one place where ‘I’ exist but rather ‘i’ am a vastly complex collaboration of internal and external influences that somehow produces this unique human being.

    I did not chose my family, the country I was born in, when, the political system, the class, the intelligence (or not!) that I am bundled with, the opportunity that comes (or doest) come my way, I could go on but you get the picture I am sure.

    Luck seems to be a sort of magic we all dance with – BUT we live at least in the west in cultures infused with the image of the hero, the self starter, the, self self, self – the community the collective the collaborative is reduced – yet human beings have only managed to harness parts of the worlds potential by working together.

    Consider our totality – we are a vast collaborative effort of trillions of cells – none of which ‘we’ can control or direct in any way and when they fail we fail.

    now the system around us is open to change and the system as is affords certain groups an abundance of opportunity and freedom while crushing it for many- changing systems has to be a collaborative effort.

    its not necessarily about blindly blaming the ‘system’ or getting angry at it but observing and discussing how the system and its powers operate and being honest about our individual attempts to change ourselves rather than identify and seek to change in collaboration with others the system.

    It seems we are like a beautiful flower grown in the conditions for life and thriving then planted out in the dark on rubbish soil and when we whither, suffer and diminish, we try and talk to the flower and pour artificial feed in the form of therapy and its ‘tools’ onto it. perhaps this gives the flower a temporary but ultimately futile perk. suffering is massively increasing year in year out, suicide up, human misery up – this must and has to change.

    we need to work together to create the conditions for life to flourish we have all the possibility and tools we need but we have poverty of access hence the power of the system as it is to maintain divide and conquer

  • Thank you Shaun- I wonder who decides when someone is ‘Refusing to accept things as they are’ and surely being ‘stuck in unhappiness, bitterness, anger, sadness’ is absolutely necessary because those powerful emotions are also channel for change through direct action.

    Sadly many people experience legitimate but often misdirected anger and are not helped to understand the broader rational for their anger but are most often directed towards something like an ‘anger management course’ or a ‘low self esteem course’ or some individual therapy where they can learn to ‘manage’ themselves and simply get on with it – my main point of concern is that the mental health system we have appears to be fundamentally obfuscating and colluding with cultural/systemic disorder and power abuses and is also defusing possible collective actions to bring change to the system not each person’s own supposed gains. Sadly this anger is being cynically used by the ruling class to further hide the gaze from themselves and misdirect the anger by scapegoating other groups of ordinary people so we fight with each other – it seems divide and conquer is in full swing

  • what we need to reduce burnout is not more psychological interventions but a full and proper fight back from workers to ensure the mass sickness of jobs that harm people in myriad ways is challenged and changed – everything else is simply a way of getting us to accept our lot – had mindfulness and all the rest of the therapy industry been around when children were stuck up chimneys and thrust down mines we would never have had the fight back we had giving us an 8 hour work day that is in desperate need of being reduced dramatically again – how can wellbeing be achieved while working the average full time job – its just about impossible – this is an idea worth fighting for and a basic income to compliment it

  • Hi Shaun F – thank you too for your thoughts, ideas and respectful communication.

    I must say I find the idea of radical acceptance quite frightening as I do industrial systems of therapy like IAPT in the UK.

    I find myself pondering the thought, if we had these ideas/systems so firmly embedded in the culture and largely aimed at the working classes earlier in our history would we have what we have today?

    A history of working class struggle where ordinary people stood up against the government and their class position and made demands to absolutely NOT accept the rubbish conditions and servitude they and their children suffered in – these brave, courageous people did not just ‘get on with it’ but fought and died in the streets so we might have such things as an 8 hour work day, time for recreation and rest, and so our children would not be stuffed up chimneys and thrust down mines – so we might have some basic benefits like holiday pay and sick pay, the right to vote etc.

    no these people did not have what I can only think of as a major play into the hands of power ‘radical acceptance’ or considering themselves to be disordered and in need of therapy –

    NO these people knew that in order to change things for the better they must change the world and this can only be done in radical solidarity with others not some futile attempt to simply change yourself to just ‘get on with it’

    This is a sickness at the heart of our culture and looked at from this angle individual therapy is certainly holding us back. as are the labels and the drugs – we’ve now reached the stage where we are begging to be labeled, drugged and therapised in order to delude ourselves into some personal/individual gain in the form of perverse incentives or scraps from the table in the form of benefits or just to be left alone.

    Why aren’t we as therapists helping people to see and connect with the structural abuse and the gross limitations of changing our individual selves and offering people encouragement and support to get together to change the world? David Smail might argue because of self interest.

    maybe this could be a place to start

  • Hi Shaun – thank you for your thoughts.

    When you said ‘Therapy does not prevent social problems like poverty, discrimination, wealthy inequality, war, and government corruption’ I found myself in full agreement and then found myself wondering how individualistic therapy located in cultures biased towards extroversion, soaked in images of the hero and personal responsibility actually serves power to maintain the toxic status quo?

    Take CBT as an example with its declaration that it is based more in the here and now and basically claims the world is okay but your thinking, attitudes and beliefs are the issue.

    The models are all reliant on the language of psychiatry GAD, PSTD, Depression, OCD etc and also, like biological psychiatry reduces the world and its systemic causes of harm to mere triggers for some hypothesized personal pathology – then after reducing the irreducible and therefore hiding the real causes of suffering it converts it into a mission of personal responsibility to do your homework, self monitor and simply select the correct thoughts and emotions from a sort of illusion of rationality.

    EMDR is just another form of exposure therapy that is often hard for people to do and I also think the idea that we can just ‘tap in resources’ like a ‘safe place’ or ‘wise benefactor’ etc is ludicrous – what we get is usually clients people pleasing – i’ve asked plenty of people about the processing aspect of EMDR and from the outside in, it would have looked like a textbook success reduced affect, lowering SUDS etc but most tell me it did nothing = what they do value and find useful is sharing their story with someone compassionately interested in it, something any of us could do for each other if we had cultures that helped rather than hindered human connection.

    on the point of connections you might enjoy this book
    Lost Connections: Uncovering the Real Causes of Depression – and the Unexpected Solutions

    and on the subject of power you might enjoy these
    Power, Interest and Psychology: Elements of a Social Materialist Understanding of Distress

    Psychology and Capitalism: The Manipulation of Mind

    be well

  • Hi Shaun F, I wonder, perhaps longer term therapy might be helpful for some people some of the time especially where a trusting relationship has been developed but short term therapy seems to have been completely oversold in the culture. Having said that if we lived in healthy cultures with healthy relationships etc I am sure therapy would seem ridiculous.

    We just need to consider the evidence -we’ve had around 100 years of clinical psychology and the hundreds of ‘talk therapies’ it has spawned – we’ve had much longer with psychiatry and we’ve also got dozens prescribed drugs – after all this ‘evidenced based’ practice have we better wellbeing? improving wellbeing? less suffering?

    clearly not year in year out suffering increases – we now live in cultures where the largely culturally induced issue of depression is now our common cold and this is just accepted like its to be expected.

    Most therapy offers people a place where after say 6- 25 x 50 minute sessions with a therapist you are expected to become good self monitoring robot able to sift through the vast complexity of influences and powers that constantly surround us in order to choose the correct thought for the correct emotion and behavior – in fact we’re not expected to sift through the vast complexity but to somehow just pretend it doesn’t exist and just come back to reducing the irreducible your ‘thinking errors’ these might seem like errors but are they really?

    if we add in the complexity that therapy ignores, obfuscates or plays lip service to then surely they are reflections of our disordered world and unless and until we foster not insight but outsight we shall all remain vulnerable to more suffering than is needed.

  • I think questioning the opening statement ‘There is extensive evidence suggesting psychotherapy is effective for a wide-range of mental health concerns’ would demonstrate that this is not true – there are many critics of the poorly controlled, unreproducible, rubbish research out there here are a couple

    there are many others – how can any therapy really help beyond what David Smail suggested of comfort, clarification and encouragement – mental health problems are not personal issues but meaningful results of a disordered culture/experiences

  • self assessment questionnaires seem an almost total waste of time to me – in the production line of suffering known as IAPT in the UK they routinely use the PHQ9 and GAD7 two measures that measures nothing more than someones best guess at how they may or may not be feeling in a given subjective moment of time – near useless, yet these measures are how the service deems someone to have received a ‘successful treatment’ an empty notion for an empty measure for if your life is falling apart around you and you score ‘below clinical’ on these measures you have been successfully treated and are now in ‘recovery’ another empty term yet these same empty measures are also lined to continued service funding and are the driving force behind the mass burnout of staff as all anyone has time to care about are these useless self assessment measures.

  • very much agree with this piece we have a mental (ill) health system that does little but obfuscate where the real disorders lie namely in our culture through the misuse of power, ideology, class, jobs people hate and are harmed on mass by, debt, zero community, fear, mass distractions and many other cultural harms.

    The mental (ill) health system is also seriously bad for the health of those working within it and burn out is increasing especially in the UK’s ridiculous IAPT service that is a nonsense of target driven short terms sticking plasters – the entire industry has oversold it self so now we have people convinced they have this or that disorder and coming to services looking for ‘techniques’ and ‘tools’ to somehow magically manage away the cultural disorders already mentioned – no wonder distress and suffering are massively on the increase we are looking in the wrong place for the causes of our suffering and most ‘therapeutic’ approaches take these causes and reduce them to mere triggers for some hypothesized personal pathology – madness

  • Thanks for those links Brett. In my experience working in the mental (ill) health field for many years and attempting to ‘treat’ people with phobias and all manor of trauma using CBT, EMDR and just being present with people as well as talking with many colleagues, it is clear that these issues are hard to resolve and people most often drop out because they cannot tolerate it.
    Not to mention the chaos and complexity that is often currently present in our lives beyond the comforting confines of any therapy room. From all of my years of working with people attempting to help, people tell me they most value having someone to share parts of their story, with someone truly and compassionately interested in them and their distress and who doesn’t burden them with judgement.
    This could be done by a good friend or family member IF we were living in healthy cultures where people actually had some time, energy and resources to care properly for themselves, others and their (none existent) communities.
    But they/we don’t because most are trapped in jobs that harm and that most hate, mass struggles with debt, family breakdown, and so on – most are running ever faster to either stand still or actually go backwards in life and insecurity and uncertainly are increasing everywhere as the current political ideology crushes more and more people.
    It is interesting to note that one of the features of so called PTSD is that it is aid to bring about a state of ‘pathological’ fear and uncertainty about the world – it could be argued that this is not pathological but actually quite accurate and it is WE well-adjusted people to a profoundly sick society that are actually quite dissociated and distracted from the reality of massive and growing uncertainty and fear and the sheet volume of systemic threats around us.
    Perhaps the traumatised are seeing the world and its many, varied and often random threats with a new sharper clarity but this is intolerable to both them and us. Like the research that shows the mildly depressed (whatever that means) have a more accurate view of the world than those considered ‘normal’.
    I am sure for some people exposure when tolerated is helpful but for how long for given the issues with our disordered cultures? do people really have a discrete disorder called OCD or are we seeing reactions to the world and seeking to ‘treat’ this set of experiences might bring some temporary relief but leaves us all vulnerable to harm because its utterly missing the context and system we operate in.

    I agree that EMDR is pseudo scientific but there again many critical psychologists tell us the entire field of clinical psychology is pseudo scientific and is driven more by fashion, fad and self interest than any sort of science – just a look over the history of the field and that of psychiatry clearly shows the nonsense that has been upheld as the ‘gold standard’ treatment of the age.

    Take CBT the marriage of two not so long ago utterly opposed ideas where behaviourists would have said the cognitive/psychological cannot be measured or seen. We know we are largely rubbish at introspection, we story tell automatically and fabricate to fill in the gaps and we are largely a mystery to ourselves and each other. yet insight based therapy is mostly what we have – the main insight for me is that we have little insight into our selves and others.

    It seems quite clear to me that the mental (ill) health system looks almost exclusively at the individual as having a disorder – rather than seeing US as reacting quite understandably and meaningfully to a disordered world.
    So do we need to stop looking within at hypothesized personal pathology and look without to make the world a place we can actually thrive in? .

    We’ve had many decades of psychology, psychiatry and pharmacology and each year suffering increases massively. Something is very wrong with this picture.

    Maybe you’ve heard of this critic? his books are interesting and this interview is useful

    #056 – Why Psychotherapy is Bullsh*t (Dr. William Epstein)
    In today’s episode Dr. William Epstein joins us to explain why he believes psychotherapy is not only ineffective and possibly even harmful, but why it is little more …

  • Hi Brett there are some really good books analyzing the research thats often poorly controlled, biased and cannot be reproduced – several good books are:
    The Therapy Industry: The Irresistible Rise of the Talking Cure, and Why It Doesn’t Work

    Psychology Gone Wrong: The Dark Sides of Science and Therapy

    Psychology Led Astray: Cargo Cult in Science and Therapy

    Power, Interest and Psychology: Elements of a Social Materialist Understanding of Distress

    exposure therapy can be useful, if the person can actually tolerate it but a significant majority can’t.

  • the article states ‘The latest findings of the Tavistock Adult Depression Study (TADS) show that 44% of depressed clients who were provided 18 months of weekly psychoanalytic psychotherapy no longer met the criteria for a depressive disorder two years after treatment ended, compared to 10% of those receiving standard short-term problem-solving therapies, or medications’

    however after 18 months or just 6 sessions our lives are constantly changing and in many ways and the overwhelming majority of this change happens far away from any therapy room – perhaps the elements of any psychotherapy mentioned by David Smail of comfort, clarification and encouragement might have been helpful but to put it all down to a few hours talking in a room is to grossly oversell.

    Where are these people with a neat issue like ‘major depressive disorder’ it seems to me that our experience is closer to a vast and unknowable weather front constantly moving and changing even if we ourselves can’t grasp the change – most of our experience seems beyond awareness – im reminded of the iceberg metaphor – its amazing to me that we’ve managed what we have given the bias and blindness we all have.

    It seems that suffering like everything else changes and suffering is a normal and natural response to life experiences, not a sign of a disorder more a response to disorder in the culture full of meaning and confusion.

    It seems we need some adversity to grow and problem solve but much of the cultural level disorders stemming from government policy, economy, education, advertising, class, re food industry, drug industry, etc sulting in poverty real or relative , harmful jobs, family breakdown, community breakdown, substances issues, physical issues, insecurity, stress, physical health issues, dependence etc can and should be healed by valuing life on earth and compassionate policy that honors this overwhelming mystery we call life.

  • The mental health system including the psychotherapy industry is disordered and seems to do more harm than good – just helping to hide the misuse of power is a pretty nasty unintended consequence – not to mention pathologising people for suffering with seems more accurately like cultural experience disorder

    just come across this ex therapist explaining why he is an ex therapist
    nice honesty

  • Just to echo some of the other comments – to identify correctly the harmful nonsense of biological based labels within psychiatry is great – however to assert there are scientific talk therapies is to psychologise social/cultural distress and falsely represent the talk therapy industry.

    We’ve had around 100 years of clinical psychology and its spawned hundreds of talk therapies many now make claims of being science based or evidence based with the RCT often held up as the gold standard – yet the RCT has been shown to be useless for talk therapies for many reasons like mind small sample sizes and the myriad confounding variables you simply cannot control for and that an effective placebo is impossible to find – then there is the massive issue of reproducibility Bruce Wampold in the great psychotherapy debate basically states that there is little difference between the ‘therapies’ and what is useful are three marginally helpful aspects namely the alliance, some structure and getting the person to do something between sessions.

    Again after 100 years of this you’d think perhaps we might be seeing human beings getting better, wellbeing increasing etc but the opposite is true very soon the WHO predicts that the cultural disorder of depression currently re-framed as personal pathology will be the biggest cause of suffering on earth.

    Self interest is really harming us all on a massive sale – this is a great book to summarize the issues with psychotherapy

    This fellas work is also great – this could heve been written last week

    We need to come together as human beings point to what is wrong and seek collective action to change it – we’ve been surrounded by ‘experts’ for so long we have almost lost the ability to feel and think with clarity. One thing that might help is to drastically reduce the time most of us spend at repetitive boring, stressful jobs that bend people out of shape and make community and caring almost impossible

    be well people