CBT – Cognitive Behavioural Therapy – has, by now, been through the full cycle of having been the latest fad in “mental health” services.
It starts with being trialled, then touted as the latest cure-all, then operationalized and stripped-down, manualized, cost-stripped, and reduced to a “treatment” you receive sitting in front of a computer while clicking on clicky-things – and then even turned into an app on your phone. There is already talk of what it will be replaced by in the next whirling whoosh of change designed mostly to look like things are changing, but not really.
Meanwhile there’s a steady, swelling, stream of liberally-applied criticism of how CBT is evil because it aligns with a neoliberal agenda.
The difficulty with CBT is not that it’s evil or even bad, or totally useless, or even neoliberal – or any of that bullshit. The difficulty arises from how, like anything else, it got jumped-on as the latest-greatest fix-for-all-that-ails-us, and pushed on us as what
CBT and the Annual Festive Toy Craze
The timescales are a little different but it is a similar pattern and more visible: the annual rush to buy the latest toy-craze at the end-of-year festival-of-shopping. It generates the same fever, same false advertising, same pushing-and-shoving and the same disappointment of unmet, hyper-inflated expectations.
When really, all it is, is the thing they need to push on us this year so they can pretend that they know what’s up, pretend they’re fixing things, and mostly so they can feed the machine- reporting what they did to /for us in their management statistics.
Now, here’s an article that places CBT in a slightly different light, someone who’s life was going off rails and wanted to find how he could make some change and discovered in Stoicism , the phillosophy at root of [early] CBT his own path to doing just that.
Perhaps it shows where we can realistically place CBT – as an option some of find useful and part of a long tradition of learning to put-up-with-crap so we can not get eaten by lions today.
Of course it doesn’t make the lions go away – they are generally CBT resistant.
CBT emerged out of an approach devised by a guy named Albert Ellis [a Canadian] who had the idea that a very good many of his patients who were struggling with life situations might find their life became a little easier to live if they could learn to practice some stoicism in face of their struggles. He then started to figure out how he could share with them some of what he’d learned studying philosophy as a student.
Whatever a tetus is,
his sure was epic.
Now, Seneca was Roman not Greek and born well-to-do and became a great educator but came to find his world pretty closed-in when chosen by Emperor Nero be his personal adviser and to tutor his offspring – which all sounds great except for being under daily, instant threat of death if he did anything that gave rise to his boss’s displeasure.
Which in the end is exactly what happened when Nero ordered Seneca to take his own life as punishment for something he probably didn’t do – but the very Stoical, and it seems artful, way in which he went about it became the very romanticized subject of many beautiful paintings.
Life sucks and then you die
and then somebody paints you dying, eh?
You might think it’s hard to envisage some great artist portraying you doing your CBT in some romantic masterpiece that one day will hang in the Prado but, you know, you never do know until you’ve performed a small experiment and weighed up evidence for and evidence against.
Feeling Trapped in a “so-called life”?
If you live a life in which you feel like – or indeed are – a slave, or that you are being given very little choice, very little room to maneuver, very little control over anything, then you might decide that learning a bit of stoicism might come in useful.
That’s where CBT comes in – kinda like Stoicism for Dummies*, you don’t need to read a bunch of books, though you might have to fill-out a squillion forms and spend time in their company listening to their bullshit.
There’s more to stoicism than listening to Winston Churchill speeches and biting your stiff upper lip …
And CBT isn’t all there is to stoicism either but it does include some nuts-and-bolts from it then it got turned into a “manualised” therpy with a stuck-on a bunch of crap that’s not really stoical at all but really about making it easy to measure stuff in trials.
This was a smart idea because it led to lots of CBT trials, and lots of CBT data – or “evidence” – so they can call it “evidence based” and get more money for more money-making CBT.
That’s why there’s so much CBT about. Not so much because it’s effective but because it was designed to yield numbers to put on a powerpoint slides in boardrooms.
It’s also designed from the start to be “problem-focussed” and “time-limited”, so it’s pretty cheap and cost-predictable compared with other wishy-washy, never-ending, talk-therapy approaches.
Again, if it is a success, then CBT’s greatest successes are in boardrooms – convincing boards to spend money on it.
Dumbed down to a $15 value
It’s also been dumbed-down and stripped-down so much that a cat could probably qualify – and likely do a better job than some who are called “human”.
Putting up with lifecrap to avoid getting eaten by lions.
Learning some new skills on a CBT thing might well be a path that you can take to learn some stuff that you can use to make those unbearable times in life a little more bearable.
Using some of those skills might help you get through the day without being thrown to the lions.
It’s stoicism Jim,
but not as we know it
So CBT is a stripped-down, “manualized” version of Stoicism devised so they can get to paid to “treat” you to with CBT – and treat you to spending time with them.
Yeah, that sucks, but you might find enough in it to help you survive their game and one day escape that game altogether.
Does that means that it’s “treatment” ?
Does it bol-locks.
Does that mean its right, or moral for MH workers, services and society to push it on those who already struggle ?
No, that’s absolutely, freakn’ not OK.
Does that mean there’s nothing in it you might find personally useful, that you like and that you can use?
No. You just might.
When might CBT be worth trying?
Don’t do it because they want you to.
Don’t do it because they say “you need it”.
If you do it, do it because you choose to.
And if you do do it, don’t think you have to fill in all their bloody forms.
Just do it your way.
– It’s you doing the real work
– Only you decide if it works for you.
CBT wont fix everything – because nothing can
Just like any other “treatment”, CBT helps some people, somewhat, some of the time.
In the end, the really ironic thing about CBT is that stoicism can be a really useful strategy for dealing with all that MH services bullshit.
*= Nope, there is no Stoicism For Dummies book but if you’re interested, there’s a bunch of watchable you tube vids on both Epictetus and Seneca – and there is a CBT For Dummies – and a free PDF version of it here.
Anxious? Depressed? Try Greek philosophy
Crippled by social anxiety and burnt out after a decade of hedonism, Jules Evans eventually found inspiration from the ancient Greeks. Here he tells how 2,000-year-old words of wisdom transformed his life and equipped him to help others solve their modern-day problems
By Jules Evans
Daily Telegraph, 29 Jun 2013
Growing up in the Nineties, my friends and I were amateur neuroscientists. Every weekend, we conducted experiments on our brains with various chemicals, to see what happened: marijuana, LSD, MDMA, amphetamine, mushrooms, all tossed into our system like ingredients in a cauldron. We had some hilarious, beautiful, even spiritual times. Then I noticed my friends beginning to burn out.
My best friend had a psychotic breakdown when he was 16. He’s been in and out of mental care homes ever since (he’s now 35, like me). Other friends developed paranoia, bipolar disorder, depression and anxiety. In my first year at university, I started to get panic attacks, too. My body would be filled with mortal terror, in the most un-mortal of situations. I lost confidence in my ability to know myself or to steer a coherent course through life. I started to distrust myself, to avoid social situations. I was terrified that I had permanently damaged myself before the age of 21.
After graduating, in one of the universe’s little jokes, I got a job as an intern at Tatler magazine. This is not the best place to work if you have social anxiety. I was surrounded by a pashmina mafia of glamorous society ladies, unimpressed by my atrophied social skills. The only other boy working there was Ben Fogle, and his radiant charm further illuminated my social inadequacies.
Then I hit rock-bottom: I became a financial journalist. I got a job reporting on the German mortgage bond market. My life had truly gone awry. By that point, an expensive therapist at the Priory had diagnosed me as suffering from depression, social anxiety and post-traumatic stress disorder (I think he was paid per diagnosis). I investigated these disorders on the internet, and found they could apparently be treated by something called cognitive behavioural therapy, or CBT. I also found there was a CBT support group for people suffering from social anxiety, which met every Thursday in the Royal Festival Hall (not on the stage). One Thursday I went along.
I found 10 people sitting in a circle, eyeing one another nervously. One of them had bootlegged a CBT audio course from the internet. For 10 weeks, we listened to the course, practised the exercises, and did the “homework”. And for me, it worked. The panic attacks stopped after a few weeks, and I gradually got back my confidence in my ability to steer a course through life. I steered a course to Russia, where I worked as a foreign correspondent for four fun, vodka-soaked years.
When I came back to the UK in 2007, I decided to research CBT. I went to New York to interview the psychologist who’d invented it, Albert Ellis, and asked him where he’d got the idea for it. He told me he’d been directly inspired by ancient Greek philosophy, particularly by a line from the Stoic philosopher Epictetus: “Men are disturbed not by events but by their opinion about events.”
Ellis, like the Greeks, suggested that our emotions always involve beliefs or interpretations of the world. Our interpretations may often be inaccurate, irrational or self-destructive, and this will make us emotionally sick. In my case, I had a value system that put a huge emphasis on popularity and social performance (I went to one of those schools where popularity is practically a religion), and this flawed belief system had caused me to suffer.
We might not be conscious of how we interpret the world, because our beliefs are ingrained and habitual. Our beliefs are like a pair of glasses we have worn for so long, we forget we’re wearing them. But we can learn to bring our unconscious life philosophy to consciousness by asking ourselves questions. In CBT this is known as the “Socratic method”, from Socrates, who tried to teach his fellow Athenians the art of asking themselves questions. Then, if we decide our life philosophy is no good, we can choose to think differently.
That might sound incredibly simplistic and over-optimistic. Some philosophers, psychologists and neuroscientists would argue that our capacity to choose a path in life is severely constrained by our genes, our childhood, our circumstances. They might insist that we’re not the “captain of our soul” as the Stoics suggested – we’re helpless spectators.
The Stoics were aware of how little we control in life. None more so than Epictetus, a Stoic philosopher of the first century AD, who grew up a slave in the Roman Empire (his name means “acquired”). He divided all of life into two categories: the things we control and the things we don’t. We don’t control the economy, the weather, other people, our reputation, our own bodies. We can influence these things, but we don’t have complete control over them. The only thing we do have control over is our own thoughts and beliefs, if we choose to exercise control.
Epictetus suggested that emotional problems arise when we try to exert complete control over something external. When I had social anxiety, for example, I rested all my self-esteem on others’ judgments of me. This made me feel very helpless, anxious and paranoid. The antidote to this self-enslavement was to stop trying to manage others’ opinion of me (which is impossible), and instead to focus on controlling my own thoughts and beliefs (which is possible). Then I immediately felt stronger and more in control, and eventually people started responding to me differently.
Sounds easy, right? Unfortunately, it’s not quite that simple. The problem, as the Greeks well knew, is that we’re incredibly forgetful creatures. We sleepwalk through life, as Socrates put it. We might read a book or hear a lecture and have a light-bulb moment, but then a few days later we forget and go back to our old way of seeing things. We are creatures of habits. Aristotle wrote: “It makes no small difference, then, whether we form habits of one kind or of another from our very youth; it makes a very great difference.”
The good news is that we can change our habits. Epictetus said “there is nothing more malleable than the psyche”, and contemporary neuroscience agrees. Every day, we have a choice to either reinforce a habit, or challenge it. The Greeks understood the importance of habits to the good life – their word “ethics” comes from “ethos”, meaning habit – and they developed some great techniques for habit-formation.
One technique is the maxim, which is the condensation of an idea into a short, memorisable phrase, like “everything in moderation”, “know thyself”, or “the robber of your free will does not exist”. Greek philosophy was designed to be memorised. Students would repeat these maxims over and over, even sing them, until they became neural habits. They’d also write maxims into little handbooks (enchiridia), which they carried around so they were always armed against their old bad habits.
CBT uses a similar technique. In the social anxiety audio course, we would read out handouts for half-an-hour every day for 10 weeks, and listen to them on tapes. I also had a little handbook with useful maxims in it – if I was having a bad day at work, I’d retreat to a nearby park and repeat some of its phrases to myself.
Another technique the Greeks used was keeping a journal. This is an important way to track your progress in strengthening moral habits. Epictetus recommended that, if you want to improve your temper, “count the days when you were not angry”. CBT also recommends using journals to keep track of unconscious habits and follow your progress.
Philosophy needs to be more than theory, it needs to be practice too. Epictetus warned: “We may be fluent in the lecture-room, but miserably shipwrecked when it comes to practice”. I couldn’t get over social anxiety purely by challenging my thoughts in the safety of my bedroom. I also needed to go out and practise, and make myself go to parties even when I was nervous. Every situation we’re in can be an opportunity to practise philosophy. Seneca, the Stoic philosopher and politician, wrote: “The Stoic sees all adversity as training.”
Today, CBT is available free on the NHS. It has brought some of the Greeks’ ideas to millions of people. Many people have used it to learn to “take care of their souls”, as Socrates put it – which is where the word “psychotherapy” comes from. I hope some of them might go back to the original source in philosophy, because CBT leaves a lot out – Greek philosophy wasn’t just a feel-good therapy, it was also a road map for the good life, and the good society.
I now live in London, and help to run the London Philosophy Club, which is the biggest in the world with more than 3,000 members. My book, Philosophy for Life, is being published in 19 countries, and I have taught in universities in the US and South Korea.
For someone who used to have crippling social phobia, I do a lot of talking – this summer I’m talking at Camp Bestival, at the School of Life in London, and at a “festival of happiness” in Holland. In November, some other Stoics and I are organising a week of events around the world, called “Live Like A Stoic Week”.
I’ve realised that philosophy can heal suffering and save lives. But it’s not necessarily the last word. Now, after 10 years of practising philosophy, I wonder if it leaves something out, if it’s too rational, self-controlled and unemotional.
I work at the University of London, at a place called the Centre for the History of Emotions, where this year I have started researching ecstatic experience, and how people can achieve euphoria through music, dancing, drugs or the passionate love of God. As a friend put it recently: “Back on ecstasy, eh?”
Five coping techniques from Stoic philosophy
1 Accept the limit of your control over externals
The Stoic philosopher Epictetus wrote: “Some things are up to us, others are not”. We don’t have complete control over externals, despite our best efforts, but we do have control over our thoughts and beliefs – so concentrate your energy there without driving yourself crazy over things you can’t immediately influence.
2 Focus on the present moment
Seneca, another Stoic, wrote: “What is the point of dragging up sufferings that are over, of being miserable now, because you were miserable then?” We can go through life walking backwards, constantly ruminating on past injuries or on how things were better in the past. Likewise we can worry endlessly about the future. Or we can simply choose to make the most of the present.
3 We are what we repeatedly do
It’s not enough to have occasional epiphanies. The key to the good life is good habits. We can create habits by memorising and repeating certain maxims, and by seeing every situation as an opportunity for training.
4 Contemplate the universe
If ancient philosophers were feeling particularly stressed by everyday concerns, they would find a quiet place and imagine the vast expanse of the universe. On such occasions the Stoic philosopher and Roman emperor Marcus Aurelius told himself: “Many of the anxieties that harass you are superfluous… Expand into an ampler region, letting your thought sweep over the entire universe.”
5 Let love lift you up
We don’t always think of philosophers as great lovers, but Plato claimed that the secret to philosophy was learning to love. He believed that we could lift ourselves out of egotism by passionately loving other people, or beauty, or goodness, and through love we could even connect to God.
The revival of stoicism
Stoicism was invented around 300BC, but it’s enjoying a revival today. Here are some contemporary Stoics:
Albert Ellis, the inventor of cognitive behavioural therapy, was inspired by the Stoics’ therapeutic ideas.
Derren Brown, the magician, is a big fan of the Stoics. His TV series, Apocalypse, was inspired by the Stoic technique of imagining the worst that can happen to you.
Elle “the body” Macpherson named her son Aurelius, after her favourite book: Meditations by the Stoic and Roman emperor, Marcus Aurelius.
The former prime minister of China, Wen Jiabao, claims to have read Meditations more than 100 times.
James Stockdale used Stoic philosophy to survive seven years in a Vietnam POW camp. He went on to become vice-admiral of the US Navy.
Tom Wolfe “converted” to Stoicism after reading about Stockdale. The hero of his 1998 novel, A Man In Full, discovers Stoicism in prison.
‘Philosophy for Life: And Other Dangerous Situations’ by Jules Evans (Rider) is available from Telegraph Books at £8.99 + £1.10 p&p. Call 0844 871 1514;