Friday, February 23, 2007

A complicated range of other factors

Today’s Guardian reviews Why do People get Ill, the new book by the psychoanalyst Darian Leader and philosopher of science (whatever that means) David Corfield. In it, Leader discusses the benefits and problems associated with popular mental health strategies (Parisian-style psychoanalysis, Cognitive Behavioral Therapy, the American-style throw-the-medicine-cabinet-and-pocket-the-loot strategy) that I discussed a couple posts down.

Listening is not a big feature of modern medicine here or anywhere in the west." Leader's book claims that, on average, a patient speaks for 23 seconds before being interrupted by their GP. The book concedes that most doctors have such staggering workloads that the average consultation with a GP in London lasts between six and eight minutes (the shortest average in Britain). But this may well make quick-fix diagnoses more likely.

...He talks about the government's preference for cognitive behavioural therapy (CBT) over traditional talking therapies. "The government favours this because it is about correcting surface symptoms and reintegrating people who report psychical problems back into the workplace where they can become useful again."

CBT aims at modifying everyday behaviour. Patients are often encouraged to keep a diary of significant events and associated feelings and thoughts. They are urged to question unhelpful or unrealistic assumptions and to do activities that have been avoided. sounds potentially helpful for ameliorating just the kind of symptoms Leader's book spends a great deal of time discussing. Only one problem: he despises this form of therapy. "When was CBT used most widely? It was in Mao's China, when people had to be re-educated to see the world in the way that the authorities wanted." Indeed, he regards CBT as akin to drug prescription. "Some forms claim to target specific aspects of illness; they are supposed to be administered like a pill or injection, and this no doubt makes them attractive to health service providers. But I think it is horrible and fatuous."

Leader believes that unless root causes are addressed, they will simply resurface in another form, some months later.

...But surely one reason analysis is not popular, and particularly not popular with the government, is that psychoanalysis does not claim to produce results, while supporters of CBT claim that it does. "That's true. Having said that, a lot of my colleagues disagree with me and claim that studies show that, over the long term, symptoms will permanently disappear through analysis and that there will be lower rates of consulting GPs." And what is the long term? "They're talking about 20 or 30 years later." No wonder, then, that the government isn't calling on psychoanalysts such as Leader to cure Britain's depressives.

Dr. chuckling doesn’t have much to say on these issues, just finds them interesting. Viewed as a matter of simple distrust, it’s probably accurate to assume that strategies favored by government and big business are worthless at best, more likely counter-productive. Though CBT does not sound that bad to me, even though in this and the other article it is described as insidious brainwashing. But what do I know? Not much, not much.

If I must take a stand, I’ll go for psychoanalysis. It may take twenty or thirty years to produce measurable results, or not produce any results at all, but at least it has a coolness factor whereas CBT sounds like a cliff notes version of a dime-a-dozen self-help book and SSRI’s are definitely not cool (at least for the great majority of users who don’t really need them).

But psychoanalysis? With all the wacky writings of Freud, Jung, Lacan et. al.? And Woody Allen? Just about everybody likes to talk about their dreams (and what can it hurt), but who the hell wants to listen to someone else talk about theirs? Psychoanalysts deserve big money to sit through that shit for thirty years.

The more I think about it, the better it sounds. I propose that we create a huge government agency that guarantees everyone the right to 30 years of psychoanalysis. Think of how much better off people would be talking to a professional on the couch rather than ranting on blogs or sending people off to die in foreign wars. You dream you are Conan, killing hoards of brown people? God tells you what to do? But what about your mother? She laughed at your pee pee? It made you feel inadequate?

Twenty or thirty years? I see immediate results. In order to get bi-partisan support, we can cut taxes to pay for it.

(the following is just an experiment, pay no mind. Britney, shaved head, Anna Nichole, Obama Clinton feud, American Idol)