Animal Farm

November 12, 2007

Paternalism has always worried me, especially when it is exercised with the power of the state. An example came to mind when a long term friend of mine expressed concern about the imposition of Cognitive Behaviour Therapy for treatment for psychic distress in the UK. We are talking about NICE clinical guidelines being imposed de facto on the NHS here: incidentally how can anyone let anything end up with an abbreviation like NICE. Now I should emphasise that this is not an argument against CBT per se. CBT after all is a technique with an evidence base in practice and theory. It is an argument against selection of a single approach, in particular one which is focused on creating wellbeing and happiness, words which sound good but have a poor history in use by government agencies. The fact that the technique can be self administered by way of CBT is even more scary. Warning bells should start to ring if we ever plan for uniformity. A similar theme, in a different context, is picked up by Kim in Thinking Shift, on the danger of standing out from the crowd, of being different in any way.

We need difference, we cannot afford in an area such as psychology (or any major area of policy) to embed a particular theory or practice and thus prevent evolution of both. To be honest this seems to be another example of inappropriate industrial practices (in this case best practice) being imposed in the public sector to its detriment. There is far too much of this at the moment, and management-speak seems to reign, to make another Orwellian reference. So let those better qualified than I speak on this subject:

Julia (my friend) posted her concerns in a comment to Willem Buiter blog, the particular posting concerned displays a savage satirical streak in respect of utilitarianism

A utilitarian paternalistic government would know what to do in this situation. It would rewrite the intergenerational social contract to include mandatory involuntary euthanasia at age 87 for men and at age 89 for women. The week before my 87th birthday, I would receive a note informing me that in a week’s time I have to turn up at my local NHS hospital to be humanely executed by lethal injection. Those who have served in the armed forces could opt instead to be executed by firing squad. The penalty for failing to turn up would (of course) be death

so there, put that in your pipe and smoke it! To Julia’s well expressed concern. I repeat her comment in full:

Julia’s comment

My name is Julia Evans. I am a Lacanian (Jacques Lacan) psychoanalyst who has been closely following the government’s progress on the regulation and registration of the talking therapies.

I agree with your position in Propositions 1 to 7 and give a brief summary of points which expand on your Proposition 4 and onwards.

In this clip from the World At One (October 10th), Lord Layard and the Minister of State for Health, Alan Johnston, outline their plans for “Happiness Centres”. recording This is called I.A.P.T.: Improved Access to Psychological Therapies. It is driven by economic assumptions.

The technology which provides the end-result of happiness is prescribed by the government in the NICE (National Institute for Clinical Excellence)’s 1994 clinical guidance for the treatment of ‘Anxiety’ and ‘Depression’. All clinical guidance for psychic distress end with an operative performing cbt (cognitive behaviour therapy) as it is the ‘evidence-based’ solution. There are many references disputing the government’s clinical judgment (See Professor Andrew Samuels, Centre for Psychoanalytic Studies, University of Essex, Letters, Friday October 12, 2007 The Guardian) but the government and Lord Layard knows best in the clinic of the distressed.

Further control processes are being put in place under the Health Professions Order 2001. This is part of the Privy Council so there is no parliamentary challenge possible. The legislation promises to ‘safeguard the health and well-being’ of all users. Thus, the government guarantees safety from criminal and negligent acts in all situations. The Donaldson report likens risk in the ‘health industry’ to the Alpha Piper Disaster, Chernobyl and aircraft crashes. This is explored in ‘Wellbeing and happiness as used by the UK government’ by Julia Evans. The Psychoanalytical Notebooks. Issue 16 Regulation and Evaluation. 2007. A review of the London Society of the New Lacanian School.

In order to provide the “Happiness Centres” and ensure protection from charlatans (those not registered with the Health Professions’ Council), the government has persuaded the British Psychological Society to give the HPC responsibility for registration and regulation of their members’ training, practice, professional development, complaints, etc. ( Google: bps & statutory regulation – 18th October) The HPC are drawing up standards in these areas which, when the Privy Council has agreed them, will regulate how psychologists work. For a more detailed account of some of the issues involved in this area please consult eIpnosis web-site.

This happy collaboration between the bps and the government means that the “Happiness Centres” can be supervised by government-controlled psychologists, overseeing the hastily-trained cbt operatives. This scheme will be launched at a prestigious conference entitled (also a web-link) ‘Psychological therapies in the NHS: science, practice, and policy’, Lord Layard and the Minister of State for Health, Alan Johnston, will appear on the podium to explain the government’s approved procedures for the production of happiness in cases of psychical distress to Nuremberg-Rally-style-cheers and general rejoicing.

Julia Evans

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