I was going to blog about the end of the strike, but I'm still too upset. So this is a piece I wrote in 2006 and never published.

Psychoanalysis is an exciting science. Probing the pysche, dredging up memories, finding patterns in experiences, thoughts and emotions where none existed before. Academics devote reams of paper to it: Freud, Lacan, Deleuze & Guattari have conferences and journals dedicated to their work. Psychoanalysis can be one of life's great endeavours: patients devote years to it, going two or even three times a week to a doctor who will help them reveal their inner lives.



But psychoanalysis is exclusive in more than just its depth and time required. It costs a lot of money. A good psychoanalyst charges hundreds of dollars an hour. Which is why psychoanalysis is the science of healing rich people. Poor people get self-help. It's why magazines, books, and courses for poor people are so popular. They're produced in mass quantities, and promise instant results. The self-help industry brings in over $6 billion a year in the U.S. alone.

If you open up Cosmopolitan, you won't find articles on competing models of the Self or ego-development courses. You will find, however, tips on how to change your behaviour: satisfy your man in bed, lose those extra pounds, get more out of your career. The difference is clear: psychoanalysis is about changing what's inside you in a deep, fundamental way. Self-help is about making cosmetic changes. It's no accident make-up ads appear next to "snag a hunk" quizzes: both operate on the surface.

The dogma of self-help is a particular type of treatment: cognitive-behavioural therapy (CBT). Its premise is that when someone has a problem, you don't treat the feelings underlying it. You treat the behaviour instead. You 'reprogram' the brain's neural pathways onto more productive routes, so that when a person faces adversity, they stop their negative thoughts and think positive ones instead.



There's an impressive body of literature on CBT: it gets results. It takes around six weeks of therapy at most, until the patient learns new behaviours. It works - but on what level does it work? If it's so successful, why aren't psychoanalysts out of business? After all, five year treatment programs are incredibly inefficient.

The answer is that CBT is cheap therapy for the working class. It doesn't go deep: it fixes up the symptoms. It's not about getting you to re-evaluate your life, but to cope with the life you have better. It's reformist: it assumes, like the old adage, that there are some things you can change, and some things you can't. In the latter category is: everything but yourself.

Unlike psychoanalysis, which in its best moments, understands the individual as shaped by capitalist exploitation (see Erich Fromm, for example), CBT not only skips the environment of the patient, it says that environment doesn't matter. It's individualist from the beginning, and not in a way that gets people to question their circumstances. It's all about acceptance.


If you don't like your job, there must be something wrong with you

In that way, it mirrors the life conditions of working people. We're atomized, set against each other, forced to compete to survive. CBT naturalizes that competition, because anything that goes wrong is your own fault for not thinking properly, for not responding correctly to trauma. Its answer is classic liberalism: you're empowered. You do have the ability to change - not what's around you, but how you view what's around you. As Darian Leader argues (and I swear I wrote this article before I read his!),

The market has triumphed here, as our inner worlds become a space for buying and selling. We pay experts such as life coaches to teach us how to change in the desired way. Aspects of ourselves, such as shyness or confidence, become commodities that we can pay to lose or amplify. Depression or anxiety are seen as isolated problems that can be locally targeted without calling into question the rest of one's existence

This is why CBT's success rates are so high. Working people want to survive. Having their attitudes as solely products of their own heads gives an illusory sense of control. The problems aren't fundamental - because there's no need to talk about where they came from. They can be mastered by thought games: lists on mirrors, snapping rubber bands on your wrist, etc. Everything is fine, once you adjust yourself.


For many, the adjustment takes a little help

I want to stress that mental illness is not a false ideology. Working people do have mental health problems, because living in this system does your head in. It's simply impossible to exist without facing the contradictions. There's the difficult choices families make to survive and the pressure they face when a family member can't cope. Or you don't get enough to eat while someone else can pay $5 for a coffee. And that's under normal circumstances. Al-Jazeera reports that, among the after-effects of the Israeli invasion of Gaza, half of all Gazans suffer from mental illness.

Under these conditions, CBT provides the proper ideological framework for capitalism. CBT captures the sense that something's wrong - a sense that comes out in depression, alcoholism, and very occasionally social unrest - and blunts it. That energy has to be turned to fixing your behaviour, not the environment past and present.


Violence is often a means of coping

And best of all, CBT is cost-effective. Treatment is something that used to take huge investments of time, emotional energy and money. Now it can be mastered in a weekend. This is the perfect therapy for neoliberalism: it's the mental equivalent of lean production and speed-up. Leader says:

In today's outcome-obsessed society, people must become countable, quantifiable, transparent. And this leads to a grotesque new misunderstanding of psychotherapy. Therapy is now conceived as a set of techniques that can be applied to a human being. This makes sense if we see it as a business transaction with a buyer, a seller and a product. But it totally ignores the most basic fact: that therapy is not like a plaster that can be applied to a wound, but is a property of a human relationship.

There are therapists who are beginning to recognize they're acting as apologists for the ruling class. From Prilleltensky & Prilleltensky, Beyond Resilience:

Treatment was designed, implemented and evaluated by a host of professionals, with the disabled individual having little input regarding the process. What could not be cured had to be rehabilitated, and what could not be rehabilitated had to be accepted. Psychological theories focused on the need to adjust to one's misfortune and make the best out of a tragic and limited life.

It's hard to transcend your limitations - Fitzcarraldo

What's tragic are the limits imposed on people's lives. Yes, there are millions of examples of people treating each other brutally - so many, in fact, that we can't see it as a problem of individuals (which is what 'human nature' arguments boil down to - individual choice.) If Marx is right, and we're creative at the core of our beings, then stunting that creativity - through war, unemployment or bad jobs - is going to damage us:

Wellness and liberation exist in a dialectical relationship. Without liberation many oppressed people cannot experience wellness, and without wellness there is no superordinate goal for liberation.

"Doctor, are you trying to make me personally responsible for alienation and social dislocation?"

Wellness must be begin personally: our inner lives are rich and our histories are unique. But coming to terms with our feelings - the goal of any individual therapy - is only the first step. Wellness must become social. I'd suggest Marx's 11th Thesis can be applied creatively: "The therapists have only interpreted your world; the point, however, is to change it."

Labels: CBT, Cognitive Behavioural Therapy, mental illness, psychoanalysis, self-help