A dark age for mental health

A therapy last used on a mass scale in China's cultural revolution is to be unleashed on the NHS
It looks like good news. In an era where psychological problems are increasingly explained in terms of biological deficits, the government has announced that it will spend £170m by 2010 on talking therapies for depression and anxiety. The scheme should pay for itself as better mental health will mean fewer sick days and benefits - £170m isn't much compared with an annual £12bn cost to the economy. But will it really help?


Given these well-known problems, why has the government bought into CBT? The answer is simple: it produces results on paper that keep NHS managers happy. However, these results come from evaluation techniques that are mostly devised by the makers of the therapies, and are designed to avoid the complexity of human suffering - shortcomings highlighted by Paul Verhaeghe, the professor of psychodiagnostics at Ghent University. Therapy trials tend to follow the medical model, with two groups of patients who have the same profile and the same symptom. Treatments are then standardised to rule out the influence of the therapist. Trials are short, usually a few months. But these basic features are seriously flawed.

First, there is really no such thing as the same profile or, indeed, the same symptom. Each person's experience will be unique, and no real patients will have only one symptom. Second, since therapy traditionally relies on the personal and unpredictable input of the therapist, removing this means we are no longer measuring therapy but something else. The irony is that those therapies that cannot be tested in this way are deemed unscientific and unsupported by evidence. Rather than recognising that the methods of testing need to be radically changed, evidence-hungry NHS managers embrace short-term behavioural treatments - and who can blame them?

When patients are back on the waiting list, the answer is another dose of CBT. Treatment becomes part of our management culture: instead of getting to the root of the problem, we just address the surface symptoms. It's like imagining that killing a few terrorists will get rid of terrorism, rather than exploring the factors that give rise to it. In this new dark age, a century of sociology, anthropology, and history and philosophy of science has been ignored.

CBT-style therapies were last used on a mass scale in China in the cultural revolution. Separated from loved ones - having perhaps witnessed their murder - people were taught to deny the legitimacy of their symptoms: depression was just the outcome of false beliefs.

Where CBT aims to get rid of symptoms, other psychotherapies seek to give symptoms a voice: to hear what is being expressed in them, rather than stifle them. This requires not only time, but the effort and commitment of the patient. Real mental health policy has to recognise that there are no easy answers, that human beings are complex and contradictory, and, most important, that we can never know in advance what will be best for a patient.

A true exploration of psychological suffering is perfectly possible in the framework of the NHS - if policymakers can think beyond mental hygiene and start listening to the patient.

· Darian Leader is the author of Why Do People Get Ill?; Paul Verhaeghe's paper is available at Health4Life Conference 2007 darianleader.com