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Monthly Archives: June 2012

PoW: The journal, from Marcus Aurelius to Bridget Jones

What do Marcus Aurelius and Bridget Jones have in common? The answer, of course, is that they both kept a journal, and used it in their efforts to change themselves. The first page of Bridget’s diary, on January 1st, shows her performing something of a ‘moral audit’ on herself after a two-day binge:

129 lbs. (but post-Christmas), alcohol units 14 (but effectively covers 2 days as 4 hours of party was on New Year’s Day), cigarettes 22, calories 5424.
Food consumed today:
2 pkts Emmenthal cheese slices
14 cold new potatoes
2 Bloody Marys (count as food as contain Worcester sauce and
1/3 Ciabatta loaf with Brie
coriander leaves–1/2 packet
12 Milk Tray (best to get rid of all Christmas confectionery in
one go and make fresh start tomorrow)

Bridget is performing a spiritual exercise at the heart of ancient philosophy, which has also been taken up by Cognitive Behavioural Therapy: using a journal to keep account of one’s habits and one’s progress in changing them.  Epictetus, the Stoic philosopher, told his students: “If you do not wish to be prone to anger, do not feed the habit…[instead] count the days when you were not angry: ‘I used to be angry every day, then every other day: next every two, next every three days!’ and if you succeed in passing thirty days, sacrifice to the Gods in thanksgiving.”

Keeping a journal helps us keep track of our progress in kicking bad habits and building good ones. It’s a technique I’ve been using this week, as I try to quit smoking for good (I’m on day thirteen, woo hoo!) People also use journals for more serious health problems, like bulimia. I read a story in this book on bulimia of a girl who kept a journal, keeping track of the times she binge-ate, or purged herself. After several weeks, she hit a low point, and felt she wasn’t making any real progress at all. Then she looked at her food journal, and reminded herself of quite how much progress she had made: her progress was clear, visible, quantifiable.

Keeping an account of oneself helps you, as the Roman philosopher Cicero put it, ‘to be doctor to yourself’. Today, new technology on computers and smartphones have massively increased our ability to keep track of ourselves. We are all becoming the doctors of ourselves.

Larry Smarr, the Marco Polo of his own body

The Atlantic magazine, for example, tells the story this issue of Larry Smarr, an astrophysicist turned computer scientist, who, like some digital Montaigne, is using computer technology to map his every physical function, and to help him battle Crohn’s disease (that’s him on the left with a computerised map of his gut). Larry thinks the health sector is about to become massively transformed through ordinary people’s access to digital technology that enables them to keep track of themselves and be their own doctors. The movement spear-heading this change is  called the Quantified Self movement, which has the very Socratic motto: ‘Self-knowledge through numbers.’

The self-help guru Tim Ferriss, who is both an avid self-quantifier and a big fan of ancient philosophy, makes the connection to Socrates:

It’s a Socratic process. First and foremost, I have to have a very clear, measurable objective, whether that’s in language acquisition or in power lifting. The common element is measurement, so you need to know when you have succeeded and how to measure progress to that success point, whether that’s a 500 pound dead lift or a 50 kilometer ultra marathon.

Quantified Self happen all over the world.

Of course, the end-goal of Greek philosophy was not power lifting or language acquisition but eudaimonia – ‘spiritual flourishing’. That’s quite difficult to define and measure (although some Positive Psychologists are trying to do just that). But, as individuals, we can certainly identify good habits that we want to strengthen, and bad habits we want to weaken, and measure our daily progress in those goals. And we can share our progress with others, via new apps like GE and Facebook’s new project, ‘Healthy Share’. We can also go along to Quantified Self meetups, which happen all over the world, to hear about some of the fascinating new apps people are inventing to help themselves and other people achieve greater well-being.

Some more links:

In the UK, a new report came out by Lord Richard Layard warning that national and local government were cutting funding for the UK’s ambitious expansion of Cognitive Behavioural Therapy (CBT).  He went on the Radio 4 show The Moral Maze to discuss the report. I wrote this piece suggesting the panel were too critical and had not done enough to celebrate the government’s support for mass therapy. Even if CBT isn’t all of the answer, it’s certainly some of the answer.

Here’s a great debunking of Slovenian philosopher Slavoj Zizek by John Gray.  And another bad review in the Guardian. I wish the Left would stop admiring this totalitarian poseur. His ‘radicalism’ is just verbiage, it demeans philosophy the same way Lacan’s pretentiousness demeaned psychology.

The Darwinians are in an up-roar over the concept of ‘group selection’. Could natural selection favour certain forms of social organisation, or does the idea only work at the level of the individual? Against the idea are Richard Dawkins and Steven Pinker, who wrote this eloquent piece explaining why he’s against it. And here’s an equally eloquent defence of the idea by EO Wilson, who is its principal champion.

Here’s a piece by Ben Goldacre and the British government’s Behavioural Science Unit on using randomised controlled trials to test public policy.Here’s a cover story I wrote for today’s FT Books & Arts, on philosophy clubs and the rise of the mass intelligentsia (a phrase invented by Melvyn Bragg, who is interviewed in the piece).

Finally, it’s Rousseau’s 300th birthday this week. Rousseau’s Confessions was written in conscious imitation of Marcus Aurelius’ Meditations, except that where Aurelius writes in order to change himself, Rousseau writes merely to celebrate his perverse uniqueness. Self-writing becomes, in his hands, not a means to self-transformation, but merely to self-justification and self-celebration. Rousseau did more than anyone else to invent the vain, self-regarding, neurotic modern self…which is not a great legacy to have left. But boy, could he write.

See you next week,


CBT, lost in the Moral Maze

Radio 4’s Moral Maze this week looked at the government’s expansion of Cognitive Behavioural Therapy (CBT), and at a new report from Lord Richard Layard of the LSE (the principal arranger of the government’s embrace of CBT), which warns that local and national governments are failing to honour the spending commitments they made to CBT.

I personally think that the expansion of CBT is one of the major achievements of the last five years (God knows there haven’t been that many national achievements during that time). Finally, we’re taking mental health seriously. Finally, we’ve found a therapy which works for the most common emotional disorders. And finally we’re putting in place the people and resources to enable the suffering to get help quickly. But, like most big steps forward, it’s been almost entirely un-celebrated by our media – unnoticed even – except by a few angry psychoanalysts who are indignant that CBT should have got so much funding and their own therapy so little.

So I’m disconcerted that, on one of the rare occasions that the government’s support for CBT was discussed, not one of the panellists (Michael Portillo, Matthew Taylor, Claire Fox and Melanie Phillips) should have felt the need to support it. Not one of them saw the need to defend that Service, and to try and protect its funding. What a missed opportunity. Rather than unpicking it, they should have applauded it.

Instead, the need for a National Mental Health Service was criticised from both right and left. On the right, Michael Portillo thought Richard Layard had massively over-emphasised the number of people who are affected by depression in the UK (6 million, according to David M. Clark, the psychotherapist who is the chief architect of the national CBT strategy). Portillo accused Layard of confusing depression, which is serious and nasty, with unhappiness. Lots of people are unhappy, for lots of reasons – calling it ‘depression’ just serves various ‘powerful lobbies’ (i.e. Big Pharma and the CBT industry), and gives scroungers a free ticket to benefits. If extended into the criminal justice system, it also lets people off the hook for bad deeds. Psychology becomes ‘excuseology’.

On the left, Matthew Taylor of the RSA thought Layard was medicalising unhappiness, and suggested that people might have very good social, economic and political reasons for being unhappy. CBT focuses too much on the ‘inner man’, and not enough on the outer conditions. It puts the blame for any dissatisfaction we might feel firmly on our own shoulders, which is a convenient move for government and the rich.

These concerns and confusions come about partly as a result of CBT’s origins in Greek philosophy, and I think we can clear them up if we replace CBT in its original context.

CBT emerged from Socratic and Stoic ethics, which developed as a form of ‘therapy for the soul’, which everyone could use to take care of themselves and transform their negative emotions. The idea was that you practice philosophy your whole life, both in periods of emotional turmoil (what we might call depression today) and when things are going well. The Greeks, lacking the Diagnostic Statistical Manual (DSM), did not divide emotional disorders into endless categories. They simply recognised emotional suffering – those moments when we become the passive victim of our passions, when they block us from enjoying a ‘good flow of life’. And they offered a way for students to get out of such situations, by learning how to examine their unconscious beliefs and values, and to change them.

CBT emerged from Socratic ethics, which taught people to 'take care of their souls'

As for  the ‘medicalisation’ of ethics and emotions, that goes all the way back to the Greeks too. They called negative emotions ‘passions’, from the Greek pathe, meaning suffering or sickness. They often compared the philosopher to the physician, and called philosophy a ‘medical art for the soul’ (as Cicero put it). So the idea that the unhappy are also unwell is a very old one. So is the idea that the morally bad are, in fact, deluded and sick – that’s what Seneca, Plato, Marcus Aurelius and others argued. It is no easy thing to separate these categories, as the Anders Breivik case shows. Of course Breivik should be held accountable. But of course, he is also fucked up – shooting 65 teenagers is fairly strong proof of being mentally ill, to my mind.

When we go back to the ancient Greek roots of CBT, it clears up various issues.

First, the question of how much to concentrate on the inner man versus the outer conditions. We see that CBT emerged particularly from Stoic philosophy, which focuses entirely on the inner man rather than outer conditions. The philosopher, according to the Stoics, is so mentally resilient that they can be happy in any situation, even while being tortured. They make their soul an ‘inner citadel’ against their culture’s toxic values. CBT inherits this same highly individualistic focus – change your self and make it an inner citadel against the fucked-up-ness of your society.

We can (and should) disagree with this intense focus on the inner man, and point to the strong influence of environmental factors like poverty on mental health. At the same time, the Stoics were right that all humans have some capacity to control our emotions, and helping people develop this capacity gives them the strength and autonomy to change their environment and change their society.

So Stoicism / CBT doesn’t have to be some sort of neo-liberal atomised self-help. If you look at Aristotelian philosophy, for example, it shares the Socratic principles of Stoicism / CBT (i.e. the idea we can use our reason to change ourselves and achieve flourishing) but it also recognises that our society and culture plays a big part in our well-being, and that as citizens we should take care of both ourselves and our society. We should balance the inner work of CBT with the outer work of changing our society. I think Layard recognises that. He’s not saying we should focus entirely on the inner man, only that we have ignored that factor for far too long in western politics. That’s a wise realisation for a Fabian in his 70s to reach.

Secondly, the question of personal responsibility.  Does CBT excuse people from their moral behaviour? Or does it put too much responsibility on our frail shoulders? Again, going back to the Greeks helps. They didn’t argue that we are all born free, rational, sovereign agents. But they argued that the vast majority of us can become slightly more free, slightly more self-aware, slightly more self-controlled, if we practice philosophy for several years. Autonomy is an exercise, and like other forms of exercise, we become better at it through practice.

But the first step is to take responsibility for our own beliefs and actions – not blame them on our environment, on our parents or friends or the economy or the weather. The economy may be terrible, and you being unemployed will almost certainly affect your mood. That’s not your fault. But how you think about your situation is going to affect your feelings. You can make that shitty situation a lot worse, if you want, or you can cope with it in a wiser and more effective way – not beating yourself up, while also looking for opportunities to get out of the situation.

Since my book has come out, I’m often asked by worried parents if their offspring’s mental / emotional problems are their fault. They are often relieved to hear about CBT, as an alternative to the old Freudian line that ‘they fuck you up your mum and dad’. Well, actually, you might very well have been fucked up by your mum and dad. They might very well have indoctrinated you in the thoughts and habits that are making you miserable today. However, these are now your thoughts and habits. Your mother and father aren’t standing over you forcing you to harm yourself. You’re doing it to yourself. As the great Bill Knaus says in my book, what happens to us is not necessarily our fault. But how we think about it is our responsibility. Don’t be a masochist. Don’t beat yourself up and then blame it on someone else.

Of course, some people are born into much harder situations than others. Some people grow up in environments that are constantly pushing them to depression or vice. Others grow up in environments that are constantly pushing them to flourish. That’s unfair, and we should do what we can to correct that. Part of that is giving people the tools to be resilient to their environment, to resist its bad influences and find the good influences.

Finally, the question of the division between Depression and unhappiness. Are we medicalising the entire society and pathologising perfectly normal things like unhappiness, shyness or anxiety? Again, let’s go back to the Greeks. Without the benefit of the Diagnostic Statistical Manual (DSM), the Greeks didn’t recognise particular emotional disorders, nor did they try to ghettoise them from ‘normal human experience’. Instead, they saw emotional suffering as on a continuum, from the very distressed to the quite distressed to the well to the flourishing. And they recognised that philosophy could and should help people all along this continuum.

Today, most people still don’t seek help for emotional problems, because they’re worried about ‘making a fuss’, or about admitting that they’re somehow officially broken or sick. Might it appear on their permanent NHS record? What if their employer found out, or their friends, or their family? Would they lose respect, authority or even their freedom as a result? And besides, isn’t it narcissistic to worry about their feelings? Who the hell is happy in this world anyway? And so most people do nothing to take care of themselves. They carry on veering through life, like a car with a flat tyre.

Philosophy, as Socrates insisted, helps us learn how to take care of ourselves. That isn’t selfish. It’s responsible. If we’re not taking care of ourselves, we’re probably affecting the people around us, and we’re also probably not engaging as effectively with our society as we could be. CBT is a form of therapeutic philosophy for people in serious distress – that could mean a particularly stressful period of your life, or a bout of depression, or panic attacks, and so on. Such moments affect many of us – perhaps 25%, perhaps as much as 50% – so go get some help, either from a GP, or from a CBT book, or from my book! Learn how to take care of yourself, how to steer yourself.

The Greeks thought philosophy should be available for everyone. I agree. I think everyone should be introduced to it, to learn how to take care of themselves. However, there is a difference to helping people in a serious emotional crisis, as CBT does, and helping people not in a serious crisis, as Positive Psychology tries to do. The latter group should not be told how to be happy. They can be taught some of the basics – how emotions arise, how we can change them – while also being encouraged to explore the different ethical visions of the good life that we can use these basics for.

One of the panellists, Michael Portillo, was particularly scornful of the fact we diagnose people with depression by asking them how they feel. People could lie, he pointed out. Well, that’s true, and no doubt many people do. But how else can we diagnose depression? How can we know how someone is feeling, except by asking them?

Aaron Beck, the pioneer of CBT, took ideas and techniques from ancient philosophy, and then married them to scientific empiricism. He invented the Beck Depression Inventory, which measures how depressed a person is by asking them, for example, how often they think about killing themselves. Now of course that sort of diagnostic technique can be fiddled by the unscrupulous. And of course, it is a bit simplistic. But it’s also a useful way of discovering if a therapy is really having any obvious effect. If a person, at the beginning of a therapy, says they’re extremely unhappy and think about killing themselves often, and at the end of the therapy they say they’re fairly happy and don’t think about killing themselves ever, then that’s a measurable success, isn’t it? And crucially, it’s only through such measurements that governments have been persuaded to support CBT. If it wasn’t for such measurements, far fewer people would be reached or helped by CBT.

I, like Portillo, am wary of the power of Big Pharma, and of a world where we have defined the entire population as in need of chemical interventions. But I do, actually, think that, in the words of Albert Ellis, 99% of the world is out of their fucking minds. Including me. We’re all on a continuum of mental health, and I certainly don’t think I am ‘flourishing’. I’m pretty well, but I’m self-aware enough to recognise I have a long way to go yet. Philosophy, no doubt, will help me on my journey.

Anyway, this is all a rather roundabout way of saying I think it is a very good thing that we now have a National Mental Health service, and that CBT has become available to ordinary people, rather than just the rich. So many of my friends have suffered from mental health problems at one time or another – most of them in quiet desperation. A lot of them could be really helped by some therapy, whether through the NHS, or through DIY therapy like reading a CBT book. That’s not narcissistic. It’s responsible. It helps them contribute to their society. Please can policy makers and opinion-influencers celebrate our new National Mental Health Service, rather than attacking it?