On Tuesday I went to talk by Brigadier-General Rhonda Cornum (pictured right), who used to be in charge of the US Army’s $125 million resilience-training programme. The event was also the launch of the Young Foundation’s Resilience project. It was held at Macquarie Bank in the City, in a penthouse office-room full of funders, NGOs and policy wonks. A huge amount of interest in resilience, clearly.
I’ve long had an interest in the Army’s resilience programme – I interviewed Cornum back in 2009, and the interview is in the second chapter of my book. The programme was designed by Martin Seligman and his colleagues at University of Pennsylvania, based on techniques from Cognitive Behavioural Therapy (CBT) and Positive Psychology.
It was rolled out by the US Army in rather a hurry, in an attempt to cope with the epidemic of post-conflict suicides among the troops. According to this useful report from the Centre for the New American Security, 18 American veterans kill themselves every day – that includes veterans who served decades ago, but still, it’s an awful statistic. The US Army lost 164 active duty soldiers to suicide in 2011, and a Freedom of Information act recently obtained by a US newspaper found that 2,200 soldiers died within two years of leaving the military – half of whom were being treated for post-traumatic stress disorder.
The Army, to its credit, is taking this problem seriously and trying to do something about it, by rolling out a CBT / Positive Psychology resilience programme which has been shown to reduce the incidence of depression in school children.
I got over PTSD myself through CBT, so I support the idea of making it more available in the Army, but there are aspects of the Comprehensive Solider Fitness programme (as it is called) that I don’t support. First of all, Seligman added the idea of teaching ‘optimistic thinking’, one of the features of which is to learn to take credit for things when they go well, but to blame your external circumstances when they go badly. I’m generalising – but not much. I think that’s a terrible thing to teach young people. It’s teaching them irresponsibility. Sometimes things go badly because you screwed up, and you need to be able to recognise that.
Secondly, I don’t like the programme’s claim to have discovered a scientific model for emotional and spiritual flourishing, which everyone must fit into, and which can be measured by a computer questionnaire. That’s a crude, vulgar and narrow-minded idea. By all means, help people avoid depression and PTSD, but don’t tell them you can measure a person’s ‘spiritual fitness’ with five questions in a computer questionnaire. This isn’t Cosmopolitan magazine, this is life!
Anyway, perhaps it is worth accepting these really dumb bits of the programme in order to get CBT out to the troops. The proof will be in the evidence. There wasn’t a pilot programme done (which is strange when you think how expensive the programme is), but the initial results are in, and they show that soldiers who took the course are about 1% more ’emotionally fit’ than soldiers who didn’t take the course (I’ll post the slides that show this once the Young Foundation makes them available). That’s a pretty tiny impact for such an expensive intervention. Suicides, meanwhile, continue to rise among active troops: they were higher in 2011, two years after the introduction of this course, than they were in 2010 and 2009.
I hope the results of the programme improve – but I would be wary of defining resilience as strength and PTSD as weakness, as Cornum repeatedly did. So Cornum didn’t get PTSD after she was shot and captured. Good for her. But some people go through awful experiences and do get PTSD. That’s not necessarily because they’re weak. It could be because the US Army puts its soldiers through tours that are, on average, twice as long as the tours of British soldiers, which in turn might explain why PTSD is apparently so much rarer in UK troops. It could be because they experienced some awful, awful things. It could be because war is an ugly and corrupting experience that leaves scars, real and hidden, on all who are immersed in it. We are not going to make it a perfectly hygenic and healthy experience with a bit of CBT.
As for teaching resilience in schools, well, we tried that here in the UK, in a government sponsored pilot programme designed by Seligman, the results of which were also disappointing: no long-term impact on children’s well-being or academic achievements. And I have even more ethical concerns about how technocratic, automated, rigid and prescriptive the Penn resilience course is if we start to teach it to children in schools. We shouldn’t claim there is only one scientific answer to the question ‘how to flourish’ – there are many answers to that question, and children should learn to be sceptical of experts who appear before them claiming to have all the answers. They should be trained to see the flaws in people’s arguments and to find their own response.
We need to find the right balance between the sciences and the humanities, between the wisdom of the ancients and our freedom to choose our own path. I personally think we should develop ‘art of living’ classes that combine the cognitive techniques of CBT with open discussion about the ethics and philosophies from which those techniques came.
On the philosophy side of that equation, here are some videos from an excellent sounding course in the Art of Living which Stanford University recently launched. And here is an article in the Telegraph, of all places, calling for compulsory philosophy in schools. That’s a decent idea – but, again, I think it could be very usefully combined with insights from the social sciences, and with an introduction to some of the basic techniques of well-being, like meditation or Socratic self-examination. Philosophy isn’t just about conceptual discussion, it’s also about learning really useful techniques and practices for living, some of which have now been tested out by science.
While we’re wondering whether CBT can be automated, here is Aaron Beck, one of the two inventors of CBT, discussing that very question recently at the Beck Institute. His answer is, yes, maybe.
Here in the UK, it looks like the government’s NHS bill is in trouble. Even Tory journalists are now calling for it to be dropped. Meanwhile, a new report from the King’s Fund says that the NHS needs to do more to recognise and treat mental illnesses among the severely ill. Meanwhile, Labour’s shadow health secretary, Andy Burnham, gave a fascinating speech calling for mental health to become the core focus of the NHS, and even perhaps of government as a whole.
Talking of the King’s Fund, I was at their offices in Cavendish Square last night to talk at a Psychologies Magazine event called ‘Make It Happen’. It was the first sort of self-help talk I’d given. It was really fun: I basically approached it like a London Philosophy Club event and tried to get people to offer solutions to other people’s problems. The attendees were really good at it. Kind of crowd-sourced therapy. I met a lot of people there who were trying to write a novel or get published. I can’t recommend The Literary Consultancy enough – they were a huge help to me in getting published.
Here’s a good article in the New York Review of Books, which suggests something I also have thought: that the Occupy movement is as much a spiritual movement as a political one. It reminds me rather of some sort of pre-modern cult, which expects a new Age of Love to arrive.
Here’s a funny article in the NYT about how young life-coaches are becoming.
Taiwan has become the latest country to measure national well-being.
Here is an eyebrow-raising video of one parent’s reaction to finding an anti-parent rant on his daughter’s Facebook page.
Finally, just to put all this well-being stuff in context, here is a news story about the people of Homs in Syria, saying goodbye to each other as they prepare for the ground assault on their town. I hope they can stay safe, and that Assad and his security advisors have to answer for their actions.
See you next week,