Tuesday, 21 June 2011

NICE and psychotherapy ... part 1

This is the first of a few posts dedicated the the UKCP's document "Nice Under Scrutiny", published a few days ago. UKCP have commissioned an authoritative academic report into NICE's foray into the world of psychotherapy, and the resulting roll-out of CBT via the IAPT programme.

NICE is an organization steeped in the biomedical model, where a linear pathway is assumed to be the norm - diagnosis, treatment, cure. Symptoms, or pathology, is the major focus of attention; the patient is simply the carrier or presenting 'face' of the pathology that is to be treated.

The debate about the dangers of the biomedical view in mental health is not new... not by a long way. Back in the sixties, the Radical Psychiatry movement was making noises about the oppressive, alienating effects of psychiatric diagnosis. The 'manifesto' of the Radical Psychiatry movement, which was produced in 1969, still feels relevant today, and is worth a read..... http://www.emotional-literacy.com/rpman.htm

Today, as in 1969, the medical establishment (including NICE) are trying to shoehorn the emotional lives of real people into diagnostic boxes. They have picked on depression as seemingly the most prevalent 'condition', and of course Lord Layard has picked on it due to its perceived economic effects. But the obvious truth is that human emotionality cannot be distilled down into such narrow (and some might say arbitrary) criteria. As Irvin Yalom said, the medical model is a "wafer-thin barrier against uncertainty".

This is to say nothing of the interpersonal effects of diagnostic labelling, and the dehumanizing effect of psychiatric treatments upon patients.... see R.D. Laing, for a start! The bottom line is, you can't treat people's distress by trying to use a standardized approach.

I recently heard a tale of IAPT which sent shivers down my spine. A person had been referred to the IAPT service by their GP, due to multiple trauma including a recent bereavement. They were telephoned by an IAPT worker, who tried unsuccessfully to 'treat' her with the manualized CBT-style spiel. The person later told her (face-to-face, psychodynamic) counsellor that they needed to talk about their sadness and loss, not be told to 'make a list of negative thoughts you need to change, and have it ready next time I call you'. What kind of therapy is this?

The use of a treatment protocol is fine, in cases of actual organic illness. But treating, say, a strepto-throat-infection is so very different from treating sadness, fear, loss, anguish, or any other kind of mental or psychic pain. The 'pathology' can't be isolated, so the medical model falls over.

The determination of NICE to push ahead in this way, and the onward rumbling of IAPT, seems to represent an unwillingness to accept that psychotherapy is different.


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