The Sale of Certainty

This morning I heard health expert Dame Prof Sally Davis, on BBC radio 4, talking about the health of UK children. (It seems that cases of rickets are on the rise. She suggested the introduction of vitamin supplements for all kids).
During the interview (which you can listen to here, at approx 2h 39min), she was also called upon to comment on mental health issues in family life, and their treatment.
How disappointing it was to hear the same old line trotting out once again, like a soundbite, or one of those management-speak buzzwords that seems to be infectious in the meeting-room spreading from one employee to another. It goes something like this:
 (a lot of mental health problems) "will respond to.... Cognitive Behavioural Therapy... talking therapies..... "

The words used here are telling. They show a lack of understanding about the therapy world; its different modalities, and their potential use in the wide range of mental health issues. The words also show a willingness to endorse, publicly, a particular form of treatment.

I have previously drawn attention to this advertising of the CBT 'brand' here.

Dame Sally makes it very clear to us exactly why she wears this logo on her T-shirt. She says "I believe that we should only offer treatments that are evidence-based."
What she's saying, then, is that she only values treatments (and that includes therapies) which offer a statistical probability of "success" based on "outcome measures", and perhaps therapies which lend themselves to a widely-accessible "treatment protocol".
(For a deliciously sarcastic take on this kind of approach, see my friend Jason Mihalko's blog here).

Dame Sally is, of course, coming from her own training and heritage. She is steeped in the politics of medicine; a world of ever-increasing tension between public treatment needs and public costs. She values 'evidence-based' therapies, because, perhaps rightly, it would be hard to advocate the spending of public cash on therapies that aren't shown to be 'cost-effective'. The taxpayer deserves value for money, of course.

Evidence-based treatments are useful because, in the medical world, they offer the best assurance that a certain drug/intervention will work. The science tells us that in (n) cases, (x) show a measurable improvement compared to a control group who haven't been given this intervention. Therefore, the chances of your symptoms improving with this treatment are predictable to a certain level of probability.
Evidence-based treatments are also seductive, because they offer us a sense of safety and hope for a particular outcome that we are invested in.
We invest psychologically as patients, because we all want our symptoms to improve.
We also - as Dame Sally illustrates - invest financially. This, on a political level, has huge consequences, because government will clearly be much happier to offer therapy that offers clear, predictable outcomes.

Easy, then, to be fooled into thinking that therapies offering statistically-supported outcomes are the 'best'.
Sure, if you have the type of problem that fits neatly into the standardized diagnostic boxes that NICE and the APA prefer. But the problems of our life and our world are, to my mind, mostly in a different category than this.

How many times, for instance, have you lost a night's sleep because of a meeting, interview, or other event the next day that you are uncertain about?
We have all become stressed and irritable, maybe felt depressed, because of an ongoing issue in life that we can't control or predict.
Maybe you have thought about making a major decision in your life but have been held back for some time, because of the fear of the unknown. "If I knew I could get more work over there, I'd leave this job for good. But how do I know...?"

If only there were an assured, statistically-supported outcome, that you could be certain of....!

I don't believe I'm in the business of offering people assured or certain outcomes. Because in lots of ways, I don't believe there are many to be found. However, the selling of empirically-supported therapy is popular because it fits with an economic and medicalized model of human suffering. The natural human needs for self-exploration, mutual discovery and understanding, and psycho-spiritual development, are not necessarily part of the 'treatment plan'.....

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Economics, Morals, and The Bystander

I note that UK Prime Minister David Cameron, and his colleague William Hague, were optimistic yesterday about ongoing relations with Russia...

http://www.tinyurl.com/43rlrz7

I heard a few stories too about the approach of the Russian regime that we're familiar with ... torture, murder, and the corrupt dealings of business and government.

Of course, there are many other administrations in the world that show a dubious morality - Japan continues to promote 'scientific' whaling, Canada continues to allow seal culling, and Zimbabwe is just one of the African states where murder and all sorts of other grievous violent acts are taking place daily.

The Russian story got me thinking today in particular because one could almost hear in Cameron and Hague's voice a slight hint of economic desperation. Oil and gas, oil and gas.... the economic climate in the UK is such that Cameron is flirting with China, and basically turning down the volume on any residual issues with Russia. The economic pressure on him to work in the UK's interests are too high.

At a high political level, then, there is discounting at work. Not the kind of discounting one might encounter in therapy, though - out-of-awareness, just-under-the-cognitive-surface discounting. This is a kind of active, purposeful discounting. I fact, I'm reminded of Petruska Clarkson's writing on The Bystander. Are we, as nations, becoming more prepared to take the bystander role with each other (on, for instance, human rights abuses), in order to keep trade moving and support the global economy?

This is the tightest economic era in generations. I worry that more international bystanding will result; more abuses of self (the citizens) and each other (armed conflict, over oil and resources, for instance?) that gets overlooked in favour of economic harmony.
Maybe there's a risk too that we become more bystanderish towards each other, as our own economic safety makes us more prepared to overlook the sufferings of others.

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