Tag: PsychologistsAgainstAusterity

Critique of the ‘Origins of Happiness’ study. Psychologists Against Austerity respond

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Clinical psychologists have widely criticised Labour peer and economist, Richard Layard, over research he led that claims failed relationships and physical and mental illness were bigger causes of misery than poverty. 

“Happiness scholars” and authors of the study report, Andrew Clark, Sarah Fleche, Richard Layard, Nattavudh Powdthavee and George Ward say:

“Understanding the key determinants of people’s life satisfaction will suggest policies for how best to reduce misery and promote wellbeing. This column discusses evidence from survey data on Australia, Britain, Germany, and the US which indicate that the things that matter most are people’s social relationships and their mental and physical health; and that the best predictor of an adult’s life satisfaction is their emotional health as a child.”

In the their study, the Origins of Happiness, the authors call for a new focus for public policy: not ‘wealth creation’ but ‘wellbeing creation.'”

The authors say: “Most human misery is due not to economic factors but to failed relationships and physical and mental illness. Eliminating depression and anxiety would reduce misery by 20% while eliminating poverty would reduce it by 5%. And on top of that, reducing mental illness would involve no net cost to the public purse.” 

So the authors propose the delivery of more Cognitive Behavioural Therapy (CBT), whilst income redistribution and social justice perspectives are considered trivial and insignificant because they are deemed too costly. Layard in particular enthusiastically endorses CBT, which he regards as the modern evidence-based psychological therapy of choice. Layard was one of the key signatories of The Depression Report, and one of the main campaigners, along with David Clark, for the Increasing Access to Psychological Therapies (IAPT) programme, which has entailed the mass provision of CBT.

CBT is a cheap, short-term, goal-oriented treatment that practitioners claim takes a “hands-on, practical approach to problem-solving.” Its goal is to change patterns of thinking or behaviour that are claimed to be behind people’s difficulties, and so change the way they feel about their circumstances. However, I have critiqued this approach more than once. 

I’ve also critiqued the use of quantitative methodology and survey methods more generally in policy-making, as such methods frequently fail to pay due regard to authenticity, reliability and validity, inclusion and full participation: quantitative methods tend to be used non-prefiguratively. (See for example: The importance of citizen’s qualitative accounts in democratic inclusion and political participation.)

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Happiness is a neoliberal warm gun: depopulating policy

CBT is of course premised on the assumption that interpreting situations “negatively” is a bad thing, and that thinking positively about bad events is beneficial.

The onus is on the individual to adapt by perceiving their circumstances in a stoical and purely “rational” way. CBT is primarily about self-governance techniques.

So we need to ask what are the circumstances that the authors are expecting people to accept stoically. Socioeconomic inequality? Absolute poverty? Sanctions? Work fare? Being forced to accept very poorly paid work, abysmal working conditions and no security? The loss of social support, public services and essential safety nets? Starvation and destitution? Political authoritarianism? The end of democracy?

It’s all very well challenging people’s thoughts but for whom is CBT being used, and for what purpose? It seems to me that this is about helping those people on the wrong side of draconian government policy to accommodate that, and to mute negative responses to negative situations. CBT in this context is not based on a genuinely liberational approach, nor is it based on any sort of democratic dialogue. It’s all about modifying and controlling behaviour, particularly when it’s aimed at such narrow, politically defined and specific economic outcomes, which extend and perpetuate inequality. In this context, CBT becomes state “therapy” used only as an ideological prop for neoliberalism.

CBT is too often founded on blunt oversimplifications of what causes human distress – for example, it is currently assumed that the causes of unemployment are psychological rather than sociopolitical, and that particular assumption authorises intrusive state interventions that encode a Conservative moral framework, which places responsibility on the individual, who is characterised as “faulty” in some way. The deeply flawed political/economic system that entrenches inequality isn’t challenged at all: its victims are discredited and stigmatised instead.

Yet historically (and empirically), it has been widely accepted that poverty significantly increases the risk of mental health problems and can be both a causal factor and a consequence of mental ill health. Mental health is shaped by the wide-ranging characteristics and circumstances (including inequalities) of the social, economic and physical environments in which people live. Successfully supporting the mental health and wellbeing of people living in poverty, and reducing the number of people with mental health problems experiencing poverty, requires engagement with this complexity. (See: Elliott, I. (June 2016) Poverty and Mental Health: A review to inform the Joseph Rowntree Foundation’s Anti-Poverty Strategy. London: Mental Health Foundation).

In the social sciences there is a longstanding and unresolved debate over the primacy of structure or agency in shaping human behaviour. Structure is the recurrent patterned social, economic and political arrangements which influence or limit the choices and opportunities available to citizens. Agency is the capacity of individuals to act autonomously and independently of “outside forces” to make their own free choices. 

Layard et al. dismiss the importance of context on human behaviours, cognitions, perceptions, attitudes and states of mind, and the study is premised and proceeds as if this controversy has been resolved. It hasn’t. 

Such an approach crucially overlooks conflict, the impacts of political decision-making, economic arrangements, social structure, prevailing cultural norms and ideologies, for example.

Rather predictably, Layard’s approach to research (for he’s an economist, not a psychologist, hence his approach shares more in common with the behavioural economists from the cost-cutting, antidemocratic Nudge Unit) conflates human needs and wellbeing with narrow ideological (antiwelfarist, “small state” neoliberal) outcomes, by removing any consideration of the complex interactions, constraints and impacts of the economic, social, cultural and political context on human happiness. Layard’s neuroliberal approach therefore may be read as an endorsement of existing socioeconomic inequalities. 

Furthermore, definitions of “happiness” are culturally specific. They are susceptible to culturally (and politically defined) dominant moral judgements. The happiness imperative may be regarded as an artifact of modern history, not as an inherent feature of the human condition. Across cultures and time, happiness has most frequently been defined as “good luck” and arising because of favourable external conditions. Some definitions place notions of a virtuous life and “hard work” as essential and central qualities of happiness. It’s worth noting that from 1997 to 2001, Layard was an adviser to New Labour and one of the key architects of the “New Deal” and “Welfare to Work” policies. He certainly has clearly defined ideological inclinations.

In those countries with a dominant ideology that is founded on competitive individualism, such as the US and the UK, the definitions of happiness and wellbeing based on chance and context were replaced by definitions focused on favourable internal feelings and states. In other words, happiness came to be regarded as an inner state that we have some personal control over. The significant rise in the availability and popularity of “self help” literature in the western world is a testament of this view that the happiness of citizens is a personal responsibility, and not a political one.

A central theme in this individualist approach is a relentless optimism about the capacity of individuals to improve their own mental health, and accept things as they are in order to bask in earned and fully deserved human happiness and fulfilment. The starting point of the self help perspective, (dating back to Samuel Smiles and his moralising, conservative disquisitions on Thrift and Self help: the austerity ideologue of mid Victorian laissez faire) is that the world is basically okay, the problems arising at an individual level are simply because of how we choose to perceive it – this is reflected in an emphasis on the necessity of changing the way you see and think about the world, particularly in neoliberal economies. It’s very clear why CBT is so appealing to the UK Conservative government. It doesn’t challenge the status quo at all. 

Establishing happiness as a metric is only meant to serve a political end. Indeed, it may even be regarded as a form of political gaslighting. I’m not alone in my concern that “happiness” research could be used to advance authoritarian aims. Studies show that in European elections since 1970, the subjective “life satisfaction” of citizens is the best predictor of whether the government gets re-elected  – this apparently is much more important than economic growth, social conditions, unemployment or inflation.

CBT is the modern descendant of the discredited, ever so quantitative behaviourist tradition, spearheaded by B.F. Skinner, who views persons as nothing more than empty and simple mediators between behaviour and the environment. Integral to this perspective of behaviourism is the concept of behaviour modification through rewards or “consequences.” This has been politically translated into a reductionist economic language of incentives and outcomes. (Stimulus => response.)

This is paralleled with the growth of nudge, which is a technocratic behaviourist solution and ideological prop in the form of behavioural economics, which is also all about generating public policies that aim to quantifiably change the perceptions and behaviours of citizens, aligning them with narrow neoliberal outcomes.

Even the likes of Oliver James (author of Affluenza and The Selfish Capitalist, among other works) critique the symptoms of neoliberal policies rather than the disease: neoliberalism itself.

This is precisely why independent research findings consistently highlight the value of adopting less idiomatic and more value neutral historical, political, cultural and linguistic perspective in the study of public happiness.

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I think it’s fair to say that mental illness is not caused by just one thing. Poverty can be one factor or trigger that interacts with a complexity of other events, such as adverse life events, genetic predisposition, poor physical health or substance abuse. But so far, the strongest evidence suggests that poverty can lead to mental illness, especially disorders such as depression.

Living in poverty causes chronic distress and struggle. Failure to meet basic human needs certainly has an impact on human and social potential – Abraham Maslow explored how our cognitive priorities are reduced when our physiological needs are not met or our survival is threatened. Struggle and distress may have an ultimate biological impact on brain function. According to one controversial hypothesis, schizophrenia is the result of chronic experience of social adversity and defeat, which disturbs the dopamine level and function in the brain, for example.

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A report published by the World Health Organization this year strongly suggests that poor individuals are twice as affected by mental health conditions compared to rich individuals. The report concludes: “Whilst the relationship between poverty and mental health is complicated, individual measures taken to reduce global poverty are likely to have positive impacts on mental health issues in underprivileged populations.”

Regardless, a society may be judged on how it treats its most disadvantaged citizens. The harrowing problems of poverty, as described in Charles Dickens’ David Copperfield, and social rehabilitation, or lack of it, as portrayed by Victor Hugo in Les Misérables, sadly remain as pressing today.

The statement from Psychologists Against Austerity

The Origins of happiness study overlooked the social and political context of mental health, say campaign group Psychologists Against Austerity. This lets politicians and the architects of austerity off the hook.

The London School of Economics (LSE) study, led by Layard, was published in early December. The report claims that eliminating depression and anxiety would be a cheap way to reduce misery by 20 per cent, while eliminating poverty would be more difficult – and, besides, it would only reduce unhappiness by 5 per cent.

Psychologists against austerity (PAA) have condemned the stark and simplistic dichotomy presented in the report between income and mental illness as predictors of life satisfaction.

In a response published online, the group, which is made up of practising mental health professionals, highlighted the fact “some media reports have gone further, apparently taking the results to imply that there is no causal relationship between poverty and mental illness”, and blamed the researchers for not making the complex relationship between poverty and mental health clearer. According to the psychologists, the two things “are related in a complex variety of ways, with both causally influencing the other”.

The group of psychologists said it was easy for the researchers to downplay the link in their findings, because the relationship is not as simple as happiness being dependent on income alone.

“Living in poverty is more stressful, with fewer buffers, so challenges are more likely to be catastrophic,” their statement said. “People living in poverty have less agency and control over their lives, and live with lower status, often accompanied by stigma, powerlessness and shame.”

Layard’s emphasised that as UK average incomes have increased, the country has not got happier. But PAA point out that in addition to becoming richer, Britain has also become a profoundly more unequal society since the 1980s.

The original study states that relative poverty is more important than absolute poverty in mental health terms, but does discuss this in detail.

Decades of previous research supports PAA’s statement, and many individual psychologists and academics agree with the anti-austerity group’s statement. 

The study “lets politicians off the hook, it lets austerity off the hook” by treating mental illness as if it exists in a void and is not intrinsically linked to societal factors, director of clinical psychology at Canterbury Christ Church University, Dr Anne Cooke, told the Guardian:

“It says that all that doesn’t matter, making a better society doesn’t matter, just offering technical treatments,” she said. “I am one of the people that offers technical treatments and I think they can be extremely helpful to some people but that argument is being stretched beyond the point at which it applies.”

Dr Peter Kinderman, president of the British Psychological Society, has said he welcomed Lord Layard’s call for a focus on national wellbeing through investment in mental health services. But he added, speaking to the Guardian, that he had misgivings about how the study had treated mental illness as a distinct variable from human misery.

Layard’s work has previously led to David Cameron’s adoption of national “wellbeing” statistics, and he was also a driving force behind the adoption of the Improving Access to Psychological Therapies to increase access to “talking therapies” on the NHS.

That latter policy was particularly controversial because it established finding work as an outcome of psychological treatment, which critics said may not be a suitable outcome for some and encouraged a policy of forcing people into work which may not be appropriate for them. PAA and other campaign groups have previously called aspects of the scheme’s implementation “profoundly disturbing”, attacking 2015 plans by then-chancellor George Osborne to link welfare and therapy by placing IAPT therapists in job centres. Layard, who is an economist rather than a psychologist, is now calling for a “new role for the state” that “swaps wealth creation for wellbeing creation” through targeted mental health interventions.

The LSE study has worried psychologists because Layard is highly influential with policymakers. The Labour peer’s recommendations previously led David Cameron to adopt national wellbeing statistics, and Lord Layard was also a driving force behind the Improving Access to Psychological Therapies (IAPT) scheme to increase access to “talking therapies” on the NHS.

Dr Jay Watts, a clinical psychologist, told the Guardian Layard’s call “negates decades worth of data linking mental health to poverty”.

“It’s ripe for misuse … in the current political climate,” she added.

Dr Anne Cooke said there were better ways to improve wellbeing than by focusing on isolated mental health interventions. Policy should take a more holistic public health approach, she proposed.

“Cholera wasn’t eradicated by developing new treatments, it was eradicated by improving drains back in pre-Victorian times.

What [Layard] neglects is the people at the bottom of the pile who are really, really struggling, and in current circumstances there are a lot of them. People who you see at food banks for example, who are in incredible distress and certainly would – most of them or a lot of them – meet the criteria for an anxiety disorder or depression,” she said.

But it’s largely a response to their circumstances. If we do something about that, rates of mental illness in the population are going to come down a lot more effectively than providing a lot more therapy.”

Meanwhile, PAA suggested that rather than doing nothing to help the most disadvantaged people, the study could actually contribute to perpetuating poverty.

“Discussions of mental health that leave out a thorough analysis of poverty and income inequality may be used uphold policies that maintain disadvantage and oppression in society,” the group said.

You can read PAA’s full response here

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Adults in the poorest fifth are much more likely to be at risk of developing a mental illness as those on average incomes: around 24% compared with 14%.

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Related

The Psychological Impact of Austerity – Psychologists Against Austerity

Psychologists Against Austerity: mental health experts issue a rallying call against coalition policies 

The power of positive thinking is really political gaslighting


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Psychologists Against Austerity: mental health experts issue a rallying call against coalition policies.

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I wrote an article in March about the government plans to make the receipt of social security benefits for those with mental illnesses conditional on undergoing “state therapy.” I raised concern about ethical issues – such as consent, the inappropriateness of using behaviour modification as a form of “therapy,” and I criticised the proposed Cognitive Behaviour Therapy (CBT) programme on methodological and theoretical grounds, as well as considering wider social implications.

The 2015 budget included plans to provide online CBT to 40,000 claimants and people on the Fit for Work programme, as well as putting therapists in more than 350 job centres.

Since I wrote, over 400 psychotherapists, counsellors and mental health practitioners have written an open letter, published by the Guardian, about the broader, profoundly disturbing psychological and quality-of-life implications of the coalition government’s austerity cuts and policies. However, the letter was particularly critical of the government’s benefits sanctions scheme, which has been condemned by many of us – human rights advocates across the state – as brutal, unjust, ill-conceived, ineffective and inhumane.

In particular, the letter stated that the government’s proposed policy of linking social security benefits to the receipt of “state therapy” is utterly unacceptable. The measure, casually coined “get to work therapy,” was discussed by Chancellor for the Exchequer George Osborne during his last budget.

The letter’s supporters included psychotherapist and writer Susie Orbach. She called the Conservative proposals “beyond shocking.” Echoing the concerns I raised earlier this year, she said:

“It undermines the fundamental principles of one’s right to physical and mental care – that you have to be able to consent and that the people you go to have to be highly trained and have your best interests and aren’t meeting targets.”

The letter’s signatories, all of whom are experts in the field of mental health, have said such a measure is counter-productive, “anti-therapeutic,” damaging and professionally unethical. The “intimidatory disciplinary regime” facing benefits claimants would be made even worse by further unacceptable proposals outlined in the budget.

Among the groups represented by the signatories were Psychologists Against Austerity, Britain’s Alliance for Counselling and Psychotherapy, Psychotherapists and Counsellors for Social Responsibility, the Journal of Public Mental Health, and a range of academic institutions including Goldsmiths, Birkbeck, the University of London, the University of Amsterdam, Manchester Metropolitan University, the University of Brighton, Disabled People Against the Cuts and others.

More generally, the wider reality of a society thrown completely off-balance by the emotional toxicity of social conservatism combined with economic neoliberalism (which I have argued is manifestly authoritarian) is affecting Britain in profound and complex ways, the distressing effects of which are often most visible in therapist’s consulting rooms.

This letter sounds the starting-bell for a broadly based campaign of organisations and professionals against the damage that neoliberalism is doing to the nation’s mental health.

The letter said that for now, we call on all the parties in this election to make it clear that they will urgently review such regressive, anti-therapeutic practices, and appropriately refashion their commitment to mental health if and when they enter government.

Andrew Samuels, an Essex University professor, and immediate past chair of the UK Council for Psychotherapy, said he believed there was “a bit of a public school ethos” behind the work-capability regime introduced under the conservative-liberal democrat coalition and new conservative plans.

Characterising the government attitude as “Pull yourself together man, for heaven’s sake,” Samuels added: “It is wholly inappropriate. It symbolises a society that has lost all moral compass.”

Absolutely. Public schools are notorious for a culture of bullying. However, it’s one thing to be treated as a privileged and insulated public school boy by a peer from an elite background to “character building” rhetoric, but quite another to adopt that same bullying approach towards the ill and most vulnerable citizens. All to justify an ideological drive to “shrink the state” and remove support from the poorest.

All of this said, public schools are regarded by many as institutions that inflict a particularly British form of child abuse and social control. I also think it has to be said that soul trauma and pain don’t respect social status.

Samuels insisted the open letter was not “pro-Labour” but was aimed at getting a review of measures taken and proposed over the past five years.

He said: “If Labour decides afterwards all this is in order, it will go on. But I don’t think it will.”

The Labour Party does value professional opinion and rational discourse. The Conservatives, on the other hand, are not widely recognised as a party that welcomes democratic, open debate, transparency and accountability. The Tories simply exclude critical professionals and representative organisations that may challenge and disagree from the discourse.

A spokesperson for Labour said mental health “is the biggest unaddressed health challenge of our age.”

“It’s essential that we give mental health the priority it deserves if we are to thrive as a nation and ensure the NHS remains sustainable for the future,” he said.

The Labour Party have pressured the government to “write parity of esteem between physical and mental health into law,” and in the response, Labour have stated that the party is committed to implementing this policy if elected in May.

The spokesman pledged the Labour will bring an end to the “scandal of the neglect of child mental health,” indicating a welcomed return to a comprehensive preventative approach. He said: “It is simply not right that when three-quarters of adult mental illnesses begin in childhood, children’s mental health services get just six per cent of the mental health budget.”

Richard House of the Alliance for Counselling and Psychotherapy, the letter’s main organiser, said there had been a mounting groundswell of concern: “When one hears story after story of dramatic negative health impacts, psychological and physical, after people are subjected to these back-to-work practices, the time has surely come for an ‘emotional audit’ of the impact of what, to many, appear to be heartless, un-thought-through policies that are merely penalising and punishing the already disadvantaged still further.”

Yes, the time has come for a change of government. On May 7, we must ensure that the regressive, oppressive regime of the past five years is replaced by a progressive, inclusive and democratic alternative.

Related

The power of positive thinking is really political gaslighting

The just world fallacy

Cameron’s Nudge that knocked democracy down – a summary of the implications of Nudge theory

Rising ESA sanctions: punishing the vulnerable for being vulnerable

Suicides reach a ten year high and are linked with welfare “reforms”

Mental Health Services in crisis because of Coalition cuts to funding

The Psychology of Austerity

A group of mental health professionals have come together under the banner of Psychologists Against Austerity (PAA) to highlight the psychological impact of austerity.

Now, with only a few weeks to go before the general election, PAA have started a campaign calling for a Parliamentary Inquiry into the psychological damage austerity has wreaked across the UK.

You can read more and sign our petition here: 38degrees/psychological costs of austerity inquiry.


 

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