Follow Up on British Debate on Wellbeing

I must confess that I’m reporting on an event that I don’t completely understand. Last week, there was a “debate” in the House of Commons on the politics of wellbeing. Except the format seemed to be 6 panelists of sorts (2 MPs, one economist, one psychologist, a TV figure who has a reputation as an expert on children, and a former trade union researcher and advisor to Gordon Brown who is now a writer and editor, followed by questions from the floor. It sounds as if it was the sort of event that would be held at the Society for Ethical Culture were it in New York, a public meeting with perhaps higher profile and clout than the average gabfest.

It may be self-congratulatory on the Guardian’s part to tout it as a seminal event (the chair and trade union researcher/writer on the panel are in the Guardian’s fold) but if nothing else it is a sign of a change of sentiment.

I am intrigued because the social issues in the UK really aren’t that different from those in the US (high divorce and breakdown of traditional families; growing ethnic diversity; rising income inequality; increasing obesity; a health care system under strain; high and increasing rates of mental illness). Yet the Brits are willing to subject these issues to debate and try to come up with a consensus, or at least ascertain where the fault lines are, while in the US, we want at most to address the symptoms.

It’s worth noting that even though the summary lists five issues, two of them are mental health. So one might surmise that the debate about wellbeing is really a willingness to acknowledge that many people, despite being moderately or even very well off, are unhappy, and maybe this is really a social rather than an individual issue. From “The Road to Wellbeing,” by Derek Draper (the chair):

[L]ast night’s wellbeing debate at the House of Commons attracted the numbers, but did we get the insights?….

One thing I am clear about is that this issue heralds a sea-change in British political discourse. As James Purnell said, wellbeing will be at the centre of the next general election. It was no accident that last night one of the key strategists who will run Labour’s campaign slipped into the room to take the temperature of the debate.

In that election Labour will face an opponent unrecognisable from the Tory party of yesteryear. Now is not the time to debate how real the “new” Tories are, my point is they look and feel totally different. Tim Loughton, the Conservative mental health spokesperson charmed many last night, including one magazine editor who is a life-long Labour voter. You can still see and hear the more traditional Conservative when he speaks but there is also an engagement – genuine I think – with an agenda that just would not have been embraced by the Tories of old. People on the left can no longer assume that this is “our” agenda. Far from it. We will have to develop and fight for a social democratic response – James Purnell, sure to be in Brown’s first cabinet, has begun the process of formulating that.

Less clear is exactly what the different elements of the wellbeing agenda are, and how they fit together. Last night at least five themes emerged but it would be good to hear your perspective. First, there is the issue of mental health, with its sub-category of what type of therapy should be offered….Sue Palmer focussed on child-rearing, her preferred term for parenting because it puts the child “back into the picture”. Neal Lawson of Compass dealt more with values and cultural issues….Finally, a lone voice complained that there was no religious voice on the panel. I think that reflected a wider question of whether some of this agenda is more concerned with spiritual or certainly ethical matters than politics per se.

So there seems to be five overlapping areas:

•Mental illness – causes and cures?

•Types of therapy – CBT [cognitive behavioral therapy] plus?

•Government – what can/can’t it do?

•Childhood – putting children first?

•Cultural change – what and how?

Interweaved among these are the vital questions of values and ethics.

Another Guardian writer/blogger, Oliver James, caused a stir by raising the question of why rates of mental were twice as high in the US and England as on the Continent. His post, “It’s a mad world” not only takes a swipe at the American fixation on optimism, but also at cognitive behavioral therapy and links the two. FYI,CBT is a short-term oriented therapy that works by training patients to learn to avoid recurrent negative thinking patterns. In the US, it is regarded as one of the few forms of therapy proven to be effective. James cites research that finds that CBT’s benefits aren’t lasting, and sees our preference as part of a general American cultural pattern that places great stock in optimism, whether it is justified or not. And tellingly, he sees this optimism as an obstacle to fundamental change. Ouch. No wonder the powers that be are so happy to hand out Prozac. It’s our Soma.

[H]appiness evidence does not tally at all with properly conducted studies of mental illness – happy countries are often severely mentally ill. Since both bodies of evidence cannot be right, I am much more inclined to trust the very detailed and numerous questions entailed in evaluating mental illness. Many happiness surveys are based on one crude question: are you very happy, happy, unhappy or very unhappy, or somewhere in the middle? I find it implausible that answers to this question tell us anything significant about individual or, when collated for collective results, national happiness.

Finally, I take Richard Layard to task for having bought into the cognitive behavioural therapy (CBT) and positive psychology industries. While I have great respect for Richard and am singing from the same hymn sheet as him on many issues, and while I am all in favour of the setting up of a network of therapy centres (as proposed in his Depression Report), he is wrong about CBT. Quite simply, if you read the evidence, it shows that it does not work in the long term (see the definitive review of empirically tested therapies by Drew Westen).

Above all, it is an American confection for returning workers to the workplace with a temporary and wholly false smile on their face. Studies of Americans show them to be living in a rose-tinted bubble of positive illusions. They are unrealistically optimistic about how much their friends like them or about the future. When asked to rate how sensitive they are to others, 90% of Americans believe they are in the top 10% of sensitivity – by definition impossible – and it is similar for their falsely bloated self-esteem or view of their own capacities.

Americans who have accurate perceptions of themselves are deemed by researchers to suffer from “depressive realism”. That is a dangerously barmy formulation, personally and nationally.

If you do not know that things are going wrong, you cannot put them right. There is a real danger that CBT is often no different from the spin which political parties put on their performance. A spun society will find it harder to change direction when it is heading for the rocks. Likewise the CBT patient.

What we need is a campaign for real therapy, not this psychic face-paint, and nationally it is the same. We need a return to the ideals which informed us post 1945 – meritocracy, female emancipation, egalitarianism and democracy.