daniel ilan

These days the most widely used therapeutic approach is CBT (cognitive-behaviour therapy). A highly effective treatment for anxiety and depression, which works by training your mind to think differently about things that make you anxious or depressed.

For example, say you struggle with anxiety about the future. You might notice you tend to assume that if things don’t go well, they will go catastrophically not well. This is unhelpful, because fearing the worst leads to more anxiety, and potentially to avoiding responsibilities or relationships that could actually mitigate the risk. It’s also a cognitive distortion, because you don’t really know what will happen in the future — there are many more ways things can go than catastrophically — and if you learn to notice when you are thinking this way, using mindfulness and thought records, you can challenge your assumptions, and reduce the amount of anxiety you feel.

But, you might ask, what if you are anxious because millions of people are struggling to afford their rent, and the excesses of capitalism are laying waste to the conceit that our social and political systems will ever care about the welfare of people and the environment, and the government recently committed billions of dollars to America’s military industrial machine, and your kids will probably never own their own home?

Should you recognise this as catastrophic thinking? Should you remind yourself that alternatives exist besides the world imploding? Should you convince yourself to feel less terror at the thought of how little faith it’s possible to have these days?

Maybe so.

But you should also consider that all forms of therapy are contextual. That is, inseparable from prevailing cultural norms and available technologies.

For example, when Ugo Cerletti came up with the idea for electroconvulsive shock therapy to treat manic depression, he was watching pigs be prepared for slaughter with electric shocks to calm their nerves. Of those people who weren’t helped by the retrograde amnesia the shocks induced, the dark truth is that many went on to complete suicide.

Seriously, context matters.

And it’s no coincidence that CBT ascended the ranks of the evidence-base in Western culture during the same period that widespread medicalisation of death rendered dying an unnatural enemy, and cracks began to appear in our collective sense of environmental security.

To be sure, CBT is highly effective. It really does help reduce symptoms of anxiety and depression. Like everything else you can buy these days, it contains powerful technology. But its effectiveness has little to do with the underlying causes of mental anguish, just as the effectiveness of mobile phones has little to do with the nature of fulfilling conversation.

This is obvious when you consider that depression and anxiety are on the rise, especially among young people.

What’s most likely is that self-monitoring and mindfulness (the hallmarks of CBT), are effective tools for thinking better, but can also become mechanisms for denying uncomfortable truths that could undermine our sense of security. Such as the thought that the welfare of people and nature is being sacrificed to capitalism’s insatiable appetite for growth.

Put another way, when the ship is sinking it helps to know how to remain calm, but it doesn’t help the ship. The threat is not anxiety. It’s water.

And therein lies the danger of medicalising anxiety to the point where it becomes a life-threatening disease to be eradicated.

So, as therapists and patients, let’s ask ourselves what therapy would look like if we welcomed anxious thoughts for the immutable realities they reveal. If we learned to listen to anxiety in ourself and others, not as distorted thinking, but as single notes in the chorus of collective concern.

What would that mean for the capacity of future generations to face the challenges of these uncertain times?