Assisted suicide is never out of the news for long. This week, a further discussion in parliament will take place. As with other debates, this one has been heavily covered by news media. However, my article, originally published in the British Journal of Psychotherapy, considers the implications of any change in the law, particularly the unconscious and conscious implications for disabled people.
Disability rights advocates are drawing attention to the dangers in a government backed bill being discussed in the British parliament (November 2018). The Mental Capacity (Amendment) Bill would make it easier, they argue, for disabled people to be deprived of their liberty as part of their care, without adequate human rights safeguards. The UK has been criticised by the United Nations Committee on the Rights of Persons with Disabilities for failure to make progress on UN Convention rights of disabled people.
The proposals, if agreed, would give new powers to arrange deprivation of liberty assessments to care home managers, and an independent assessor would only be asked to carry out a review if the service-user was believed to be objecting to the deprivation of their liberty, and it would be up to the care home manager to decide if that person was objecting.
Its a new year and if your thoughts have turned to the future direction of your life or work, you may be interested in exploring psychoanalytic ideas and practice in a more formal educational way. If so, you may be interested in the training courses provided by apptraining. Apptraining, organised by the Association for Group and Individual Psychotherapy, includes a one year foundation course and a three year clinical training course. You can obtain more information via the apptraining website or at one of the Open Days being held in January, March or April.
A new report shows a large rise in suicide attempts among people who claim the main out-of-work disability benefit. The research, reported by Disability News Service (DNS), draws on NHS data and covers the period between 2007 and 2014. It indicates that in 2007 – a year before the introduction of the much-criticised work capability assessment (WCA) used to determine who is awarded Employment Support Allowance – 21 per cent of incapacity benefit (IB) claimants (as the main out of work disability benefit was then called) told researchers they had attempted suicide at some point in their lives. The following year, IB began to be replaced by ESA, with eligibility tested by the WCA. By 2014 more than 43 per cent of claimants were saying they had attempted suicide.
DNS also reports that the ‘strongest evidence until now that there was a link between the WCA and an increase in mental distress came in November 2015, when public health experts from the Universities of Liverpool and Oxford showed in a study that, for every 10,000 IB claimants in England who were reassessed for ESA between 2010 and 2013, there were an additional six suicides, 2,700 cases of self-reported mental health problems, and an increase of more than 7,000 in the number of anti-depressants prescribed.’
This article by Oliver Burkeman takes a thorough look at the evidence base for psychoanalytic-based therapies compared to cognitive behavioural therapy. Given the increasing media chatter about an impending robotics revolution, some of his coverage evokes the (worrying) thought of the potential role for robots in some kind of future mental health provision. Burkeman cites a patient’s comments on the alienation and isolation she was left with when a computer programme all too unconvincingly announced its sympathy: ‘… “I don’t think anything has ever made me feel as lonely and isolated as having a computer program ask me how I felt on a scale of one to five, and – after I’d clicked the sad emoticon on the screen – telling me it was ‘sorry to hear that’ in a prerecorded voice,” Rachel recalled.’
‘Rachel’ goes on to suggest that completing CBT worksheets under a human therapist’s guidance wasn’t much better: ‘… “With postnatal depression,” she said, “you’ve gone from a situation in which you’ve been working, earning your own money, doing interesting things – and suddenly you’re at home on your own, mostly covered in sick, with no adult to talk to.” What she needed, she sees now, was real connection: that fundamental if hard-to-express sense of being held in the mind of another person, even if only for a short period each week.’
Burkeman uses data to argue that psychoanalytic therapies, long derided by their critics as too time and money intensive, are longer lasting in their effects: ‘Ask how people are doing as soon as their treatment ends, and CBT looks convincing. Return months or years later, though, and the benefits have often faded, while the effects of psychoanalytic therapies remain, or have even increased…’
Online comments to the article object that Burkeman’s analysis is too harsh and generalising, and insist that CBT, delivered by adequately trained therapists, can be effective – and it’s an argument worth thinking about. But central to Burkeman’s argument is the very question: what is the point of therapy? CBT and psychoanalytic approaches have different ends in mind to an important extent. These different ends shape the structures of the therapy and alter the subjective experience.
Burkeman puts it: ‘CBT’s implied promise is that there’s a relatively simple, step-by-step way to gain mastery over suffering. But perhaps there’s more to be gained from acknowledging how little control – over our lives, our emotions, and other people’s actions – we really have?’. He ponders: ‘what should count as a successful outcome anyway?’ Psychoanalysis argues that ‘there’s more to a meaningful life than being symptom-free. In principle, you might even end a course of psychoanalysis sadder – though wiser, more conscious of your previously unconscious responses, and living in a more engaged way – and still deem the experience a success.’