CBT: The Cognitive Behavioural Tsunami: Managerialism Politics, and the Corruptions of Science
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Farhad Dalal tells the story of a brazen heist that occurred in plain view. It is a tale of two influential men, one an economist, the other a cognitive psychologist, who, armed with what Dalal calls corrupt science, and with a sleight of hand known as ‘‘evidence-based practices,’’ changed the ethos of mental health provision in Britain’s National Health Service (NHS). The shift toward an econometric approach to mental health delivery, coupled with mandated ‘‘efficiencies’’ of manualized, time-limited therapy, has changed the NHS beyond recognition and dealt what is likely a death blow to widespread use of psychoanalytic, humanistic, existential, and other therapies that take human suffering seriously and that may harbor emancipatory conceptions of therapy as a lever for addressing social inequalities. With advances in digital therapeutics, underwritten by huge sums of venture capital, the likelihood is that in the future psychotherapy for the masses will be delivered by minimally skilled ‘‘clinicians’’ communicating via scripted text,
until in due course they are replaced entirely by ‘‘intelligent’’ digital therapists. By no means confined to Britain, this healthcare ‘‘solution’’ is spreading rapidly across neoliberal western democracies. For psychodynamically oriented clinicians, this book makes for grim reading. While individual analysts in major metropolitan centers will continue to carve out a living catering to an intellectual and wealthy elite, graduate training in psychoanalytic therapy or psychodynamic clinical psychology is declining rapidly. It is hard to leave Dalal’s book without the impression that psychoanalysis has lost the war to cognitive behavioral therapy (CBT). Buoyed though it may be by endorsements from twenty-five leading intellectuals, it is doubtful that this book will shift an insidiously entrenched CBT paradigm; indeed, it may serve more as an obituary for the practice of psychoanalysis than a call to action. Complementing Nancy Fraser’s (2016) ‘‘Contradictions of capital and care,’’ Dalal demonstrates the need to understand the embeddedness of human services in neoliberal capitalist discourses. As such, the book is also a timely warning of the need to be on guard against further encroachment by neoliberal managerial systems. The dystopian view of British social services presented by Ken Loach in his film I, Daniel Blake (2016) is a salutary reminder of the terrible social cost of outsourced staffing, unbridled managerial ‘‘efficiency,’’ and ruthless cost-cutting. This story of the conquest of the NHS, narrated in a tongue-in-cheek style that accentuates the author’s outrage, reflects a similar dystopian sensibility.
2020 Springer Nature Limited. 1088-0763 Psychoanalysis, Culture & Society www.palgrave.com/journals
Book Review
Dalal’s inquiry has profound implications for academics engaged in any kind of critical, contrarian, or counter-discursive intellectual work. The forced relocation of Central European University in 2018 from Budapest to Vienna, sustained attacks on feminist
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