Oliver James’ Condescending Psychology

In Saturday’s Grauniad there was a debate on the topic of “Should workplaces have on-site psychiatrists?” Personally I think it would make more sense for workplaces to have on-site counsellors and mental health first aiders than psychiatrists, but that’s not really the point of this post. I’ve been irritated by the condescension of Oliver James, one of the debate participants.

The debate was between Oliver James and Alistair Campbell, the former Downing Street spin doctor who has spoken publicly about his recovery from depression and alcoholism. James is a psychologist (though he doesn’t appear to be registered with the Health and Care Professions Council as a practitioner psychologist), and author of books such as Affluenza and They F*** You Up.

In the debate, James states,

Psychiatrists mostly offer pills and other sticking plasters, like cognitive behavioural therapy (CBT). For the commonest problems, depression and anxiety, neither really work. The major part of the effect of antidepressants is placebo; the patient might as well swallow coloured chalk. Meta-analyses show that 18 months after undergoing CBT, there is no difference between people who had it and those who did not.

Campbell responds,

I have benefited both from the expertise of psychiatrists and from medication.

To which James replies,

If the medics have done the business for you, great. But the evidence suggests you are very much the exception. I suppose I do concede a small part of the stigma could be reduced by the wheeze. However, my core point is that the Human Genome Project is rapidly proving that genes play little part in causing mental illness: the huge differences in prevalence between different countries strongly suggests politico-economic and cultural factors are vital.

There’s a couple of unsourced claims in there – that CBT has no benefit after 18 months, and that the Human Genome Project is disproving genetic theories of mental illness. I’ve been trawling through Google Scholar looking for papers to back up the latter claim and drawing something of a blank.

But what’s really annoying me is James’ assertion that antidepressants are as therapeutic as swallowing chalk, and when Campbell suggests they’ve worked for him, James just dismisses this experience as some sort of anomaly.

Don’t get me wrong. I do think antidepressants are over-prescribed, and often in inappropriate ways. We can all think of examples of this. Somebody is sinking into a reactive depression because he’s lost his job and can’t find another one. He goes to the GP. What he really needs is a new job, but the GP doesn’t have one of those to give, so he gets a packet of fluoxetine instead.

I’m a nurse therapist in CAMHS. Much of my job involves psychological therapies with young people who are low in mood. CBT has its uses, but it’s certainly not a cure-all panacea. I find that systemic and family approaches can often have good effects, as can just good old-fashioned problem-solving and relationship-building. So in that sense I’m partly with James on the limitations of antidepressants and CBT.

 But…there are also those times when a young person has sunk so low that the therapy isn’t helping. Often, they can’t even engage with it. Meanwhile their school attendance and grades are going through the floor, they can’t sleep, they can’t eat, they can’t concentrate. At this point one could be slavish to “medication bad, therapy good” and leave the kid to carry on suffering. Or you could offer a trial of a low dose of fluoxetine.

And what happens when we take the latter path? More often than not, they get better, and they get better quickly. As for James’ assertion that antidepressants only offer placebo, and Alistair Campbell is some sort of one-in-a-million exception, I see evidence to the contrary on a regular basis.

It’s the fundamentalism of James’ approach that annoys me. Sure, people with depression often need to make life changes in order to recover, but sometimes they need that chemical boost just to have the energy to do it. Sometimes they need the lift just for therapy to make sense, which leads me to another bugbear I have about “medication vs therapy” arguments. They ignore the fact that the two can sometimes complement each other.

So, what are James’ alternatives to antidepressants and CBT? Mostly he seems to be arguing for structural changes in society to reduce materialism and inequality, and more focus on the wellbeing of children in their early years. I’m fine with both of those, though I doubt that doing so is likely to eradicate mental illness altogether.

And what is he proposing for those adults who still experience mental health problems even after the established of the Glorious Peoples Republic of Oliver James? From his background I’m guessing psychodynamic therapy. While that’s a type of therapy that some people find helpful, it’s arduous, takes a long time and costs a hell of a lot of money for something that by no means guarantees a helpful outcome.

And that’s even before we get into the sheer number of outright quacks working as psychodynamic therapists, particularly in the private sector. Take a look at what happened with this therapist. Does it sound like (a) he was doing a good job of helping people or (b) that the UK Council for Psychotherapy are doing a good job of regulating people like him?

If we really want to say what helps in mental health, there’s a straightforward mantra and it goes like this:

“Some people find medication helpful. Some people find therapy helpful. Some people find medication and therapy helpful. Some people don’t find either helpful.”

Why is that so difficult to understand?

 

 

 

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About Phil Dore

Trained as a nurse, currently working in Child and Adolescent Mental Health Services (CAMHS). All views expressed are in a personal capacity and not necessarily the views of my employer.

22 Responses to “Oliver James’ Condescending Psychology”

  1. In your experience, does the rule of thirds ring true?
    (A third get better, a third stays the same and a third get worse)

    A recent large genetic study which found 5 new loci and confirmed 2 previously identified in a sample of >50,000. Which is quite impressive.
    http://www.nature.com/ng/journal/v43/n10/full/ng.940.html
    I do find it particularly bothersome when people throw out unfounded claims which could ultimately have a negative impact on the population. :/

    • The rule of thirds? It’s hard for me to put a neat figure on it, mainly because so much of what he deal with are complicated mish-mashes of all sorts of issues – in among the psychiatric stuff there’s often family issues, social issues, school problems, safeguarding matters…

      What I can say is that of the children we see, the majority wind up being discharged before they turn 18, and therefore aren’t transferred to the adult service. That in itself suggests we’re probably doing some things right.

  2. Hi, I definitely feel my mental health may not have worsened so much had there been an intervention when I was at school. I do feel some sort of therapy may well have helped, in particular some sort of family therapy as well as possibly medication.

    The trouble is in my case things were left too long, at the time I didn’t really know what was going on, and didn’t see the numerous things piling up. Which means things were allowed to set in, and it’ll now take longer for things to work. I’m pleased child mental health services are better these days than they were.

  3. I’ve been to several talks by Oliver James over a period of years. At each he has seemed slightly more hubristic and apparently unable to distinguish evidence from things he has just made up. I remember in the Q&A after one he confidently stated that the reason mental health ‘was better’ in Denmark was because ‘they didn’t have iphones there’. (I think this was in 2010) A Danish friend also in the audience texted me from hers to tell me what she thought. He’s a crowd pleaser (and has a devoted worshipper following who I wouldn’t mess with), but a storyteller rather than a scientist when it comes to appraising evidence.

  4. Whilst I wouldn’t want to be seen as a fan of OJ – he bends the knee too often towards Freud for my liking – I think that he has some good points to make about the way we live. I have read Britain On The Couch and at times you could mistake him for having a background in Sociology rather than Psychology. (Mrs Squeers like, most psychological professionals could do with a severe dosing of Sociology, it would do them the world of good.)

    What he focusses on is the myriad of ways we make one another utterly miserable and the way that our expectations and the world we live in can contaminate us with all sorts of expectations that act as drivers for unhappiness. Worth a read but beware, he is an old windbag and never says in a couple of words what can be said in a dozen.

    As for workplace therapists, well, I really do think this is a distortion. There are now greater and greater demands for productivity, people are working in organisations with a skeleton staff, salaries are being frozen and jobs consolidated with very little or no notice and ceratinly no supportive management or appropriate training. Autonomy? Control of Work organization? Forget it! To put the locus of distress within the individual against that background is sheer foolishness.

  5. I know nothing of Oliver James, but it sounds a bit like the anti-psychiatry movement of the Sixties all over again? As part of the Post Qualifying Course in Social Work, I completed in the late 1990’s I read an article, which was a critical overview of all the schools of therapy, in many countries over a long period of time, and this article concluded that CBT was the most effective over the widest range of conditions, for the longest period of time. It synthesized information from thousands of studies, but I am afraid to say that with retirement I very much doubt that I have kept it! And surely with the Human Genome project all the evidence points the other way. Increasingly it seems to be showing that we are prisoners of our genes; that is not to say we are absolute prisoners, it is perhaps like being in an open prison. When I was an adoption manager I read many reports on children due for adoption, and the upshot of those reports which do quote the evidence is that if you have one parent with a high level mental health disorder you have a higher than average chance yourself of developing such a disorder, if you have both parents it is higher still. Now this of course can be environmental or learnt behaviour; but if you have one mentally well parent, one mentally ill parent, and a mentally ill grandparent, the chances are significantly higher than if both your parents are mentally ill – which implies a gentic component. Now of course these sources would be the very people that are being criticised – namely psychiatrists. However these are reports for court, or likely to be made available to court, and in any case I have never met a professional who would want to reduce a child’s chance of adoption, so I doubt that the gentic component was ‘over-egged’.

  6. James is a psychologist (though he doesn’t appear to be registered with the Health and Care Professions Council as a practitioner psychologist)…

    No, and he doesn’t appear to have been a registered Psychologist prior to the HPC taking on a responsibility for Practitioner Psychologists in July 2009 as can seen from the Peter Mandelson debacle from the pages of the Guardian in February 2001.

    http://www.guardian.co.uk/politics/2001/feb/15/mandelson.labour

    Shame, sometimes he produces some good stuff.

  7. I’m all for psychiatrists in parliament – so long as they section the the lot of them on grounds of being a danger to others, diagnose them as DSPD and give them a relatively high dose of Olanzepine after 6 sessions of CBT to help them cope with doing shelf stacking on the Work Programme for their recovery [after Atos have found them fit for work]

  8. The world seems to be filled with psychologists like James who 1) Dn’t believe in psychology and 2) are mentally ill. Someone explain to me why crazy morons get to be psychologists?

    As for CBT I think it is a thousand times better than traditional psychodynamic therapy, which is mostly hand-holding and whining about something Daddy said 36 years ago that upset you. It is also ridiculously expensive and time-consuming. People hate CBT because it forces you to solve your problems instead of crying about them for years on the taxpayer’s dime, which is probably what James advocates since – surprise, surprise – he practices it 😉

    • People hate CBT because it forces you to solve your problems instead of crying about them for years on the taxpayer’s dime, which is probably what James advocates since – surprise, surprise – he practices it

      Or, more to the point, on the dime of psychodynamic therapists. As in, psychodynamic therapists like Oliver James. 😉

  9. Seeing as how society is highly unlikely to change for the better produce “structural changes in society to reduce materialism and inequality” most of us have to deal with life as it is. I was suffering from anxiety rather than depression. The root cause was the conditions at work but I needed a course of low-dose anti-depressants to enable me to become calm enough to make an informed decision as to what to do about it. Since then I have looked into CBT to reduce the lingering effects on my sense of self-worth. I don’t consider either to have been pointless and I suspect not that much of an anomaly either. We can’t afford to suffer and not cope while we wait for society to improve.

    • Absolutely. Likewise for those who say we should abandon meds and CBT in favour of long-term psychodynamic therapy. That can take years, and by no means with a guaranteed outcome that it’ll help the patient recover. Are people supposed to be left to suffer for all that time?

  10. Psychologists at war with psychiatry at war with neurology.

    This should be interesting.

    • Nah. There’s the occasional inter-disciplinary spat, but it should be pointed out that Oliver James isn’t even a registered clinician. He’s just a media rentamouth.

      Behind all these things, the truth is that there’s many examples of psychologists and psychiatrists (and nurses, OTs, social workers etc) working together in a multi-disciplinary way, sharing the difference perspectives of their respective professions in a constructive manner, which is as it should be.

  11. This former NHS psychiatrist has some rather peculiar views:
    http://www.telegraph.co.uk/culture/theatre/9889188/Put-away-the-pills-and-listen-to-Tennessee-Williams.html#disqus_thread

    ‘In the modern world, Blanche Dubois, Big Daddy and Doc would all have been “diagnosed” according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, and given antidepressants. Their serotonin levels would have been considered low and in need of a boost. The antidepressants wouldn’t have worked, of course, but at least they would have prevented them from the need to look inwards, to examine themselves.’

Trackbacks/Pingbacks

  1. Frontline Friday round-up 22nd February 2013 - 22 February 2013

    […] a different subject, writing on The World of Mentalists, Zarathustra had a go at psychologist Oliver James and his criticisms of both cognitive behavioural therapy (CBT) and […]

  2. Who you can and can’t trust when hiring a psychotherapist - 3 March 2013

    […] There’s a few exceptions to this. Arts therapists, including drama and music therapists, have to register with the Health and Care Professions Council. So too do what’s referred to as practitioner psychologists, which covers such titles as clinical psychologists, educational psychologists and counselling psychologists. However, simply calling yourself “psychologist” is not a protected title, and again, anyone can call themselves one. That’s something to bear in mind when noticing that Oliver James is simply called a psychologist rather than clinical psychologist when he regularly appears in the media. That possibly explains why he oftenspeaks utter rubbish. […]

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