Environmental Trauma, Mental distress and the question of its treatment:

Professor Richard Bentall wrote an article in the Guardian Journal section on Friday 26th February this year which should be cause for celebration for psychoanalytic psychotherapists, as he promotes evidence that mental illness/distress is usually a result of early environmental trauma. As he points out in the article; ‘Recent studies have pointed to a wide range of social and environmental factors that increase the risk of mental ill health. These include poverty in childhood, social inequality, early exposure to urban environments, migration and belonging to an ethnic minority (all trending in the wrong direction); early separation from parents, childhood, sexual, physical and emotional abuse and bullying in schools’. I might myself go further and include earlier parental neglect and abuse but Bentall makes his point well; namely that genes are not the primary factor in most cases of mental distress, it is trauma that we are most likely to find to be the contributing factor in our discourse with patients in the consulting room, often early trauma, although not always of course, as trauma can come at any time in life.Go to link for this article

Bentall points out something that we ( psychotherapists) have argued for many years; namely that mental illness is not a result of ‘discreet brain conditions that are largely genetically determined and barely influenced by the slings and arrows of misfortune’ as the biological approach to psychiatry would have us believe.  Bentall could not be more un- equivocal in his positioning here, stating that ‘In an analysis of all the research on childhood trauma and psychosis, my colleagues and I found that exposure to any of these childhood adversities increased the risk of psychosis approximately three fold, and those who had multiple traumatic experiences were at much higher risk. In fact, the evidence of a link between childhood misfortune and future psychiatric disorder is about as strong as the link between smoking and lung cancer’.

This of course is where the psychotherapist/analyst should come in, but in todays underfunded NHS this is not always possible for patients who cannot afford much needed long term talk therapy. As Bentall states, ‘Arguably, the biggest cause of human misery is miserable relationships with other people conducted in miserable circumstances’, and goes on to crucially point out that ‘many psychiatric patients in Britain feel that services too often ignore their life stories. In the words of Eleanor Longden, a mental health activist, “They always ask what is wrong with you and hardly ever ask what happened to you”. Patients are routinely offered powerful drugs, but very rarely the kinds of psychological therapies that may help them come to terms with these kinds of experiences, or even practical advice’. The opposite is true of course, in the psychotherapists consulting room, where we allow more time for the patient. The 1st question I ask of my patient is “tell me why you are here. What is your story”.

This brings me onto another recent in depth and important article from the Guardian, by Oliver Burkeman, published on Thursday 7th January, and which I strongly recommend to anyone interested in mental health, not just mental health professionals and therapists but everyone; the article challenges the NHS’s (backed by successive government’s looking to save a buck) over reliance on CBT, a much cheaper form of psychological treatment which has to a large extent barged more traditional forms of talk therapy aside in recent times. Burkeman starts his article by stating that ‘Cheap and effective, CBT became the dominant form of therapy, consigning Freud to the psychology’s dingy basement. But new studies have cast doubt on its (CBT) supremacy – and shown dramatic results for psychoanalysis,’ going on to ask, ‘Is it time to get back on the couch?’ Let’s hope so!

CBT has often been accused of short termism; quick fix thinking; of applying a band aid to a gaping wound, and Burkeman’s piece makes this point strongly and effectively, while arguing equally strongly for the long term positive effects of psychoanalysis/ talk therapy. He also makes the well worn point that for decades (if not centuries now in fact, since Freud began his work in the 1800’s) Freudian analysis has been a bourgeoisie, snobby, elitist pursuit, resistant to qualitative research and full of its own self- importance, ironic given that in his life time Freud was keen to establish his theories within an empirical scientific framework. But for a long time Psychoanalysis did seem reluctant to open its doors to the outside world and seemed impenetrable. But nowadays anecdotal and qualitative evidence/proof of the efficacy of the process is more widespread in the face of a plethora of case study books by therapists such as the populist Irving Yallom and our own Stephen Grosz and his ‘Examined Life’ to name but a few. We have finally began to put our house in order and are beginning to produce examples of how long term, talk therapy can be wholly effective and have life changing effects on those prepared to commit to its requirements and Burkeman’s article explores this thoroughly and intelligently.

Another important point I would make as a practising psychotherapist working with patients long term, is how many people have said to me in our 1st meetings (and I have hear this often from colleagues also) that they had CBT a year or so ago and feel that although it seemed to help for a while, they now want something more, to go deeper, and to ultimately get to the heart of their suffering, and not just be given a quick fix response to emotional stress that involves some basic mindfulness and ‘positive thinking’ techniques that ultimately wear off in the face of overwhelming unconscious processes. Without ‘getting to the bottom’ of our unconscious processes, we will, ultimately I believe, be overwhelmed by them. And to their credit, our patients, in their suffering seem, to intuit this point and seek us out for a bigger, in depth fix.

Don Butler – AGIP – Feb 2016