One of the reasons for the growing success of The Site is the fact that it actively embraces the challenges thrown up by radical uncertainties. Here is Chris Oakley's statement from the homepage of our website:
Against all odds we wish to shake received assumptions by proposing this cross-disciplinary interweave, thus effecting a critical intervention, the Site of the fold, in the terrain of established and establishment psychoanalysis. Our desire is to open its somewhat closed systems, to rethink its universalising tendencies, and to raise a challenge in the face of master narratives… (Oakley 1989: 14)
Some speakers at the conference, Psychoanalysis and Class, which inspired these papers demonstrate how class continues to produce subtle effects in the consulting room. Others have elected to place class in a wider cultural and political context. I believe that this leaves an interesting space for a ‘Site-style’ critical intervention which addresses the effects of class on the psychotherapy professions themselves. Why does the practice of psychoanalysis in Britain continue to be deeply inflected with class issues? This state of affairs will in future, I predict, create an even greater divide between other psychoanalytic types of training and practice and that of the Site where criticism, mostly of the constructive variety, is a normal way of life.
Here is an account—perhaps slightly exaggerated—of our current situation. Therapists of all stripes employ a very British approach to argument and debate. Criticism often consists of thinly veiled ad hominem comments. Each interest group secretly despises the others and believes their own brand of therapy to be superior. It is no accident that the comedy sketch where John Cleese, upper class man, looks down on Ronnie Barker, middle class man, who in turn looks down on Ronnie
Corbett, working class man is enduringly popular. For my purposes, I apply it as follows: the upper classes (psycho-analysts with the hyphen) look down on the middle classes (psychotherapists), who in turn look down on the working class counsellors (psycho-nothings). Each of these groups seem to think they live in a cloistered world separated from the allegedly materialistic practice of the psychologists who treat people with the brand-new ‘evidence-based’ science, Cognitive Behavioural Therapy (CBT).
I have recently co-written two short books, The Problem with Cognitive Behavioural Therapy with Furhan Iqbal, and The Problem with Psychoanalytic Psychotherapy with Nicola Godwin and Iain Snell (both in press). It is rare to criticise as I and my co-writers have done, both CBT and psychoanalytic psychotherapies without recourse to thinly-disguised class-based slurs and slights. Why should this be? In the case of CBT, Furhan and I had the sense of venturing into uncharted territory. Why don't psychotherapists look at the factual detail of CBT's evidence base as a starting-point for constructive criticism? Instead, they often complain that CBT is trespassing on what they consider to be their own patch. Many practitioners consider their version of clinical practice to be superior to that of their rivals: they simply know this to be the case. Some of our more sophisticated colleagues argue that CBT is ethically problematic because there are elements of coercion involved in its practice. Others point to the fact that, anecdotally, CBT does not live up to the admittedly high expectations of both therapists and clients. These observations may be true, but they set aside the desperation which makes many sufferers happy to endure coercion in the faint hope of a cure. Most are too distressed to notice that they have been coerced. Evidence, if any, always seems to be purely anecdotal and limited to the experience of a few people. It is as if practitioners are afraid that, were they to investigate the claims of CBT (and other evidence-based therapies), they would find out that their own brand of therapy was indeed inferior. The most obvious means of examination of the tenets of CBT—an analysis and critique of its own claims—is the very method that is conspicuously avoided.
On the other hand, the practitioners of CBT and evidence-based therapies, whether trained as psychologists, psychiatrists or, more recently, nurses, rarely come from an educational background that
enables them to criticise their practice on the basis of first principles, that is from an understanding of the history and philosophical beliefs which have shaped their discipline.
A psychoanalyst might wonder whether something is going on here that is connected to neurosis, anxiety and disavowal—the operation of the death drive perhaps. However, before I discuss the psychoanalytic elements of the argument, I will present a more detailed description of how class differences operate within the psychotherapies.
To my mind, the writer who has most vividly described Britain's complacent acceptance of class differences is C. P. Snow. It is now fifty years since Snow gave a lecture entitled ‘The Two Cultures’ where he exposed some of the more shocking features of a culture riddled with class inequalities. At the time, Britain was governed by civil servants and politicians educated in the public school classical tradition. They were challenged by bright grammar school boys who went on to study sciences rather than the arts at university. Each group misunderstood, mistrusted and often hated the other. The Civil Service mandarins looked down on the grammar school scientists because, it was alleged, they had not read Jane Austen. Intellectuals in Britain were assumed to be ‘literary’ intellectuals. On the other hand, as Snow (a grammar school boy who started his working life as a scientist) witheringly commented, most Civil Servants did not have a clue about the workings of the Second Law of Thermodynamics. Snow even wondered whether, in scientific terms, they could ‘read’ at all—did they understand what the terms ‘mass’ and ‘acceleration’ meant? Snow himself had a foot in both camps as a scientist who wrote a series of novels based around this topic collectively entitled Strangers and Brothers. The Civil Service classicists usually prevailed over the upstart working class scientists and maintained their vested interest in what they would have termed the ‘status quo ante’.
Snow appreciated that even in Britain there was the possibility of a different, less class-ridden approach to society. As he documented elsewhere, there was a brief ‘truce’ during the Second World War (see Snow 1971 [1960]). For a short time during the beginning of the war scientists' views prevailed. The new invention of radar was rapidly developed and deployed, together with appropriate training of personnel, with very un-British efficiency. However, the war had not even ended before normal class hostilities resumed. Those who had spearheaded the successful
introduction of radar were sidelined and ignored by Churchill (an old Harrovian soldier, journalist and politician who did not have a scientific education). The contemporary class divisions in the psychotherapies reflect the same cultural phenomena—mutual suspicion and ignorance.
Presciently, Snow argued that the stakes were very high. In 1959 he thought the key issues facing the human race were, ‘… H-bomb war, over-population, the gap between the rich and the poor’ (Snow 2008 [1959]: 46). The global impact of the last two issues in particular is now obvious. For all the talk of global warming however, as any regular reader of Ben Goldacre's ‘Bad Science’ column in The Guardian will know, much of the British population is still scientifically illiterate. For example, children's health has been put at risk as a result of unsubstantiated allegations of a connection between the onset of autism and taking the MMR vaccine. As Goldacre points out, our media is dominated by those who are either scientifically ignorant, or worse, choose to appear ignorant because they believe that neither the middle classes nor the working classes can understand difficult scientific concepts. Thus, most of their reporting is based upon finding something newsworthy—preferably dramatic, sexy and scary—rather than balanced and informative exposition, and is assumed, thereby not to be newsworthy. Despite the much-trumpeted expansion of university education, signs of class strife are still pervasive. There is enormous competition for jobs and unpaid internships in a British media that is still dominated by graduates from middle class backgrounds with humanities degrees who report on sex and scandal. Science topics (if any) are to be found somewhere inconspicuous in the inside pages.
There is a similar aversion to considering the scientific claims of psychotherapies. The talking cures continue to experience a burgeoning popularity and the recession may increase demand still more. In this situation, would it not be a good idea, at a very basic level, at least to think about whether the therapy we practise with so many clients is among the best available? Freud was not averse to the term ‘science’.2 In ‘The Question of a Weltanschauung’, he averred that psychoanalysis was indeed a science: if it could not be considered to belong to the realm of either religion or philosophy, what other home could it have? (See Freud 1933 [1932])
In my view, asking problematic and interesting questions about the nature of education and its complex unclear relationship to training does not exclude the possibility that our colleagues who practise CBT and humanistic therapies may also have something to offer. Snow did not suggest that scientists should stop making use of The Second Law of Thermodynamics, nor that civil servants should give up reading the classics. He suggested that educated people should be able to do both. In many European countries, philosophy is a popular topic amongst school pupils, included in the normal range of arts and science subjects. In Britain, philosophy is rarely offered as a topic to science undergraduates. Thus, if psychotherapists should not shun the sciences, at the same time psychologists and psychiatrists need to widen their education in the opposite direction. One reason why psychotherapists and psychologists in Britain are still firmly rooted on the opposite sides of a class and cultural divide is the continuing major differences in their education. Each uses the device of class difference to avoid engaging with the practices and precepts of the other.
I shall now change my vertex. The 1950s also saw the publication of another classic text, J. K. Galbraith's The Great Crash 1929. This is a beautifully written, witty and insightful analysis of the causes of the Depression of the 1930s. In his foreword, Galbraith remarks:
The story of the boom and crash of 1929 is worth telling for its own sake. Great drama joined in these months with a luminous insanity. But there is the more sombre purpose. As a protection against financial illusion or insanity, memory is far better than law. When the memory of the 1929 disaster failed, law and regulation no longer sufficed. For protecting people from the cupidity of others and their own, history is highly utilitarian. (Galbraith 1992 [1954]: 11)
We are again living in times of great economic turbulence with a grim future ahead. This situation is, I suggest, a powerful impetus for potential change in perceptions of class difference, just as important as personal experience and political events. This may in fact be a time of great opportunity for The Site since others are less well placed to analyse, in multiple senses of this word, our current situation. The mysterious
workings of economics (known to psychoanalysts as the workings of the unconscious) are often in the driving seat. In case you think I am being unnecessarily alarmist, here is Galbraith again:
Early in 1928, the nature of the boom had changed. The mass escape into make-believe, so much a part of the true speculative orgy, started in earnest. … [T]he time had come, as in all periods of speculation, when men sought not to be persuaded of the true reality of things but to find excuses for escaping into the new world of fantasy. (Galbraith 1992 [1954]: 40)
The Great Crash of 1929 followed. At the end of his book the nature of collective fantasising had changed dramatically:
Americans, though in years now well in the past, had shown a penchant for tinkering with the money supply and enjoying the brief but heady joys of a boom in prices. In 1931 or 1932, the danger or even the feasibility of such a boom was nil. The advisers and counsellors were not, however, analysing the danger or even the possibility. They were serving only as the custodians of bad memories. (Galbraith 1992 [1954]: 201)
The consequence of this change in attitude, Galbraith suggests, was the extension of the depression (which for economic reasons in theory could have ended in the early 1930s) for a full ten years until the extraordinary stimulus provided by the onset of the Second World War. Galbraith comments:
… [C]hange is normal in a capitalist economy. The degree of regularity in such movements is not great, though often thought to be. No inevitable rhythm required the collapse and stagnation of 1930-40. …
In 1929 the labour force was not tired; it could have continued to produce indefinitely at the best 1929 rate. …
Obviously if men, materials, plant and management were all capable of continued and even enlarged exertions a refreshing pause was not necessary. (Galbraith 1992 [1954]: 190-1)
Galbraith cannot explain why, then, the depression lasted so long. It is clear however that the emotional as well as the material effects of the loss of work and income were profound. Of course, he did not live to see the current recession. The only real suggestion Galbraith makes for the prevention of future boom and bust economics is that the experience of those who have lived through such times should be heeded. We are now 80 years on from 1929 and clearly Galbraith's view of history as ‘corrective emotional experience’ does not work, once those who had first-hand experience of the Depression are no longer part of the work force. However, The Great Crash 1929 is a powerful description. It offers psychoanalysts the opportunity to use his material to analyse the fantasies that accompany boom and bust economics.
Adapting Galbraith's remarks, the task before us, then, is to try to be something more than ‘custodians of bad memories’. Given the parochial nature of much psychoanalysis and psychotherapy in class-ridden Britain, this is a task indeed. As a profession, many of us are still fighting the turf wars of the 1940s Controversial Discussions. The challenges of the future inter alia over-population, food shortages and the effects of globalisation—let alone the daunting task of trying to help those whose lives are blighted by the current recession are not often mentioned in psychoanalytic circles. CBT may not be a treatment we would choose to offer; however as we describe in our book, The Problem with Cognitive Behavioural Therapy:
Depression and other mental health problems cause many lost days from work and there is a plethora of evidence which shows that the longer someone is out of work, the less likely they are to find another job. The numbers of people made redundant are rapidly increasing as a result of the credit crunch. The view is therefore adopted that CBT could be used as a form of early intervention so that people don't become depressed; they can then (it is hoped) find jobs and return to work (even though jobs are being lost
Page 91rapidly) as quickly as possible. There is no suggestion that they have suddenly become mentally ill. However an assumption that underlies this proposal is that misfortunes in life quickly lead to mental illness. Would society sanction the prophylactic use of anti-depressants to ward off illness in the same instance? (Hall & Iqbal 2009: in press)
However inadequate its methodology and practice, CBT practitioners are ready and willing to take up the challenge thrown up by the recession. Is prophylaxis ipso facto a bad idea? The prophylactic analysis of children conducted by psychoanalysts 50 years ago is now frowned upon. Should we take up the gauntlet thrown down by the positivists in the form of CBT practitioners? Is it enough to restrict our interest to the existing range of human suffering that finds its way to our consulting rooms? Should The Site be considering the wider picture? These are all questions ripe for debate. It seems that many of our colleagues in other organisations prefer to deal with the familiar class slurs and innuendo that have continued since the Rugby conference3 in 1982 to the present day. The bad old fantasies are somehow more comforting than new nightmares. We do not need to employ a theory of fantasy from psychoanalytic texts; here is Galbraith again:
That much of what was repeated about the market—then as now—bore no relation to reality is important, but not remarkable. Between human beings there is a type of intercourse which proceeds not from knowledge, or even from lack of knowledge, but from failure to know what isn't known. … Wisdom, itself, is often an abstraction associated not with fact or reality but with the man who asserts it and the manner of its assertion. (Galbraith 1992 [1954]: 99-100)
Lacan could not have described the power of méconnaissance more appropriately. In 2009, Galbraith's book is a salient reminder that history is repeated because people behave predictably, always illogically hoping against hope that the death drive and its effects can be magically avoided. Arguably our whole profession is under threat because of our
collective inability even to identify, let alone challenge, the possible (even if not very probable) threat of extinction.
Turning from the economics of our present position, what are the sociological effects of persistent class distinctions in our profession? Richard Sennett's early work, co-written with Jonathan Cobb, addresses the issue of class as it arose in the 1970s. They describe the ‘hidden injuries’ inflicted by class differences. Sennett, like Galbraith, is sceptical of received wisdom based on biased class assumptions. Writing in 1972, Sennett and Cobb state:
A fundamental challenge to the idea of intelligence-as-commodity has been posed by psychologists like Jean Piaget and Bärbel Inhelder in Geneva. Intelligence, they say, is rather a process changing over time and place to provide a repertoire of symbols that human beings need to understand their own phases of growth. (Sennett & Cobb 1972: 60).
Their book has clearly not been read by those currently on the U.K.'s Health Professions Council who are producing the fixed, supposedly definitive but in fact meaningless criteria that are supposed to govern our profession in the future. Criteria attempt to ‘fix’ standards so that when people make use of a service such as psychotherapy, they can reliably know what to expect. One of many problems with this approach is that people are not fixed in life. They grow older, experience different emotions and events and change constantly, if sometimes imperceptibly. Education is one of the processes which facilitate these constant changes; it too must keep changing in order to accommodate and keep pace with current challenges and convictions.
Sennett describes the way in which class is transmitted through education. Indeed, many of us have experienced how education moves us away from our roots to … where? The same education that inculcates class beliefs is also the engine that separates people from their class roots. Education leads to the discovery that not everyone thinks as you do. It leads to a feeling of uneasy dislocation—leaving behind a much-loved background and/or constitutes a welcome escape from the cruelties of your particular class. Whatever our personal feelings and class of origin, educated humankind tends to be ambivalent. Psychoanalysts
recognise ambivalence as a normally neurotic state. As Sennett and Cobb comment, ‘Fragmentation and divisions of the self are the arrangements consciousness makes in response to an environment where respect is not forthcoming as a matter of course (Sennett & Cobb 1972: 214)‘.
Trainees at The Site need stamina. They are invited to question their assumptions and interrogate and analyse their views about the entire corpus of psychoanalytic thought exploring its many intersections with philosophy. In addition, they are expected to discuss and constructively criticise the role of science (variously defined) in the talking cure. Members continue this process since education does not stop with the Pass. Site members and trainees alike share a respect for rigorous critical thinking leading in some cases to wide differences of opinion. Education at The Site thus engenders mutual respect.
This word leads me to a more recent book by Sennett, Respect: The Formation of Character in an Age of Inequality where he demonstrates the widening gulf engendered by the recent boom culture. In the field of the psychotherapies of all kinds, respect for differences between practitioners and practices is sorely lacking. For example, are there objective grounds for thinking that counsellors are inferior to psychoanalysts?
Few practitioners of any stripe have the benefit of a ‘classical’ psychoanalytic education of the kind offered by The Site. Furthermore, they are seldom conversant with the latest research in more conventionally ‘scientific’ fields such as neuroscience, drug therapies or medical statistics. The number of people who inhabit both worlds is vanishingly small. The true picture in the psychotherapy professions is often worse. The educational fare provided in training for entry to any of the professional ‘psycho-classes’ is largely the same series of half-baked nostrums based on class snobbery rather than on thoughtful discussion. Here are a few examples from my training as a psychoanalytic psychotherapist in the early 1990s. ‘You must interpret the transference.’ A typical remark from some quarters was, ‘Are you really seeing her only once a week?’ Moving to the present day, the current flavour of the month is, ‘The best psychotherapies are those which, like CBT, are evidence-based.’ There are a variety of ripostes to each of these remarks which would merit a further paper. My point here is the ubiquity of statements made
by all concerned which contain value judgements without supporting arguments or evidence.
Perhaps the origins of these snobberies—the signifiers of class difference—are the same as the compulsion in the regulatory bodies to set criteria for judgment and evaluation of professionals. In each case, there is an ultimately futile attempt to create stasis, fixed points for comparison and evaluation in a world run by human beings. One of the most striking qualities in human thinking is its endless variety, creativity and restless change. An infant does not learn to walk by following a fixed, laid-down, step-by-step manual. Different babies tackle the process differently. Some go from crawling to walking. A few dispense with crawling altogether. Some walk early—others a few months later. The effort involved in learning to walk can easily be seen just by watching a child try, try and try again. There is little that is fixed about this complex but almost always ultimately successful process.
If we think that learning to walk is child's play, why should we assume that adults who experience a huge variety of emotions can tackle their problems in a uniform manner in a fixed period of time with predictable rates of success (assuming of course that we know how to define the latter)?
A further point that can be derived from the above is the sterility of much current thought in psychoanalysis. Anyone who is a practitioner who wants to go and find out what is happening by dint of attending conferences or buying many of the latest books in the field needs to be extremely patient and to be able to tolerate a high level of boredom. Many, but not all conferences are quite unlike those held by The Site. Many papers are delivered with genuflections to the masters and mistresses whether they be Winnicott, Klein or Lacan. If you read reports of such conferences and delete references to historically-based events, it would often be hard to place them correctly in their place in time. The repetition compulsion in the field is writ large.
In conclusion, it seems clear to me that the class inequalities are alive and kicking today. They twist and turn and, like the neuroses of Freud's hysterics, they never entirely disappear. In analysing the stubborn persistence of class difference in the psychotherapies in Britain, I could explore many Freudian concepts that I have hinted at—the death drive, the repetition compulsion, neurosis and disavowal. However, I will
focus on the common element running through this paper, the influence and operation of unconscious fantasies. C. P. Snow's two cultures were (and are) maintained in a state of stasis by unconscious fantasies of mutual suspicion, fear and ignorance represented consciously by both groups as disdain and dislike. Fears about the consequences of change, however unfounded, play a vital role. Galbraith describes the fate of whole economies driven to bankruptcy by the power of collective wishful thinking. The conscious idea is, ‘This is too good an opportunity to miss—I'm going to make a fortune and drink champagne’. The looming reality of straitened circumstances, perhaps, poverty, hunger and a future which is dimmer, not brighter, literally cannot be thought about.
Sennett's work points to the effort required by both sides of the class divide if respect is to be fostered. Only where respect exists, can learning take place. Then knowledge can be acquired and people learn from each other. Unpleasant facts and fantasies can be faced because anxieties can be tamed. Once respect becomes the dominant relationship between classes, Roosevelt's famous remark, ‘The only thing we have to fear is fear itself—nameless, unreasoning, unjustified terror which paralyzes needed efforts to convert retreat into advance’ surely then applies. The ethos and practice of The Site provide its members and trainees with the opportunity to break down class differences and allow all the psycho professions to talk to each other, the first step in creating change.
The title pays homage to C. P. Snow's essay, ‘The Two Cultures’.
Freud uses the term ‘Wissenschaft’. This German word can be translated equally appropriately by the English words, ‘science’ and ‘knowledge’. It is a peculiarly British phenomenon therefore that separates the two domains so clearly.
A conference was held at Rugby in 1982, prompted by the recent publication of the Foster Report, ‘Enquiry into the Practice and Effects of Scientology and the Siegert report, ‘The Professions’ Joint Working Party on Statutory Registration of Psychotherapists'. This
conference marks the beginning of the discussion of the need for state regulation of the psychotherapies.