Unravelling the Dominance: An Exploration of the Relationship Between the Medicalisation of Ordinary Mental Distress, the Primacy of Cognitive Behavioural Therapy, and the Influence of Neoliberal Ideology in the UK Mental Health Economy
Main Article Content
Abstract
This article explores the predominant status of Cognitive Behavioural Therapy within the UK mental health sector, and critiques its alignment with the concept of individual responsibility within neoliberal ideology and the tendency towards the medicalisation of mental distress. Drawing from the field of critical psychology, which historically questions the medicalised approach to mental health within the field of psychiatry, this analysis extends into cognitive psychology's clinical applications and questions the scientific underpinnings and widespread acceptance of cognitive behavioural therapy as the prevailing clinical method. Through a critical literature review and evaluation of existing research, the article reports potential biases and methodological flaws identified by researchers, drawing conclusions that its efficacy has been exaggerated and its scientific credibility might be partly constructed. Furthermore, by reviewing research into the qualitative dimensions of the conceptual framework and discursive practices of cognitive behavioural therapy, the author describes how its dominance could be perpetuating individualistic and pathologizing approaches to mental distress. These approaches contribute to the broader medicalisation trends observed in contemporary mental health practices, which both reflect and reinforce the ideological role of individualism in late modern capitalism.
Keywords:
cognitive behavioural therapy (CBT), evidence based therapy (EBT), CBT critiques, medicalisation of mental health, mental distress, scientification of mental health, individualisation of mental health
Article Details
How to Cite
ROWLAND, Helen.
Unravelling the Dominance: An Exploration of the Relationship Between the Medicalisation of Ordinary Mental Distress, the Primacy of Cognitive Behavioural Therapy, and the Influence of Neoliberal Ideology in the UK Mental Health Economy.
Medical Research Archives, [S.l.], v. 12, n. 5, may 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5399>. Date accessed: 30 june 2024.
doi: https://doi.org/10.18103/mra.v12i5.5399.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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2. Moncrieff J. The Political Economy of the Mental Health System: A Marxist Analysis. Frontiers in Sociology. 2022a;6:771875. Available at: https://doi.org/10.3389/fsoc.2021.771875.
3. David D, Cristea I. The New Great Psychotherapy Debate: Scientific Integrated Psychotherapy Vs. Plurality. Why Cognitive-Behavior Therapy Is the Gold Standard in Psychotherapy and a Platform for Scientific Integrated Psychotherapy. Journal of Evidence-Based Psychotherapies. 2018;18(2):1–17. Available at: https://doi.org/10.24193/jebp.2018.2.11.
4. Cuijpers P, Cristea IA, Karyotaki E, Reijnders M, Huibers MJ. How effective are cognitive behavior therapies for major depression and anxiety disorders? A meta-analytic update of the evidence. World Psychiatry. 2016;15(3):245-258.
5. Kaczkurkin AN, Foa EB. Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues in Clinical Neuroscience. 2015;17(3):337–346.
6. Cuijpers P, et al. Cognitive behavior therapy vs. control conditions, other psychotherapies, pharmacotherapies and combined treatment for depression: a comprehensive meta-analysis including 409 trials with 52,702 patients. World Psychiatry. 2023;22(1):105–115. Available at: https://doi.org/10.1002/wps.21069.
7. Dalal F. CBT: The Cognitive Behavioural Tsunami. Routledge; 2018.
8. Dalal F. CBF: Cognitive Behavioral Fallacies. Psychoanalytic Inquiry. 2021;41(8):580–592. Available at: https://doi.org/10.1080/07351690.2021.1983399
9. Davies J. Sedated: How Modern Capitalism Created Our Mental Health Crisis. Atlantic Books; 2021.
10. Kazdin AE. Arbitrary metrics: implications for identifying evidence-based treatments. Am Psychol. 2006;61(1):42–49.
11. Scheel KR. The empirical basis of dialectical behavior therapy: Summary, critique and implications. Clinical Psychology: Science and Practice. 2000;7(1):68–86. https://doi.org/10.1093/clipsy.7.1.68
12. Shedler J. Where Is the Evidence for “Evidence-Based” Therapy? Psychiatric Clinics of North America. 2018;41(2):319–329. Available at: https://doi.org/10.1016/j.psc.2018.02.001.
13. Westen D, Morrison KA. Multidimensional meta-analysis of treatments for depression, panic, and generalized anxiety disorder: an empirical examination of the status of empirically supported therapies. Journal of Consult Clinical Psychology. 2001;69(6):875–99
14. Westen D, Novotny CM, Thompson-Brenner H. The empirical status of empirically supported psychotherapies: Assumptions, findings, and reporting in controlled clinical trials. Psychological Bulletin. 2004;130(4):631–663. https://doi.org/10.1037/0033-2909.130.4.631
15. Cresswell JW, Cresswell JD. Research Design 5th Edition. Sage; 2018.
16. Wampold BE, Budge SL, Laska KM, et al. Evidence-based treatments for depression and anxiety versus treatment-as-usual: a meta-analysis of direct comparisons. Clinical Psychology Review. 2011;31:1304–1312.
17. Wiles N, Thomas L, Ridgway L, et al. Cognitive behavioural therapy as an adjunct to pharmacotherapy for primary care-based patients with treatment-resistant depression: Results of the CoBalT randomised controlled trial. The Lancet. 2013;381:375–384. https://doi.org/10.1016/S0140-6736(12)61552-9
18. Gray AM. Inequalities in Health. The Black Report: A Summary and Comment. International Journal of Health Services. 1982;12(3):349-380. doi:10.2190/XXMM-JMQU-2A7Y-HX1E
19. Moncrieff J. The Political Economy of the Mental Health System: A Marxist Analysis. Frontiers in Sociology. 2022;6:771875. Available at: https://doi.org/10.3389/fsoc.2021.771875.
20. Wilkinson R, Pickett K. The Spirit Level: Why Greater Equality Makes Societies Stronger. Bloomsbury; 2011.
21. Purās D. [https://www.ohchr.org/en/statements/2017/09/statement-mr-dainius-puras-special-rapporteur-right-everyone-enjoyment-highest]. Accessed May 1, 2023.
22. Davies J. Back to balance: labour therapeutics and the depoliticisation of workplace distress. Palgrave Communications. 2016;2(1):16027. Available at: https://doi.org/10.1057/palcomms.2016.27.
23. Doblytė S. “The almighty pill and the blessed healthcare provider”: medicalisation of mental distress from an Eliasian perspective. Social Theory & Health. 2022;20(4):363–379. Available at: https://doi.org/10.1057/s41285-021-00165-1.
24. Elias N. The Civilizing Process: Sociogenetic and Psychogenetic Investigations. Revised edition. Blackwell Publishing; 2000.
25. Abend G. Thick concepts and sociological research. Sociological Theory. 2019;37(3):209-233.
26. Doblytė S. Under- or Overtreatment of Mental Distress? Practices, Consequences, and Resistance in the Field of Mental Health Care. Qualitative Health Research. 2020a;30(10):1503–1516. Available at: https://doi.org/10.1177/1049732320918531.
27. Doblytė S. “Women are tired and men are in pain”: gendered habitus and mental healthcare utilization in Spain. Journal of Gender Studies. 2020b;29(6):694–705. Available at: https://doi.org/10.1080/09589236.2020.1780420.
28. Jones C, Edwards S. Making sense of mental health: a qualitative study of student counsellors. British Journal of Guidance & Counselling. 2023:1–16. Available at: https://doi.org/10.1080/03069885.2022.2162482
29. Flyvbjerg B. Five Misunderstandings About Case-Study Research. Qualitative Inquiry. 2006;12(2):219–245. Available at: https://doi.org/10.1177/1077800405284363
30. Haslam N. Folk psychiatry: Lay thinking about mental disorder. Social Research: An International Quarterly. 2003;70(2):621–644
31. Ratnayake S. “I will never love anyone like that again”: cognitive behavioural therapy and the pathologisation and medicalisation of ordinary experiences. Medical Humanities. 2022;48(2):e7–e7. Available at: https://doi.org/10.1136/medhum-2021-012210.
32. Moncrieff J, Cooper RE, Stockmann T, Amendola S, Hengartner MP, Horowitz MA. The serotonin theory of depression: a systematic umbrella review of the evidence. Mol Psychiatry. Published online July 20, 2022b. doi:10.1038/s41380-022-01661-0