Knowing what we do

Bertrand Russell once said that if you wear blue glasses the whole world will appear blue. The depressed look though a dark lens and may experience themselves as useless persons, living in an unpleasant world and facing a miserable future. The anxious see a world of threat in which danger is constantly in prospect, and their ability to cope is threatened by self-doubt. The obsessive are linked into a cycle of activity needed to keep themselves and others safe, although enough can never be done.

There is nothing unusual about these people. Their fears and their difficulties are shared by all of us. The difference is that in these cases the difficulties have grown so severe that they can no longer cope. They may not be able to stay employed or perform their family roles. And, if they can work, their contribution may be much reduced. No wonder that the government, in 2007, thought it worthwhile to fund a network of therapists. The economic case for helping people with a wide range of psychological issues back into the workplace made sense. The method to be used was cognitive behavioural therapy (CBT). There is hard evidence of its effectiveness with many disorders and it is relatively easy to train therapists.

In my last column I introduced CBT, noting that it retains the therapeutic force of behavioural therapies, while addressing our understanding directly. Its focus is not on the original causes of problems but on the current issues as expressed in current dysfunctional behaviour.

The underlying principle is that our emotional response to experience is not caused by the experience itself, but only by the experience as we interpret it. Supposing, for instance, that you are ignored by your hostess at a party. Various interpretations are possible: she was too busy and flustered, she had more interesting guests to talk to, she took you for granted as an old friend, you are the sort of worthless person who gets ignored. The interpretation you choose will probably tell you more about yourself than about your hostess.

Take, as a simple example, someone who feels so shy and anxious about company that he will avoid any social occasions. His therapist will explore with him the whole situation. Is there a pattern? What are the different feelings he has, and what triggers them? How does he see himself? Does he find some social occasions more comfortable than others? What bad social experiences come to mind? What would be the rewards of successful therapy?

This is not an interrogation. The form of questioning is usually “Socratic”, that is, open questions are used which provide the patient with an opportunity to explore his experiences in a liberal and accepting discussion. There are no correct answers, but the therapist, from experience and training, will be looking for certain features that are often found to accompany this disability.

From this will arise certain realisations or cognitions. These are likely to identify the negative thoughts which spring unbidden to the mind. Dysfunctional assumptions (“people recognise how useless I am”) will be explored, along with core beliefs (“I am unlovable”). From such discussions it becomes possible to formulate the deeper nature of the problem and its various aspects. While the therapist is a teacher and a guide, the results should be a mutual understanding on which a treatment plan can be agreed.

Such plans cover as wide a range as the diversity of problems, though the therapist will major on those for which there is good empirical evidence. Part of the process will be to improve recognition of half-expressed negative thoughts. A patient might be asked to note these down when they occur, for they do not survive long in the sunlight. Feelings associated with behaviour may be tracked, and their intensity and change noted. Dysfunctional assumptions can be tested, sometimes in real life. Programmes of behaviour may be agreed and monitored. Goals may be set and instruction in self-monitoring given. Ways in which patients can face their difficulties in gradual steps can be established. Deep relaxation and mindfulness meditation may be used. Progress will be measured by both therapist and patient for observing change is part of the therapy itself.

Practitioners understandably put emphasis on the measurable bases of their therapy. But I would want to emphasise the quality of the therapist himself. The healing relationship itself is important and so acceptance of the patient, depth of human understanding, ingenuity and perseverance will be needed. In the end, this is one human being endeavouring to serve another human being at a profound level. I would not hesitate to describe it as an art guided by science.

My description of CBT has been cursory but I have thought it important for us to understand, at least in outline, a major and widespread therapy which we might encounter. I think that it can teach us important things about human nature — and indeed about another channel of God’s healing work. Those who would like to study this more deeply will benefit from a clear and readable book: An Introduction to Cognitive Therapy by David Westbrook et al (Sage, £21).

About Quentin

Portrait © Jacqueline Alma
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81 Responses to Knowing what we do

  1. Nektarios says:

    SERIAL NO: AV710801
    TITLE: Talk 7, Saanen, 01 August 1971
    PLACE: Saanen, Tent
    DATE: 01-Aug-1971

    2 You know.there are various contradictory states of the world, outside our skin as it were – the refugees, their torture, and the horrors of war, poverty, the national division, and the religious separations of people, and the economic and social injustice.
    It is not merely verbal statements but actual facts of what is going on in the world – violence, terrible mess, hatreds and every form of corruption.
    And in ourselves the same phenomenon is going on. We are at war with ourselves, unhappy, dissatisfied, seeking something which we don’t know about but we are seeking, violent, aggressive, corrupt and astonishingly miserable, lonely and with a great deal of suffering. And somehow we don’t seem to be able to get out, to be free of these conditionings. We have tried every form of behavioural therapy, religious sanctions and their pursuits, the monastic life, a life of sacrifice, denial, suppression, and blindly seeking, going from one book to another, or one religious or behavioural teacher to another, political reforms, revolutions. We have tried so many things, and yet somehow we don’t seem to be able to free ourselves from this terrible mess, in ourselves, as well as outwardly. And now we have placed before us the latest – CBT, that offers some system, panacea, some way to crawl out of our own misery, and that again doesn’t seem to resolve any of our many inward and outward problems, so what does?

  2. Vincent says:

    The passage you quote could bring us to some odd conclusions. Were I to offer you an aspirin for your headache in the hope of enabling you to “crawl out of your misery” would you reject it on the grounds that the vale of tears will not be rectified thereby?
    There doesn’t seem to be any suggestion that CBT is a panacea or indeed infallible in its operation. It appears merely to be a remedy for some common psychological difficulties. It’s a practical help. not Redemption in disguise.

    • Nektarios says:

      I agree with you to a point, however I was highlighting the many and varied and complex problems, inward and outward that cause psychological problems. I was also highlighting that there have been many attempts to help and CBT is another one, and no doubt there will be further discoveries down the line.
      Quite frankly, I think the world is in such a state presently where violence and stress and other factors are increasing. Nobody says to the business world or the political or religious world, you are just pushing people to far and there will be serious consequences, such as the fragmentation of societies. This is not just a Western issue, but global.

  3. overload says:

    I have no experience of CBT. Almost entirely bad experience of Psycotherapy. Yoga/Gong-Fu/Tai-Chi, then vipissana meditation and fasting, served a purpose of helping find some much need discipline, though in opening up spiritual energies when I had deep unerlying problems caused things to emerge when I did not have wisdom/experience/faith to know how to deal with this — dangerous.
    Vipissana medition is the true origin of what is called mindfulness meditation. This actaully helped eminsely (to break through mental/emotional noise, confusion and anxiety, and get a taste of mental/emotional wholeness), helping clear the way for an opening to Christ; problem was that I put all my eggs in a self-guided (solitary) vipissana basket, and in the need for deeper and more stable concentration, became obsessed about fasting, and then with that, numerous different internet-guided idolotrous opinions and half-truth doctrines relating to how/what/when to eat. I ended up compulsive overeating vs fasting. Then I discovered unclean spirtual distortions and magnifications by what I ate. So in turn I actually ended up in an even worse state, in another deep hole, of which Christ (bible, prayer, Church, growing faith) was the only way out.
    Other problem with vipissana was that I was seeking to the very heart of buddhism; yet I a million miles away from being a disciple of Gautama Buddha.
    Now I do miss vipissana meditation; I still practice it (mostly) indirectly along with Christian meditation/prayer. But my concentration and physical energies (in state of prolonged depression, agitation, stress) has not recovered since eating disorder (though thank God helped/transcended with faith in Christ), so now much more difficult to find the concentration and desire to practice vipissana that I had in the begining.

    • Quentin says:

      Overload, your account of spiritual experiences reminds me of the old joke that Catholics in Heaven will be surrounded by a wall so that they can continue to think that they are the only ones there. But in fact there will be Buddhists there, and Hindus and members of other religions. How does this come about when we know that salvation only comes through Christ?

      The clue lies in Pope Francis’s remark that the whole human race is redeemed. Everyone who seeks the truth in love does in fact do so through the grace of Christ. Eastern religions and philosophies offer paths towards enlightenment. We believe that, as Christians benefiting from Revelation, we have the complete story. (Although it’s scarcely complete, and our misinterpretations are legion.) Other cultures which have developed without Revelation have taken other paths, bred from their cultures, towards the same destination. We know that we have the better path but, in our conceit, we fail to notice that we have much to learn from others.

      • Gruntled says:

        I must say that this sounds like indifferentism. You appear to be putting all religions into the same box — and it doesn’t matter which you happen to pick. Why should a Buddhist turn to Christianity if they’re really just the same thing under a different name?

      • Quentin says:

        Gruntled, you may have misunderstood me. Let me illustrate. Suppose an individual believes that his life has purpose, and seeks to live it in the best way he can. He may perhaps be within a Buddhist culture and so, not surprisingly, that is the path he takes. Or perhaps he comes across Buddhist teaching and judges that that is the right way. Are we to suppose that he is excluded from Heaven because he has not encountered, or cannot understand the relevance of Christianity to his search. And if he is not so excluded, by what power has he unknowingly been redeemed?

  4. overload says:

    If I remember correctly, when I first started going to RCIA sessions, I still found the notion of praying to God to be fraudulent — I would not even venture to try it. Vipassana meditation was slowly opening me up to the spiritual reality to be explored in spoken prayer, and helped me to begin to embrace the person of God from this experiential starting point. And the Buddhist scriptures prepared me for the living spirit and hidden reason to be found in the bible (the bible, with its poetic exposition of reality, which flirts with reason but will not easily submit to reason). Buddhist teaching is much more a (very deep and subtle) logical analytical exposition of reality; the poetic and emotional dimension is kept contained by the rational.

    None the less, I have also found there to be a signifiant friction or ambiguity between Christian doctrine and Buddhist doctrine. This may largely be about a problem with the Christian Church’s attitude towards other religions. But there is also the problem of treating Christianity as just another religious “tradition” which — one might mistakenly think — self-righteously brings everything under its own bracket. The implication of the truth of the Son of God is that all imperfect religions are either ended, negated, or find their true meaning and fulfilment, in the person of Jesus and the sacrifice and victory of His cross. The only other perfect doctrine, Buddhism, does now presumably directly belong to Jesus; so might it be subject to subordination and remodelling? (This is suggested to me by the post-Christ Buddhist movement — a movement away from the original teachings — known as Mahayana, or “great vehicle”, which teaches the postponement of final liberation for the sake of compassion towards all beings.)

    In my understanding, for what it is worth, I am doubtful as to whether there are many, if any, true disciples of Gautama Buddha in the world today. Devotees I see as another matter.

  5. Nektarios says:

    I remember reading somewhere a long time ago, that Gautama Buddha on his deathbed said, ` I am still searching for the truth.’ If this is true, he did come across certain facts as do we all. He pushed the limits of that, and what we land up with is a psychological explanation of this life, and projected forward, an explanation of existence. However it is an explantion that does not fulfil anything, simply put, karma and reincarnation.
    On the latter point you make, `you are doubtful if there are many true disciples of Gautama Buddha
    today. Perhaps that is that too general a statement to make. It is a fact that Buddhism is divided into several schools of thought.
    If I may suggest, overload, that there is a beauty in simplicty. If you are Christian, follow the Good Shepherd, hear his voice. Then you will know the truth. However it will require, faith, humility and simplicity and the later is not so simply got at.

    • overload says:

      Simplicity is difficult. For me it is in many ways greatly needed. The RCC on the other hand, making the claims it does for her own purpose and legitimacy, and teaching others about absolute truth, cannot afford to be so simple.

      The Buddha did not propose any universal Reason such as is provided by the Word of God. According his doctrine, we find ourselves in a mass of perpetual suffering underpinned by ignorance, that is the situation which needs addressing. He is not interested in the question of “why?” (ie. the love and freewill of God in Creation), since he is addressing the problem on an individual basis (that the individual might be set free, and teach other individuals likewise). He does not teach karma and reincarnation (the correct terminology is “rebirth”, since in Buddhism there is no really such thing as a “soul”); rather he teaches escape from karma and rebirth, and an end to suffering and ignorance.

  6. milliganp says:

    We now have 10 posts and not one of them is about CBT but various exotic spiritual practices. The mind is no at co-terminus with the soul and there are various mental illnesses and conditions that have nothing to do with the spiritual state of the patient. You can no more pray your way out of a bipolar disorder than you can pray back an amputated leg.
    The mind is subject to various physiological conditions, thus depression ‘can’ be moderated by, for instance, SSRIs – though personally I’d prefer the NHS to give me 4 weeks in Southern California.
    It is however demeaning to those with mental health problems to confuse mental health with prayer and spirituality.
    I will post on CBT later when feeling less irritated by the tendency of this blog to never address the principal issue.

    • Nektarios says:

      I started the ball rolling on this present topic. I was observing the needs of many, and also know the needs of many suffering from the ravishes of mental illness. I am not qualified to speak on or for CBT, perhaps you are?

      On your second point about confusing of mental health with prayer and spirituality. In clinical mental health problems I would tend to agree with you. The person suffering from mental illness, suffers with any intellectual/ spiritual information and probing, and it is often distorted and disturbing to them.
      I would not go so far as to say that people cannt be through spiritual means/ psychotherapy also be healed.

  7. Ignatius says:

    ” And now we have placed before us the latest – CBT, that offers some system, panacea, some way to crawl out of our own misery, and that again doesn’t seem to resolve any of our many inward and outward problems, so what does?..”

    ” I am not qualified to speak on or for CBT, perhaps you are?”


    CBT, and mindfulness as a whole is an interesting development. I’ve done a bit, read a bit about it and been to a workshop on its applications to my job. There is a very good website which will give you a good idea about CBT:
    Try it out for a week or so!
    PS I’ve just come back from a 3 day retreat at Belmont abbey titled:
    ‘A deep and dazzling darkness…’
    About St John of the Cross, Sr Therese, Thomas Merton and others. It was very interesting and we were considering the issue raised by MilliganP:

    “It is however demeaning to those with mental health problems to confuse mental health with prayer and spirituality…”
    I agree with this overall and would probably go further to say that confusion of the two issues (though they are of course linked) leads to many problems.

  8. milliganp says:

    My experience of CBT was that it was a lot more “trite” than this article implies. There is a tendency to categorise anxiety related depressive disorders into terms like “low self esteem”, “obsessive-compulsive behaviour”, “post traumatic stress” etc, and then apply packaged, often simplistic, solutions.
    Most human behaviour is learned, particularly in early childhood, where the sense of self first develops.
    Most anxiety situations start with something and CBT seeks to help the subject to recognise the trigger emotion and to modify the chain of events which occur thereafter. Thus a simple challenge or the lightest of criticism will trigger in some a major crisis. There is a Marple episode where the vicar, helping Miss Marple wind some wool asks “why did you choose this colour”, Miss Marple replies “why, don’t you like it?” to which the Vicar replies “I enquire, I do not comment”.
    The challenge is where there is a deep rooted trauma which can’t be treated so easily. Talking therapy can cost thousands of pounds and take considerable time before the root cause emerges, so it is understandable why CBT is favoured.

    • Quentin says:

      Of course I do not know what your experience of CBT may be. But I do not recognise what you write. Bearing in mind that it is estimated that one person in four on average will have a mental health issue in this country each year, and that depression is foreseen by the WHO as the second highest cause of illness in the world by 2020, we are talking about a serious situation.

      CBT come is two forms: a ‘lite’ form which deals with relatively mild problems, and a full form used for more serious situations. The training for the second is much more extensive, and the connected literature is voluminous. This comes about because CBT advocates are aware of the importance of solid evidence to back up the therapy. As a result, NICE (which rates the value of therapies for the NHS) has a list of conditions for which CBT is indicated as effective. It can of course be used in conjunction with drugs. (I don’t think that labelling discrete conditions is wrong; we tend to label medical conditions so that we know what we are talking about.)

      This is in stark contrast to talking therapies such as psychoanalysis. Here, the evidence that the therapy is better than doing nothing is simply lacking. Of course many people, I think rather self-indulgently, enjoy being analysed. But the idea that it cures mental conditions is simply unproved. However many ‘deep laid traumas’ as you describe them, tend to shrink in importance when the current trying symptoms are removed.

      • overload says:

        “shrink in importance”. I wonder if this means that the real unresolved problem to which the trauma refers (if there is one) has been now dealt with (by God), or one is finding a common-collective comfort blanket to take refuge in?

      • milliganp says:

        I did CBT ~2 years ago before I started on Psychotherapy. It consisted of 6 40 minute sessions of rather simplistic Q&A questionnaires to help with the sources of depression and panic, however it did not have the purpose of discovering underlying causes. I thought it was very much “one size fits all”, it entirely used standardised documentation. It helped for a while but the lack of any root cause analysis meant that when the next crisis occurred in my life everything fell completely apart.

        It took some considerable time in Psychotherapy before I came to understand the effect of abuse at the hands of a priest as a child. To describe psychotherapy as self-indulgent is, frankly, offensive. I fully realise it does not offer a cure but it keeps me sane enough to continue to hope and not to commit suicide (yes, I know that’s self-indulgent too).

        I do believe your final sentence however, in my case so far, the Church has refused to accept that I might have been abused and is treating me like a liar who has made up a story.

        When I last attended A&E at the local mental hospital (during a period of overwhelming desire to end it all), the Consultant Psychiatrist advised me to keep doing the talking therapy and did not even hint at CBT being a better option.

        I also am sure, were I to go to my GP, that I’d end up on a six month waiting list for CBT and would be unlikely to be offered a “full fat” version.

      • Quentin says:

        I am truly sorry if you were offended. My comment was in respect of psychoanalysis which is almost a ‘cult’ with some people, and remains very popular in the USA. Certainly, information about unpleasant early experiences which have an overhang in one’s feelings are relevant to psychological therapy — whether CBT or not. Understanding what effects such experience can have often helps with irrational feelings of guilt, or helps one to understand and manage one’s current feelings or behaviours. Psychoanalysis classically deals with problems assumed to exist in the unconscious, usually in accordance with some guru’s theory.

      • milliganp says:

        Can I add a sort of humorous comment. 4-5 years ago I was referred to the local mental health trust. Without bragging, I’m very intelligent, articulate, self aware and analytical ( I call myself a high-functioning manic depressive). The person given the job of assessing me decided I was more than capable of coping with myself.
        When I went to A&E and talked with the Consultant Psychiatrist, who gave me a lot of his time, I explained that I felt that it was presumed that someone like me couldn’t have a “real” mental illness. He agreed with me and said something to the tune of “you’re not a typical patient”. However he did admit that I had a real problem and needed real help.

      • milliganp says:

        Quentin, I was somewhat offended but I’m over it. I’m well aware of “guru therapy syndrome” and am personally unhappy with the idea of “talking about myself” forever. My therapist is Jungian and the Jung concept of shadow at least has some parallel in terms of conscience. We often have past emotional issues with which we haven’t dealt but it does seem important that, if we decide to dig them up we ought to also re-inter them with appropriate dignity.

  9. overload says:

    As to “The challenge is where there is a deep rooted trauma which can’t be treated so easily”, I wonder if there might be cases where the ill person knows (or has a good idea) what the root cause is, but cannot speak about (or properly think about) it because the subject matter is too volatile (not just for themself but volatile also for others).

    It is demeaning to Christ to suggest that He hoes not embrace all our ills (this does not exclude the use of therapies, medications etc; but not depending upon or necessitating such things according to mans prescription). And to suggest that illness does not relate to spiritual issues (ie. sin), is again bringing us back to the subject of Original Sin, and Catholic Dogma.
    Obviously if we do not have deep enough faith and contact with God, then we cannot be healed. In such a case we might have a need for (and with faith agree to) some kind of therapy or medicine to give us a helping hand.
    Also can be important to talk to others; prayer is not just a private thing, and communication/testimony/confession can allow for prayer from others and/or together with others, as the Church.
    There are also cases where we simply cant be healed, because it is God will and the Cross for us to share — ie. St Pauls “thorn in the flesh”. He did not ask for that thorn, nor want to keep it, but once he KNEW it to be Gods will, it became something to rejoice in.

    I think of something like meditation: apart from being a form of (silent) prayer in itself, it also helps clear the “room” of the mind and the heart so that we can identify what really needs praying about — and to uncover and illuminate the root of trauma etc. That is, if one can meditate effectively without continued distraction of mental illness/ spiritual afflictions.
    It is an easy thing to perpetually use worldly distractions to obscure our awareness of what is really going on in both ourselves and the world. This is a demonic and instinctive self preservation technique which is so deeply ingrained and commonly shared that most don’t notice it.

    • milliganp says:

      Overlord you state “Obviously if we do not have deep enough faith and contact with God, then we cannot be healed.” You seem to imply this in relation to mental rather than physical illness. It is important to remind ourselves that the mind (and therefore mental illness) is material just like the body. When we die our mind dies with us, it is not in any way co-terminus with the soul. The soul informs us (principally, I presume) through our minds as God speaks to us in our silences.

      A person cannot pray themselves out of schizophrenia; if the film “A beautiful Mind” is accurate then John Nash managed to realise that his voices and lucid hallucinations were entirely a construct of his mind and thereby overcame them.

      My daughter has a schizophrenic stalker; he is convinced that they were once engaged to be married. Fortunately, at the moment, he is unable to pester her as he is on the run from the British secret service as he is the one person alive who knows how they killed Princess Diana! However I do dread the day he turns up on the doorstep again.

      I suspect every parish has one or two people whose OCD is the continuous need to pray and go to confession -this seems no more healthy to me than standing on the side of the road arguing with an imaginary adversary.

      • overload says:

        Milli, I think you are confusing brain (part of body), and mind. mind is not associated exclusively with brain, although primarily.
        My own thoughts on schizophrenia are, roughly, that it is a confusion of a persons over sensitivity and volatility to the spiritual, perhaps insights which they do not know how to correctly understand, or how to stably translate their awareness into the reality of their life; so a real awareness is reduced to simplified and fabricated delusions and illusions, which are very powerful. Thus difficult or impossible to discern (also for someone giving a medical dignosis) between what is “in the mind”, and what is actually real. Easier for society to say that it is all “in the mind”.
        Maybe your daughter was engaged to him in a previous life? Maybe he is confusing himself and your daughter with two different people, with whom there is some unknown link?

      • milliganp says:

        Overlord this is almost insulting stupidity. I’m a Catholic and don’t believe in previous lives, parallel universes or lizard people.
        Do you believe that my daughters stalker might have actually killed Princess Diana in a previous life as well. He has stalked her for over 18 years. The last time I met him face to face was in a secure mental hospital, which is where he apologised to me for breaking off the engagement which never was. He also told me he was “purifying” himself by only having sex with black women. Like many schizophrenics he varies from “extremely difficult to deal with” on medication to “barking mad” when not taking medication.

        If your views were taken with any seriousness we should close all our psychiatric hospitals, fire the psychiatrists and replace it all with transcendental meditation.

      • overload says:

        Milli, it seems we are having another ding-dong.
        I would not be so idealistic, nor so ignorant of Christ, as to believe that Buddhist meditation is going to save the world. However, to give an idea of what Buddhist meditation (in a modern simplified form) can, in the right spirit, offer, you might be interested in this youtube film about a prison in India

      • milliganp says:

        Overlord, I hadn’t read all your posts so I could not relate to those parts of your posts which relates to Buddhist thinking – so we are at entirely crossed purposes. There is a way in which Buddhism and Christianity find themselves incompatible (Emeritus Pope Benedict XVI – in one of his -lets not worry about anybody else’s toes moments – called Buddhism intellectual auto-eroticism (that beats Quentin’s “self-indulgent psychoanalysis” by a country mile).
        I suspect if one were to write a “natural history of religion” we would identify the quest far more easily than the destination. Buddhism, I suspect, is one of the more important journeys even if, as a Christian, I believe it followed the wrong route. Now I understand where you are coming from I can respect, if not agree, with you’re thinking.
        Perhaps, in some forms of mental illness, particularly anxiety, OCD and depression, there may be a problem of attachment (to old sorrows) which mindfulness / meditation could address.

  10. overload says:

    Regarding my recent comment (November 3, 2014 at 9:58 am; I think it has been removed), it was not some kind of coded message about myself, I was actually talking about my friend, who is acutely ill both spiritually and mentally. I said “siamese twin” because I have thought sometimes that this describes something unusual about our relationship — whether this relationship is demonic, or something of God, is difficult to say, probably both.

    • Quentin says:

      No, your earlier comment was removed because it did not make sense in terms of the context of the Blog. As Milliganp has rightly chided us elsewhere, good discussion needs to be to the point, preferably brief, and clearly argued. While I am on the subject I have noticed a recent tendency to splash Scripture about like a broadsword. Scripture needs to be used with care, and certainly sparingly.

  11. Ignatius says:

    “He agreed with me and said something to the tune of “you’re not a typical patient”. However he did admit that I had a real problem and needed real help…”

    I went for a handful of sessions of CBT and came to pretty much the same conclusion as MilliganP I wasn’t a ‘typical’ patient either though and since I wasn’t in clear and evident need …no dagger stuck clumsily in the side or anything ..was shown the door forthwith.
    My absolute all time favourite non typical patient works at a retreat centre as a spiritual director. Once when he was preaching at Mass he came out with the immortal line:
    “If you see me smiling it probably means my medication is wrong!”
    Sooner or late we must try and discuss suicidal despair and spirituality as it is such a fascinating subject….one only needs to read the lives of a few saints to realise that, cast into darkness and despair, one is in excellent company! My own view on this is that suicidal despair is a natural and probably quite healthy phenomena (as long as it doesn’t actually kill you that is!)
    which is part of thee breadth of human experience and which becomes ‘spiritualised’ when the saints, being ordinary oddballs themselves, inevitably fall into it through overwork or temperament. Before anyone jumps down my throat to accuse me of flippancy pease bear inn mind I’ve been there myself and, during my time as a Samaritan have talked to literally dozens and dozens and dozens of persons on the edge of the abyss.
    Just to stay on track I wouldn’t go for CBT again personally but I do think that as a model it is interesting and does have overlap with spiritual practice.

    • milliganp says:

      According to Archbishop Fulton Sheen, the ability to reconise absurdity, which is what humour really is, was given to us by God to set a limit on our personal pride.

      In that vein, one of my OCD symptoms is to try and have the last word on every blog.

      BTW, I do think spirituality may be a bridge between mind and spirit. Perhaps I need to do something about my spiritual life.

    • overload says:

      I have read that Ignatius (Loyola), when undergoing his spiritual conversion, became desprately suicidal. It appeared to me this was not some oddball (over)reaction, but because the power and suddenness of his conversion opened him up to the despair of sin and meaninglessness of his former life, which he couldn’t bear. This makes me think of a confusion between godly sorrow (which is good), and worldly sorrow (which we hope to die to in Christ).

  12. Nektarios says:

    As I said previously, I am not qualified to speak on or for CBT, but would like to thank first Ignatius for the link on the subject. The presentation was more like a sales pitch for CBT, but apart from that,
    I did notice something of a fundamental flaw in it and that was, looking at individual psychological problems that people have instead of the whole.

    Man not only suffers but causes suffering. That is part of us. We try to avoid that because we haven’t solved it, we think pursuit of pleasure is the main thing. We at least can have something accurate, something real, so that becomes dominant, and fear, sorrow, anxiety, all that is going on in the background; not only sexual pleasure, the remembrances of traumas, abuse, the pictures and all the rest of it that goes on in the mind, if you watch it, see what is happening. Your own minds become full of that, not the actual act but the whole, so pleasure, love, suffering, fear are all entangled, all interrelated.

    So the question is: will you take fear, pleasure, sorrow, separately? One by one or will you have the capacity to deal with the whole of it? You understand? Because our minds, being broken up, taking our problems one by one, and hoping to resolve them one by one we will somehow come to the end of breaking up all the fragments.

    Now how will you deal with the whole of it; deal with our disorder, pleasure, fear, sorrow as a total movement of life, not as something separate – as a whole – can you do it? That is, can you look at yourself as though it were in a mirror, psychologically, as a whole being, or do we only look at a part? Do you understand? How do you look at yourself? Your job is different, your wife and children are different, your religion is different, your particular way of thinking is different, opposed to so many other ways, you have your own experience which is different from others, your own ideals, you own intentions, ambitions, all that – you follow? Can you take all that as one unitary movement? You understand what I am saying? That is the only way to solve the whole thing, not through fragments. Right?

  13. milliganp says:

    One of the factors in depression is Serotonin. Recent research seems to show that people in the UK and North America produce Serotonin less efficiently than – in the example quoted – the Danes. This might explain why Danes are happier in general than British people. Those who live further south are exposed to greater sunlight and this also increases level.
    The best news, of this perhaps trite report, was that the French produce even less Serotonin than the British which might explain why, in France being depressed has the status of being an art form.

  14. overload says:

    Nektarios, are you talking about the Universal mirror, which embraces wanted and not wanted, chosen and not chosen, the whole person, which is the cross of Jesus?

    Milliganp, am I a slave to Serotonin? Sounds a rather arbitrary reality if I am. Can/will you say that Christ cannot, in an instant, fix my Serotonin levels? (Assuming that it is, as you suggest, necessary or at least desirable that they be normalised.)

    • Nektarios says:

      No, while there may be an aspect of `universal mirror’, in the sense, you are everyman, and everyman is you, it was more the whole mirror of how one sees oneself. It is an illustration.

    • milliganp says:

      We are not slaves to Serotonin but there is a direct causal link (on average) between Serotonin levels and happiness. Thus SSRIs are one of the principal drug groups used in the treatment of anxiety and depression. Christ can just as easily fix your Serotonin level as he can mend a broken leg. Miracles do happen, but God has chosen to be sparse with them, However prayer, of itself, can no more raise Serotonin levels than fix a broken leg.

      • overload says:

        “Miracles do happen, but God has chosen to be sparse with them”. I think this is wrong, rather I suspect God is not stingy, however this does not mean He satisfies our whimsical desires.
        What is the definition of prayer? Could CBT conceivably be a form of prayer?

      • milliganp says:

        overlord, give us a break. To say that someone who is manic depressive or has schizophrenia to the point they have almost no contact with reality, or worse commit murder because of a voice in their head as being so because God thinks their desire to be better is whimsical is as big an insult to God as it is to the victim.
        People sitting in bombed out buildings in Syria who pray for deliverance are not being whimsical.
        CBT is entirely a behavioural solution and in fact almost the antithesis of prayer. If I told a CBT practitioner that I would pray to overcome a phobia he or she would have to put me on a “don’t think you can cure things by prayer” programme.

      • overload says:

        My friend might possibly be described under a spectrum of labels including schizophrenia, depression, autism/aspergers, OCD, and anti-social behaviour disorder.
        Although he is often overwhelmed with fear and bitter hatred, and vengeful thoughts, he really wants peace and love in Christ.
        When he prays (I am oversimplifying here for the sake of illustration) he tends to revert to asking God to bring world peace (or at least in that direction), along the lines of making everyone like the people in certain places (ie. with certain kinds of generic personality traits) where he feels most comfortable. So rather than finding the faith to embrace God within; within his fear — rather than “Your will be done”, he is — quite naturally whilst unable to cope — yearning for some kind of whimsical idea of God’s Kingdom.

      • Vincent says:

        I see the distinction you make between natural and supernatural intervention. But if you believe in the power of prayer, why not use it? — after all we’re supposed to be living our human experience for the greater glory of God. At the very least a prayer to the Holy Spirit when faced by a challenge is worthwhile. Christ made himself one with the depressed with his cry “My God, why hast thou forsaken me.”

      • milliganp says:

        Vincent, I’ve prayed to 1am, 2am,3am in the morning and eventually I go and get a pill that knocks me out. I know we’re supposed to carry our crosses, unite our sufferings with the Lord but, at the risk of blasphemy, even Jesus didn’t get crucified every day for a year.

      • Vincent says:

        So I will pray, too.

      • milliganp says:

        Vincent, thank you; sometimes the hardest part of depression is the loneliness – as indeed Christ was on the cross.

  15. Geordie says:

    Most of the blogs recently have been long, rambling posts and very much off the point. I just haven’t got the time to read them. Also I am sick of initials being used instead of the full title. I don’t know what they are writing about. I may be misjudging people but it appears to be an exercise self-promotion. Sorry to be so grumpy.

  16. Ignatius says:

    ” I may be misjudging people but it appears to be an exercise self-promotion…”
    Not best impressed with this, especially on this topic. Sorry we fail your exacting standards but we were talking of personal issues on a topic bound to elicit them. I agree about the grumpiness.

  17. Ignatius says:

    To get back on the topic,
    Yes we ARE slaves: to serotonin, to thyroxine, to acetylcholine, to dopamine, to potassium, to sodium, to blood gas levels…… Sorry but we are creatures. One of the gifts of depressive illness is the realisation of just how much of our cherished religious view is simply a matter of bio- chemistry. Any serious defect in brain chemistry will produce a havoc that is little understood except by the unwilling participants. I have come to the conclusion that depressive illness is simply a part of the human condition…like any of the major diseases or the simple process of degenerative change. CBT (sorry Geordie here it is again) is a system which attempts to examine mental reactions and consciously use triggers to alter them. It has some level of success I should think particularly with individuals not familiar with the processes of reflectivity and change that may be called upon.
    In other words it may come as a great shock and welcome surprise to me that I have the capacity to alter my habitual pattern of thought or action. To those who are used to altering patterned thinking as a matter of course it may be a different matter. For example I am long habituated to singing hymns as a matter of changing a thought pattern (silently or at the level of a hum I might add!) I might spend a number of hours a day humming away to myself because I have discovered how effective song can be against the thought patterns that lead to desolation. I also exercise because I know it changes my internal environment quite dramatically and quickly. Because of long practice I am quite familiar with the processes of CBT and so am likely already engaged in that kind of thing……but it doesn’t change negative script-only diverts them. CBT to me is as has been stated a kind of sticking plaster, no problem with that but that’s all it is.
    As to prayer and consolation with depressive conditions I think one needs to ask oneself this question: Do I expect God to cure my diabetes/ blood pressure condition if I ask Him to? If so why don’t Catholics live forever? It is naïve to assume that God is just waiting round the corner for your special prayer in order that he might leap in with an everlasting cure. On the other hand if God is God then one might expect that there might be some consolation available to the believer even in the darkest night. I believe there is, but it is over time and not available on tap as a kind of mystical antibiotic. There is consolation in the suffering Christ for cancer sufferers, for depressives and for those dying of whatever is killing them, consolation but often not cure.

  18. Ignatius says:

    ” Part of the process will be to improve recognition of half-expressed negative thoughts. A patient might be asked to note these down when they occur, for they do not survive long in the sunlight..”
    I think this is the issue, in my experience negative patterning can bloom quite happily in sunlight or in rain. There is a German saying:
    ” The first Adam is alive and well having learned how to swim”

  19. Ignatius says:

    If you have opportunity get hold of : Ascent to Love by Ruth Burrows. It is enormously helpful, or at least I found it so. For example where the author discusses the temperament of St John of the Cross:
    “He would perhaps see things in others he could not understand; much that to him seemed like useless distraction irrelevant to a total search for God, yet in reality perhaps necessary for them. Maybe he could not fully discern what was merely natural weakness and defect of temperament; and, as such, no obstacle to union with God” p14
    “Some natures suffer very much from inner turmoils, bouts of depression and resentment which they cannot will away. Ultimately there is nothing for it but acceptance, self control, peace within turmoil…”
    We would probably add ‘ and medication when necessary’.

    There is a really funny part in the book when the author ,discussing faith, says something about how those with a nervous temperament can afford to be a little nervous – because they have Christ…!!! In other words there is a degree of safety even in profound neurosis…there may be a storm but there is still a boat…this could be called CBT for the soul I think. I have found that studying through the monastic writers is very helpful because the Monastic community is the place where temperament really gets put under the microscope and prayer is thoroughly tested. In other words they understand that of which they speak.

  20. St.Joseph says:

    Has this type of counselling ever tried to cure sicknesses such as kleptomania and paedphillia., and other types of inbalance in the brain?

    • Quentin says:

      CBT has been described as the therapy of choice for both these conditions. But, reading between the lines, it is not tremendously successful. Certainly in some cases it may help with symptoms, but complete cures are another matter.

  21. overload says:

    Milliganp, Benedict called Buddhism “intellectual auto-eroticism”. What a bizarre thing to say. Was he talking about his own experience of it, I wonder?

    • Quentin says:

      As I understand it, the remark was originally written in French — where the word used was auto-erotism, meaning “self-absorption,” in English. And it is correct to note that Buddhism is concerned with self and its own enlightenment. That does not prevent it from having important values, or being a starting point to further religious understanding.

      • marywip says:

        “it is correct to note that Buddhism is concerned with self and its own enlightenment”.
        This opinion, I suspect, is determined by misunderstanding of translation and context.
        Buddhism is concerned with “not-self”, teaches compassion towards all beings, the not-harming of oneself and others, the not-doing of any evil, the teaching of other beings for their and all others benefit: to be truly happy and freed from suffering. I would not call this self-absorption.

      • marywip says:

        sorry, accidental name change (overload).

  22. overload says:

    Milliganp, you say of Buddhism that “I believe it followed the wrong route”. If you are speaking for yourself and any prospective Buddhist, or even practicing Buddhists, in the world today, then fair enough. As for Gautama Buddha and those that followed him in India 2500 years ago; unless you are suggesting that he and they were frauds and a liars, or you grossly misunderstand the teaching, then I do not believe you can believe this.

    • milliganp says:

      I believe they have followed the wrong route only in as much that, as a Christian , I believe Jesus to be “the way, the truth and the light”. I would never accuse any serious religion of being fraudulent or dishonest (though I have moments with Jehovah’s witnesses and Latter Day Saints).
      However Buddhism, Sikhism, Hinduism, Islam and Christianity can’t be all right unless we believe God is indifferent to the specifics of religion.

  23. St.Joseph says:

    Do you know the answer to the question I asked Ignatius?
    Quentin maybe you can tell me something that relates to criminal offences and sickness.
    I am ignorant in all this just my own thoughts!

    • milliganp says:

      St.Joseph, my understanding is that pedophilia is not ” curable” which is why pedophiles are not sent to mental hospitals. However CBT can help the individual to recognise and manage their impulses, the battle between compulsion and will is, in some ways, the story of sin. Handbooks for Confessors have always recognised that compulsion impedes the normal moral process and thus reduces moral culpability.
      However, in our society, were I to suggest a pedophile was not fully morally responsible for their crime, I would be loathed as the pedophile himself.

  24. Geordie says:

    Sorry you have taken it personally. I don’t have exacting standards. I just want to understand what’s going. I’m grumpy by nature but that doesn’t mean what I say is incorrect.

    • Ignatius says:

      If you want to understand what is going on any particular thread then perhaps asking for clarification from the particular poster might be a good way to go? We can all do grumpy, very well and without too much persuasion!

  25. overload says:

    I am trying to stay on topic, here, not quite sure how.
    Maybe here is an exercise in cognition? How you cognise you respond to this cognition?

    This is a simplified analysis of causation in human nature.
    Ignorance causes craving.
    Craving causes clinging and then possessiveness.
    Possessiveness causes stinginess.
    Stinginess causes defensiveness.
    Because of defensiveness: quarrels, lies, accusations, divisive speech, schisms, fights and wars, etc.

    • Vincent says:

      You would have Socrates and Plato on your side with regard to ignorance. The doctrine which Plato teaches is that wicked behaviour is always the result of lack of complete knowledge. However many commentators have disagreed with this as over simplified.

      • overload says:

        Vincent, I am not knowledgable about greek philosophers. I wonder what commentators you refer to?

        Does the Catholic Church teach that Satan is subject to ignorance?

      • Quentin says:

        It’s confusing because Plato was ostensibly referring to Socrates’ teaching. So Plato/Socrates taught that wrong behaviour was the outcome of ignorance — remove the ignorance and you behave well. Commentators have argued that knowledge cannot ensure that we behave well because we may choose act against what we know. But it’s not a desperately important point..

      • overload says:

        Quentin, if I am the kind of Catholic or born-again Christian who has merely a pure and simple faith in and obedience to our Lord — or if I am not seeking to bridge the gap between science and faith — then I think I can probably dismiss this question altogether. Do you possess such power or luxury?

  26. Iona says:

    St. Joseph, I think people coming for CBT must want to be “cured” of whatever negative mental condition is besetting them; and I think people with criminal tendencies don’t necessarily want to be “cured” of them. Hence perhaps paedophiles and kleptomaniacs wouldn’t be helped.

    • St.Joseph says:

      Thank you.
      I was looking at a programme on TV yesterday and in it was a young man who had served a sentence in prison for child abuse. After a while when coming out of prison he found himself inclined to abusing children again,so he was so concerned he went to hospital and asked for help,and was given some injection to curb his desire.
      Perhaps that was just fantasy but it got me thinking if this was something that could be forced on those who have those inclinations. I dont know how true it is but is there some tablet given to men to curb their sexual desires in prison.

      I am sure you had a lovely holy time in Lourdes. Thank you for your prayers.

      • Ignatius says:

        Hi St Joseph, nice to see you up and causing trouble as usual!!
        Hormone therapy I think it is. Trouble is people stop taking the stuff then revert. I don’t think ‘chemical castration’ as it is called can be forced on anyone against their will. Too be honest I wouldn’t give CBT much of a chance with such people, but I havent read any research on the subject.

    • milliganp says:

      Iona, there is an old joke
      “How many therapists does it take to change a light bulb?”
      “Only one, but the light bulb has to want to change”

      Nearly all psychological therapies rely on willingness on the part of the subject, and this obviously required the subject to recognise they have a problem and desire to change it

      Most pedophiles have themselves been abused and their disorder is thus not always wilful. We use the criminal justice system to manage them and protect the public. To call them criminally inclined cannot be said in the same way as a career villain.

  27. overload says:

    Another exercise in cognition and response.
    If you are a Christian, try now and say this daily prayer aloud, and from the heart…

    Make me, Father, even this day, willing and pliable, that if it be your will (and only yours), I will:
    quit my job; let go of all my possessions; abandon my family; even embrace death — for no other reason, Jesus, Father, Spirit of Truth and the Church, but for the love of you.

    (Is there resistance? What thoughts and emotions arise?)

  28. St.Joseph says:

    Thank you for your reply.
    BTW. I cant help it if I was born with a big wooden spoon in my mouth instead of a small silver one!!

  29. St.Joseph says:

    Wooden spoon (stirring) in case you dont get it!

  30. overload says:

    Milliganp, “Buddhism, Sikhism, Hinduism, Islam and Christianity can’t be all right unless we believe God is indifferent to the specifics of religion.”

    ‘Catholics’ generally want the truth to be as fixed and simple as 1+1+1=3, they will not tolerate if this is questioned (why?), missing that the Holy Scripture is (generally) living poetry before it is science and fact.
    I like the idea that the truth is actually a pure & simple child playing at the — in Quentin’s words — meeting point of three roads: contradiction, paradox, and ambiguity. Maybe this is not just a nice idea, but a serious point.

    Sikhism, from what I know/remember, believes in a series of gurus. Perhaps it has had some gurus, though not sure this makes any claim to absolute truth?

    Hinduism is apparently a mish-mash; it has its roots in spiritual and philosophical teachings practices and beliefs very ancient, from which Buddhism and Jainism arose and fed back into. (I have heard some suggestion that the Semitic languages, even civilisation itself, have their origins in the Indian subcontinent.) Hinduism today, as far as I can see, embraces everything, good and bad, spiritual, material and secular; no discrimination. I don’t see Hinduism as making a distinct claim to being “right”.

    Islam seems to be some kind of late fulfilment of the promise God made (in the OT) to Abraham’s first son Ishmael.
    The Koran tells us that Jesus is the Word of God and was born of the Virgin Mary, so apparently it is a confused reworking of Christianity. Perhaps there are good reasons that God allowed this fabrication. Does it, for instance, compensate for any misrepresentations / perversions / imbalances of the gospel and/or the Church which may have arisen over the centuries?

    Buddhism is built upon the Dharma (the greatest created Natural Law, if you like), the core of which is “the Four Noble Truths”. In accordance with the forth truth, Buddhism makes the claim that Gautama and his “worthy” disciples attained nirvana; thus made perfect, unsurpassable, even as men in this world. (Jesus on the other hand, Scripture tells us, was perfected through death, for our sakes, and for all creation.) Perfect no doubt equates to equality / unity with the Supreme Being (or rather, reaching definitively the deathless and supreme state of being), which is beyond merely a state of what we call sinlessness. This is why I ask you if you believe Buddhism to speak fraudulently and dishonestly.

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