A critique of CBT – Part 2

Kantian Critique as Just Generosity

Kant’s conception of critique is meant to give us an accurate assessment of the instrument under investigation: of its proper uses, overuses, and misuses. There is a generosity of spirit in showing a pupil how something is to be used as well as in admonishing her for using it in ways that cannot possibly work.

Yesterday, I set out to critique Cognitive Behavioral Therapy (CBT). It is worth recalling the method and aim of CBT:

“The central method of cognitive therapy,” Donald Robertson writes inThe Philosophy of CBT, “consists of monitoring one’s thoughts and challenging those ones that are irrational or unhelpful and the beliefs that underlie them” (169). The aim of this exercise (or set of exercises) is to move the ‘client’ from a state of mental disturbance to a state of mental equilibrium.

I suggested that, when properly used, CBT can be helpful in training us in the art of stepping back and taking second looks. First thoughts are not always good ones, and second thoughts may make all the difference. At the end of this post, I hope to be even more generous. I want to make the case that CBT can be good preparation for philosophical inquiry.

I also suggested, however, that CBT is quite limited in its application. In the following sections, I discuss the limits of CBT. There are 4 problems in particular that are worth canvassing. (Note: The 4 problems I discuss below do not line up exactly with those I mention in Part 1.)

4 Problems with CBT

1. “Are Facts really Distinct from Values?” On the Problems of Pollyanna and Psychological Development. 

CBT holds that our descriptions of facts qua states of affairs (“It is raining in NYC at 9 a.m.”) can be disentangled from our value judgments, which are mental projections cast over the world of facts (“Yuck! This rain will make for an awful day!”). CBT, like Positive Psychology, thinks that reality is the kind of thing that is up for value-added grabs such that it admits of different ‘takes’.

I’m not so sure that this concept of reality is right. Consider Robert Nozick’s thought experiment about a Holocaust survivor:

“A proponent of maximizing our own happiness might recommend we ignore these negative portions of reality and focus our attention selectively only upon the positive. Sometimes that might be appropriate; a person in a Nazi extermination camp might focus eventually upon memories of Mozart’s music in order to escape the horrors around him. But if this were his preoccupation from the beginning, smiling constantly in fond memory of the music, that reaction would be bizarre. Then he would be disconnected from important features of his world, not giving them emotional attention commensurate with they evil they inflict.”

There is something immensely bizarre about focusing one’s attention only on what would be ‘uplifting’ when having a good understanding of total reality would require us to see that there is something evil or disgusting or repugnant about the way things are. To say that we are placing value on a value-free reality is perhaps to say that we’ve got an emaciated picture of reality from the get go. And this is indeed to say something patently bizarre.

There is a another problem with the fact/value split, and it surfaced during a conversation I had a few years ago with an acquaintance of mine. She wondered whether this fact/value story wasn’t the endpoint of good story of psychosocial development. The well-intact, mature adult would be more likely than the poorly raised pseudo-adult to distinguish between the value judgments he makes and the way things are. My acquaintance’s point is a good one as it goes to show that something like a Capabilities Approach to human development (there’s a nice piece by Martha Nussbaum about this at Harvard Press Typepad) underlies CBT’s general accounting.

2. “How Much is Really Under my Control?” On the Problem of Coercion.

CBT begins from the premise that there are things within my control and things that are not. I take it that this distinction is also the product of good psychosocial development. However, it is also already ‘too psychologistic’ inasmuch as it does not take seriously–or does not take seriously enough–the problems presented by an unjust social world.

Bad institutions are bad in virtue of their being coercive. (They also be bad in other ways and for other reasons.) One way that coercion works is by degrading and corroding the hard distinction between an individual’s powers and his sense of powerlessness. E.g., I speak with conversation partners who are working for bad corporations that have taken on board the “great speedup.” Bad parents and bad schools abuse their charges by making them believe that there is only this way of living. Bad marriages, bad relationships, etc., etc. are all bad in virtue of their approaching, asymptotically, an act of torture.

The reply could be, “Well, now we need to relearn what’s within your power.” Perhaps. Or we need to acknowledge that the mental faculties of some persons may be “corroded” or “degraded” for good. Human life is plastic, true, but not entirely plastic and not so readily re-shapable.

CBT has no room in its moral universe for human tragedy.

3. “How Should I live?” On the Problem of Teleology.

One conversation partner I work with said that his CBT practitioner always told him to “act in accordance with your values.” He is sharp enough to know that (a) his values may not be intrinsically worthwhile (he could be wasting my life, his talents, and so forth), (b) his ultimate values may be in conflict (final end P being incommensurable with final end Q), or (c) he may have no idea whether he has any values of this sort. He can act, but why should he act? And in what way? And for what reason?

A thought experiment will make this more perspicuous. Suppose you are a master of CBT techniques. The problem is that you really could be mind-numbingly dull, boring, uninteresting, uncurious, exhausting to be around, or downright evil. (Practicing CBT techniques is not inconsistent with murdering activists during years of apartheid in South Africa.)

It is readily apparent, then, that CBT has no answer to and cannot even entertain the inquiry about how one should live.

4. “Is Peace of Mind Better than Truth?” On the Problem of Instrumentalism. 

CBT seeks to bring us back to a state of calm. All right. But is that the ultimate aim (or the only aim or the chief aim) of reasoning well?

Instrumentalism states that we do X for the sake of Y. According to CBT, we use reason and learn good habits for the sake of being calm. (You can see why CBT is now at the core of resiliency training for military personnel.)

Consider the instrumentalization of meditative practice. We now read in medical journals that one should meditate for the sake of being healthy. This is utterly puzzling not least because meditation is supposed to move one out of finite egoicity and into a state of a-egoicity. To say that you are going beyond the self for the sake of selfhood is patently bizarre. Furthermore, one might ask, “What’s the use of being in good health if one has no reason for living?” We circle back to point 3. And we have just toppled most self-help.

And what to make of my intuition that I value getting certain things right for its own sake despite the fact that getting things right for its own sake may cause me great pain. E.g., I value knowing that I have hurt someone period. (I don’t value the hurting someone bit.)

CBT as Good Preparation for Philosophical Inquiry

There are two things that can be said in favor of CBT. The first is that it provides us with good exercises, albeit of a limited kind, type, and duration. Doing CBT exercises, like doing push-ups or sit-ups, is good at returning us to a ‘zero state.’ This is much more than nothing.

The second is that CBT is good (though not necessary) preparation for philosophical inquiry. It’s good to know that other people might see things differently. It’s good to develop the capacity for second thoughts and third looks. It’s important to learn how to make relevant distinctions and to see that those distinctions can make a significant difference in our lives. And it’s good to recall the limits of human endeavor and the limited capacities of human beings. The virtues of patience, circumspection, discrimination, fallibility, humility, unhurriedness are of vital importance.

Finally, the lessons we learn from CBT could very well be the first steps on a long, remarkable philosophical journey into the depths of our being and out into the vast expanse of our all-too-human world. Perhaps, our critique of CBT should end, as it began, in gratitude.