I personally think that the expansion of CBT is one of the major achievements of the last five years (God knows there haven’t been that many national achievements during that time). Finally, we’re taking mental health seriously. Finally, we’ve found a therapy which works for the most common emotional disorders. And finally we’re putting in place the people and resources to enable the suffering to get help quickly. But, like most big steps forward, it’s been almost entirely un-celebrated by our media – unnoticed even – except by a few angry psychoanalysts who are indignant that CBT should have got so much funding and their own therapy so little.

So I’m disconcerted that, on one of the rare occasions that the government’s support for CBT was discussed, not one of the panellists (Michael Portillo, Matthew Taylor, Claire Fox and Melanie Phillips) should have felt the need to support it. Not one of them saw the need to defend that Service, and to try and protect its funding. What a missed opportunity. Rather than unpicking it, they should have applauded it.

Instead, the need for a National Mental Health Service was criticised from both right and left. On the right, Michael Portillo thought Richard Layard had massively over-emphasised the number of people who are affected by depression in the UK (6 million, according to David M. Clark, the psychotherapist who is the chief architect of the national CBT strategy). Portillo accused Layard of confusing depression, which is serious and nasty, with unhappiness. Lots of people are unhappy, for lots of reasons – calling it ‘depression’ just serves various ‘powerful lobbies’ (i.e. Big Pharma and the CBT industry), and gives scroungers a free ticket to benefits. If extended into the criminal justice system, it also lets people off the hook for bad deeds. Psychology becomes ‘excuseology’.

On the left, Matthew Taylor of the RSA thought Layard was medicalising unhappiness, and suggested that people might have very good social, economic and political reasons for being unhappy. CBT focuses too much on the ‘inner man’, and not enough on the outer conditions. It puts the blame for any dissatisfaction we might feel firmly on our own shoulders, which is a convenient move for government and the rich.

These concerns and confusions come about partly as a result of CBT’s origins in Greek philosophy, and I think we can clear them up if we replace CBT in its original context.

CBT emerged from Socratic and Stoic ethics, which developed as a form of ‘therapy for the soul’, which everyone could use to take care of themselves and transform their negative emotions. The idea was that you practice philosophy your whole life, both in periods of emotional turmoil (what we might call depression today) and when things are going well. The Greeks, lacking the Diagnostic Statistical Manual (DSM), did not divide emotional disorders into endless categories. They simply recognised emotional suffering – those moments when we become the passive victim of our passions, when they block us from enjoying a ‘good flow of life’. And they offered a way for students to get out of such situations, by learning how to examine their unconscious beliefs and values, and to change them.

CBT emerged from Socratic ethics, which taught people to 'take care of their souls'

As for  the ‘medicalisation’ of ethics and emotions, that goes all the way back to the Greeks too. They called negative emotions ‘passions’, from the Greek pathe, meaning suffering or sickness. They often compared the philosopher to the physician, and called philosophy a ‘medical art for the soul’ (as Cicero put it). So the idea that the unhappy are also unwell is a very old one. So is the idea that the morally bad are, in fact, deluded and sick – that’s what Seneca, Plato, Marcus Aurelius and others argued. It is no easy thing to separate these categories, as the Anders Breivik case shows. Of course Breivik should be held accountable. But of course, he is also fucked up – shooting 65 teenagers is fairly strong proof of being mentally ill, to my mind.

When we go back to the ancient Greek roots of CBT, it clears up various issues.

First, the question of how much to concentrate on the inner man versus the outer conditions. We see that CBT emerged particularly from Stoic philosophy, which focuses entirely on the inner man rather than outer conditions. The philosopher, according to the Stoics, is so mentally resilient that they can be happy in any situation, even while being tortured. They make their soul an ‘inner citadel’ against their culture’s toxic values. CBT inherits this same highly individualistic focus – change your self and make it an inner citadel against the fucked-up-ness of your society.

We can (and should) disagree with this intense focus on the inner man, and point to the strong influence of environmental factors like poverty on mental health. At the same time, the Stoics were right that all humans have some capacity to control our emotions, and helping people develop this capacity gives them the strength and autonomy to change their environment and change their society.

So Stoicism / CBT doesn’t have to be some sort of neo-liberal atomised self-help. If you look at Aristotelian philosophy, for example, it shares the Socratic principles of Stoicism / CBT (i.e. the idea we can use our reason to change ourselves and achieve flourishing) but it also recognises that our society and culture plays a big part in our well-being, and that as citizens we should take care of both ourselves and our society. We should balance the inner work of CBT with the outer work of changing our society. I think Layard recognises that. He’s not saying we should focus entirely on the inner man, only that we have ignored that factor for far too long in western politics. That’s a wise realisation for a Fabian in his 70s to reach.

Secondly, the question of personal responsibility.  Does CBT excuse people from their moral behaviour? Or does it put too much responsibility on our frail shoulders? Again, going back to the Greeks helps. They didn’t argue that we are all born free, rational, sovereign agents. But they argued that the vast majority of us can become slightly more free, slightly more self-aware, slightly more self-controlled, if we practice philosophy for several years. Autonomy is an exercise, and like other forms of exercise, we become better at it through practice.

But the first step is to take responsibility for our own beliefs and actions – not blame them on our environment, on our parents or friends or the economy or the weather. The economy may be terrible, and you being unemployed will almost certainly affect your mood. That’s not your fault. But how you think about your situation is going to affect your feelings. You can make that shitty situation a lot worse, if you want, or you can cope with it in a wiser and more effective way – not beating yourself up, while also looking for opportunities to get out of the situation.

Since my book has come out, I’m often asked by worried parents if their offspring’s mental / emotional problems are their fault. They are often relieved to hear about CBT, as an alternative to the old Freudian line that ‘they fuck you up your mum and dad’. Well, actually, you might very well have been fucked up by your mum and dad. They might very well have indoctrinated you in the thoughts and habits that are making you miserable today. However, these are now your thoughts and habits. Your mother and father aren’t standing over you forcing you to harm yourself. You’re doing it to yourself. As the great Bill Knaus says in my book, what happens to us is not necessarily our fault. But how we think about it is our responsibility. Don’t be a masochist. Don’t beat yourself up and then blame it on someone else.

Of course, some people are born into much harder situations than others. Some people grow up in environments that are constantly pushing them to depression or vice. Others grow up in environments that are constantly pushing them to flourish. That’s unfair, and we should do what we can to correct that. Part of that is giving people the tools to be resilient to their environment, to resist its bad influences and find the good influences.

Finally, the question of the division between Depression and unhappiness. Are we medicalising the entire society and pathologising perfectly normal things like unhappiness, shyness or anxiety? Again, let’s go back to the Greeks. Without the benefit of the Diagnostic Statistical Manual (DSM), the Greeks didn’t recognise particular emotional disorders, nor did they try to ghettoise them from ‘normal human experience’. Instead, they saw emotional suffering as on a continuum, from the very distressed to the quite distressed to the well to the flourishing. And they recognised that philosophy could and should help people all along this continuum.

Today, most people still don’t seek help for emotional problems, because they’re worried about ‘making a fuss’, or about admitting that they’re somehow officially broken or sick. Might it appear on their permanent NHS record? What if their employer found out, or their friends, or their family? Would they lose respect, authority or even their freedom as a result? And besides, isn’t it narcissistic to worry about their feelings? Who the hell is happy in this world anyway? And so most people do nothing to take care of themselves. They carry on veering through life, like a car with a flat tyre.

Philosophy, as Socrates insisted, helps us learn how to take care of ourselves. That isn’t selfish. It’s responsible. If we’re not taking care of ourselves, we’re probably affecting the people around us, and we’re also probably not engaging as effectively with our society as we could be. CBT is a form of therapeutic philosophy for people in serious distress – that could mean a particularly stressful period of your life, or a bout of depression, or panic attacks, and so on. Such moments affect many of us – perhaps 25%, perhaps as much as 50% – so go get some help, either from a GP, or from a CBT book, or from my book! Learn how to take care of yourself, how to steer yourself.

The Greeks thought philosophy should be available for everyone. I agree. I think everyone should be introduced to it, to learn how to take care of themselves. However, there is a difference to helping people in a serious emotional crisis, as CBT does, and helping people not in a serious crisis, as Positive Psychology tries to do. The latter group should not be told how to be happy. They can be taught some of the basics – how emotions arise, how we can change them – while also being encouraged to explore the different ethical visions of the good life that we can use these basics for.

One of the panellists, Michael Portillo, was particularly scornful of the fact we diagnose people with depression by asking them how they feel. People could lie, he pointed out. Well, that’s true, and no doubt many people do. But how else can we diagnose depression? How can we know how someone is feeling, except by asking them?

Aaron Beck, the pioneer of CBT, took ideas and techniques from ancient philosophy, and then married them to scientific empiricism. He invented the Beck Depression Inventory, which measures how depressed a person is by asking them, for example, how often they think about killing themselves. Now of course that sort of diagnostic technique can be fiddled by the unscrupulous. And of course, it is a bit simplistic. But it’s also a useful way of discovering if a therapy is really having any obvious effect. If a person, at the beginning of a therapy, says they’re extremely unhappy and think about killing themselves often, and at the end of the therapy they say they’re fairly happy and don’t think about killing themselves ever, then that’s a measurable success, isn’t it? And crucially, it’s only through such measurements that governments have been persuaded to support CBT. If it wasn’t for such measurements, far fewer people would be reached or helped by CBT.

I, like Portillo, am wary of the power of Big Pharma, and of a world where we have defined the entire population as in need of chemical interventions. But I do, actually, think that, in the words of Albert Ellis, 99% of the world is out of their fucking minds. Including me. We’re all on a continuum of mental health, and I certainly don’t think I am ‘flourishing’. I’m pretty well, but I’m self-aware enough to recognise I have a long way to go yet. Philosophy, no doubt, will help me on my journey.

Anyway, this is all a rather roundabout way of saying I think it is a very good thing that we now have a National Mental Health service, and that CBT has become available to ordinary people, rather than just the rich. So many of my friends have suffered from mental health problems at one time or another – most of them in quiet desperation. A lot of them could be really helped by some therapy, whether through the NHS, or through DIY therapy like reading a CBT book. That’s not narcissistic. It’s responsible. It helps them contribute to their society. Please can policy makers and opinion-influencers celebrate our new National Mental Health Service, rather than attacking it?

Philosophy for Life - official website of author Jules Evans -

“Things got much better when I had my own little project and outlet for creativity”, he says. Quite quickly, the magazine did well. His friend and co-founder, Gavin Pretor-Pinney, was a design graduate and the magazine looked much better than the average alternative zine. Tom’s writing articulately laid out his Idler philosophy. And, from the start, he showed a genius for getting interviews and guest articles, from the likes of Damien Hirst, Will Self, Louis Theroux, Alain De Botton, Alex James of Blur, Bill Drummond of the KLF, and others. “We were interested in interviewing anyone who had managed to get through life without a proper job.” The Idler diversified into books, producing works glorifying the Idler lifestyle such as How To Be Free, How To Be Idle, and The Book of Idle Pleasures, and other books attacking the rat-race, such as Crap Jobs. For one who openly extolled the pleasures of the slacker life, Tom was surprisingly busy, and successful.

In his early 30s, however, Tom and his wife, Victoria, decided to leave the wild London nights behind them and move to Devon, where they rented a ramshackle old house without central heating, and devoted themselves to the bucolic dream of growing your own vegetables, raising livestock (including some ferrets), making your own beer (“that particular experiment was a disaster”, Tom confesses), and having long, leisurely lunches. “I can make a living working three to four hours a day on writing and journalism, and the rest I can hanging out with my kids, reading, going for walks, doing whatever I want really.” It has been quite a creative time: Tom’s written three books since he moved to Devon in the early Noughties. His wife and he also organized occasional weekend workshops on rural self-sufficiency, in partnership with Alain De Botton’s School of Life.

The School of Life, like the Idler Academy, has a bookstore and a classroom where workshops and talks take place. It also holds ‘secular sermons’ every Sunday, the first of which was given by Tom back in 2008. The shop has tree trunks in it “in honour of Epicurus”, and a bust of the master. De Botton says that the School, like the Garden, “gathers a regular contingent of people, and together we eat, hear lectures, go on journeys and, most importantly, attempt to live philosophically.”

Tom decided to set up his own Academy in 2010, after organizing Idler events at Port Eliot literary festival and other festivals during that year, where talks and classes were held alongside lessons in music and merriment. Classes at the Academy also take place beneath a bust of Epicurus, and cost around the same as the School of Life (£20-35 a class, including wine and nibbles). However, unlike Alain De Botton, Tom is a very visible presence at his Academy – manning the till, answering the phone, making the tea, introducing the classes in the evening, although he doesn’t actually teach them himself. The philosophy classes are mainly taught by Mark Vernon, who also teaches at The School of Life (both schools ask him what the other school is up to).

Philosophy for Life - official website of author Jules Evans -

The blog, which is hosted by the magazine Psychology Today, requires him to write a post about anxiety every week, which is enough to turn anyone into a nervous wreck.

One post that caught my eye was called How Big A Problem is Anxiety? Very big, says Leahy:

The average high school kid today has the same level of anxiety as the average psychiatric patient in the early 1950’s. We are getting more anxious every decade. Psychologists have speculated about the possible reasons for this increase in both anxiety and depression over the last fifty years. Some of the reasons may be a decrease in “social connectedness”—we tend to move more, change jobs, participate less in civic organizations, and we are less likely to participate in religious communities. People are far less likely to get married, more likely to delay getting married, and more likely to live alone. All of these factors can contribute to worry, uncertainty, anxiety and depression.

And our expectations have changed in the last fifty years. We expect to have a more affluent life-style, we are driven by unrealistic ideas of what we need (“I need the latest ipod!!”), and we have unrealistic ideas about relationships and appearance. In the 1950’s sociologists would write about “The Organization Man” who worked for the corporation for his or her entire career. Today many people would love to have a job that had that kind of stability. And our expectations about retirement also lead us to feel anxious. We now have to rely on our own savings—rather than a company pension plan—to help us survive during retirement.

Speculations about whether we have become more anxious, or why, are always slightly general and untestable. We may say we’re more anxious, or depressed, simply because our culture is now able to talk about these feelings and give them names more easily.

Anxiety is a part of being human – it’s just that, 100,000 years ago, the anxiety would have been about whether a tiger would eat us, or whether we’d survive the winter. Now, we no longer live under the daily threat of violent death or sickness. But you can’t just turn off our evolutionarily developed capacity for worry, so it has to find new things to worry about – what our workmates think of us, will we find a life partner, is our nose too big, are we too fat.

Sometimes these modern anxieties seem incredibly petty compared to old-school anxieties about death and starvation. But anxiety is rarely completely irrational. What our workmates think of us does matter, and will affect how we do in our career. If we’re too fat, it might affect our ability to find a nice life partner.

Of course, anxiety is very often self-defeating: we worry excessively about what our workmates think of us, and our insecurity communicates itself to them, and they think less well of us. Sometimes, in modern life, the least anxious seem to thrive the best.

The ancient world, and the Renaissance, had a good method of dealing with anxiety, which I find still works – the memento mori, or reminder of Death. Ancient philosophers, particularly the Stoics, would train themselves to consider Death , to consider how everything around them would turn to dust, how they themselves would soon be eaten by the worms, and forgotten by everyone on earth.

Asian philosophers, particularly the Buddhists and Hindus, also trained themselves to contemplate Death, even going to meditate in charnel houses, surrounded by skeletons and corpses. The Christian Medieval Church was one big memento mori – its art works were overflowing with grinning skulls and dancing skeletons, showing the supremacy of Lord Death over all human pretensions.

And Renaissance artists, inspired by ancient philosophy, revitalized this sombre tradition – Shakespeare’s Hamlet, for example, is in some ways an extended memento mori, and other artists and writers like Holbein and Montaigne were equally ready to remind themselves of Death and bring it before their eyes.

Somehow this tradition was lost, probably around the eighteenth century, the century of politeness, urbanity and materialism, when it started to seem barbaric, morbid, even fanatical to focus on Death. The emphasis becomes much more on man’s ability to control nature, to achieve his wishes, to cheat Death. Death became merely death, a minor embarrassment in the cocktail party of life.

But I don’t think the ancient tradition of the memento mori was necessarily morbid. It was a way of turning down the volume on modern anxieties. By reminding yourself that you would die very soon, you learned to detach yourself from worldly anxieties, from all the petty striving after reputation or status. It was a way of achieving release, liberation, peace.

I remember when I had social anxiety at university, and was really anxious alot of the time, I one day had an epiphany that we would all die. I was sitting in my room, and I suddenly saw that everything in it would turn to dust, that the entire town would crumble and disappear, that I myself would be dead and buried within a few years, and the universe would not have been significantly altered. For some reason, I found this amazingly liberating. Why was I worrying what such-and-such thought of me…what did it matter how my finals went…why did we cling on to worldly things, when they were turning to dust in our fingers? Why do we torture ourselves worrying about our place in the world, when we are only here for a few, brief and insignificant moments?

Later on, when I found myself getting anxious again, I found that reminding myself of Death helped me achieve detachment and perspective on my problems. I couldn’t take myself, my career, my love-life or whatever else I was worrying about that seriously, knowing I would be dead in a few weeks, months or years. What was the point? I had no idea why I was alive, but I knew I was going to die soon, in a few decades at most, so I might as well relax, try to enjoy life, and maybe try and help others as well.

So I really think reminding myself of Death helped me to overcome anxiety. The ancient technique still works, that’s why we have passed it down to modern times. And I think our modern society, so obsessed with itself, its own glamour and importance, would do well to remind itself occasionally of the grinning skull beneath all the make-up.

Here’s one of the few memento moris from popular culture, The Flaming Lips’ song, Do You Realize:

[youtube=http://www.youtube.com/watch?v=qvdma6tCnjw]

Philosophy for Life - official website of author Jules Evans -

I’ve never thought of mental illness in this way. I don’t think you can draw a line and say, everyone on this side is ‘normal’ or ‘neuro-normal’, and everyone on that side is ‘sub-normal’, or ‘malfunctioning’ or ‘mad’. You can’t have a model of psychology where the psychologists are all on the other side of the line, peering over the wall at the sub-normals, taking notes.

Then, you end up with basically a war between the sane and the insane. In the workshop after the meeting, one ‘user’ was complaining bitterly about the psychology profession: “They’re all arrogant. I dislike them all. They all try to control me, to belittle me.” She was making the same mistake – drawing that line between psychologists and the mentally ill, imagining (or being made to imagine) that psychologists were somehow above her, superior, better.

There is no line. Anyone can experience mental illness. It can be a psychotic episode – you could, like my best friend Neil, abruptly descend into schizophrenia in your adolescence. But it could also be minor forms of mental illness – you could take too many drugs and develop social anxiety, like I did. You could get mugged, and develop post-traumatic stress disorder. You could have a bout of mid-life depression. It happens. Mental illness happens to ordinary people, all the time.

I had an anxiety disorder for several years, but I’m not sub-normal. My IQ is not below the average. Think of all the mentally ill people who were far above the average IQ – was Nietzsche sub-normal, or Artaud, or Jung, or Wittgenstein, or Stephen Fry? Their IQ was actually far higher than normal. They were excessively sensitive, that was part of the problem.

I asked the therapist in question, during the workshop, what methods she used to deal with anxiety. We were going round the group asking everyone else to share, and I wanted the other therapists to share as well, because everyone has bad moods to some extent, and methods of coping with them. I wanted to break up the boundary between the therapists and the users. She said: ‘well, I don’t really get anxious’. Her comment put up a division between her and the users, the weak people who suffer from anxiety. It was basically saying ‘I’m a neuro-normal, I’m functioning, I’m on the other side of the barrier’.

Good psychologists, it seems to me, are prepared to cross that barrier, to accept that madness is a part of them, is a part of being human. Think of Jung and his crazy visions. Think of Albert Ellis, the founder of CBT, who was chronically afraid of talking to women, or of Aaron Beck, the other founder of CBT, who was a depressive child. These people could talk back to mental sickness because they could talk its language, they had visited the country, rather than just seen postcards that other people had sent.

And when patients hear that a psychologist has had his or her own experience of mental illness, with all its humiliations and frustrations, they will be less inclined to put up barriers themselves, less inclined to view the psychologist as an arrogant or superior person trying to put them down.

It’s a frightening, but necessary, step of empathy that the psychologist must take – recognizing they could lose it too, they could become mentally ill, they could find themselves among the dreaded ‘neuro-abnormal’.

That realization fosters a humility, an awareness that we all share a common human nature, and that nature is to some extent mysterious, and destructive, but also beautiful. Our nature can suddenly turn on us, wreck our ambitious plans, demand that we take time out of our busy lives and tend to it. Nature sometimes forces us to our knees, when we have got too cocky. As psychologists, we have to learn the tragic patience, acceptance and humility before nature that the mentally ill already know.

Philosophy for Life - official website of author Jules Evans -

Philosophy for Life - official website of author Jules Evans -