Philosophy on the NHS

Havi Carel had everything going for her. At 35, she had recently met the love of her life, she’d just brought out her first book, and she was about to start her dream job, teaching philosophy at the University of West England, in Bristol (UWE). The future looked bright. Then, she started to notice she lost her breath very easily. She had always been fit and healthy, yet suddenly she couldn’t keep up with her aerobics class, or walk up a hill while talking on her mobile. She thought she might be getting asthma.

On a visit to her parents in Israel in 2006, her father, a doctor, suggested she have a CT scan of her lungs. The evening after the scan, her father suggested they stop off at the radiology clinic so he could pick up the results. Havi tells me: “I sat in the car and waited for him to come back. And waited. After half an hour, I knew something was wrong, so I went into the centre. I walked into the lab, where my father and the radiologist were staring at a CT scan of my lungs. My father looked in shock. The radiologist looked surprised and embarrassed to see me there. He said to me: ‘Do you know what you’ve got?’ I said I didn’t. ‘Have a read.’ And he handed me this enormous diagnostic manual, opened at an illness called Lymphangioleiomyomatosis (LAM). It was full of dense terminology, but at the bottom it said ‘prognosis: 10 years’. I felt this deep, physical shock, and just kept thinking, I’m going to be dead by 45.”

At first Havi thought it must be some mistake. Then she was furious. She was an atheist, but she still found herself railing against fate. “I didn’t smoke, I didn’t drink, I didn’t take drugs, I’d always been good, and now I get this incredibly rare illness? It seemed deeply unfair. Why me? Then I wondered if I was somehow being punished. I’d just finished my first book, about death. I wondered if writing about that subject had somehow caused the illness. It was really difficult to accept the randomness of it – the fact that it was simply a one in a million piece of very bad luck. Then I had to cope with the social reality of having a life-threatening illness: first of all, you’re often treated by medical staff just as a body with an illness, rather than a person experiencing an illness. And then many of your friends and acquaintances don’t know what to say. So they leave you alone, when in fact, I was terrified of being alone. The first few nights after the diagnosis, I slept in the same room as my sister, with the light on.”


Then, after a few months, Havi decided to use one resource she had: philosophy. “I thought, how will philosophy help me now? If it couldn’t, there was no justification in carrying on with it.”
She found Epicurus to be her most helpful mentor. She says: “I knew my future had been curtailed, but I could still find happiness even within illness, by using the Epicurean technique of focusing on the present. I tried to really enjoy whatever I was doing at that moment: yoga exercises, say, or going for a walk, or talking with my husband. Epicurus is right: we don’t need that much to be happy.” And yet, Havi is less sure about the Epicurean claim that ‘what is painful is easy to endure’. In fact, as her condition deteriorated, she found it harder and harder to endure. “You get used to a stage of the illness, and then suddenly it gets worse, and your world shrinks further. I really found that hard.”

Luckily, in 2007, a new drug treatment stabilized her condition. The clouds have lifted, and her prognosis is much more positive. Havi says she’s incredibly relieved to have come through the experience. Yet she also says: “You think you will never forget it, that you will never forget not to worry about the small stuff and to enjoy each moment that you have like it’s your last. The sad thing is, you do forget it. You get caught back up in the small stuff.”

Nonetheless, Havi seems to have been transformed by the experience – not least, her concept of philosophy has changed. She’s no longer so interested in an “academic, highly specialized” subject that is cut off from ordinary people’s concerns, and is now organizing a pilot programme to provide a ‘philosophical tool-kit’ in the National Health Service for people confronting serious illness.

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Havi’s story made me wonder if other philosophers are working within the NHS. I know there are some ‘humanist chaplains’ working in some hospitals, and that a colleague of Theodore Zeldin’s, John Reed, is doing some work in a GP clinic in London. There’s a philosopher at Oxford called Hanna Pickard who is also a therapist at the Oxford Complex Needs Service,
using Aristotle to help people with personality disorder. And there’s Derek Bolton of Kings University in London, who’s a philosopher and also a clinical psychologist at the Maudsley Clinic.

And I think we’re beginning to see more ‘philosophical counsellors’ get training in cognitive behavioural therapy, to work within the NHS Improved Access for Psychotherapies scheme. I hear
Tim Le Bon recently trained in CBT, for example – I’ll be interviewing him about it next week. The ancients, of course, thought of philosophy as a ‘medicine for the mind’ – wouldn’t it be wonderful if the NHS provided brief philosophy classes for cognitive therapists, to introduce them to the philosophical roots of their practice?

Even better, people coming through the CBT conveyer belt could then be eligible for a ‘CBT Plus’ class, introducing them to some of the traditions that CBT draws on (Stoicism, Epicureanism, Socratic philosophy, Buddhism) so that they could use these philosophies for life, rather than just for eight weeks. I wonder if doing so would encourage them to practice more often, thereby lowering the risk of relapses?

Havi Carel’s 2008 book, Illness, talks more about her experience.

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This conference on psychotherapies in the NHS looks good, on 24th and 25th of November in London. Speakers include David Clarke, the main advisor on Improved Access for Psychotherapies (IAPT), and Sir Gus O’Donnell, head of the civil service, who is talking about measuring well-being.

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Here’s some free podcasts by Mark Williams, the Oxford Uni-based pioneer of mindfulness-based CBT, on the treatment of depression.

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I went to the Landmark Forum last weekend, for their 3-day course. Pretty intense! It was research for my book. Landmark was invented by Werner Erhard – check out this interview with him from Adam Curtis’ great documentary, the Century of the Self. It’s 31 minutes in.

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Sad to see Giles Fraser resign as the Dean of St Paul’s. Giles was the driving force behind the St Paul’s Institute, a sort of ethical finance think-tank set up last year, which aimed ‘to recapture the cathedral’s ancient role as a a centre of public debate’ and ‘engage the financial world with questions of morality and ethics’. Isn’t that exactly what the Occupy movement is doing? Yet perish the thought the occupation was costing the Cathedral money. Now St Paul’s is seeking an injunction to evict the occupiers. Jesus ejected the money-lenders from the temple – today, they want to eject the anti-money-lenders.

See you next week,

Jules

Comments:

  • Kelsey says:

    Jules,

    Great story, thanks for sharing. I was struck by the idea of "people coming through the CBT conveyer belt." Is that how the NHS thinks of CBT?

    Also, have you ever heard of MBCT (Mindfulness-Based Cognitive Therapy)?

  • Jules Evans says:

    Hi Kelsey

    I dont know if thats how the NHS think about it – i guess my point is, its only an 8-16 week course, so is quite brief.

    Yes, re mindfulness CBT. Do you get the newsletter? I included a link to a podcast by one of the pioneers of it, Mark Williams.

    all best

    Jules

  • Kelsey says:

    Ah I see I didn't scroll down far enough :/ Thanks though!

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