"Sure, many of the misfortunes that befall you will not be your fault, and you’ll often get knocked down no matter how hard you try to resist. But if you seek explanations for your suffering in things beyond your control, you risk falling prey to a culture and industry that are motivated to keep you feeling ill. So never blame on your circumstances [for] what you can blame on yourself. Look within for the causes and, most times, within you’ll find the cures. Modern society will tell you otherwise, but it’s within your power to defy it, for you are not a helpless leaf in the wind but a mind that holds a world, which, depending on how you think, can be a hell in heaven, or a heaven in hell."
Fantastic advice! Far too much of the "helplessness" we might experience is learned, or maybe I should say, "taught" by those hoping to gain advantage, either political or economic--and maybe even both--from our internalization of that helpless feeling. Of course, their ability--and only THEIR ability--to help us, is part of the bargain!
With obvious apology for replying to myself, let me add one other point, particularly in light of some other poster's comments. I look forward to Gurwinder, and/or others, pushing back upon my thinking, should we disagree.
One of the reasons this article appealed to me, and why I chose the section above to highlight stems from a very old--and yet very relevant--point of view. That point of view, while not characteristic of Stoicism at the time, strikes me that way now. In his [first] book, Stephen Covey spoke of Circle of Concern, Circle of Influence, and Circle of Control. It seems to me that much, in fact FAR too much, of the helplessness that seems currently prevalent, particularly on social media, stems from too much focus on the problems of distant people, or the actions of more local people, who are still far outside even the most expansive view of our circle of influence, much less our circle of control. Yet, we believe that their actions will directly and negatively impact our lives. As such, it is hopeless! The (admittedly overly) simplistic advice---to clean up your bedroom, remains relevant. I believe the successful application, particularly of CBT or any other mental tool, rests somewhat upon an understanding of what is actually within one's control, and how best to address that. What am I missing?
As a left-leaning Long Covid sufferer who has used self-motivation and CBT to cope with the condition, I strongly support your conclusions on therapy. However, you spend much of the article going on about 'Leftists' and implying people who (by your own conclusion) need CBT support are imagining their problems. This sets a certain tone that could be used to denigrate those people. You also don't address the possibility that right wing people bottle up their problems or are to proud to ask for help.
This is a fair point, but keeping the article at a readable length requires me to forgo many qualifiers and caveats. I have a high opinion of my readers so I trust that they won't denigrate certain groups of people based on my omission of certain points.
I actually thought much of the exploration of liberal vs right wing tendencies was superfluous to the pathologisation argument and conclusions via CBT. My hackles were up and I had to withhold judgement (so maybe you're right to respect your readers 😁). I do think the internal and external locus is very interesting and really worth a separate article. I'm a liberal with a strong internal locus, which believe me causes a lot of mental stress!
Gurwinder, thx for this conversation. Tim, I agree that liberal and leftism are conflated a bit here, I think due to indistinct definitions of both broad words and categories. Please write a separate article on internal/external locus for sure 👏Yet, I appreciate how this piece seeks to link a misapprehension of reality and ill mental and physiological effect with the American leftist focus on external structure beyond one’s ability to change it within a diverse and intentionally grid locking democracy. Social media influence? Certainly. Pathologization? I think so. Naming and placing faith in changing so many external ‘systemic problems’ seems futile when relation to the systemic is often thru newly created digital means. Another influence to consider: my discipline’s role in uncritically forwarding a disempowering worldview/ideology that I believe also uniquely contributes to this misapprehension of reality and identity. As a college educator for the last 10yrs, I see student exasperation and despair when systemic change fails to materialize as believed and preached in universities. Erec Smith’s A Critique of Antiracism in Rhetoric and Composition: The Semblance of Empowerment (2021) argues for problem-based reality testing to counter the reductivist deficit model found in antiracist writing pedagogies commonly found in first-year writing courses (a required course I teach and most millions of freshman take every Fall). I think John McWhorter’s Woke Racism (2021) also captures this generation’s societal elements that have taken up this systemic-centered academic ideology popularized by writers like Di’Angelo, Kendi, and Hannah-Jones. My opinion on this is of course subject to change via new evidence and experience!
Conflating leftism and liberalism didnt bother me massively, but the pejorative focus just seemed to detract from the message. But I'm in the UK & not in education so much of this might be cultural. I'm not personally convinced the attribution of being left or right wing alone is helpful. What if you first ascribed people as 'wealthy/secure' vs 'poor/insecure'. For sure the former tend to be right wing, the latter left wing. In which case the position of the locus aligns with self-interest in each case surely? In which case outliers then become interesting.
I see how the left/right focus could detract from the message tonally, if taken pejoratively, especially the possible generalizations readers could take away from internal/external locus of control findings (which I still need to review) that Gurwinder cited. Yet I took the concession that leftism, while seemingly responsible for a disempowering pathologization in youth, should not be wholly discouraged in said youth as an admission that left-right leanings should not be seen as sole causes of medical illness but tributary cultural conditions (along with cyberchondria). Using left/right could be more superfluous or even pejorative, to your point Tim, except that left and right attributions are useful heuristic terms in US discourse given our current culture wars. That said, ascribing people thru 'wealthy/secure' and 'poor/insecure' terms could preclude pejorative simplification if added to left/right, especially since it's been observed the Democratic Party has left the working class (poor/insecure), which has begun shifting center and right, increasingly voting in greater numbers for the Republican party over the last 10 years. Ruy Teixeira's recent Liberal Patriot post sums this electoral and demographic event nicely (https://www.liberalpatriot.com/p/five-reasons-why-democrats-should?utm_source=profile&utm_medium=reader2). NYU psychologist Jonathan Haidt's substack and book the Coddling of the American Mind takes up how CBT could counter the safetyism culture/mindset that left-leaning and leftist US professors and college admins promote on campuses (parallels and expands on Gurwinder's assessment of the pathologization problem and his CBT solutions).
I pointed out that leftists are more likely to report (and be diagnosed with) mental illness, and, in my search for the reason why, I followed the evidence toward a victimhood mindset and external locus of control. If you consider that denigration then you're guilty of the very victimhood mindset I warned against.
And your link doesn't lead to any "good scientific bases" for repressed memories.
The rise in trauma as an explanation is interesting and likely , as you point out overdone, but in terms of an explanation , it is the counterbalance to "chemical imbalance" narrative. The chemical imbalance narrative itself is very geared toward pathologization in a more deterministic aetiological sense. 'Trauma ' at least offers us the concept that the environment moulds and shapes us and we are not just a genetic code that executes. The field of Epigenetics helps straddle the two concepts I expect. I understand why the language of trauma might feel overdone since over the last 10 years there has been a shift toward thinking in these terms which can for some feel freeing offer a kinder diagnosis. For instance Dr Gabor Matte use of trauma etc as a causative reason for development of adhd.
If the inheritance of trauma is non credible I apologise. Maybe I misused the term but I think I was as much thinking of the transcriptional aspects of genetics that are environmentally derived during our lifetimes. I.e simplistically, stressor switches a gene on or off . If trauma is a strong word which is overused , the idea that environment is involved in potentially causing a state of disease is credible and offers part of the explanation. Remembering such things although tending to offer the chance for victim Mindset to set in , leaves the concept that events shape us as well as genes. Genetic determinism as it applies to mental health diagnoses could be a problem in addition to the processes you identified.
Thanks for the reply! Funnily enough I am actually biased with you on thinking leftism is pretty bad for mental health, and agree with a lot of what you said. I still found your post to be biased against leftism though.
I think the biggest problem for me is that you focused quite a bit on explaining what the overall leftist mindset is, how it relates to negative mental health, and pinned all of the different factors on mindset. You cherrypicked a weakman of an obviously foolish journalist blaming an increasingly conservative worldview, and ran with that all the way. You don't even give a cursory admittance that there could be other factors at play, off the top of my head:
1) Self-reporting bias
2) Difference in religiosity
3) City vs rural living
4) Genetic differences
It just seems like you came into this with a conclusion and found evidence to back up the story you wanted to write. Which is ironic considering I did that exact same thing with the link to trauma research...
I'll admit that link I sent with trauma science is pretty weak in retrospect. I've been convinced that repressed emotions or at least repressed instincts are real more from a personal experiential sense than being convinced by scientific papers, and it was dishonest to try and just dump links on that. Apologies there.
"You don't even give a cursory admittance that there could be other factors at play."
This is utterly false. I explicitly stated that we mustn't make the mistake of pinning the blame on any one cause, because "pathologization can have as many causes as it damn well pleases."
It seems to me you are guilty of what you're accusing me of. You came into this with a conclusion and saw what you wanted to see.
This exchange reminds me of the Dartmouth scar experiment that you brought up in previous articles, whereby subjects who were convinced there was a scar on their face (that wasn’t there) perceived their interactions with others to be discriminatory. I went to the actual original article and read it, and Kleck et all’s conclusion was priceless - there is very little, if anything, others can do to alter the way “victims” feel. They have already decided they’re affronted.
Interesting! I must have missed you give that caveat. I still think your writing could benefit from less politicized language, but I concede that you’ve covered your bases.
And well, what can I say? I’ve already admitted I came into this conversation heavily biased. Apologies for the combative tone, I do enjoy your writing quite a bit.
On "self-derogation", for some, the damaging effects of being online (not just in what would typically be called social media platforms) can come from reading brilliant pieces by very smart people (such as the current blog post!) and then feeling that one's own writing is futile. The internet (and especially Substack) lets us see the thoughts of the very best (and most prolific) thinkers and writers. It's easy to ignore the fact that these are a tiny fraction of the population and that we can still bring value. I haven't seen this discussed but I think it's a real thing.
This is probably true of any creative endeavour. In my previous life I was a freelance writer, but it was pretty much pre-internet, so it wasn't as much of an issue. Now, though, I make my living as a jeweler/silversmith. I am pretty good at it, but there's no shortage of people online who are much better, let alone the goldsmiths with formal training and decades of experience. Occasionally I cut myself off from looking at their work, because I can feel the comparison eating at me subconsciously. Then I remind myself that what I do makes enough people happy that I can support myself, and it's fine to be in my little niche. The ones I admire inspire me to do better, but I'm mostly happy with where I'm at for now.
I think your analysis has some good points, but I'm not sure the solution is sufficient. Sure, CBT can be helpful, but then again if it were so helpful then wouldn't you'd think all the young people going to therapy would be getting less neurotic, not more? We'd expect to see some effect I'd think. For all the weird, out-there kinds of psychotherapy you can find, still most therapists are trying to help their patients be more functional, healthy, sane, etc. So I think there are still unanswered questions and the dynamic is complicated.
But I agree that the pathologizing of everything is a problem. We should remember, though, that objectifying our inner problems is not new, and is a very natural thing to do. Some cultures may use demonic possession or magic to explain mental illness. In daily life we might say "sometime came over me". etc. A teenager may explain her unhappiness by saying "I have generalized anxiety disorder and dysthymia."
Taking ownership of one's own unhappiness is important, but difficult.
The original, Stoicism-based CBT is becoming less common in favor of more "inclusive" forms of therapy. Which is a shame, as its ability to train people to cope with despair and mental illness is well-documented by decades of research, and unsurpassed in the entire field of psychiatry.
One question is: how common are these newer forms "watered-down" CBT? My sense is that they aren't very common, and probably get more press/hype than is representative of its use in practice. I'd also want to see specific examples of the supposedly new and inferior CBT, especially regarding anxiety and depression which are by far the most common issues treated.
The efficacy of CBT is also overstated. Part of its claim to efficacy is that for a long time it was the only form of psychotherapy that was being subjected to study. A lot of CBT research has substantial problems as well. This is a huge topic, too big for comments, but there is a compelling argument that CBT is just as effective as any other therapy and that the more important factor is the therapist, not the modality. Check out Jonathan Shedler's stuff on efficacy of psychodynamic therapy as one example.
I have a personal soft spot for Stoicism and that flavor of CBT, but I think it is easy to get too focused on it as a panacea because of the supposedly rock-solid evidence base. Also worth stating that most therapists don't just practice CBT, or DBT, or any other kind of therapy "by the book". Most therapists are eclectic and use techniques that both suit them as well as the particular patient in question.
I don't think the efficacy of CBT is overstated at all. Even the one meta-analysis that finds its effectiveness has declined over time concludes with this:
"it is clear that the evidence-base of CBT is enormous. Given the high cost-effectiveness of the intervention, it is surprising that many countries, including many developed nations, have not yet adopted CBT as the first-line intervention for mental disorders."
I agree there is a legitimate debate here. “Overstated” is also a relative term. I’ll probably write more on the CBT issue at some point. I think it can be very useful--I’ve got the Stoics, Albert Ellis, Pierre Hadot all on my bookshelf. The main thing is that I think you are on the right track in general, at least as I see things, so not trying to say you’re wrong, but just would like to see more elaboration on the solution aspect at some point, and just an encouragement not to be too narrow in your CBT focus at the expense of bigger issues. But that’s just my two cents.
I don’t trust a lot of statistical meta analyses—it’s too easy to support claims that, when you look at the raw data, turn out to have multiple confounders. But you might want to note that David Burns—who is probably more responsible than anyone for the growth of CBT—says that the major problem with the research is that it compares CBT efficacy with psychiatric medications, which actually have lousy efficacy.
Consider that many current therapists are practicing variations on “the affirmation model”, whereas they take what their client says as truth. In some states here in the US, if a therapist does not affirm, say a transgender identity and actually tries to help a teen explore the roots of their distress, that therapist could lose their license and be accused of “conversion therapy”.
I started laughing within the first minute of reading. Why? Well, I'm sure many other readers know that feeling when you know instinctively that what you have been seeing and hearing is sad-case bullshit and self-pity but you haven't been collecting the research evidence to make your case. So you shrug and keep your thoughts to yourself. That's why I started laughing. Because here was Gurwinder saying what I instinctively felt was true, but in a way I'd never had the time or intellectual precision to assemble. I'd like him to write a piece on the dilemma facing lifelong liberals who still cling to rationalism and are faced with the realization that we need to hand in our badge now that liberalism is so intolerant, judgmental and authoritarian. Pity the children (those that survive).
Great article. Thought provoking and much to argue about (in a good way).
I wasn't very convinced about left politics causing mental health problems though. In fact I would guess that causation was mostly the other way round? In my limited experience, 'sensitive souls' often seem to gravitate to "compassionate" and charitable causes i.e. leftism. Either directly, or because of the financial consequences of mental health problems. Or possibly the mental health consequences of financial problems (many confounding factors relating to financial security and health as well).
A great and timely article. The negative impact that the Pathologization Pandemic will have on our society and economy is massive. The institutions that should serve to protect our children are not doing so. Kowtowing to idealogy and corruption rather than truth. A perfect storm of neglect, naivety, compassion and greed.
Thanks for this article. Liked your ending of paraphrasing Milton's Satan!
Are you aware of high school curricula that incorporate CBT and then track the results?
I was School Board Chair of the Riverdale Country School about ten years ago when our headmaster incorporated Character into as many parts of the curriculum as made sense. One of the foundational principles was "grit."
Great piece. One component I might add relates to the more cynical and dark side of things: the weaponization of aspirational victimhood for personal gain. René Girard referred to this as “victimism, which uses the ideology of concern for victims to gain political or economic or spiritual power.”
This is too long and involved for me to have a chance in hell at rebutting debate-club style. Yet for all the excellent questions raised, the overall shape you end up with feels incongruous. To the degree that this is generational, I’d submit it’s primarily the full-throated, wide-spectrum rejection of 20th century artefacts. At the macro level, we are stampeding headlong towards quite a dark place. Is continuity of tradition out of mere habit such a great idea? Teenagers in particular dedicate so much of their brain-development quota to coming to grips with a society that has become (I propose) toxic to our souls. If I came of puberty today, I hope I’d find utterly surreal the idea of shouldering any inherited manifestation of masculinity. If I were brave enough, I hope I’d find a different path. Would I be able to articulate precisely why? Certainly not. But most of the time I believe we know what to do long before we know why. Gender is societal. If society is broken, so is gender. Dysphoria can’t always be caged in biological terms or even isolated from other goopy patterns in our communal vocabulary of identity building blocks. Surely it’s well-understood that even self-harm is often just acute distress, at a level too fundamental for words; some attempt to assert control against the ceaseless programming we levy against our young. Let them go wild, I say.
You may have already come across this fascinating piece by Musa al-Gharbi in your research, but if not, I encourage you to give it a read; I suspect you'll appreciate it:
How to Understand the Well-Being Gap between Liberals and Conservatives
Great article. As a soon to be father of a girl I am concerned about this deterioration of girls' mental health. I intend to teach her of her inherent value and her inherent power to make her own world.
As a parent of two teenage girls, one of whom has been sucked into the ROGD cult, I can only wish you the best. Know everything she does on a computer, be as involved in her education as you can, surround her with loving family and friends, get into outdoor activities as a family, and hold on. It’s a beautiful and terrifying ride.
" The newest forms of CBT, such as “Transgender-Affirmative CBT,” are the opposite of traditional CBT because they seek not to transcend feelings but to validate them."
Thanks very much for bringing this to light. It's an issue I follow in the work of other writers on the topic, that we as a society have gone into validating heavily. As Haidt and Lukianoff put it in their book, "You must always trust your emotions over reason." is one of the great modern "myths" we grapple with and has become mainstream. It sounds like, based on your writing, that even therapies branded as CBT are actually working against CBT's very principles? This isn't my area of expertise, but it's all interesting to watch, in order to see how our culture and society evolves in the next decade and beyond.
"Sure, many of the misfortunes that befall you will not be your fault, and you’ll often get knocked down no matter how hard you try to resist. But if you seek explanations for your suffering in things beyond your control, you risk falling prey to a culture and industry that are motivated to keep you feeling ill. So never blame on your circumstances [for] what you can blame on yourself. Look within for the causes and, most times, within you’ll find the cures. Modern society will tell you otherwise, but it’s within your power to defy it, for you are not a helpless leaf in the wind but a mind that holds a world, which, depending on how you think, can be a hell in heaven, or a heaven in hell."
Fantastic advice! Far too much of the "helplessness" we might experience is learned, or maybe I should say, "taught" by those hoping to gain advantage, either political or economic--and maybe even both--from our internalization of that helpless feeling. Of course, their ability--and only THEIR ability--to help us, is part of the bargain!
With obvious apology for replying to myself, let me add one other point, particularly in light of some other poster's comments. I look forward to Gurwinder, and/or others, pushing back upon my thinking, should we disagree.
One of the reasons this article appealed to me, and why I chose the section above to highlight stems from a very old--and yet very relevant--point of view. That point of view, while not characteristic of Stoicism at the time, strikes me that way now. In his [first] book, Stephen Covey spoke of Circle of Concern, Circle of Influence, and Circle of Control. It seems to me that much, in fact FAR too much, of the helplessness that seems currently prevalent, particularly on social media, stems from too much focus on the problems of distant people, or the actions of more local people, who are still far outside even the most expansive view of our circle of influence, much less our circle of control. Yet, we believe that their actions will directly and negatively impact our lives. As such, it is hopeless! The (admittedly overly) simplistic advice---to clean up your bedroom, remains relevant. I believe the successful application, particularly of CBT or any other mental tool, rests somewhat upon an understanding of what is actually within one's control, and how best to address that. What am I missing?
This is a core consideration of Stoicism. More detail here: https://gurwinder.substack.com/p/stoicism-the-ancient-remedy-to-the
I am reminded of the Serenity Prayer 🙏 with focusing on the things we can change versus that which we can not.
Well said. Put another way: personal responsibility and self-reliance.
The second one cannot be an absolute of course (for the reasons you give) but both are core precepts for what used to be called The Good Life.
As a left-leaning Long Covid sufferer who has used self-motivation and CBT to cope with the condition, I strongly support your conclusions on therapy. However, you spend much of the article going on about 'Leftists' and implying people who (by your own conclusion) need CBT support are imagining their problems. This sets a certain tone that could be used to denigrate those people. You also don't address the possibility that right wing people bottle up their problems or are to proud to ask for help.
This is a fair point, but keeping the article at a readable length requires me to forgo many qualifiers and caveats. I have a high opinion of my readers so I trust that they won't denigrate certain groups of people based on my omission of certain points.
I actually thought much of the exploration of liberal vs right wing tendencies was superfluous to the pathologisation argument and conclusions via CBT. My hackles were up and I had to withhold judgement (so maybe you're right to respect your readers 😁). I do think the internal and external locus is very interesting and really worth a separate article. I'm a liberal with a strong internal locus, which believe me causes a lot of mental stress!
Gurwinder, thx for this conversation. Tim, I agree that liberal and leftism are conflated a bit here, I think due to indistinct definitions of both broad words and categories. Please write a separate article on internal/external locus for sure 👏Yet, I appreciate how this piece seeks to link a misapprehension of reality and ill mental and physiological effect with the American leftist focus on external structure beyond one’s ability to change it within a diverse and intentionally grid locking democracy. Social media influence? Certainly. Pathologization? I think so. Naming and placing faith in changing so many external ‘systemic problems’ seems futile when relation to the systemic is often thru newly created digital means. Another influence to consider: my discipline’s role in uncritically forwarding a disempowering worldview/ideology that I believe also uniquely contributes to this misapprehension of reality and identity. As a college educator for the last 10yrs, I see student exasperation and despair when systemic change fails to materialize as believed and preached in universities. Erec Smith’s A Critique of Antiracism in Rhetoric and Composition: The Semblance of Empowerment (2021) argues for problem-based reality testing to counter the reductivist deficit model found in antiracist writing pedagogies commonly found in first-year writing courses (a required course I teach and most millions of freshman take every Fall). I think John McWhorter’s Woke Racism (2021) also captures this generation’s societal elements that have taken up this systemic-centered academic ideology popularized by writers like Di’Angelo, Kendi, and Hannah-Jones. My opinion on this is of course subject to change via new evidence and experience!
Conflating leftism and liberalism didnt bother me massively, but the pejorative focus just seemed to detract from the message. But I'm in the UK & not in education so much of this might be cultural. I'm not personally convinced the attribution of being left or right wing alone is helpful. What if you first ascribed people as 'wealthy/secure' vs 'poor/insecure'. For sure the former tend to be right wing, the latter left wing. In which case the position of the locus aligns with self-interest in each case surely? In which case outliers then become interesting.
I see how the left/right focus could detract from the message tonally, if taken pejoratively, especially the possible generalizations readers could take away from internal/external locus of control findings (which I still need to review) that Gurwinder cited. Yet I took the concession that leftism, while seemingly responsible for a disempowering pathologization in youth, should not be wholly discouraged in said youth as an admission that left-right leanings should not be seen as sole causes of medical illness but tributary cultural conditions (along with cyberchondria). Using left/right could be more superfluous or even pejorative, to your point Tim, except that left and right attributions are useful heuristic terms in US discourse given our current culture wars. That said, ascribing people thru 'wealthy/secure' and 'poor/insecure' terms could preclude pejorative simplification if added to left/right, especially since it's been observed the Democratic Party has left the working class (poor/insecure), which has begun shifting center and right, increasingly voting in greater numbers for the Republican party over the last 10 years. Ruy Teixeira's recent Liberal Patriot post sums this electoral and demographic event nicely (https://www.liberalpatriot.com/p/five-reasons-why-democrats-should?utm_source=profile&utm_medium=reader2). NYU psychologist Jonathan Haidt's substack and book the Coddling of the American Mind takes up how CBT could counter the safetyism culture/mindset that left-leaning and leftist US professors and college admins promote on campuses (parallels and expands on Gurwinder's assessment of the pathologization problem and his CBT solutions).
You failed, in my opinion. You seemed to clearly denigrate leftists at the expense of right-wing folks.
And for what it's worth, there are good scientific bases for repressed trauma and reactions. Check out Dr. Peter Levine's work: https://www.somaticexperiencing.com/se-research
I pointed out that leftists are more likely to report (and be diagnosed with) mental illness, and, in my search for the reason why, I followed the evidence toward a victimhood mindset and external locus of control. If you consider that denigration then you're guilty of the very victimhood mindset I warned against.
And your link doesn't lead to any "good scientific bases" for repressed memories.
The rise in trauma as an explanation is interesting and likely , as you point out overdone, but in terms of an explanation , it is the counterbalance to "chemical imbalance" narrative. The chemical imbalance narrative itself is very geared toward pathologization in a more deterministic aetiological sense. 'Trauma ' at least offers us the concept that the environment moulds and shapes us and we are not just a genetic code that executes. The field of Epigenetics helps straddle the two concepts I expect. I understand why the language of trauma might feel overdone since over the last 10 years there has been a shift toward thinking in these terms which can for some feel freeing offer a kinder diagnosis. For instance Dr Gabor Matte use of trauma etc as a causative reason for development of adhd.
There is no epigenetic basis for transgenerational trauma. It's woke pseudoscience. https://www.razibkhan.com/p/you-cant-take-it-with-you-straight
If the inheritance of trauma is non credible I apologise. Maybe I misused the term but I think I was as much thinking of the transcriptional aspects of genetics that are environmentally derived during our lifetimes. I.e simplistically, stressor switches a gene on or off . If trauma is a strong word which is overused , the idea that environment is involved in potentially causing a state of disease is credible and offers part of the explanation. Remembering such things although tending to offer the chance for victim Mindset to set in , leaves the concept that events shape us as well as genes. Genetic determinism as it applies to mental health diagnoses could be a problem in addition to the processes you identified.
Thanks for the reply! Funnily enough I am actually biased with you on thinking leftism is pretty bad for mental health, and agree with a lot of what you said. I still found your post to be biased against leftism though.
I think the biggest problem for me is that you focused quite a bit on explaining what the overall leftist mindset is, how it relates to negative mental health, and pinned all of the different factors on mindset. You cherrypicked a weakman of an obviously foolish journalist blaming an increasingly conservative worldview, and ran with that all the way. You don't even give a cursory admittance that there could be other factors at play, off the top of my head:
1) Self-reporting bias
2) Difference in religiosity
3) City vs rural living
4) Genetic differences
It just seems like you came into this with a conclusion and found evidence to back up the story you wanted to write. Which is ironic considering I did that exact same thing with the link to trauma research...
I'll admit that link I sent with trauma science is pretty weak in retrospect. I've been convinced that repressed emotions or at least repressed instincts are real more from a personal experiential sense than being convinced by scientific papers, and it was dishonest to try and just dump links on that. Apologies there.
"You don't even give a cursory admittance that there could be other factors at play."
This is utterly false. I explicitly stated that we mustn't make the mistake of pinning the blame on any one cause, because "pathologization can have as many causes as it damn well pleases."
It seems to me you are guilty of what you're accusing me of. You came into this with a conclusion and saw what you wanted to see.
This exchange reminds me of the Dartmouth scar experiment that you brought up in previous articles, whereby subjects who were convinced there was a scar on their face (that wasn’t there) perceived their interactions with others to be discriminatory. I went to the actual original article and read it, and Kleck et all’s conclusion was priceless - there is very little, if anything, others can do to alter the way “victims” feel. They have already decided they’re affronted.
Interesting! I must have missed you give that caveat. I still think your writing could benefit from less politicized language, but I concede that you’ve covered your bases.
And well, what can I say? I’ve already admitted I came into this conversation heavily biased. Apologies for the combative tone, I do enjoy your writing quite a bit.
Yeah I agree. I think that the article is well-founded but would be much better without the obvious political bias.
On "self-derogation", for some, the damaging effects of being online (not just in what would typically be called social media platforms) can come from reading brilliant pieces by very smart people (such as the current blog post!) and then feeling that one's own writing is futile. The internet (and especially Substack) lets us see the thoughts of the very best (and most prolific) thinkers and writers. It's easy to ignore the fact that these are a tiny fraction of the population and that we can still bring value. I haven't seen this discussed but I think it's a real thing.
This is probably true of any creative endeavour. In my previous life I was a freelance writer, but it was pretty much pre-internet, so it wasn't as much of an issue. Now, though, I make my living as a jeweler/silversmith. I am pretty good at it, but there's no shortage of people online who are much better, let alone the goldsmiths with formal training and decades of experience. Occasionally I cut myself off from looking at their work, because I can feel the comparison eating at me subconsciously. Then I remind myself that what I do makes enough people happy that I can support myself, and it's fine to be in my little niche. The ones I admire inspire me to do better, but I'm mostly happy with where I'm at for now.
I think your analysis has some good points, but I'm not sure the solution is sufficient. Sure, CBT can be helpful, but then again if it were so helpful then wouldn't you'd think all the young people going to therapy would be getting less neurotic, not more? We'd expect to see some effect I'd think. For all the weird, out-there kinds of psychotherapy you can find, still most therapists are trying to help their patients be more functional, healthy, sane, etc. So I think there are still unanswered questions and the dynamic is complicated.
But I agree that the pathologizing of everything is a problem. We should remember, though, that objectifying our inner problems is not new, and is a very natural thing to do. Some cultures may use demonic possession or magic to explain mental illness. In daily life we might say "sometime came over me". etc. A teenager may explain her unhappiness by saying "I have generalized anxiety disorder and dysthymia."
Taking ownership of one's own unhappiness is important, but difficult.
Thanks for writing.
The original, Stoicism-based CBT is becoming less common in favor of more "inclusive" forms of therapy. Which is a shame, as its ability to train people to cope with despair and mental illness is well-documented by decades of research, and unsurpassed in the entire field of psychiatry.
One question is: how common are these newer forms "watered-down" CBT? My sense is that they aren't very common, and probably get more press/hype than is representative of its use in practice. I'd also want to see specific examples of the supposedly new and inferior CBT, especially regarding anxiety and depression which are by far the most common issues treated.
The efficacy of CBT is also overstated. Part of its claim to efficacy is that for a long time it was the only form of psychotherapy that was being subjected to study. A lot of CBT research has substantial problems as well. This is a huge topic, too big for comments, but there is a compelling argument that CBT is just as effective as any other therapy and that the more important factor is the therapist, not the modality. Check out Jonathan Shedler's stuff on efficacy of psychodynamic therapy as one example.
I have a personal soft spot for Stoicism and that flavor of CBT, but I think it is easy to get too focused on it as a panacea because of the supposedly rock-solid evidence base. Also worth stating that most therapists don't just practice CBT, or DBT, or any other kind of therapy "by the book". Most therapists are eclectic and use techniques that both suit them as well as the particular patient in question.
I don't think the efficacy of CBT is overstated at all. Even the one meta-analysis that finds its effectiveness has declined over time concludes with this:
"it is clear that the evidence-base of CBT is enormous. Given the high cost-effectiveness of the intervention, it is surprising that many countries, including many developed nations, have not yet adopted CBT as the first-line intervention for mental disorders."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3584580/
And your point that most therapists don't just practice CBT "by the book" helps answer your question about "watered down CBT."
I agree there is a legitimate debate here. “Overstated” is also a relative term. I’ll probably write more on the CBT issue at some point. I think it can be very useful--I’ve got the Stoics, Albert Ellis, Pierre Hadot all on my bookshelf. The main thing is that I think you are on the right track in general, at least as I see things, so not trying to say you’re wrong, but just would like to see more elaboration on the solution aspect at some point, and just an encouragement not to be too narrow in your CBT focus at the expense of bigger issues. But that’s just my two cents.
I don’t trust a lot of statistical meta analyses—it’s too easy to support claims that, when you look at the raw data, turn out to have multiple confounders. But you might want to note that David Burns—who is probably more responsible than anyone for the growth of CBT—says that the major problem with the research is that it compares CBT efficacy with psychiatric medications, which actually have lousy efficacy.
Consider that many current therapists are practicing variations on “the affirmation model”, whereas they take what their client says as truth. In some states here in the US, if a therapist does not affirm, say a transgender identity and actually tries to help a teen explore the roots of their distress, that therapist could lose their license and be accused of “conversion therapy”.
I started laughing within the first minute of reading. Why? Well, I'm sure many other readers know that feeling when you know instinctively that what you have been seeing and hearing is sad-case bullshit and self-pity but you haven't been collecting the research evidence to make your case. So you shrug and keep your thoughts to yourself. That's why I started laughing. Because here was Gurwinder saying what I instinctively felt was true, but in a way I'd never had the time or intellectual precision to assemble. I'd like him to write a piece on the dilemma facing lifelong liberals who still cling to rationalism and are faced with the realization that we need to hand in our badge now that liberalism is so intolerant, judgmental and authoritarian. Pity the children (those that survive).
Great article Gurwinder. Thankyou.
Great article. Thought provoking and much to argue about (in a good way).
I wasn't very convinced about left politics causing mental health problems though. In fact I would guess that causation was mostly the other way round? In my limited experience, 'sensitive souls' often seem to gravitate to "compassionate" and charitable causes i.e. leftism. Either directly, or because of the financial consequences of mental health problems. Or possibly the mental health consequences of financial problems (many confounding factors relating to financial security and health as well).
A great and timely article. The negative impact that the Pathologization Pandemic will have on our society and economy is massive. The institutions that should serve to protect our children are not doing so. Kowtowing to idealogy and corruption rather than truth. A perfect storm of neglect, naivety, compassion and greed.
Thanks for this article. Liked your ending of paraphrasing Milton's Satan!
Are you aware of high school curricula that incorporate CBT and then track the results?
I was School Board Chair of the Riverdale Country School about ten years ago when our headmaster incorporated Character into as many parts of the curriculum as made sense. One of the foundational principles was "grit."
I've read this several times over. This is so fucking brilliant it hurts.
Great piece. One component I might add relates to the more cynical and dark side of things: the weaponization of aspirational victimhood for personal gain. René Girard referred to this as “victimism, which uses the ideology of concern for victims to gain political or economic or spiritual power.”
No insights to add. Just a thank you, for an illuminating and persuasive piece that I'll be referencing in my next article.
This is too long and involved for me to have a chance in hell at rebutting debate-club style. Yet for all the excellent questions raised, the overall shape you end up with feels incongruous. To the degree that this is generational, I’d submit it’s primarily the full-throated, wide-spectrum rejection of 20th century artefacts. At the macro level, we are stampeding headlong towards quite a dark place. Is continuity of tradition out of mere habit such a great idea? Teenagers in particular dedicate so much of their brain-development quota to coming to grips with a society that has become (I propose) toxic to our souls. If I came of puberty today, I hope I’d find utterly surreal the idea of shouldering any inherited manifestation of masculinity. If I were brave enough, I hope I’d find a different path. Would I be able to articulate precisely why? Certainly not. But most of the time I believe we know what to do long before we know why. Gender is societal. If society is broken, so is gender. Dysphoria can’t always be caged in biological terms or even isolated from other goopy patterns in our communal vocabulary of identity building blocks. Surely it’s well-understood that even self-harm is often just acute distress, at a level too fundamental for words; some attempt to assert control against the ceaseless programming we levy against our young. Let them go wild, I say.
Fascinating, thought provoking, and brilliantly written! I will read this again, for sure. Thank you for your time and efforts!
Really excellent work, Gurwinder.
You may have already come across this fascinating piece by Musa al-Gharbi in your research, but if not, I encourage you to give it a read; I suspect you'll appreciate it:
How to Understand the Well-Being Gap between Liberals and Conservatives
https://americanaffairsjournal.org/2023/03/how-to-understand-the-well-being-gap-between-liberals-and-conservatives/
Thank you, Brian. I'll check it out!
I read this a while back and found it fascinating, careful and nuanced.
Excellent article and a solid complement to Guewinder’s.
Great article. As a soon to be father of a girl I am concerned about this deterioration of girls' mental health. I intend to teach her of her inherent value and her inherent power to make her own world.
As a parent of two teenage girls, one of whom has been sucked into the ROGD cult, I can only wish you the best. Know everything she does on a computer, be as involved in her education as you can, surround her with loving family and friends, get into outdoor activities as a family, and hold on. It’s a beautiful and terrifying ride.
" The newest forms of CBT, such as “Transgender-Affirmative CBT,” are the opposite of traditional CBT because they seek not to transcend feelings but to validate them."
Thanks very much for bringing this to light. It's an issue I follow in the work of other writers on the topic, that we as a society have gone into validating heavily. As Haidt and Lukianoff put it in their book, "You must always trust your emotions over reason." is one of the great modern "myths" we grapple with and has become mainstream. It sounds like, based on your writing, that even therapies branded as CBT are actually working against CBT's very principles? This isn't my area of expertise, but it's all interesting to watch, in order to see how our culture and society evolves in the next decade and beyond.
Thank you for this great piece!