When I first came across his blog, Damian Counsell was a research scientist in Cambridge. Then, in August 2005, it all changed. The Rosalind Franklin Centre closed down, and he moved to a new career in a totally different field, and to a different home, in Brighton. Damian is now regarded by discerning people as amongst the very best photographers in the south of England, producing images full of warmth and proper humour. He has also worked for the EU, and was a founder member of the blogosphere’s best known Oxford University alumnus group.
But ever since Cambridge, there’s been a link on his blog pointing back to those days. It reads, â€œI used to be Damian Counsellâ€, and it’s a nonserious reminder of just how much our identity and our job can coincide. It’s always brought to mind for me a dusty Italian hillside, Roman soldiers, and hundreds of slaves in chains, who, threatened and challenged, one by one rise to their feet and cry â€œNo! I used to be Damian Counsell!â€
Now it’s my turn to investigate that self-and-job concept. A mix of eighty percent personal incompetence and twenty percent Northern Rock crisis has brought my psychotherapy practice crashing down. A future, long in the planning and the subject of a decade’s work, is gone. As you read this, I, too, used to be Damien Counsell.
It could be so much worse, of course. It’s only a job, and I could be Rachel From North London or Gary Farber or one of the many bloggers I read and benefit from whose lives have been a great deal less blessed than my own. (See if you can’t help Gary out while you’re there).
Barriers to entry were what brought me to it initially. My generation left university in the middle of the last Tory recession, and the traditional graduate recruitment drive had closed for the duration. None of my friends entered their career of choice, or have made it there since. I ended up working in a series of London public libraries, in one of life’s â€œhidden jobsâ€ which outsiders know nothing of beyond their own inaccurate clichees. I loved it, to tell the truth: no money, even less status, but it was a people job, and my colleagues were the best people in the world. Some later made names for themselves â€“ the poet Paul Farley, for instance, or Film4’s correspondent Ali Catterall.
My family had a tradition in business, however, and it was one I wanted to follow. But I had no capital â€“ less than none after my first startup went for a burton in its first six weeks.
Neuroscience and psychology were just hobby interests then. One sunny afternoon, I was sitting up on the mezzanine of my Earls Court flat, dragging on a cigarette and paging through Allen Carr’s Easyway to Stop Smoking when it struck me, in true entrepeneurial fashion, that here was a problem that lots of people had. If I could find an answer to it, then I’d have a business on my hands, and one moreover requiring only minimal funds to get going. Who knew â€“ I might even be able to stop smoking myself.
I spent the next year wading through bluejacketed BMJ and Lancet archives, and their multifarious rivals, reading every peer-reviewed paper on the subject of smoking that I could find and get access to. No Google Scholar back then. And I talked to smokers, and stopped smokers, ad nauseam, more than a thousand of them in the end. Patterns emerged, which I used in half-day seminars in a West Kensington hotel. These were hard to fill, and those who came kept asking me if I was a hypnotherapist. I found that insulting at first.
Barriers to entry, you see: had the resources been there, I’d have gone back into education and done a Raj Persaud double of qualifying both as a psychiatrist and a clinical psychologist. Instead, I crept into the psychotherapy world by the back door, with a diploma in hypnotherapy. That’s not to cause offence to friends and colleagues, but it was how it felt and how it was. Once in, I intended to do my own thing anyway.
That diploma was enough to set me up in professional practice.. How long ago it feels. And how wrong I was about so much. Private psychotherapy â€“ for that’s what it became â€“ is not a low-capital start-up. That was my fantasy, pure and simple, maintained because I wanted it to be true.
I’d joined a clinic in Botley, west of Oxford. On my first day, Osney Island flooded and then froze. I waded it: there was radiator time for my suit trousers and shoes before my client arrived. Elsewhere in England, those hypnotherapists daft enough to turn out early on a wet, cold Sunday morning had either started with sufficient capital or else saw the job as a nice part-time hobby alongside their main income. Or else they were deluding themselves, as I was. The money in therapy is not in therapy itself, but in training, in seminars, in the provision of services to therapists. I know that now.
The enjoyment in therapy isn’t in therapy, either. Daniel Gilbert’s written a minor bestseller about how askew our predictions are about what we will and won’t enjoy. I imagined a pleasant, book-lined room, confidence in what I was doing, satisfaction in the results I would help people to achieve. I saw myself broadcasting and using the gaps between client sessions to write books and articles on a walnut-cased laptop. (I know..)
The reality has been a series of poorly-decorated rooms, along with my own perpetual and petulant dissatisfaction with the state of human knowledge about abnormal psychology â€“ along with my obsession not with successes, but with the people whom, with the best will in the world, I was unable to help. The pleasures were elsewhere: planning student services in the Magdalen SCR as spring sunshine leapt through the coloured windows, or talking football with Jim White on camera, or lecturing in panelled rooms in London and Surrey, or spotting my byline in the Times. Whatever the reality and wherever the pleasures, the bottom line was always red.
No one tells you what a solitary business it is. I have never spent so much time alone as I have in the last few years. In part, this is because of lack of funds. Invitations are refused, holidays not taken â€“ nothing more than a weekend away in six years, and those all on tick. I don’t mind my own company, but…
So I don’t think I’ll miss it all that much.
I wonder how different it would have been had psychotherapy been a British invention.
Therapy is the product of thought experiments conducted by a series of foreign men with a penchant for bow ties. In the time of Freud and Kraepelin, thought experiment was – almost – all you could do. Even in more recent times, significant numbers of the major psychiatric drugs, drugs which have saved the lives of millions, have been accidental discoveries.
The foreign background matters. Mental health, for those of you who don’t follow the subject, is heavily culturally determined. Disorders that Freud saw every week are now rare birds, even in Vienna. Gone are the fugues, the glove anaesthesias, the hysterias. But they still crop up in the Far East and the Indian subcontinent, along with a host of uniquely local variations.
I suspect on anecdotal evidence alone that there are even regional variations between places as close and connected as London and Surrey.
Just as the problem is culturally determined, so is the solution. A solution devised to fit wealthy Viennese, or middle Americans, is one not devised with the British in mind. It’s always going to be a bendy bus, for all that it longs to be a Routemaster. It might just get you where you want to go, but it won’t be much of a ride, and half the time, you’ll get off in disgust and dive onto the tube instead.
Little wonder there’s so much scepticism and suspicion of psychotherapy in Britain.
It makes me wonder what kind of beast a British psychotherapy would be. I know one thing: it wouldn’t be called â€œpsychotherapy.â€ Ugly word. All people want to do is feel better. I think it would be thoroughly peer-reviewed. It might have positive things to say about restrained emotional display. It would be unambitious but effective within its scope. It would be something your local doctor could take with him in his bag, or feel able to refer to without misgiving.
It would be something Ben Goldacre might approve of. But the very existence of Ben’s column and website is a straw in the wind. For all his efforts, and those of the likes of Richard Dawkins, Dan Dennett, for all that it’s a stunning golden age of popular science writing, the wind’s in the east. I suspect that just my qualifying as a hypnotherapist helped that wind; if so, it’s something I regret.
In the past, I’ve leaned to some extent on the knowledge that hypnotherapy has has a place in the NHS since the early 1950s, and that it’s recognized by the BMA. These things are still true. It’s just that I’ve come to question how much all that means. Homeopathy too is available on the NHS.
Homeopathy has a deservedly bad reputation for obfuscating the research issue. Psychotherapy might do too. CBT, it’s true, has a host of research studies behind it, but until recently those studies had been made possible only by the discounting of hard-to-measure things like the relationship of therapist and client, which CBT practitioners are coming to regard as more important than they once did. (The likes of the impressive Professor Paul Salkovkis and certain of his peers are completely exempt from this – and I don’t want to make general aspersions anyway).
There’s also something of a gulf between psychotherapy and neuroscience. (Less of one between psychiatry and neuroscience, as you might expect). For instance, the consequences of this paper for the basic theory behind CBT are surely devastating
(https://content.nejm.org/cgi/content/extract/340/19/1476 Well worth registering for, by the way.)
There is very little serious research on hypnosis or hypnotherapy in existence or underway. Nor is there much in the way of thinking what such research might consist of, or what questions it might seek to explore. Hypnosis and hypnotherapy roll on just outside the aegis of proper science, recipients of enthusiasm or disgust depending on the individual. As a therapist, when I heard my clients utter phrases such as â€œI’ve got a very open mindâ€ or â€œI do believe in this sort of thingâ€ I felt nothing but dread and pessimism. The placebo effect exists, but who would want to build a career on it? And, given that the placebo effect boils down to physical expression, chemically and electrically within the brain and body, neuroscience will overtake it sooner or later, with who knows what results. Pace Dawkins, but placebo might be one rainbow likely to be unwoven in time.
Whatever the status or not of the relevant research, the fact remains that for an ever-increasing number of people, complementary and alternative medicine are very attractive ideas. Of course, cognitions have aesthetic as well as logical sides to them.
I realize now that my Anglican faith was entirely a matter of aesthetics: I preferred the look and atmosphere of the Church of England to the ’70s pop culture on offer to my friends and myself. It had a more serious feel, an underpinning, a permanence and a point. I felt, only vaguely consciously, that there had to be something to an organizational tradition that had so much beautiful architecture, so much stunning music, painting, poetry and the loyalty of so many brilliant men and women through the ages. I loved the hole for the doughnut, in short. What the hole consisted of didn’t worry me very much, and yet it was the hole my non-Christian friends wanted to take issue with me over. I felt then that they were missing the point. We’d both missed different points, and that’s something I see happening time and time again as that debate moves into the media mainstream. I missed the logic and grammar; my opponents missed the aesthetics.
But that’s how people work â€“ I still function in this way over a myriad of things, and so do you. And the aesthetics of an idea have the prevailing imperative over the idea’s logical and grammatical integrity. What’s more, it can be hard to divide the parts up, often impossible. Western political discourse is strewn across with this. So’s political blogging.
I consider myself fortunate to find beauty, awe and wonder in science. As I’ve said, I’ve lived through an era of fabulous science writing. At school, it looked dry, dull and limited; it won’t do again for me, but that impression remains with many or most people.
In that context, alternative and complementary medicine look welcoming, colourful, warm, optimistic, kindly and alternately exciting and down to earth. Famously, it has time for you. It’s the pseudomedical equivalent of â€œCheers.â€ These aesthetics provide a swift, elegant means to assess the personal validity of a thing, and, as with all aesthetic issues, different people take them in different ways.
If we like something, if we’re attracted to it, then it’s human nature to defend it. How many people feel constrained from making comment on a religion or a therapy because they know and like and respect someone involved in it? To me, that can feel like attacking the man for all that I know I’m only going for the ball.
Unless, of course, one wants to go for the â€œmanâ€. Aesthetics can help you out when logic and grammar do not. There are, out there, somewhere, substantial criticisms of Richard Dawkins, but they are hard to find in among the swarm of aesthetic ones, the â€œshrillâ€, â€œdogmatic,â€, â€œfundamentalist,â€ â€œarrogantâ€ (that last is especially British, don’t you think?) â€œneo-Atheistâ€ (gosh! Does that mean they’re something like those…. neo-cons you told me about?) and so wearily forth. Martin Amis has been getting much the same lately. In relation to homeopathy, so has Ben Goldacre, and in that case, something that is ordinarily done unconsciously and as a matter of course was done rather more deliberately; he took it with enormous humour and patience.
I have wanted things to be true, and so behaved as though they were true, and in much of my life that’s served as a convenient compression codec: I live my life as though Yellowstone won’t erupt during it or the comet strike Earth. But there’s a difference between wanting, or being inclined towards, and what can turn out to be the case. I thought I was stubborn, a sticker, one who persevered against the odds, when all I was was a fool with money.
I won’t miss it â€“ not the clinical side. But I have something related coming up that I will enjoy and which I think other people will enjoy too. And this site will go on, but more as a hobby than any expression of my erstwhile job. Of course it will; as he who used to be Damian Counsell showed, what will remain of us are blogs.