Socialist Worker

Richard Layard, inequality and the 'science' of happiness

New Labour’s approach to mental healthcare is being driven by an individualist ideology and the drive to cut benefit costs, argues Iain Ferguson

Issue No. 2030

Smiley tiles

Smiley tiles


Walk into any high street chain bookstore these days and before very long you are likely to encounter a stand packed with books devoted solely to the subject of happiness.

These range from academic texts at one end of the spectrum to Positively Happy: Cosmic Ways to Change Your Life by the nauseating Noel Edmonds at the other.

The issue of happiness – what is it is and how to get it – has become one of the dominant themes of the first decade of the 21st century.

Discussions around happiness, of course, are hardly new. The relationship between happiness and other valued social goals such as justice and freedom has been a central concern of philosophers from Aristotle to Jeremy Bentham.

What is new, however, is the way in which a certain “scientific” notion of happiness has moved in recent years from the fringes of public debates to having a profound influence on the government’s policies over mental health and the welfare system.

The past few years have been marked by the development of a “happiness industry” on an international level.

This industry even has its own academic journal – the Journal of Happiness Studies. Over 3,000 articles have been published on happiness and numerous websites have been set up on the subject, such as Professor Martin Seligman’s Authentic Happiness, which claims 400,000 users.

In Britain, the key role has been played by Richard Layard, a professor at the London School of Economics who also sits as a Labour member of the House of Lords. In contrast to other key figures in the happiness industry, Layard is not a psychologist but an economist.

He is also the author of a study called “The Depression Report: A New Deal for Depression and Anxiety Disorders”, published earlier this year.

The language of “New Deals” is not accidental – Layard is an influential figure in New Labour circles and helped draw up the government’s “New Deal” for the unemployed.

The report’s starting point is that “crippling depression and chronic anxiety are the biggest causes of misery in Britain today”.

Layard and his colleagues note that one in six of us will be diagnosed as having depression or chronic anxiety disorder. That works out as one family in three being affected at any one time.

But the “good news”, as they call it, is that most of this misery is totally unnecessary and avoidable since “we now have evidence-based therapies that can lift at least half of those affected out of their depression or chronic fear”.

Good news?

This, they argue, is good news for two groups of people – not just those who are currently experiencing mental distress, but also for a New Labour government seeking to slash spending on incapacity benefit.

Layard’s report acknowledges that mental ill-health is a waste of people’s lives, but swiftly adds:

“It is also costing a lot of money. For depression and anxiety make it difficult or impossible to work, and drive people onto incapacity benefit.

“We now have half a million people on incapacity benefits because of mental illness – more than the total number of people receiving unemployment benefit.”

A key objective, then, of Layard’s report is to find ways of reducing the number of people with mental health problems currently claiming incapacity benefit. He proposes the recruitment of an army of 10,000 therapists.

Half of these would be clinical psychologists, while the other half would comprise nurses, occupational therapists, counsellors and social workers. They would be given part-time training over one or two years to become “psychological therapists”.

On the all important question of costs, by 2013 the gross costs of the service would have reached about £600 million a year, with an additional annual training cost of around £50 million.

But the report’s authors suggest that these costs would be “fully offset” by “rapid savings to the Department of Works and Pensions and HM Revenue and Customs” – presumably by removing hundreds of thousands of people from incapacity benefit.

Critical look

So how should we respond to Layard’s proposals? The first thing is to take a critical look at the basis of this new “science of happiness” – and in particular at the “evidence-based therapies” it relies on so heavily to deal with the problems of mental ill-health.

Foremost among these techniques is cognitive behaviour therapy (CBT), which is based on the notion that depression is caused by negative and irrational ideas that people hold about themselves, including ideas of worthlessness.

When something goes wrong in their lives, such as unemployment or divorce, these individuals automatically blame themselves and become depressed. The aim of CBT is to help people challenge these “automatic negative thoughts” and assess situations “objectively”.

Despite the overriding role which Layard and other “science of happiness” theorists give to ideas in the creation of mental ill-health, there is curiously little interest in any of these texts as to where these supposedly “irrational” ideas come from – or why people persist in holding on to them.

Yet as the 19th century Italian Marxist Antonio Labriola put it, “Ideas do not fall from heaven, and nothing comes to us in a dream.”

In other words, if people persist in believing that they are inferior, or even worthless, human beings, then surely we should be looking to see where these ideas are so widespread and why they seem so powerful.

Nevertheless there is clear evidence that many people find such counselling much more helpful than drugs in dealing with depression.

For that reason, we should support any initiative which makes counselling services of whatever type more available and accessible.

There are major problems, however, with Layard’s suggestion that CBT, as an “evidence-based approach”, is the answer to the high levels of depression found in society.

While there is evidence to show that CBT can be effective for people with simple, uncomplicated, mild depression, there is less evidence for its effectiveness in helping people with more complicated or prolonged depression, including depression arising from early trauma – the sort of people who are more likely to be on long-term benefits.

Moreover, Layard and his colleagues suggest that CBT should become the primary, if not the sole, form of therapy on offer, at the expense of all other approaches, including person-centred and psychoanalytic approaches.

To state the obvious, different approaches are likely to work for different people. The government likes to promote a “choice agenda” in education and social care, and continually attacks a “one size fits all” approach in these areas.

So it ironic, to say the least, that New Labour should be persuaded to adopt precisely such an approach in field of mental health policy.

The science behind CBT can also be criticised. CBT lends itself more easily than other therapies to quantitative methods of evaluation – but this is not the same as saying that is necessarily more effective.

Randomised control trials are not the only, or even the most effective, way of measuring how helpful a particular therapy may be.

And neither in The Depression Report nor in the “happiness” literature more generally is there any reference to the considerable body of research that criticises the “medical model” of treating mental ill-health as a “disease” to be “cured”. On the contrary, within the work of Layard in particular there appears to be an uncritical acceptance of this medical model.

Social inequality

But the most important objection to the “science of happiness” is the fact that it systematically ignores the entire question of social inequality.

Despite its frequent references to “evidence-based” practice, there is no discussion anywhere within Layard’s report of one of the most powerful bodies of evidence in any field of social science research anywhere – namely the tight link between inequality and mental ill-health.

In a classic study of depression among women almost 30 years ago, two British academics, George Brown and Tirril Harris, also found very high levels of depression in society. In common with the happiness theorists, they too found that in the development of depression “it is change in thought about the world that is crucial”.

Unlike them, however, they sought to locate that change in thought in a complex model which stressed the impact of people’s past and present experience, especially their experience of social class, on their self-esteem and the way they viewed the world.

That model helped explain their finding that working class women were four times more likely to develop depression than middle class women.

Layard’s silence over the question of inequality relates to the political climate in which these “happiness” theories are being proposed.

For the key themes of the science of happiness fit perfectly with the individualism of New Labour and with the policy, announced by the government in July, to save billions of pounds by removing one million people from incapacity benefit.

In this context, should Layard’s plans be implemented, one can only feel concern for those with mental health problems who, for whatever reason, have failed to attain good mental health after the prescribed 16 weeks of CBT.

Simply focusing on the ideas in people’s heads and seeing depression as an attitude problem may help get some off incapacity benefit.

But it will do little to reduce the overall levels of depression – that requires addressing the poverty, inequality and the lack of hope that blight the lives of millions across the country.

Perhaps the best answer to the happiness theorists is to revive the slogan from the 1960s: “Do not adjust your mind – there is a fault in reality.”

Iain Ferguson is a senior lecturer in social work at the University of Stirling.


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Features
Sat 9 Dec 2006, 00:00 GMT
Issue No. 2030
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