In two minds about therapy

In one corner, Dr Raj Persaud (left), champion of a radical new approach to keeping ourselves mentally healthy. In the other, Professor Anthony Clare (right), who says it won't work.
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The Independent Online
So you work out a bit, watch your diet, you've given up smoking - all because you want to stay physically healthy. But what about your mental health? Chances are not only do you do nothing specific for it at all, but you'd be hard put to suggest what you should do, except maybe watch your stress levels and learn to relax.

But wouldn't it be sensible to have a mental protection plan as well? Besides hoovering up vegetables, jogging and gulping down minerals, shouldn't we also have regular psychological work-outs, so that when crises do blow up - you are downsized, your partner leaves, a close friend dies - you don't break down?

It is an idea that has divided two top media psychiatrists. Cheerleading the proposal is the ubiquitous Dr Raj Persaud, who can be seen in the Daily Mail and Cosmopolitan as well as on most television channels. In the sceptical corner is elder statesman Professor Anthony Clare, interrogator of In the Psychiatrist's Chair. There will be a clash of couches later this week when they debate the topic at Dean's Yard, Westminster on Thursday, 11 September.

Dr Persaud's new book, Staying Sane, starts with some statistics. We are constantly warned we are becoming a nation of overweight couch-potatoes, prey to killers such as cancer and heart disease, but the toll from mental distress is, if anything, even more devastating.

Nearly half of us will have a psychiatric disorder at some time, 20 per cent of us will suffer from depression and 25 per cent will have our lives massively disrupted by drugs or alcohol problems. When the misery gets too bad we kill ourselves - 5,000 every year, while 100,000 attempt it. Most at risk are young males -- the very ones who are puffing away in gyms to keep heart attacks at bay - whose suicide rate has gone up by more than 85 per cent in the past 10 years.

Anything that can reduce this despair would seem a good thing. However, at the moment we rarely consider our own mental health until the constant anxiety or depressed days in bed become unbearable. When we do seek help it is usually some form of psychotherapy; and this, Dr Persaud believes, is a bigger mistake than not taking precautions in the first place. "Therapists are of dubious effectiveness and possibly damaging. If you have the resources to find one, handle the emotional stress involved and pay for it, you've probably got enough resources to handle the problem yourself."

What Dr Persaud offers his patients at the Maudsley hospital in south London is something called cognitive psychology, which, unlike psychotherapy, isn't interested in what Mummy and Daddy did. "There are about 460 varieties of therapy but all of them believe that to relieve distress you have to find out what's causing it, and that means investigating its roots in childhood, sometimes for years," he says. "But research shows that's totally unnecessary. About 50 per cent of people who have terrible childhoods don't have problems as a result."

Cognitive psychology ignores the past and concentrates on helping the patient to deal with problems that are affecting them now. For instance, many people who seek psychological help either feel trapped in loveless or abusive marriages or they are miserable because they can't get into a relationship in the first place. What a cognitive psychologist does is to show them ways of making relationships work rather better.

"There are simple but effective ways of letting your partner know what is upsetting you and what you'd like done about it, without starting an unproductive slanging match," says Dr Persaud. "Depression is another big area where learning to change the way you think and act can bring enormous benefits. We know that mentally healthy people have a positive image of themselves, so we teach depressives, who are very negative about themselves, how to develop a more optimistic outlook."

In fact, we now know quite a bit about what it is that mentally healthy people do that saves them from cracking up. For instance, they have quite complex lives, so that if something goes wrong in one part - their job - that doesn't mean everything else collapses. They are good at making intimate relationships; they have a feeling of control over their lives; they have a generally positive outlook and look on the bright side when things go wrong; they like themselves; they have long-term goals; they can control their moods; and they are good at problem-solving.

So Dr Persaud's proposal is that when you realise that you are a bit shaky when it comes to these health markers - possibly as a result of doing the quizzes in the book - then it is time for a bit of psychological circuit-training. In the same way that someone at risk of heart attack should cut down on fat, so someone at risk for depression or panic attacks should take up psychological aerobics to shift them on to the sunny side of the street, where they are much more likely to stay mentally healthy.

Superficially logical as it may sound, Prof Clare is not at all convinced that such a mental hygiene programme is either feasible or desirable. "I think he's rather oversold cognitive psychology," he says. "I admit there are lots of problems with psychotherapy, but for the life of me I can't see that the cognitive approach is such a wonderful alternative. It's good for certain things like anxiety, depression and obsessive-compulsive disorder, but otherwise its success rate isn't that good."

But the problem goes deeper than cure rates. "I work with executives who have lost their jobs," says Prof Clare. "There's no point in telling these people to cultivate wider interests. Late 20th-century capitalism demands people give their all to the company. I don't think Persaud has any sense of the wider social reality."

The cognitive remedy may be fine for fixing the psychological equivalent of the walking wounded - the slightly worried, the angry husband, sad wife - but it doesn't offer much to the ambulance cases.

"Psychiatry developed as a discipline because it's hard to get people to change," says Prof Clare. "Persaud has this no-nonsense approach to mental problems - moderation, balance, common sense, bit of backbone and you'll be fine. I think that for people in serious distress that's bordering on the offensive."

And even if it did work, what would a cognitively shaped world look like? "It has a horribly bland feel. There's no sense of the sheer tragedy and pain of people's lives. It's a suburban vision with the lawns all mowed, the car polished and all the housework done. I don't know that I'd like to live there"n

How much do you like yourself?

People who are mentally healthy generally like themselves. Being at the mercy of a critical internal voice that constantly points out your shortcomings is linked with a tendency to depression. To see if you are at risk, answer the following questions as either "Agree" or "Disagree". 1 I can do most things, not just my work, as well as most others. 2 If others knew more about me they would like me less. 3 If others don't like me it's usually due to them, not me. 4 There are many things about me I dare not tell anybody. 5 I have very few regrets about things I did in the past. 6 When I think about myself, I focus on what needs to change. 7 My parents think of themselves as lucky to have had me. 8 Most people do not like themselves most of the time. 9 I was born with several talents that few other people have. 10 I swear as much at myself as at others.

Score one point for Agreeing with 1, 3, 5, 7, 9 and one point for Disagreeing with 2, 4, 6, 8, 10.

If you score 10-8: You like yourself a lot and so you are confident about getting on with others. However it may come as a shock to realise that others don't always share your high regard for yourself. You are not brutally honest with yourself over your failures.

Score 7-5: You're just above average, maybe because you generally feel good about yourself or because something good has happened recently. It is worth realising that your liking dips when things don't go so well. That's when you need to be kind to yourself.

Score 3-4: You score just below average and you probably had lots of criticism at some time that means there are parts of yourself you don't like. Consider the possibility that what your critics said revealed more about them than about you. Find people you trust to point out your good points.

Score 0-2: Much of the time you really don't like yourself. You need to find people who make you feel good about yourself, although you probably find yourself with people who reinforce your negative view.

`Staying Sane - How to make your mind work for you. by Dr Raj Persaud is published by Metro. Dr Persaud and Professor Clare will debate on Thursday, 11 September, 7.pm, at Church House, Dean's Yard, Westminster. A pounds 10 ticket gets a pounds 5 discount on the book.

Details: 0171-420 1000.

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