I have read the report until page 24. I admit that I did not want to go further. Perhaps I should have, for the slight hope, of finding something other than this masterful demonstration of how blind an era can become to itself. The title — “Manual for implementing psychological interventions.” Integrate psychological interventions based on evidence into existing services” (free translation) – nevertheless already announced its colors, the company too. We quickly understood that it would involve talking to us about psychological suffering in terms that are already omnipresent. Published in the spring of this year, this report from the World Health Organization (WHO) lists the most effective psychotherapies according to types of psychopathology based on evidence.
Taking up the logic of “ evidence-based medicine “, entirely embedded in the techno-scientific paradigm and reducing all dimensions of the suffering to what is observed empirically, the WHO walks in the direction of the world, that is to say towards this not even veiled desire to tell us what works, and most quickly, of course, when we are suffering psychologically.
On page 24 of this report, there is a table listing the usual typologies of contemporary psychological suffering: anxiety, depression, eating disorders, etc. Next to each of them, a treatment recognized as being the most effective; a kind of Protect yourself psychotherapy in short.
Obviously, without much surprise, psychoanalysis is completely avoided there, recommended (and in its brief version, please) strictly for adults suffering from depression. The hegemony of cognitive-behavioral therapies, brief therapies and other approaches focused on problem solving is, for its part, fully assumed.
I here reassure all my colleagues whose theoretical allegiance is cognitive-behavioral by telling them that what I do not like here is not the emphasis on this approach, which remains entirely appropriate for many people, but rather the erasure of diversity, on the one hand, and the apologia of a discourse which places evidentiary data above all other considerations in the determination of what constitutes the essential part of psychotherapeutic work.
The wars of approaches in psychotherapy lead nowhere, since we all know that one of the factors associated with the greatest therapeutic effectiveness is the quality of the relationship, regardless of the approach, the style, the objectives and, I I would even dare say, the title. I am also myself critical of a certain psychoanalysis which, like all psychotherapy, could also be transformed with culture, to create with the person who suffers a language that makes sense for them, and not to put aside its presuppositions sometimes a a little outdated (especially with regard to gender) about a person who first and foremost needs to speak out, and to be truly heard.
I therefore closed the report on page 24, having already understood where it was going, that is to say in the direction of this train already launched for years, both in our public services and in the medical offices, where the same type of therapy is constantly recommended to everyone, or in the dominant mental health discourse.
Mental health is reduced to its pathological dimensions, as if the psyche suffered in the same way as the body. Where there is dysfunction, we should therefore find techniques, advice and protocols that simply allow us to get better. Simple, effective, and absolutely in tune with an era obsessed with the functionality of humans, perceived as resources, and not as universes of meaning, mysterious, magnificent, filled with an asperity that resists smoothing, this report simply reminded me of my impression of holding in a crumbly little place, both in my office and in this column here.
In this small place of resistance, there is very little, it seems to me, to deal with this steamroller of standardization of life; a few words, a desire to find meaning and a conception of life which is not afraid of crisis, and which attempts to honor it by returning to the Greek origin of the word krisiswhich combines both the notions of rupture, of disturbance, but also of judgment, of sentence, as if something were pronounced, no longer allowing a return to the previous state, inviting an important turning point.
Isn’t this what lies at the root of every crisis in our lives? This call to transform ourselves, much more than this need for “reestablishment”, which etymologically refers to “return to the previous state”?
The crisis, in fact, does not call for any efficiency in finding as quickly as possible a way to no longer suffer, but rather a space, almost sacred, in which what needs to be transformed can be accompanied, supported, carried. This is unfortunately not what the WHO report tells us about, which continues to embrace a “crisophobic” approach to the suffering.
However, when the discourse on psychological suffering becomes in tune with what, at the time, precisely generates this suffering, there is cause for concern. What if a majority of the psychological symptoms were not linked precisely to what lingers in this era, notably an obsession with the norm, a desire to correspond to standards set in coherence with neoliberal ideals and to remain in the performative race of self ? Maintaining a posture which questions, which supports psychological suffering as sometimes being a way of resisting this same era, of standing up in a humanity which, from all sides it seems to us, is threatened with erasure, becomes a priority. And that’s not what the WHO is talking to us about here.
Adding salt to a soup that is already too salty is the impression it gives me.
And not just me, moreover, as evidenced by a petition launched by the PsiAn group (Psychotherapy Action Network), which highlights the need to maintain a diversity of approaches offered to people who suffer, also recalling the proven effectiveness of so-called “depth” or psychodynamic approaches in general, particularly for the sustainability of changes.
Crises are necessary. And if it is not necessary to suffer needlessly, it is perhaps important not to erase too quickly everything in us that pronounces the sentence that it is time to transform ourselves, to remain alive.