Happiness by rote

5th October 2007 at 01:00
Selling pupils a positive story is not a solution to depression, says Oliver James. We need to look at the pressures that cause it

What should we make of the new vogue for teaching "positive psychology"? Not a lot, if a recent review of the evidence is to be believed.

It identified 14 intervention programmes in schools designed to reduce depression and protect against it by encouraging rational, optimistic thinking and better problem-solving and coping skills. In four studies, depression was reduced after the intervention, compared with controls, but not in seven other studies. Worse still, where the pupils were followed up 12 months later, the interventions failed in every case. That is in keeping with other evidence of the effects of this approach, known as Cognitive Behavioural Therapy (CBT).

Like a form of mental hygiene, it covers the filthy dining room table of your mind with a thin veneer of positive polish. You are encouraged to ignore those difficult-to-remove marks sometimes made by childhood maltreatment.

But as Drew Westen, of Emory University in Atlanta in the USA, and many researchers have shown, two-thirds of adults treated for depression with CBT have relapsed or sought help within two years. Even just after treatment, the average CBT patient is still depressed.

After only 18 months, those given CBT have no better mental health than those untreated. In the short-term, it does reduce intensity and symptoms. But even this is questionable because CBT is akin to hypnotism.

The patient is taught a relentlessly positive story. If the therapist is skilled, the patient is able to ignore many of their true feelings, persuading themselves and others that they are feeling good. When tested after treatment, they often regurgitate the positive story, ticking the right boxes of questionnaires used by researchers to evaluate mental state. But a few months later, their negativity resurfaces. The initial gains in CBT patients may be parroting what they have been taught.

The authors conclude that focusing on the child may not be enough. Including parents whose pattern of care of the child, past and present, is a major cause of depression and the wider society, would have a greater impact.

Teachers complain that schooling has been reduced to sorting children into categories of potential employees for corporations. Certainly, the focus on exam results is a proven cause of depression among teenage girls.

Depression is twice as common in English-speaking nations, which have broadly neo-conservative, or "selfish capitalist", political economies, compared with mainland European ones which are "unselfish capitalist". (For instance, they have a smaller gap between rich and poor.) By implication, if we became more unselfish and equitable, depression would halve.

Labour has been a bad picker of interventions for well-being. Sure Start has been reduced to a giant creche. By contemplating a nationwide network of CBT for adults and positive psychology classes for pupils, it looks as if ministers are pursuing "tick the box" happiness.

If the Government really wanted to make us less depressed, it should emulate mainland Europe. It would be discouraging the workaholia, driven by property fever and consumerism, which depresses the English-speaking world and separates parents from children. But it would also be encouraging enthusiasm for children and childhood.

As Sue Palmer eloquently pointed out, formal schooling should start later and we should legislate against advertising directed at children and foster exercise as an alternative to the obesity-inducing, passive consumption of television and computer game *

Oliver James is a child clinical psychologist and the author of Affluenza How to be successful and stay sane


Review of depression intervention studies: Spence, S.H. et al, 2007, Journal of Child Psychology and Psychiatry, 48, 526-42.

Drew Westen's review of CBT: Westen, D et al, 2004, Psychological Bulletin, 2004, 130, 631 663.

Parental care as major cause of depression: Blatt, S.J. et al, Clinical Psychology Review, 12, 47-91

Evidence that exam pressure causes depression in teenage girls: West, P. et al, 2003, Journal of Child Psychology and Psychiatry, 44, 399-411

Selfish vs unselfish capitalist depression: James, O.W., 2007, Affluenza, Vermilion.

Enthusiasm for children: Palmer, Sue, 2007, Detoxing Childhood, Orion.

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