[This piece first published in The Journal of Critical Psychology, Counselling and Psychotherapy, 2, pp 175-187]

Counselling, Psychotherapy and Moral Responsibility

Christopher J. Willoughby

Counselling and psychotherapy lack moral responsibility by failing to acknowledge and act on the evidence that social determinants exist as the source of most patient (user) anguish and disadvantage.

It appears undeniably the case that we live in a violent, judgmental world, fraught with conflict and confusion. While life for many of us may be physically safer and materially better than it historically has ever been, the social and interpersonal infrastructure in which we live appears to be in a not dissimilar condition to that of our outdated British transport system. It is hardly surprising that the rage, insecurity, frustration and general tedium of having to live in a sometimes brutal and inept commercial managerial environment should elicit the kind of conduct from which mental health professionals (therapists) make their living.

A great deal has changed since the optimism of the post war consensus. In those days, get a good job and your future seemed assured. Of course, this idealistic view was grounded on values and priorities that have long since been abandoned. As a patient (user) in the British NHS, the rapid pace of change - much of it gratuitous - and the unjustifiably expedient way in which people are treated leaves me feeling alienated and demoralized. I believe that many of the problems associated with demoralization, and discussed in therapy as difficulties around distress, relationships and meaninglessness, are attributable to our existing social values. Those with the greatest audacity and the 'thickest skin' succeed or even thrive, while everyone else flounders or is allowed to 'go to the wall'. The sources of 'distal power' (Smail, 1996) that lie behind this noxious environment have no identity only managers as representatives. They gain influence by means of social structures that often lack moral propriety (Bok, 1978; Kane, 1994), through political structures of questionable political legitimacy (Kane, 1994; Lindley, 1986) which create an environment of mistrust and cynicism. Much of this grim reality emanates from the values of individualism (Fox and Prilleltensky, 1997; Pilgrim, 1997; Smail 1987), out of which emerges a confusing world of pluralism and uncertainty (Kane, 1994) where to be stoical and infinitely adaptable - resilient, like some of our disgraced politicians and greedy captains of industry, perhaps? - appears to be the only survival strategy.

The other disappointment is that therapists who have, for historical reasons (Newnes, 1999; Pilgrim, 1997; Pilgrim and Treacher, 1992; Treacher and Baruch, 1980), 'cornered the market' in dealing with the inevitable casualties of this toxic environment, appear oblivious to the social origins of psychological distress (Moloney, 2001, p.210) by themselves becoming enmeshed in the pursuit of their own self interest (Doherty, 1995, p.17; Pilgrim,1992, p.226; Smail, 1992). Inebriated by the excessive consumption of conventional psychology, they are like the drunk grovelling about under a lamp-post one night who exclaimed, 'I lost my keys over there, but the light's better here!' Thus, by concealing the social origins of mental anguish (Williams, 1999) and by cutting off the prospect of more constructive interventions (Conrad, 1979 & 1980, p.119), therapy, like the status quo it supports, is morally vacuous.

The crisis of capitalism

Human beings are significantly determined by social and cultural circumstances and are subject to the social and moral order that provides the norms for accepted conduct (Lock, 1981, p.21). In the past the moral order of Western culture was based on the legacy of Judaeo-Christian principles; but a decline in religious authority, human scale communities with which one could identify, and the increasing willingness of people to challenge authority and 'do their own thing, has led to a paucity of moral guidance through the twentieth century. This has been exacerbated by the values of the social order, which is now firmly gripped by the hegemony of a ruthless monopoly capitalism. An epidemic of psychological distress at the present time James, 1997) has led some to attribute it to the dehumanizing effects of Business Culture (Cummins & Hoggett 1995; Lindley, 1986; Pilgrim, 1997, Smail, 1996; Williams 1999). With disarming candour, the economist and adviser to former Prime Minister Thatcher, Professor Brian Griffiths (1989) acknowledges the reprehensible character of capitalist economies, yet he defends them by arguing that the market economy has proved itself remarkably successful in providing benefits beyond those achieved by any other economic system. The Crisis of Capitalism to which he refers, arises not out of the system itself but the absence of strong moral principles to regulate the tension between freedom and control.

I have never met anyone who objected to capitalism because it relied on the freedom of the individual to buy and sell, to produce and innovate, to save and invest. But 1 have met many who objected to the kind of society it has created because of its injustice and inhumanity. My contention is that both the injustice and inhumanity of capitalist societies result inevitably from the failure to assert certain absolutes and so place proper limits on the use of freedom. (Griffiths, 1989, p.29)

The apparent absence of 'certain absolutes' suggests that either 'market forces' make them unnecessary or that they are not humanly possible. Yet the existence of an epidemic of mental suffering attributable to a political and economic system devoid of moral constraint, suggests that the case for a more balanced approach to life (Kane, 1994, p.58) by establishing some absolutes in a clear moral order is at least, worth considering.

Vignette 1

'George', as his colleagues and students knew him, had by all accounts been born in eastern Europe and came to Britain during the late 1950s. He had considerable ability in his area of expertise and taught in a community college. A relationship with George was like walking on eggshells. There were days when he was generous, humorous and a delight to know. On other occasions the slightest wrong word would throw him into a rage, leaving both his students and colleagues anxious and perplexed. It was not unknown for him to occasionally reduce someone to tears.

George never spoke about his past except for one unexpected occasion during a coffee break with some of his colleagues. He briefly mentioned, in a matter of fact way that, as a child during World War Two, he had witnessed the execution of a group of people. Those who heard him were shocked, although no one felt able to press him further, and he never mentioned it again.

George had 'difficulties’ adjusting to the introduction of a business culture in British education, and reluctantly accepted an early redundancy package, much to everyone's relief.

The moral order

The need for ethical standards based on moral principles to guide personal conduct and social affairs has long been accepted (Stadler, 1986. p.3). Historically, the Golden Rule has been used as a basis for moral conduct in many religious and moral traditions (Kane, 1994. p.34). It has both a positive and negative form, and invites us to put ourselves in the place of those affected by our actions (Honderich, 1995, p.132). For example, in Christianity: 'All things whatsoever ye would that men should do to you, do you even so to them: for this is the Law and the Prophets' (Matthew, 7:12), or in Confucianism: 'Surely it is a maxim of loving kindness: Do not unto others that you would not have them do unto you.' (Analects, 5:1517)

Yet the Golden Rule is often too loosely defined and open to compromise. Robert Kane addresses this difficulty through a refining which he describes as 'the wide version of the Golden Rule', and is consistent with what he develops as the Ends Principle (Kane, 1994); a reworking of the philosopher Immanuel Kant's notion of people as ends in themselves rather than as means to an end. The Ends Principle insists that although we may believe we are right and others wrong, it requires us to allow for the possibility that they may be right by providing them with an opportunity to prove it to our satisfaction through an attitude of openness.

The attitude of openness can be translated into the language of 'ends' and 'means', if we say that to treat persons as ends (in themselves) is to respect their points of view, and hence their values (as the attitude of openness requires), thus allowing them to pursue their purposes, desires and images of happiness without interference. And to treat them as means to our ends would be to impose our purposes or desires upon them, forcing them to do what we want against their wills. (Kane, 1994, p.21)

The Ends Principle then defines the basis of the moral order and is thus defined as:

Treat every person as an end and not as a means (to your or someone else's end) whenever possible. When it is not possible, strive to sustain this ideal to the degree possible, by choosing those actions that will best restore and preserve the moral spheres (in which everyone can be treated as an end). (Kane, 1994, p.26) (Author's emphasis)

The reciprocity inherent in the Ends Principle assumes that everyone will conduct him or herself in the same manner and thus preserve the moral sphere as the absolute. This may appear unrealistic when other people do not conduct themselves in the same manner. People who behave morally well are clearly at a disadvantage in a competitive environment where they more or less share the same values, but where there is no absolute guiding principle. It therefore has to be accepted that those who wish to pursue an agenda of selfishness will do as they please. Morality cannot apply to those who equivocate and are bent on doing harm. For those who have no interest in obtaining power to advance personal gain life is treated as an aspiration or quest:

To love all others unqualifiedly in the sense of the Ends Principle was impossible whenever the moral sphere broke down. But the ideal of loving all - agape - guided us even when the moral sphere broke down. We try to depart from this ideal as little as possible in an imperfect world when we must depart from it to some degree, a goal from which flowed all the ethical implications of the Ends principle and its exceptions. In other words, it was the attempt to sustain the ideal of respect for all to the degree possible under adverse conditions that brought us to the goal...This places the ethical task firmly in the realm of aspiration - makes of it an ethical quest, which is an essential part qf the broader quest for objective worth in life. (Kane, 1994, p.85) (Author's emphasis)

Work in a service capacity recommends itself to this ideal as it is ostensibly for the benefit of others. Yet service providers have to remain ever vigilant that their praxis remains morally clear and avoids compromise by becoming subject to the expedient behaviour of others through the exercise of power over the 'social space-time' (Smail, 2001) [existential space] we share.

Existential space and morality

If people are to enjoy psychological stability they require the kind of existential space through which this can occur. How each one of us behaves not only affects how we privately feel but also how those around us feel and behave. Both the moral and social order provide the implicit rules by which we can engage with one another in mutually beneficial ways. Therefore, in a very real sense, my behaviour and that of others is determined by what is permitted in the existential space we share. The idea, commonly held, that how I act and feel is determined entirely by me as an individual simply does not bear close scrutiny (Nightingale and Cromby, 2001). When Gruen (1988) claims that we can become subject to the will of others, he is pointing to those occasions when some people assume positions of power and use the absence of a clear moral order to their advantage.

Yet such is the interconnectedness of life, what the Vietnamese Buddhist teacher Thich Nhat Hahn (1987) refers to as 'interbeing, that the abuse of power and self-interest is only undertaken at the expense of another person. Self-interest has to align with mutual interest through an attitude of generosity and openness or we eventually all suffer; we either sink or swim together. In this sense morality is as much a political matter as it is personal. The plea for the political creation of a more constructive existential space would allow for differences between people in what is permissible at the interface of the private and public. Political intervention would inevitably necessitate inhibiting excess at both an individualist and collectivist level through the maintenance of the moral order as the absolute. This would no doubt be resisted by those who believe their narrow interest is furthered by adopting selfish behaviour. Yet for politics to be relevant and enhancing it has to bring about the kind of existential space whereby people can behave morally as a social entitlement. As the agency responsible for public policy, government could facilitate this by advocating employment and delivery policies in the services for which it has responsibility. In other words, the restoration of the much needed public service ethos.

The tyranny of convention

Primal societies often have initiation rites of passage from childhood to becoming an adult. The process of socialisation is complete when the child is able to assume the responsibilities of becoming a valued member of the community whilst also appreciating the mystery of life at a personal level (Campbell, 1988). The philosopher Alan Watts (1994) likened it to desalinating preserved meat to make it edible; a necessary act of curing children of the sometimes deeply damaging process of education and socialisation. Children born into 'civilized' Western societies have no such transitional healing, other than to be socialised to obedience, power and authority (Gruen, 1988; Liedloff, 1975) through the roles of servers, producers and consumers. The consequences can feel like being made to wear a suit of clothes that does not fit properly. The child pulls itself in here, and expands itself out there to make it appear that the garment fits perfectly for fear of provoking disapproval of significant others. But inside it hurts, because the process cuts us off from a spontaneity and sense of autonomy that is essential if we are to enjoy a feeling of well being in the world.

According to Watts, there are some historical reasons why this occurs.

[W]e have identified our social and moral conventions with the will of God, with the Absolute itself ... with altogether excessive authority. As a result, a person feels a conflict between a moral convention and his natural feelings finds himself at odds, not only with his family or his community but with the very root and ground of life. (Watts, 1994, pp.108-109)

When the transcendent basis for morality disappears with the death of God so does the moral guiding principle for social conduct. Rules become modified and finally dispensed with altogether, leaving the position of moral constraint vacant. The vacancy is filled by the relative and plurality and revealed most powerfully through politics, business, science, vast amounts of information presented as facts, and ultimately convention itself. Life is increasingly perceived as a cacophony of relative relationships producing instability through uncertainty (Kline, 1994); yet the need for an absent Absolute Authority remains. In the individual this state of affairs emerges as a 'moral fanaticism.',

[A] fierce anxiety to be right, which, because it is an attempt to resolve inner conflict of a peculiar intensity, is often utterly blind to the injury which it does to other people. This is one of the many senses of the proverb that the road to hell is paved with good intention ... (Watts, 1994, p.109)

Therapists, amongst care workers, are often held by this expression of moral fanaticism, frequently finding sanctuary in a psychological theory that explains other peoples 'unacceptable conduct while providing themselves with redemption on a road of good intention. The psychological theories on which their praxis is based derive from a conformist or traditional psychology (Fox and Prilleltensky, 1997) that adopts an obedient and unquestioning stance towards the values of society. For the psychologically minded are no exception in seeking an authority as an absolute to relieve their own inner conflict and find it in a therapy of individualism of one brand or another. All therapists whatever their theoretical orientation try to persuade the client to accept reality as it is, principally because this enables the therapist to take on a helping role, provides financial benefits and permits a preoccupation. with their particular vision of reality. Yet by focusing on the private and psychological to the exclusion of the social and environmental they have ‘overemphasised individual self-interest, giving short shrift to family and community responsibilities’ (Doherty, 1995, p.7), and thus become detrimental within the predicament they seek to resolve in others.

The other response to inner conflict is by way of,

[V]iolent reaction against the entire system of convention and theology which provokes them. When the mores are impressed upon us with too great a weight of authority, we are apt to turn against them with an acrimony which throws out the baby with the bath water. (Watts, 1994, p.109)

An inability to psychologically tolerate our social circumstances can lead to social alienation through behaviour society finds threatening, embarrassing or uncooperative and inefficient. Moral fanaticism is revealed in mental health users when they withdraw from convention with an escape into their 'symptoms' (Gruen, 1988). Their 'rule-breaking behaviour' (Frank and Frank, 1991, p.278) is medicalized and regulated (Ingleby, 1980, p.43; Pilgrim, 1997 p. 22; Smail, 2001) by the provision of a sanctuary on the 'sick role' (Conrad, 1979 & 1980, p.107; Treacher and Baruch, 1980, p.139). This persists until such time as they are able to make the necessary adjustment and accept social circumstances as they are, sometimes with the help of a therapist. Yet in looking to a therapist for a resolution of their difficulty they spend time with a person who is trying to resolve their own inner conflict by recourse to the other extreme of the dichotomy. The 'tyranny of convention is complete' (Watts, 1994, p.110), and so is the cycle of enduring psychological misery. Just as the child was required to fill out an ill-fitting garment so the citizen now has to lie on the Procrustean bed of social convention. No dissent, no room for saints or lunatics, 'anyone different is pressed into a diagnostic system.' (Parker, 1999, p.108) in the name of what has become a veiled secular Absolute Authority. Difference becomes deviation, deviance or inferiority (Burman, 1997, p.137).

Vignette 2

Alex had been a history teacher for twenty-five years before he finally left the profession he loved. His teacher training had taken place in the late 1960s when child-centred education was promoted as the preferred educational philosophy. The highly influential government inquiries into education at the time Known as the 'Plowden Report' (1967) [primary education] and the ‘Newsome Report’ (1963) [secondary education], promoted the idea that 'children were candles to be lit rather than vessels to be filled'. Alex accepted this view and felt it supported his professional identity and enthusiasm for his subject, which he taught with passion and conviction. His pupils also appeared to appreciate this approach, although not in ways that were easily quantifiable.

For most of his teaching career Alex had been allowed to use his judgment and discretion which helped maintain his morale and gave him an important sense of job satisfaction. Then came the upheavals of the 1980s and'90s, and he came to feel increasingly marginalized and undermined by a formulaic and directive approach to teaching. His workload. increased, although little if any appeared to contribute to an improvement in the quality of teaching and learning in anything other than management terms. There was little doubt that the educational philosophy in which he believed had been replaced by a different 'pedagogical guiding star'. It was with this thought that he remembered the reference: 'The German schools, from the first grade through the universities, were quickly Nazified. Textbooks were hastily rewritten, curricula were changed, “Mein Kampf” was made - in the words of “Der Deutsche Erzieher”, official organ of the educators – “our infallible pedagogical guiding star” and teachers who failed to see the new light were cast out' (Shirer, 1960, p.249).

Military mindedness

In his scholarly book on the history of militarism the historian Dr. Alfred Vagts (1959) draws a distinction between 'militarism' and the 'military way'. The military way is one with which most managers and entrepreneurs will not be unfamiliar; that of winning their primary objective with the utmost efficiency and the least expenditure of human and physical resources in the most scientific way. Militarism rejects the character of the military way and ‘displays the qualities of caste and cult, authority and belief’ (Vagts,1959 p.13). It permeates society and,

[C]overs every system of thinking and valuing and event complex of feelings which rank military institutions and ways above the ways of civilian life, carrying military mentality and modes of acting and decision making into the civilian sphere. (Vagts, 1959, p.17)

In my view, the military way provides a pattern for 'militarizing minds' in the adoption of an essentially authoritarian and adversarial approach to civilian life (Cf. Galbraith, 1996, Ch.13 ‘The Autonomous Military Power’). This is no more apparent than in those spheres that have a profound influence in determining the structure of the social order in which we live. Politics, the judicial system, business and employment, all possess an adversarial military mindedness, sometimes revealed in the language used to describe their endeavour. Professor Paul Hoggett (1997) cites the following from business literature:

We are moving from the set piece trench warfare of Flanders in 1914-18 toward the quick response jungle war of Vietnam. Seventy years ago great armies moved on detailed instructions of supreme commanders and their general staffs. Today we, need the flexibility of response seen in a well-led fighting patrol, harnessed within the vision that ensures a victorious campaign. (Belescoe, 1990, p.174)

Try becoming more attentive to the use of military metaphors particularly through the media, and it seems to reinforce the point. At a more fundamental level this tendency may be regarded as a predilection for power and control over altruism and social solidarity.

People who have made the most successful societal adjustment actually turn out to be the weak ones. To conceal this fact, the 'well adjusted' have for millennia been propagating the myth that sensitivity means weakness. They are the ones who try to escape all pain and suffering by a split in their consciousness; they are the ones who perpetuate a distorted view of reality, that is, the ideology of power and domination. (Gruen, 1988, p.26)

Yet we find therapists' perpetuating the values of the so called 'well adjusted' through upholding the 'tyranny of normality' (Smail, 1996), by means of subtle forms of coercion (Dorpat, 1996; Willoughby, 2001).

Vignette 3

Gill had taught part-time as a college lecturer for many years, and was finally offered a full-time appointment where she quickly established herself at the centre of initiatives in course development and college management. Whilst her ability as a teacher and manager were never in doubt, many of Gill's colleagues found her 'difficult to work with'. There was an intensity about Gill that left you feeling drained even after the, briefest of conversations. She had a number of absences from work through sickness, and on one occasion Tom, a colleague, caught sight of her doctor's medical certificate on the secretary's desk. It described her as suffering from 'neurasthenia'. Tom had no idea what this meant and asked his mother who had worked as a nurse during the 1940s. 'But that's what we used to call shell shock’, said his mother, 'I saw service men suffering from that during the war’ Tom was puzzled, ‘What's a college lecturer doing suffering from shells shock?’ he thought.

Shell shock and abstraction

The development of clinical psychology and psychotherapy through the twentieth century owes a great deal to the treatment of traumatized combatants during the First World War (Pilgrim and Treacher, 1992). Stone (1985) claims that the legacy of shell shock was immense for the future trajectory of psychiatry, psychology and psychotherapy. The establishment of psychotherapy in Britain arguably had its origins in this period when Freudian ideas, which had previously been rejected, gained an important foothold in psychiatry through their application with shell-shocked casualties. Occupational 'neuroses' and the problems of industrial productivity in the 1920s also owed a great deal to this wartime work. Stone acknowledges Armstrong's (1980, p.293) view that 'the “medicalisation of the mind” characterized by the “invention of the neuroses” at the level of medical discourse' became established through the upheavals created by this condition and adds,

This problem did not go away when the war ended but remained in the form of a large number of 'neurasthenia’ ex-service men who besides requiring expensive medical treatment and being unfit for work were responsible for an enormous pensions bill. (Stone, 1985, p.248)

From the shell shock doctors of the 'Great War' to the problems of stress, anxiety and reactive depression today, mental health continues to take on a regulatory role as it grapples with the social and financial consequences of dealing with the sensitive non-compliant user. The historical legacy of the 'medicalisation of the mind' combined with the professional self-interest of therapists' continues to stifle a wider social view. Culturally, the Western mind reveres individuality in the form of independence and self-sufficiency, often at the expense of the collective and moral. In addition, the abstract and conceptual is privileged at the expense of more visceral responses which feeds the tendency to power and domination.

One of the factors that gave rise to and perpetuates splitting of the self, as well as violence in our life, is abstraction. It is in part the overvaluation of intelligence which has made us glorify abstract thought - at the expense of passion, enthusiasm, and openness. Soren Kierkegaard noted in 1846 that when intelligence is over-valued to such a degree, it transforms reality into ideas which then come to take its place. (Gruen, 1988, p.30)

The objectification of reality has been extremely successful in providing certain benefits. Yet the belief that everything is an object has been a mixed blessing, particularly where it has been used to subjugate people. To view someone or something as an object requires a certain emotional detachment. To view them in the belief that you can understand them in some vital way is to assume a kind of authority over them.

C.S. Lewis (1943) noted, 'We reduce things to mere Nature in order so that we may "conquer" them.' When the 'things' are people (or in the language of psychoanalysis 'objects') and their existential status is reduced to a ‘natural’ category of illness, the same logic of domination applies. (Pilgrim, 1992, p.250)

Vignette 4

Gwen had been a primary school teacher for eighteen years before she took an early retirement on health grounds. As teachers were forced to accommodate 'cut-backs’ and endless government initiatives, the occupation that she had always regarded as a vocation began to lack a sense of purpose and meaning. This feeling of demoralization persisted after she stopped teaching, and during a discussion with her doctor it was suggested that what Gwen needed was some way of 'kick-starting’ her recovery. She complimented her doctor at the time on what appeared to be an appropriate analogy, but on her way home she wasn’t so sure. It began to sound a bit mechanistic. It reminded her of something the newly appointed Headmistress in her last school had said as she viewed the children walking down the corridor at the beginning of the school year. 'Ah, here come my little units of resource’ she said humorously.

Gaps

The second half of the twentieth century has produced a substantial but largely forgotten critique of psychiatry and. psychotherapy (Gordon, 1999, p. 31; Newnes, 1999). The link between mental anguish and social determinants has long been exposed. It is hardly surprising that people show signs of disturbance in disturbing circumstances (Graham, 1990). In fact, it is more remarkable and worrying when they do not. Service users experience the conditions of work, family and community life as intolerable because they are. Were they to adopt the necessary attributes of ambition, a capacity for risk-taking and 'skills' as is frequently recommended their circumstances would no doubt change. Yet motivation is much more complex than the simple adoption of socially accepted values and behaviour would suggest. Petruska Clarkson conveys the predicament for the user and the therapist's quasi-religious response in what 1 will treat as an allegory.

There was a man hanging by his fingernails over a terrible abyss. He could not look down, it was so frightening. So the man shouted: 'Is there anybody there?' And God answered: 'Yes, my son.' So the man. said: 'Please tell me what to do!' And God said: 'Let go my son.,' The man considered this for a minute, then cried out again: 'Is there anybody else out there?' (Clarkson, 2000, p.205)

What the man needs, of course, is physical rescuing not metaphysical conjecture. Yet therapists make a virtue of their inability to offer concrete practical help (Rudkin, 2000) by maintaining the fiction that there are exclusively individual or mysterious solutions to what are essentially difficult collective problems. No doubt intelligent well-meaning people, bewitched by language, bedazzled by their intellect, can rhetorically justify unusual and exotic perceptions of reality by drawing on esoteric discourse from science and religious experience. But this only adds to the users' difficulties. As Doherty (1995) poetically puts it, 'We have been trained to use microscopes, which make the heavens invisible.' (p.91).

Now I appreciate that morality from a religious perspective can make the non-religious queasy; but it has to be acknowledged that the Church as the most recent moral lighthouse was, more or less, socially engaged. It did what it could to help the dispossessed and alienated in the face of worldly suffering, despite holding to the view that the temporal was not the last word in our understanding of consciousness and reality. Today, those damaged and disadvantaged by existing social values are just as likely to be financially better off, highly educated people as those short-changed by the market economy. A recent editorial in the Guardian commented on the decline of moral guidance and attempts to fill the gap through Do-It-Yourself spirituality.

This DIY spirituality gains inspiration from Eastern traditions (from Buddhism and yoga to Sufism) and psychotherapy but it is now in the mainstream, no longer the preserve of New Age groupies ... [W]hile the New Age (for want of a better term) may meet individual. spiritual aspirations, it has failed to develop institutions which can achieve change. (Guardian, 2001)

1 doubt there are many therapists who regard themselves as New Age groupies or who wish to be connected in any way with the term. Yet this becomes the inevitable ground within which we become mired when we lay claim to understanding the deeper recesses of human motivation. The Chinese sage Laotzu reminds us that when it comes to discussing the unknowable, ‘Those who know don’t talk. Those who talk don’t know.’ (S. Addis and S. Lombardo, 1993). What we do know and could do something about are the institutions necessary to achieve beneficial change. And in this regard there is no shortage of ideas or guidance - for example, the ecological movement (Claxton, 1999; Galbraith. 1996). These are the kind of measures that people actually need. I also understand the difficulties.

To tackle the causes of mental disorders ... would require a radical restructuring of society, including a massive redistribution of social goods; and the obstacles to achieving this within the ground rules of liberal democratic society as we know it, are so great as to be. practically insuperable. (Lindley, 1986, p.163)

But do we really have a choice?

[W]e cannot reverse the decline of Christianity and socialism, but equally clearly, there is a growing difficulty in sustaining the moral underpinning they have provided for our understanding of the common good and how to mobilise the social solidarity needed to achieve it. Sometimes the good of the whole comes before that of one of its parts - this crucial inspiration lies behind much of what we most value. (Guardian, 2001)

Counselling and psychotherapy are particularly well placed to act as a platform to facilitate social solidarity given that they are faced daily with managing the consequences of social injustice and inequality. Using their position of expertise and authority to create a critical mass of opinion as to the social determinants of mental health problems would be a major civilising factor. Whether they have the necessary sense of moral responsibility is, however, something that remains to be seen.

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Christopher Willoughby is an NHS psychotherapy user (patient), and has undertaken counsellor training.
Email address: chrisjwilloughby@aol.com

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