‘Storytelling is fundamental’

You refer to what is becoming a common state of unhappiness as 'problems in living', a phrase Thomas Szasz used in his paper 'The Myth of Mental Illness'. What are your thoughts on Szasz's argument that experiences of distress should be taken out of the realm of psychiatry and medicine? Where should support for these problems lie (the self, psychology)?

Attempting to treat 'mental illnesses' with drugs in medical settings isn't something I automatically oppose. That said, I don't think the medical model should be privileged because of reductionist arguments. Physics doesn't invalidate chemistry and chemistry doesn't invalidate biology. They are different levels of description and all of them have value.

Likewise, drug treatments do not invalidate or diminish the value of psychotherapy. What we think of as 'mental illness' is the product of many contributory factors. Where distress is clearly related to personal history and social context, it seems reasonable to suppose that psychological interventions will be more helpful than drugs, largely because they are more 'meaningful'. A traumatic experience, for example, can be understood and processed.

Broadly speaking, I agree with many of the points raised by Szasz and the anti-psychiatry movement; but not to the extent that I would reject biological psychiatry as a matter of principle. The demand for psychotherapy always seems to exceed supply. Nevertheless, not everyone who could potentially benefit from exposure to psychotherapeutic ideas needs – necessarily – to be in therapy. There are good reasons for introducing young people to psychotherapeutic thinking in schools. I suspect that adolescents would be particularly receptive. Given current and quite alarming trends in mental health statistics, the dissemination of psychotherapeutic ideas in educational settings might be a sensible prophylactic measure.

When we look at the proliferation of self-help books, apps, blogs etc., are we in danger of, as David Ingleby would say, 'the psychiatrization of everyday life'? So personal unhappiness becomes something to 'treat', or are we equipping people with the resources they need to live in a more comfortable state of being?

In The Act of Living I suggest that instead of viewing psychotherapy as a collection of competing schools, we should view it as a single tradition that has been evolving for over a hundred years. 'Psychotherapy' offers a distinctive 'worldview' that can inform and instruct beyond 'medical settings'. It can supply original answers to the big questions usually posed by philosophers and representatives of faith: Who am I? Why am I here? How should I live?

If self-help books, apps, and blogs, offer advice drawn from the tradition of psychotherapy (as opposed to pop-psychology) I think they can be very helpful. Distress can be plotted on a continuum and the precise point at which, say, ordinary sadness becomes 'clinical depression' has always been subject to debate. I don't think providing psychological support to people who are experiencing mild to moderate levels of anxiety or depression qualifies as 'psychiatrization'. It is simply acknowledging an aspect of the human condition.

Psychotherapy has never been overly concerned with cure. It has always stressed management, coping, and acceptance. Freud famously referred to the goal of psychotherapy as being 'common unhappiness'. Psychotherapy is realistic. Viewed as a tradition, that is one of its greatest strengths. It is the antithesis of the hollow (and ultimately disappointing) inspirational platitudes that flood social media.

Looking at what psychotherapy can offer people in current times, one criticism has been around its accessibility. Given that access to psychotherapy has historically been to white, privileged Western populations, how can minority and less-privileged populations benefit from what psychotherapy can offer?

There is nothing wrong with nuance and sensitivity, tailoring services for the specific needs of specific groups. But in the end – and forgive me for stating the obvious – we are all human beings. I can't help feeling that evolutionary pressures have created fundamental commonalities that unite humanity. The basic problems of living are the same for everyone. Which means that the core ideas of psychotherapy are universal and don't need to be 'translated'. We have shared objectives; to discover who we are; to satisfy our needs; to seek safety; to love and be loved; to be a valued member of a social group, and so on.

Because we are more similar than different, it is relatively easy to identify convergent thinking about the mind and optimal ways of living across time. For example, a very old system of thought, like Buddhism, has much in common with a relatively new system of thought, such as psychoanalysis. The early Buddhist concept of mind, like Freud's, is rooted in the body. It can be affected by latent tendencies – that is, unconscious thought – and human beings pursue 'sense gratifications' according to the equivalent of Freud's 'pleasure principle'. Life is suffering – a close relative of Freud's 'common unhappiness'. Psychotherapy is based on ideas – and good ideas usually transcend time and culture.  

The figures you present in your book, for some people may be viewed as consigned to history, for others their influence is reflected in their own practice and ways of being in the world. Who are the figures theorising/researching/practicing now that would make it into a revised edition of your book in a 100 years' time?

One hundred years is a long way ahead and I don't possess a crystal ball! However, there are lessons to be learned from history. Psychoanalysis was profoundly influenced by figures like Darwin, Helmholtz, and Haeckel. General scientific advances created an intellectual climate that made psychoanalysis possible. This is a recurring pattern. Advances in experimental behavioural and cognitive psychology, for example, eventually influenced the practice of psychotherapy. So, I would guess that we should look at what's happening in the world of pure (and speculative) research to predict the future of psychotherapy. Recently, there have been some very exciting 'general' developments in neuroscience and cognitive neuroscience. I am fascinated by Donald Hoffman's ideas about perception and reality, and Karl Friston's 'free energy principle' (which has already been linked with psychoanalytic ideas). I also imagine that having discovered 'mindfulness', psychotherapists will continue to excavate Buddhist psychology to greater depths.

What was your favourite chapter to write, or perhaps the one that felt most personally relevant?

I particularly enjoyed writing the chapter on narrative. I've always thought that human beings are predisposed to make sense of the world (and themselves) by telling stories… this is why a simplistic 'populist' narrative is always more seductive than facts. Moreover, psychotherapy can be construed as a process which involves patients presenting chaotic narratives to therapists, who then edit them so that they are more coherent. Coherent self-narratives seem to be associated with improved mental health outcomes. I've attempted to explain why storytelling is so important to human beings, by exploring its evolutionary origins with reference to Povinelli and Cant's 'arboreal clambering' hypothesis – which suggests that self-awareness and narrative intelligence evolved simultaneously. Storytelling is fundamental. It's how we organise experience: chains of cause and effect divided into beginnings, middles, and ends. An intuitively satisfying way of thinking about identity is as 'the story that we tell ourselves about ourselves'. The different roles that we 'perform' – mother, daughter, sister, employee, friend – are sewn together by our life story. Therefore, a strong self-narrative prevents divisions opening-up within the self and fragmentations of the self. A coherent self-narrative stops us from 'losing the plot'.

Would any of the great psychologists you discuss fall into the category of forgotten, or underappreciated?

Although not forgotten, Alfred Adler is certainly under appreciated. This is something that Henri Ellenberger pointed out as far back as 1970. Adler's name surfaces quite often, because he was the first of Freud's disciples to establish his own, independent school of psychotherapy, and his term – 'inferiority complex' – has entered everyday speech as a pejorative. However, Adler was also a brilliant psychotherapist who truly understood the importance of social and political context. This isn't surprising, considering that his chess partner in Vienna's Café Central was Leon Trotsky. Unfortunately, Adler's ideas are frequently 'borrowed' without any attribution. From where I am sitting, I can see a volume on my bookshelf – quite a famous one – that makes extensive use of Adler's ideas without mentioning him once!  

You're so prolific, writing fiction as well which has been adapted for a major TV series in Vienna Blood. How do all these strings to your bow come together?

Actually, I don't see psychology and writing fiction as separate strings that must be brought together. In my mind, they are already together. All my fiction is informed by psychology. Sometimes the connection is obvious, as with the Vienna Blood series. Clearly, seven psychoanalytic crime novels set in Freud's Vienna are going to be 'psychological'. But sometimes the connection is less obvious. For example, I wrote a supernatural novel (as F.R. Tallis) which is ostensibly about a haunted U-boat in WWII. The sea serves as a metaphor for the unconscious – the deeper you go, the more horrors you are likely to encounter.

The relationship between psychology and writing is reciprocal. Writing novels has changed how I now write psychology. Even when I'm discussing abstract ideas, I do my best to present those ideas within a narrative. I try to tell the story of those ideas. Psychology is such a versatile subject. I think this should be stressed more – particularly to undergraduates. I didn't realise it at the time, but when I was student, I was being introduced to a body of knowledge that would allow me to travel freely between two worlds: clinical and literary. A psychology degree is as much a cultural passport as it is an academic qualification.