Tuesday, June 26, 2012

LIMITS OF CBT

Under the illusion that we are self determining individuals, capable of self awareness Cbt offers an ennobling bulwark. Cognitive and behavioral in conjunction provide an illusory chimera of  intelligibility and self consciousness. Therapy amplifies the singular transference the process involves since counter transference, putatively contrapuntal reaffirms the presuppositions originally held.

It is my contention that any patient who accesses Cbt  is not going to be told something new. More often than not the anodyne platitudes proffered are those the patient himself knows. The process of being inveigled into partaking this process of normalization is a powerful counterpoint to a structure of unreason, seen as discontinuous, that constitutes a descent into a mental disorder.

And psychiatry, colluding with psychotherapy creates this patina of a physiological basis whose constituents are indubitable but whose psychological repurcussions are bothersome. To be told that you have a chemical imbalance, that the self destructive behavioral patterns you evince are beyond volition is a striking contrast to conventional ideas of madness. Both, i would argue are engendering notions of viictimhood and refuting the etymology of Cbt.

To say that something is cognitive is to assert a measure of control over what we do. And the choices we make under the effects of a mental illness are stated as being volitionless on our part, dictated by our neurotransmitters whose dysfunction perpetuates irrational and auto destructive behavior forms. My argument is this proliferation of theories of neurochemical imbalances as a form of exoneration and excoriation similarly. As a patient's life unfurls, past conducts are reviewed and rendered inadmissible , at least cognitively, in the future. Perhaps purely unconsciously the patina of randomness underlies the mistaken choices, reinforcing their irrationality, questioning while simultaneously rationalizing their provenance. If it is that acts of wrongdoing, albeit inadvertent have constituted the past then the self same action, whose repudiation is stressed becomes, by implication erroneous. A humanist language of morality underscores the accidental nature of one's actions.

This same humanist discourse, manifesting itself in the form of pat aphorisms and comforting platitudes makes the return to precarious healthfulness a naturalized phenomenon . Naturalized because the patient is given the illusion that his return would necessitate navigating the world on his own terms. Yet as poststructuralists like foucault have pointed the notion of an indivisible 'I ' is an impossibility because we are inaugurated into a world whose claims on us have already been defined. In this sense can the relationship between patient and therapist be a dialogue. It is a dialogue within, with one's superego, whose actualized corporeal manifestation is embodied in the analyst. Even when non conformity is affirmed the therapist represents an unactualized desire for acceptance which would societally, be either embraced or negated. Celebrating one's difference, following one's dreams are certainly articulated and do give the patient control over his conscious choices. But the unconscious, forever untraversed, remains , at best, something non navigable, inarticulable wherein pre existing states of the world we come to inhabit seem to offer the possibility of control but being overdetermined by it  we only ratify its assumed ontology.

Which is not to say that a life under psychotherapy doesn't get better. It certainly does but it is betterment based on a leap of faith, a willful repression of the uncontainable and unassimilable, a repression which, based on an irrecoverable desire for wholeness , continues, intermittently to haunt. We mold and reconstruct an amorphous self with which we peregrinate successfully the world we live in. The illusion is necessary yet an acknowledgement of divisiveness validates unknowability and within that unknowingness, the possibility of self realization.

1 comment:

  1. I certainly admired this piece, Bharat. At times I had trouble understanding exactly the thought, but it's an admirable work of inteligence. I like it very much.

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