EMDR PRACTITIONER - A Marxist review of a decadent capitalist so called ‘scientific’ paper

Some Marxist Reflections on a Decadent Capitalist ‘Battle’: the CBT/EMDR War
comrade Дзвид Блор
October 2006

Editor'sNote: The EMDR Practitioner aims to bring a fresh and innovative perspective in writing... so, (with apologies to Monty Python), now for something completely different. We have an article that is intended to make you sit up and take notice, and which reviews some important relationships between EMDR and CBT: "Some Marxist Reflections on a Decadent Capitalist 'Battle': the CBT/EMDR War" by comrade Дзвид Блор may well make you feel indignant, angry, in agreement, or even respond by saying "well in the best tradition of Ivan Illich, someone was going to write something like this sooner or later". Whatever your response, The EMDR Practitioner wants to know it and you can be assured that we will publish a variety of responses in due course. Don't leave others to express your point of view! SE Borrelli

Abtract: This paper comes with a health warning. The intention of this paper is twofold: firstly to highlight the absurdity of two psychological treatments attacking each other, Eye Movement Desensitisation & Reprocessing (EMDR) and Cognitive Behaviour Therapy (CBT), both of whom are recommended by the National Institute for Clinical Excellence (NICE) in the treatment of Post Traumatic Stress Disorder (PTSD), and secondly to question the use of the medium of scientific literature as a forum for a territorial rather than academic debate. Rather than fall into the ‘trap’ that other authors have done and support either or even give any credence to a blow-by-blow account from the ‘inside’ of the battle, the author has written from a ‘non-aligned’ Marxist standpoint and provided a possible solution.

INTRODUCTION

If what follows sounds like propaganda, it is no more so than that implicitly (and sometimes very explicitly) stated in the scientific literature battle that has raged unabated now for 17 years between EMDR and CBT. I would argue that this is a misuse of the entire function of scientific literature, a learned body of information, which was never intended to be used for imperialist (some would euphemistically say, ‘territorial’) purposes. If you doubt the use of the word ‘imperialist’ then how many times have you come across someone in the NHS referred to as an empire builder? The only difference here is that it is the psychological treatment not individuals in healthcare that are imperialist.

Ask a client or patient receiving either CBT or EMDR and generally the response will be an honest assessment of their experience without hurling this or that reference to support their position. If this sounds like an invitation to base objective assessment on subjective information, then perhaps it is about time. Indeed I have purposely quoted the absolute minimum of sources in this paper although readers will likely know which publications are being referred to anyway. This is not because of plagiarism, but so as not to be accused of either supporting EMDR or CBT, or not being hypocritical about the use of scientific literature. However, I offer one or two suggested items of reading at the end and a few footnotes.

A BRIEF OVERVIEW OF THE TRUTHS OF CAPITALIST HEALTHCARE

The healthcare industry is one of the world's largest and fastest-growing industries ⁽¹⁾ and from the perspective of Marxism, there is little doubt that ‘healthcare’ is one of the terms used to describe Capitalist control. Because ‘Capitalist’ and ‘Caring’ cannot co-exist, then ‘healthcare’ in a Capitalist country, is an oxymoron, i.e. ‘health’ and ‘care’ have contradictory meanings. A rough translation is therefore that Capitalist healthcare is ‘healthcareless’. It is roughly the same situation as the phrase ‘NHS Trust’ in the UK. Although it is the representatives of the people who run the NHS, what does ‘trust’ have to do with ‘NHS’ when that system exists in a Capitalist country? In addition, Capitalist organisations, particularly the drug companies and the media, continually manipulate and control the ‘healthcare proletariat’. Ownership of ‘healthcare’, is ownership of power, power, which is euphemistically, termed ‘care’. The relationship is symbiotic too: control and thus ‘healthcare’, is a tool that in turn supports and promotes Capitalism under the guise of putting individual health first. If there was ever a philosophical justification of patient empowerment, then ‘healthcare’ should be controlled by the proletariat. In some cases such as self-help groups this happens even in Capitalist countries, but ‘patient power’ should take precedence. It cannot of course because who owns the power, control and information will take precedence in a capitalist country. This then is the context to the current battle between CBT and EMDR.

A PARTICULARLY ‘NON-GLORIOUS’ BATTLE

The Capitalist countries, the UK is a good example here, have been dominated for the past 30 years or so by the reign of the ‘CBT dynasty’. Having worked in the NHS, I have personally seen the territorial gains achieved by the CBT dynasty. I vividly recall the figure of 12%, once quoted with joy as the percentage of mental health ‘clients’ whose ‘problems’ were somehow ‘amenable’ to CBT. Territorial gains increased sharply with the introduction of the ‘Law of Clinical Governance’, which was enforced the National Institute for Clinical Excellence (NICE). The real role of NICE was to be the ‘puppet’ authority of the CBT dynasty. Although NICE is outwardly a very politically sensitive organisation, recruiting as it does, ‘stakeholders’ that can and do include ‘healthcare recipients’, a little known and thus suppressed fact is that NICE – originally a secret organisation with horrific intentions - was created around 1945 (not 1999 as is popularly thought) by C.S. Lewis in the book That Hideous Strength ⁽²⁾. In latter years, Michel Foucault the healthcare philosopher, might well have seen NICE as supporting the ‘regime of truth’.

Until 1989, the CBT-ites were making steady progress towards their eventual aim of being the global healthcare superpower. One of their main weapons codenamed ‘RCT’ was extremely successful in convincing people, including themselves, that CBT would eventually conquer the biggest killer of all time – death itself. For centuries humans had sought everlasting life – now it was almost in the grasp of a selected few – the CBT dynasty. Possession of such a secret would be shattering to all other organisations – particularly religious ones (apologies here to Dan Brown’s plot of The DaVinci Code).

But then disaster occurred!

Without any authority to do so, war was declared on ‘The Supreme Authority of CBT-ites’. There is no doubt that in those days before NICE openly declared its existence, the EMDR army’s two-pronged attack (Shapiro 1989a, 1989b), was a surprise to ‘The Supreme Authority of CBT-ites’.

Although thought originally to be a splinter group of CBT dissidents, called the ‘Eye Movement’ to ‘look after’ (pun intended), the interests of the down-trodden ‘healthcare proletariat’, what was later to become EMDR, the ‘Eye Movement for Democratic Reorganisation’ turned out not to be some liberating breed from Orwell’s Animal Farm, but another Capitalist force to be reckoned with. This made it doubly important for the CBT dynasty to squash utterly any semblance of revolution.

I would ask you now to turn to the second of the two papers cited above, (Shapiro 1989b), so as to examine some of the dangerous truths revealed by the, then, new EMDR army.

Firstly I must warn readers that the readership of the Journal of Behavior Therapy & Experimental Psychiatry is the petty healthcare bourgeoisie. In this instance these persons are cleverly termed the ‘scientific community’. There are no known examples of ‘healthcare recipients’ having access to the publication. There is even a suspicion that subscription prices are kept deliberately above the means of the healthcare proletariat. Secondly, the material is presented as ‘new knowledge’. New knowledge is really code for a new method of exerting power, and thus exerting control, and thus maintaining Capitalism. In addition, publication of Shapiro (1989b) was presumably made with the full knowledge that scientific ‘feathers would be ruffled’ for even the metaphor, gives the image of senior military bourgeoisie’s inglorious decorations being disturbed. I should also point out another battle metaphor: to submit written material, especially if done in anger, is to ’fire one off’ to the publisher.

A third point is that Shapiro’s paper describes a ‘new’ psychological treatment for the diagnosis of Post Traumatic Stress Disorder (PTSD). This could of course be a helpful to the healthcare proletariat, but actually illustrates the political purpose of diagnoses per se. A little appreciated fact amongst clients and patients is that diagnoses represent ‘crimes against health’ (or rather attempts at resistance against control). They are, if you like, methods of alerting the healthcare bourgeoisie to ‘deviant’ (i.e. non-Capitalist-promoting behaviour). Why is this so? Well, labelling an individual with something termed a ‘diagnosis’ frequently gives legitimate cause for its ‘owner’ not to work and thus not support the Capitalist method of producing capital – this is what having a diagnosis really means – it sanctions time off work, why else is there such an effort to ‘encourage’ individuals back to work using… yes you guessed it, CBT!

Even from a Capitalist perspective, the fourth point, and probably most unusual aspect of this paper, is the ‘unscientific hearsay’ for an editorial footnote on the first page:

“The technique described in this article is out of the usual run… I myself have been encouraged… one (of my clients had an image of) a Mrs. K., a hostile insurance agent… with PTSD that had not been overcome (of course this means ‘subjugated’) by other methods… 2 minutes later (the client) was able to think of Mrs. K calmly” (Shapiro, 1989b added italics)

The fifth point I want to highlight is the content of the paper. Described in some detail, with brief reference only to a ‘case series’, is the ‘treatment’ of a 63-year-old female rape victim. If this doesn’t underline the rape of the healthcare proletariat, I don’t know what worse example could have been chosen. This use of suffering to illustrate a supposedly ‘heroic intervention’, for what amounts to commercial gain, is one of the clearest examples of decadent Capitalism you are likely to come across. However, there is more...

The final, sixth, point I wish to make concerns the ‘Conclusion’: in which advance notice is made of forthcoming papers that “…appear to be obtaining comparable results” (Shapiro 1989b). This is another clear Capitalist ploy, the threat of reinforcements on their way in the form of a marketing campaign.

SOME REFLECTIONS ON THE WAR TO DATE, 1989-2006

As now, in 1989 the ‘prevailing paradigm’ remains CBT. This of course means that CBT is really the bourgeoisie's ‘torture’ of choice and thus it is very powerful in the wrong hands and thus is very dangerous. Recent talk of 10,000 more CBT therapists is I believe a cause for great concern. Despite supposed good intentions (giving vastly ‘improved’ access to individuals), the sheer logistics of training that number of CBT reinforcements not to mention maintaining long term quality service provision smacks of Capitalist desperation to improve control quickly. This begs the question – are self help groups correspondingly becoming more powerful and effective? The EMDR camp is also good at foisting figures on an unsuspecting public. Quotations of increasing numbers of therapists worldwide, measured in the tens of thousands, is a clear indication of the intentions of escalation of future hostilities and merits comparison with Armageddon.

Incredibly by 1991, the CBT camp was using the criticism of ‘commercial dissemination’ to criticise EMDR, an example of Capitalist hypocrisy par excellence. How can two Capitalist schemes meaningfully criticise each other?? The answer is immaterial, however, as this strategy didn’t work because certain ‘CBT-respected’ figures supported EMDR and its method of dissemination. The offensive was rebuffed. So what? Since both CBT and EMDR are Capitalist armies, are they not as bad as each other? The CBT generals then tried another tactic using propaganda that EMDR was really repackaged CBT. The official propaganda was “There is no new paradigm… EMDR is an illusion!” This is amazingly perceptive for Capitalism... precisely – they were, and are, as bad as each other!

The generally agreed measurement of battle success, is how many Random Controlled Trials (RCTs) are there in your arsenal? RCTs were not producing the expected capitualisation of EMDR, for by the mid 1990’s the number of RCT warheads supporting EMDR passed those of the CBT army. In 1998 an informant revealed that at least two very high profile ‘CBT Obenfurhers’, openly critical of EMDR had indeed covertly trained in EMDR. This was ‘hushed up’ promptly by the CBT-ites and welcomed by the EMDR-ites, much the same as when politicians ‘cross the floor’ of parliament.

Nowadays, NICE, renamed the National Institute for Clinical Enforcement are in trouble with the CBT-ites. Instead of automatically praising (i.e. worshipping) and sanctioning the only true CBT - for everything - in March 2005 ⁽³⁾, NICE concluded that both CBT and EMDR were to be the treatments of choice for PTSD. This decision, in direct contravention of NICE’s charter for impartiality, laboriously drawn-up by the CBT army has lead to the suggestion for the first time of open criticism of NICE by CBT-ites – an unimaginable possibility only a few years ago. I, myself, have heard rumour mongering:

“What next? NICE will be advocating that clients and patients not only treat themselves but that clients and patients take charge of all decision making processes in healthcare including our roles within the Supreme CBT Authority.” (Source withheld)

That ‘NICE/CBT’ abrogated their form of pseudo-decision making process, in favour of an ‘Armageddon of Random Control Trials’ is something only a Capitalist system can explain. This is decadent use of the concept of Revolution and of science – after all what does the average client or patient understand by an ‘RCT’?

To CBT-ites, EMDR seems an impregnable organisation, and no doubt to EMDR-ites, CBT seems as though they are the new ‘intransigentsia’. “No monopoly lasts for ever” a friend once told me, so are the days of the CBT-ites numbered? The recruitment of 10,000 new recruits sounds a ‘Godsend’ of reinforcement – I think not. The monopoly will be to unwieldy and bogged down in ever increasing spirals of inconsistent application of CBT and eventually bad press will spell the end – it may take years yet to occur. EMDR? The ludicrously tightly controlled opposite position to CBT, the inner sanctum of the higher echelons clearly put in place to maintain commercial interests will breed antagonism, dissent, and as many who know me, my prediction for several years now – a schism in the First Church of EMDR.

SOLUTION?

The battle between CBT and EMDR rumbles on to the present day. The unwritten citation for the ‘winner’ of course, will serve to indicate the paradigm to be the carte blanche torture (treatment) method from then on. I would venture to conclude that this is paradoxically good for the ‘healthcare proletariat’. How come? Well, because, the bourgeoisie are clearly in disarray and thus weakened. This means, that there is a window of opportunity for Revolution. I envisage a new and colloquially named ‘Real healthcare proletariat’ will take-over the real care of health in due course. Make no mistake about it, there are stirrings in the undergrowth already. Some of you have been through the most traumatic of times and have written your own textbooks of ‘healthcare’. It is very clever of you to have referred to these as ‘autobiographies’ and is testament to your strength of character and your perseverance against Capitalist ‘healthcare’. This is in effect the Revolution and you will be victorious eventually. However, much as I would like to quote some of these books in this article – for the time being, I do not wish to ‘blow your cover’ – hard or soft-back.

For now CBT remains the dominant ‘regime of truth’ and is supported by government (a Capitalist one, widely perceived as typically decadent) with political agendas (also Capitalist) and providing biased information (propaganda), or no knowledge thus keeping the healthcare proletariat ignorant and who therefore stand no chance of obtaining control of the care of health. However, EMDR is very popular with the brothers and sisters and they choose EMDR frequently. But be warned both armies are Capitalist. If the ‘healthcare proletariat’ chose EMDR, which seems likely, then why does the NHS have hardly any EMDR therapists, are they so Capitalist that even the NHS is too left-wing a concept? Are we exiting ‘healthcare’ and entering the realm of ’stealthcare’? Now do you understand the health warning at the start of this paper?

Footnotes

¹ See: http://en.wikipedia.org/wiki/Healthcare in which the same entry continues as follows: ‘…consuming over 10% of the Gross Domestic Product (GDP) of most developed nations, healthcare can form an enormous part of a country’s economy. In 2003 healthcare costs paid to hospitals, doctors, nursing homes, diagnostic laboratories, pharmacies, medical device manufacturers and other components of the healthcare system, consumed 13.5% of the GDP of the USA, the largest of any country in the world. In 2001, for the OECD countries the average was 8.4% with the USA (13.9%), Switzerland (10.9%) and Germany (10.7%) being the top three’. ‘Healthcare’ is thus an extremely large commercial enterprise.

² A research agency, in C. S. Lewis’ (1945) ‘That Hideous Strength’, called N.I.C.E. (National Institute for Coordinated Experiments), attempts to destroy the true nature of mankind. Is this the real intention of the body created supposedly in 1999?

³ The March 2005 NICE guidelines on PTSD can be obtained from: http://www.nice.org.uk/page.aspx?o=CG026niceguideline