Colin: You say that wellbeing is a matter of nature and nurture and not an either/or issue. But your article seems to read as a strongly anti-science one, or at least as minimising the role for science in the mental health field. Have I misread you?
Martin: I hope you have misread me. I am a scientist, so I hope I’m not anti-science. What I am trying to say is the opposite – that we are not being scientific enough about mental health. To understand mental health we need to look in more detail at the science of empathy, mentalisation, attachment and relationship and the way these factors shape us humans from the cradle to the grave. I am also trying to say that Western science is too materialistic. It reduces mind to matter (brain) and this is not good science. Many contemporary quantum physicists are now recognising the importance of mind and consciousness in all their observations, so if mind is a core dimension of the universe as much as space, matter, energy and time, it can only be measured at the (subjective) level of mind. My aim was to give hope to counsellors who are always falsely being told that they are unscientific and that they need to get on the IAPT bandwagon and become ‘evidence-based’. This may be true politically but it is definitely not good science. My aim was also to try to show that there does not need to be such a rift between art, science and religion.

Colin: I appreciate your promotion of the value of subjectivity, empathy, love and attachment, as I think most counsellors will, but this seems to idealise these qualities and not reckon with their dark side, with human error and so on.
Martin: Talking about empathy, love and attachment does not mean you are ignoring the dark side of human nature. Indeed, understanding failures and violations of empathy can show us why such dark and destructive personalities can develop in some people. When children are traumatised, neglected and abused, they are in danger of being so emotionally damaged that they turn to the ‘dark side’ by taking out their pain on others. This danger can be averted if some loving adult care-giving influences can be introduced into their lives before it is too late. This is why counselling is so important – it provides corrective empathic experience for vulnerable people every day across our society. But, obviously, the more damaged the person is, the less likely they are to seek such help and the less likely they are to be able to use it. It has also to be said that in human history some of the darkest personalities have responded to their pain by seeking power rather than help.

Colin: Are you pointing to bad science, to pseudo-science, misuse of science or over-valuation of science? Some philosophers of science, like Nick Maxwell, for example, have argued that science is ‘neurotic’ and that science and knowledge should be used with far greater wisdom.
Martin: I am pointing to all of these things. My main concern is that Western science factors subjectivity out of its calculations as a bias rather than honouring subjectivity as the basis of all our efforts to understand the universe. This almost literally mindless approach is anti-scientific and certainly not wise. Wisdom always involves a spiritual dimension, recognising that you are a subjective part of nature, inside it and not its master, standing objectively outside it. When it comes to what we call mental health science, therefore, this materialistic approach means that the mind is ironically relegated even from its own domain rather than being honoured as the gateway to understanding. You can in truth only measure a mind with another resonant mind. This is in essence empathy (co-subjectivity) and empathy is a dynamic and personalised process that cannot be objectified or guaranteed from a manual.

Colin: I agree with what you say about IAPT and NICE and it looks as if some of IAPT’s premises and expectations about CBT as superior (because ‘evidence-based’) are beginning to crumble. But my guess is that stakeholders like Richard Layard won’t readily concede they were wrong. What does it take for those in power to relinquish their scientistic certainties?
Martin: If history tells us anything it is that people in power never relinquish their certainties! Layard and co are not totally wrong in any case. CBT can help people, for the same reasons that any relationship can make a difference. At least IAPT has recognised the power of talking and relationship. However, it has also colluded with a medicalised assumption that it is certain (CBT) techniques that are the ‘golden bullet’ for helping people. To challenge this new prejudice we need to influence public opinion about the wider science and the wider issues. The debate needs to get into the public domain, otherwise it will not penetrate beyond vested interests, and this means using the media where possible. Citizens and service users of our country need to be better informed and empowered so that they can demand personalised forms of therapy that suit them from a wide range rather than having their choices artificially limited by pseudo-science. We need more debate in the media about the mental side of the human condition but, inevitably, the media (even the BBC) also reflect prejudices about science. This was, of course, why I delivered my presentation [at the BACP Healthcare conference in May this year] and wrote this paper. I hope these words can inspire counsellors to feel more part of a scientific enterprise and more motivated to defend and develop their work in society in whatever way they can.

Colin: You mention cases of people dying following the death of a loved one, and of orphans and old people being more susceptible to negative life events. But without relevant statistics and consideration of individual differences (some are more resilient than others), can we really make the kinds of inferences you make?
Martin: The observation that people can lose the will to live and the ‘meaning’ of their life following the loss of special loved ones (and other terrible losses) is a common one, as is the observation that children who are loved become happier adults than those who are not. Of course, measuring this stuff is hard but these sort of data are also in front of our noses and there in our literature, art, everyday experience, clinical experience and can be gleaned from those studies that have been done. Several studies (the 2007 study by Hart and colleagues, for example) have shown that loss of a spouse significantly increases the mortality risk for the surviving partner. This wider use of all the data in our culture, however, is perhaps what I would mean by tempering our science with wisdom. Why are almost all songs love songs? Why do human beings need love and why do they need constantly to honour that love in their art? This is simply because love gives meaning to life from the cradle to the grave. If we can’t factor the need for meaning and love into our mental health science then we are truly lost. Freud called psychoanalysis a ‘love cure’. He wasn’t far wrong.

Colin: I have a lot of respect for some aspects of evolutionary psychology/psychotherapy and how therapeutic theorists like Stevens and Price and Gilbert, for example, use it. I am also impressed by some indications of genetic underpinnings for depression, say. I'm not sure if you're suggesting all such science is mistaken?
Martin: I share your respect for evolutionary psychology. Indisputably genes are also an important part of the human condition. Genes, however, don’t even determine most physical illnesses let alone mental health problems. Gene expression is heavily influenced by the environments we grow up in and the experiences that we have. Love shapes the very development of our brains. Stress, trauma, neglect and abuse of children damage the developing personality and also alter brain development. However, only genuine care or love will reach a child or adult to repair that damage. Talking changes meanings; drugs only regulate emotions. However, where drugs are prescribed compassionately in the context of a good relationship with the doctor, then the patient is getting psychological care as well as the medication. Equally, when drugs are prescribed without compassion, the lack of compassion is also having a psychological impact. One thing that genes certainly couldn’t explain is depression. Once we look at depression (and all mental health) in a psychologically-minded way, we can see that it basically comes down to a relationship to self. People who we would describe as ‘depressed’ typically have a very low opinion of themselves that can amount to self-loathing. Human beings are not born with a pre-formed opinion of themselves or even a predisposition to have a particular opinion of themselves. Human beings have to learn who they are and what they mean to others through years of personal relationships. Genetics could, for example, make one baby more outgoing than another but only love or the lack of it can teach a baby its own worth.

Colin: I think the ‘whole picture’ of wellbeing is very complex and not a matter of science versus mind/subjectivity/spiritual-and-counselling-values. History, sociology and economics have a lot to say about our suffering too, and many political thinkers assert that no amount of talking therapy can compensate for dehumanising socio-economic conditions. How do you factor these into your position?
Martin: I agree with you about the complexity of wellbeing but, by framing the question in that way, you are appearing to reinforce the very split between counselling culture and science culture that I was trying to repair. Political and social environments are obviously another important layer in the human condition but we are psycho-therapists and not politico-therapists, for a simple reason that I will illustrate with the following example. One young girl from a privileged social background is sexually abused by her father over many years, with her mother’s collusion; another young girl from a poor background is loved and cherished by both parents. Who will have the better mental health? At what level should our intervention be addressed? Mental health is ultimately about love, family, belonging and attachment. Without it, no amount of social and political privilege can protect you. With it, many social and political deprivations can be endured.

Colin: Thanks for these interesting clarifications. We obviously can't get to the bottom of it here but, as an interesting example, there is certainly solid work arguing for a genetic underpinning to susceptibility to depression, and also Wilkinson and Pickett’s The Spirit Level argues that depression is more prevalent in unequal societies. Geneticists, political scientists and talking therapists could benefit from far greater inter-empathic dialogue (perhaps in the manner of David Bohm) than they do now.