Richard Layard is a Labour peer and a distinguished economist and David Clark is Professor of Psychology at Oxford. They are both key figures in the NHS IAPT (Improving Access to Psychological Therapies) programme. Their book was published not long after another of the same name, by Arianna Huffington, the high-profile founder of the Huffington Post. Both deal in different ways with the pursuit of happiness. Huffington’s road to personal wellbeing involves the ‘Third Metric’, which comprises getting a lot of sleep, mindfulness, relaxation, unplugging, watching your sugar intake, and self-belief in order, in her words, to redefine success and create a life of wellbeing, wisdom, and wonder. Layard and Clark have a simpler panacea: cognitive behavioural therapy (CBT).
Coming, as I do and, I imagine, that most of you do too, from the world of holistic patient care and the biopsychosocial model of illness, the efficacy of CBT in ameliorating mental and physical disorders, was not exactly news. Imagine my surprise in finding that over one 100 pages of this book, which is hardly aimed at an academic readership, consists of a list of sources, annexes, notes, references, and the index. A sledgehammer to crack a walnut I thought, and read on. But no! That wasn’t it at all. This book is nothing less than a sledgehammer to crack open the resting place of the Holy Grail: the Holy Grail of universal human happiness, to which the psychological therapies hold the evidence-based key. Forget poverty, pestilence, cancer, climate change, oppression, famine, and genetics, a good dose of CBT will soon get us back on track.
To my astonishment there are back-cover, ringing endorsements from two of my heroes — Melvyn Bragg and Daniel Kahneman, and other serious commentators have been very positive about this publication. Then, at least I think it was then, the penny dropped: we medics have been very bad about communicating what we know and do about the extent of mental health problems in the community, about the inability of much traditional, pharmacologically-based psychiatry to do much for patients, and about the intimate relationships between physical diseases and mental health and illness with which we are so familiar.
This book, which is very well written, if a touch hectoring from time to time, genuinely is news to large numbers of people outside front-line medicine, and front-line general practice in particular. Although I think that Layard and Clark greatly overstate their case, both for patient benefit and for the health and wealth agenda, one very welcome side effect of this approachable and humane book is to articulate strongly the need to recognise and respond to distress in ways that reduce dependency, increase self-efficacy, and instil resilience against future shocks.
- © British Journal of General Practice 2014