Robert Harland

In lieu of an abstract, here is a brief excerpt of the content:Why the Phenomenology Remains FoundationalRobert Harland (bio)Keywordspsychology, cognitive-behavioral therapy (CBT), phenomenology, psychiatry, depressionDemian Whiting in his paper criticizes an exclusively cognitive approach to the treatment of emotional problems. There is no doubt that the cognitive model of the mind has been recently in the ascendancy and therapies based on it are to be found in almost every subspecialty of psychiatry. Cognitive-behavioral therapy (CBT) in particular is "discovered" as being effective in everything from posttraumatic stress disorder to psychosis. The heartland of the approach is and remains anxiety and depression, the two most common emotional states that psychiatrists and psychologists are asked to deal with. As Dr. Whiting describes, leaving aside the behavioral aspects, the basic principle is about eliciting and challenging distorted cognitions. Cognitive theory suggests that distorted cognitions are the cause of, the substance of, and the maintaining factors in most if not all depression and anxiety.The author accepts that in certain cases distorted cognitions lead to an experience that is represented contra to reality. He suggests that in certain circumstances a cognitive therapist could help a patient to reappraise the world they find themselves in and by gathering evidence with the therapist, to challenge these distortions. So in depression, a patient sees themselves as worthless and their therapist suggests they gather evidence that helps them form a more balanced perspective. The cognition "I am worthless" is shown empirically to be a distortion. Whiting argues, correctly in my opinion, for the limitation of this approach. In doing so he argues against a growing psychological hegemony, one that sees itself as developing evidence-based practice that should be applied (on the back of national guidelines) to many presentations before or exclusively of others such as medication or alternative psychotherapeutic approaches.Whatever the outcome in the clinic, as opposed to the randomized controlled trials, many clinicians and health care managers are attracted to CBT because of its pragmatic, short-term, problem- and consumer-orientated nature. It has an approach tailored for most disorders and therefore fits very well within the organization of modern mental health services. With this background, nonclinical readers may more readily appreciate the potential target of Dr. Whiting's critique.Whiting suggests three examples where eliciting cognitions can at best be seen as secondary [End Page 247] to the problem in hand: First, where a drug (e.g., alcohol) or state (e.g., tiredness) directly causes an emotion; second, where an emotion causes a mistaken understanding of a situation; and third, where the representation is accurate but the response defective (e.g., the pedophile in his article, or more routinely a person particularly sensitive to anxiety). The phenomenology, before the prism of analysis, is that in all three cases the patients find themselves in an emotional state where any putative cognitive etiology is at best post hoc and at worst tautological. Furthermore, as the author states, in the cases where accurate representations elicit the wrong kinds of emotions, the question why cannot be answered by referring back to the person's representations.To answer the question of why someone is particularly sensitive to anxiety or gets aroused by children, Dr. Whiting points to several possibilities that all impact on treatment: First, the influence of noncognitive desires and emotions; second, physical contamination; third, an idiosyncratic or abnormal constitution; and fourth, a defective emotional acculturation. In all these cases, suggesting that the patient's problems will be resolved through altering eliciting cognitions seems illogical.The paper then preempts two criticisms from the cognitive approach. The first again rightly expands that, if a higher order evaluative level is proposed, this in no way answers a noncognitive critique. Either the higher level of evaluation is simply an unnecessary (or unpredictable) cognitive confirmation of a negative (or positive) representation, or the evaluation is a cognitive foil for an emotional reaction that is simply not cognitive; when someone says they are worthless they are merely giving voice to their depressed emotional state. Second, that retreating to a position where the cognitive approach is used to challenge distorted representations that are secondary to, and yet maintain, an inappropriate emotion may have a role, but does not mean that...