Urizen in the NHS: Zizek, McGilchrist, and Left Brain Healthcare, by Malcolm Hanson

Can the Theories of McGilchrist and Žižek Help in Understanding and Responding to Ideological Influences on the Delivery of Psycho-Social Care?

 

Introduction: McGilchrist, Zizek and Healthcare

This article developed from my work as a psychotherapist and manager within the National Health Service (NHS) from 2008 to 2017. It is a response to the ideologies influencing those areas of health policy which are related to emotional wellbeing through the United Kingdom’s statutory health services.

My work has been based on the theory put forward by McGilchrist in The Master and His Emissary (2009) that traits associated with the natural functioning of the human brain’s left hemisphere, which have evolved to enable us to analyse and manipulate the world around us, also have a propensity to distort the ways in which people mutually interact with their cultures over time. McGilchrist’s book covers two main themes: the neurology of the brain hemispheres and the cultural influence that arises from this interaction. He proposes that when they are unchecked by the moderating effect of the right hemisphere, the left hemisphere traits have an undue influence which is reflected in deleterious effects upon people and their culture.

McGilchrist explores many cultural aspects but he does not include an overall sociological viewpoint from which to study the wider societal impact of his theory, and it is here that I turn to the work of Žižek, who writes extensively about ideology as well as many of the problems confronting societies today, such as subjectivity, capitalism, human migration and social exclusion.

If McGilchrist’s theory is correct, there are implications not only for the interests of our society but also the way that a society’s problems are addressed through the delivery of healthcare services, particularly those related to psycho-social care: the same institutions designed to support those individuals who are negatively affected by societal difficulties. My thesis aims to discern the effects that McGilchrist warns us of and to suggest potential responses.

“If McGilchrist’s theory is correct, there are implications not only for the interests of our society but also the way that a society’s problems are addressed through the delivery of healthcare services”

According to McGilchrist, there is an optimum way for the human brain to manipulate the world around it. In general terms, the right hemisphere, which is more closely engaged with the surrounding environment, communicates its findings to the left hemisphere, which specialises in analysing fragmentary information.

The important final step is for the left hemisphere to then pass its new knowledge back to the right hemisphere, which retains the more holistic view, to assist it in making judgements about how to interact with the world. But the left hemisphere tends to value its own narrow conclusions, based on limited information, above those of the right. This arrangement can go awry if the left hemisphere becomes less inclined to co-ordinate its work with that of the right. Given that the relationship between the two hemispheres is there to enable us to work with the world around us, McGilchrist contends that over time, human cultures and practices can be negatively shaped by this imbalance.

Useful summary of McGilchrist’s thesis by RSA Animate. In terms of healthy hemispheric interaction, “the important final step is for the left hemisphere to then pass its new knowledge back to the right hemisphere, which retains the more holistic view, to assist it in making judgements about how to interact with the world.” It is this final step that so many of today’s practices and institutions fail to deliver or accomplish.

McGilchrist’s link between the neurological and the cultural is generalised through the idea of a feedback loop and the philosophical term Aufhebung, which he interprets to mean integration. McGilchrist describes cultural changes over time but does not provide a framework for understanding these beyond the interrelationship of neurology and cultural movements. This is the point where I employ Žižek to try to frame the ideological space in which this feedback loop occurs. My approach is to set McGilchrist’s theory in the wider context of Žižek’s world. Neither Žižek nor McGilchrist discuss each other – they operate in separate domains: the social and the neurological. But McGilchrist does briefly mention the influence of psychoanalytical thinking on culture (2009) and Žižek’s use of Lacanian theory, in relation to art and culture as well as to societal problems, can correspond with McGilchrist in those areas.

I begin by asking whether the theories of McGilchrist and Žižek can help in understanding and responding to ideological influences on the delivery of psychological and social care. What is the current problem with wellbeing services from a perspective based on McGilchrist’s theory?

 

Urizen in the NHS: the problems inherent to the psycho-social care system

According to Žižek (The Parallax View, 2006) ideologies arise as part of an attempt by a social system to conceal its inherent antagonisms. Based on this model, an ideology of wellbeing encourages the distressed individual to believe that the social structure around them is not a factor to consider in the formulation of their problems and urges them to change their thinking rather than to critique their surroundings.

Wellbeing is an important area to examine because it is the point where the wider societal antagonisms attempt to heal problems that they are responsible for creating.

The state delivery of psychological and social services is a useful juncture for observing ideological processes as well as being a potential point for intervention, for trying to ameliorate the effects that the ideology has upon the individual. I will be examining how a highly rational, utilitarian approach to healthcare – an approach that perceives itself to be capable of solving problems rather than causing them – actually contains inherent difficulties and is unaware of the part that it plays in creating the antagonisms around it. In McGilchrist’s terms, is there a way of articulating the left hemisphere functions so that they can be studied more easily? Unless this is done, we are at risk of trying to analyse a problem through the analytical medium that is the problem itself.

Oprah Winfrey is an excellent example of Zizek’s concept of the function of ideology: “an ideology of wellbeing encourages the distressed individual to believe that the social structure around them is not a factor to consider in the formulation of their problems and urges them to change their thinking rather than to critique their surroundings.” Aschoff (2015) claims that there is a storytelling elite who transmit a cultural message through media products such as the Oprah franchise, which encourages people to change themselves to adapt to the world rather than change the conditions under which they live.

 

The Left Brain abstraction of Wellbeing: IAPTs, NICE, and the DSM

Under the statutory health services in the United Kingdom, wellbeing, as an abstract idea that has been packaged under the mindset that McGilchrist warns us of, has been shaped by the introduction of IAPT mental health services which assume a certain form of subject.

Cognitive behavioural therapy (CBT), as delivered under IAPT (Improving Access to Psychological Therapy), is predicated on a predictable subject who receives standardised treatment in a neutral social setting. It is a pharmacological assessment tool overapplied to the field of psycho-social wellbeing where variables are far more complex (Bower and Gilbody 2010).

State delivered psycho-social healthcare in the UK follows the guidance put forward by the National Institute for Health and Care Excellence (NICE). The NICE guidelines on mental health treatment (2009), following the medical model originally designed around physical health, focus on the declared treatment method rather than the therapist, and where the relationship between the patient and their healer changes to one where the patient is seen as a site of illness and brought under the scrutiny of a medical gaze.

“How a highly rational, utilitarian approach to healthcare – an approach that perceives itself to be capable of solving problems rather than causing them – actually contains inherent difficulties and is unaware of the part that it plays in creating the antagonisms around it”. McGilchrist refers to Escher’s famous drawing, ‘Drawing Hands’, to illustrate this central feature of left brain thinking: it perceives itself to be the solution to the problems which it has itself generated.

 

Computerised CBT and the gaze of the big Other

Computerised CBT (cCBT) is the apogee of the ideological arrangement I have been describing: the human sits alone being given instructions by a computer program about their cognitions and behavior. This therapeutic intervention also exhibits the problematic left hemisphere characteristics: a left hemisphere mindset fails to look for answers outside itself.

Overtly, psychological treatment touts its objectivity, but beneath this veneer is an understanding that a lot of partiality is required to achieve this apparent neutrality. The unwritten rule appears to be that one must pretend, that one acts as if one believes in order to maintain the façade. In Žižek’s (1989) Lacanian interpretation of ideology, this pretence is to protect the gaze of the big Other, that which upholds the symbolic order, from the failure of the system supporting it.

“There is no space for an exploration of society or ideology in a CBT session. The CBT form of Socratic questioning coerces the client into accepting consensus because it limits the questioning to the basics of how a patient’s beliefs about anxiety and depression might be preventing the CBT from reducing symptoms.” You can see its appeal to an ideological healthcare system that refuses to see itself as an ideology.

The CBT form of Socratic questioning coerces the client into accepting consensus because it limits the questioning to the basics of how a patient’s beliefs about anxiety and depression might be preventing the CBT from reducing symptoms. The exercise is no longer an attempt to pursue truth or to generate an unfolding experience. Closing off extraneous information is something the left hemisphere excels at (McGilchrist, 2009). An alternative dialogue about the sources of distress in modern society and the role of psychology in treating it is excluded.

If, as I contend, society is developing along the lines that McGilchrist (2009) suspects it may, then the subtleties of the factors unique to each session, such as the therapeutic relationship, or the sheer weight of pressing external factors, such as a serious illness, will become increasingly ignored and therapy delivered by the state will be far less effective than it could be.

The healthcare system is acting like an institution which is heavily influenced by the thinking process McGilchrist describes in an unchecked left hemisphere. Ideological processes will attempt to conceal these antagonisms (Žižek, 2006) and those within the system itself will try to thrive within it by exploiting any transgressions which the system allows.

The 2015 Parliamentary Inquiry into the collapse of the children’s charity Kids Company was a classic illustration of how the ideological left-brain processes described by Zizek and McGiclhrist work in action. The committee refused to allow any material showing the actual environmental parameters in which child welfare operates (“the sheer weight of pressing external factors”), and which welfare deliverance must therefore be assessed; it refused to allow any understanding of the complexity of the system (“I am so fed up of hearing how complex it is – Make it Simple!” a civil servant declared at one point – the desperate cry of the Left Brain when faced with non-linear, non-quantifiable realities); and it relentlessly pursued only those elements that it pre-determined were relevant, such as the price of trainers, in an enquiry ostensibly about the wholesale inadequacy of child protection in this country. In other words, the whole thing operates on the level of Spectacle. It gets the results it has already decided it would get, and it fails to engage in any meaningful debate with the actual reality in front of it. It is a remarkable demonstration of how the left brain ‘wellbeing’ system, state sponsored and state run, operates.

 

Lacan and Subjectivity in Welbeing

Prior to Žižek becoming an established guide to Lacan’s work as a medium for the study of power, Lacan’s form of psychoanalytic theory had been applied to politics by figures such as Althusser as well as Laclau and Mouffe. One of Žižek’s applications of Lacanian theory is to interrogate ideologies at the point where they attempt to smooth over the antagonisms that are part of their essence; an idea that can also be applied to a clinical setting where ideologies influence health and social care delivered under the closed mindset that McGilchrist identifies.

In its most obvious form, this concealment of antagonisms manifests as the causes of emotional distress and their treatment being over-simplified so that they can be represented in a way that does not call into question the inequalities and disadvantages inherent in the way a society is structured.

IAPT, as a form of Althusser’s (1971) Ideological State Apparatuses (ISAs), educates the subject into seeing the problems as a matter of their subjective thought and behavior rather than as a result of the failures of the system itself. The antagonisms driving their upset remain concealed and once declared fit, they take their place back in the structure.

“In its most obvious form, this concealment of antagonisms manifests as the causes of emotional distress and their treatment being over-simplified so that they can be represented in a way that does not call into question the inequalities and disadvantages inherent in the way a society is structured.” So the patient internalises the ‘antagonisms’ of the system – manifested as ‘schizo’ thinking and behaviour, ‘divided’ selves, ‘‘neurotic’ manifestations (conflict between desire and agency) etc. The ‘unconscious’ of the person is where the system’s own ‘antagonisms’ are played out – the dynamics, conflicts, frustrations, and mental disorders, of those experiencing the system in particularly severe or direct forms. The system itself operates at the level of unconsciousness, because it has to conceal and repress it’s own role in the generation of these “symptoms”. Hence the origin of the orthodox “wellbeing” mantra (ideology), spoken by everyone from CBT therapists and classical psychoanalysts to Prince Harry and Oprah Winfrey: The distress, schizophrenic thinking and neuroses must be Your problem. Admit this and you can then receive treatment.

Žižek sees the weak point in Althusser’s argument as the lack of explanation linking the external ISA to the internalised obedience of the individual. Žižek’s answer to this gap is that the ISA can exert its influence “only in so far as it is experienced, in the unconscious economy of the subject, as a traumatic, senseless injunction” (The Sublime Object of Ideology). I will be working with these ideas of self-opaqueness and of the divided subject.

What generates the system ‘unconscious’ is precisely the nature of this external, social self-division: the need to keep half of the ISA conscious, and the other half ‘unconscious’ – i.e., the half linked to the traumatic nature of the ‘reality principle’ itself, which is what the system enforces. So, what Freud was hearing – listening to – in the consulting rooms of fin de cycle Vienna was not the unconscious of his patients so much as the unconscious of the ISAs – of the system itself.

The practical effect of these ideologies in state provisioned healthcare is that the individual is guided into overlooking the possibility that the causes of their distress might be rooted in the same system that is claiming ownership of that person’s wellbeing. The state’s IAPT project is a psychologically oriented programme whose narrow cognitive behaviourist interpretation of a patient’s symptoms belies the fact that many of the stressors for an individual can be seen as social phenomena which fall outside the remit of a psychologically driven intervention (Asay and Lambert). This can include factors such as housing, debt, relationships, employment and support.

The morality of IAPT is questionable, for its aim is to send people back into the conditions that generate the kind of problems that produced the distress in the individual in the first place.

“The morality of IAPT is questionable, for its aim is to send people back into the conditions that generate the kind of problems that produced the distress in the individual in the first place.”

The successfully treated individual is expected to conform and there is a tacit acceptance that a new generation will in turn take up the baton of distress.

 

McGilchrist in Žižek’s World

I have described the effects of the processes in McGilchrist’s theory as well as some ideas on how Žižek’s Lacanianism can also be seen at work through the ideas of the divided subject, ideology and the big Other. McGilchrist provides the neurological basis for the thinking style that lies behind a fixed belief in ideological structures while Žižek can give us some understanding of how the consequences unfold in modern society.

Scene from Tarkovsky’s haunting film, Stalker, a favourite of McGilchrist’s. The film’s exploration of the mysterious ‘Zone’ in which the three main characters enter, and their search for a mysterious room there, in which dreams are rumored to be fulfilled, might be seen as symbols for the “esoteric”, which the left hemisphere thinking style cannot comprehend, measure, or make explicit.

The esoteric stands for what the left hemisphere thinking style cannot comprehend and for what the health services miss among the metrics which they use to gauge humanity. It is the aspect of the subject which escapes being fully known by the system or the subjects themselves.

It is an acknowledgement that there is something within Being that is hidden and that the process of revelation involves something else becoming elusive. My response to the ideologies within healthcare is to acknowledge what is concealed – the esoteric – on the understanding that by its nature it will not be explicit and will point the way to further concealment.

“Don’t think, don’t politicize, forget about the true causes of their poverty, just act, contribute money, so that you will not have to think!” Another example of the antinomies by which left-brain capitalism works. As Oscar Wilde noted, “charity is not a solution: it is an aggravation of the difficulty”, and yet through the vacuous spectacle of televised feel-good-athons, its social ideology “buttresses the same system responsible for that immiseration”, as Patrick Stall notes. “We should instead seek to harness the potential of direct aid to create organizations which aim to abolish the conditions which make that aid necessary.”

For Žižek, ideology shapes our reality so that we cannot see it because it is the everyday fabric of our lives. Using the example of humanitarian aid, Žižek summarises the problematic attitude as follows: “Don’t think, don’t politicize, forget about the true causes of their poverty, just act, contribute money, so that you will not have to think!”

In following on from Žižek’s call to think more before acting, the works on which I am basing this thesis, those of McGilchrist and Žižek, are ones that discuss the importance of what is occurring within a person and how that person makes meaning of their world.

A theory-based approach is the frame for how I perceive the problem and my place in understanding it. I see the effects that McGilchrist describes and I see them emerge in a world for which Žižek has explanations. In the next section, I will look at how Tweedy’s (2012) application of William Blake’s creativity gives me some way of articulating this situation. For these authors, who emphasise the importance of what is happening within a person, a theory-led approach privileges the interior life at a time when healthcare focuses on external data.

 

Tweedy, Urizen, and the God of the Left Hemisphere

In this section I will introduce the concept of Urizen, a figure from the work of William Blake which I am employing as a device to better encapsulate the interface between McGilchrist’s neurological theory and the culture it shapes. Urizen, one of the Four Zoas in Blake’s worldview, is an aspect of the human mind:

Blake’s exploration of the Four Zoas and their Emanations, for example, present us with a complex and vital dynamic within the human psyche, and indeed both Blake’s visual art and his written work revolve around these inner psychodynamics (Tweedy, 2012).

Tweedy links the mental faculty of Urizen portrayed by Blake to the left hemisphere traits described by McGilchrist. Tweedy also sees a connection between the left hemisphere’s tendency to falsify and Lacan’s view of an ego compelled towards misunderstanding and misrecognition, something to which spiritual beliefs are not immune: “We are one with God only when God is no longer one with Himself, but abandons Himself, ‘internalizes’ the radical distance which separates us from Him” (Žižek, The Puppet and the Dwarf).

The problematic nature of the ego was identified by Lacan. In many of its operations, he observed, there is a compulsion for the ego to make “false connections”, such as in the confabulations or “false reasonings” which we have already seen constitute a large part of its method of operating. Indeed, Lacan argues, “the central function of the ego is to misunderstand” (méconnaissance or “misrecognition”). As McGilchrist similarly notes: “the left hemisphere exhibits a strong tendency to confabulate: it thinks it knows something, recog- nises something, which it doesn’t”. In this sense “the left hemisphere is the equivalent of the sort of person who, when asked for directions, prefers to make something up rather than admit to not knowing”. As the supposed agent of Freud’s “reality principle”, therefore, the ego is singularly ill-equipped to understand or even to recognise what is real, let alone guide the individual in engaging with reality (Tweedy, 2012).

At some point, as we extend McGilchrist’s ideas into their practical effects on our world, it is helpful to find a modus operandi beyond neurological terms. Tweedy not only emphasised McGilchrist’s references to the artist and mystic William Blake, especially through Blake’s creation of the figure of Urizen, but also found correspondence between Blake’s critique of the culture of his time and McGilchrist’s theories.

“Urizen is the limiter of Energy, the law-maker, and the avenging conscience”. Blake saw both Newton and the orthodox representation of ‘God’ of the Old Testament (‘the Ancient of Days’) as powerful instantiations of the ascendancy and dominance of this program or principle within the human brain – note how in both images the figure is dividing the world with its rationalising, measuring, quantifying compasses, and how both figures can only see what is directly in front of them (the narrow focus typical of the left hemisphere). Urizen sees everything in terms of ratio, measurement, law, efficiency, management – he is the ultimate NHS bureaucrat.

Blake’s Urizen is a figure that self-differentiated from the Eternity within which it developed: “Self-closed, all-repelling. What demon hath formed this abominable void, this soul-shuddering vacuum?” (Blake, The Book of Urizen). Urizen is a useful way to conceptualise, beyond mere brain matter, the effects that McGilchrist describes. Urizen “symbolizes Reason. But he is much more than what we commonly understand by ‘reason’: he is the limiter of Energy, the law-maker, and the avenging conscience” (Damon). Authors such as Bracher (1985) and Freeman (1997) have used the figure of Urizen in a similar way to me. The physicist Frank Wilczek (2015), in his blending of the rational with the mystical, describes Blake’s figure of Urizen as dualistic: a figure who brings and constrains life. Wilczek sees Urizen as carrying echoes of Blake’s portrayal of Newton, a figure who achieved much but who in doing so became absorbed by abstractions and ignored a wider perspective.

In the following section, as I look for evidence for McGilchrist’s theory, I will use the figure of Urizen to describe the left hemisphere faculties when manifested in areas where they are more apparent. Urizen does not just refer to the neurological in McGilchrist’s theory, but it also helps to bridge the gap between the left hemisphere and the culture it influences. Urizen also helps to provide a metaphor for the points of commonality between the situations that McGilchrist and Žižek depict.

McGilchrist’s remarkable lecture on William Blake for the William Blake Society (2016), in which he suggests the links between left hemispheric ways of thinking and Blake’s figure of Urizen.

Urizen is not going to reveal itself through normal empirical studies. Both McGilchrist and Žižek are tackling issues that are deeply entrenched within our social fabric and from which it is hard to achieve some critical distance.

 

The footprints of Urizen: tattoos, self-expression and the fragmented self image

In the remarkable novel by Thomas Harris, Red Dragon, the central character Francis Dolarhyde develops an obsession with Blake’s painting and becomes fixated with the sense of power and strength that he thinks the Dragon exudes, and even has the image tattooed onto his back. Dolarhyde later becomes a psychopathic serial-killer, like Hannibal Lecter (another character in Harris’s novel). Like the left hemisphere itself, both characters are obsessed with the idea of power (or more precisely, impotency).

I will be describing the influence of Urizen at the meeting point between art and the body through the medium of tattooing, recalling that McGilchrist sees art as the confluence of the body and soul.

Urizen’s influence in the art gallery extends onto human skin. There comes a point in body art where the disparateness of the themes begins to resemble McGilchrist’s examples of the left hemisphere’s perception of the world, in that fragments of information are isolated from their source and heavily abstracted from their original meaning.

Benson describes this interaction between body art, culture and the psyche:

The haphazard and incoherent nature of early twentieth-century tattoo reflects lives that were themselves often incoherent and fragmented, ‘one thing after another’: we should not be surprised by the absence of a master narrative of the self expressed upon the skin.

There are a variety of reasons why people get tattooed (Wohlrab, Stahl and Kappeler, 2007) and their motivations are further complicated by the influence of mainstream and social media on their decision (Walzer and Sanjurjo, 2016).

“Our bodies have become the refrigerator magnets of quotes, sayings and reminders”.

But, as with the example of conceptual art, there are influences on art displayed on the body which reflect negative aspects of modern living:

Our current society craves individuality and self expression. And now many people wear their artistic expression. We are having more trouble communicating with each other than ever before, as electronic communication will never replace face-to-face human contact. So, it’s not surprising that there’s a growing trend toward communication via body ink. We don’t have to talk, we just have to look. Our bodies have become the refrigerator magnets of quotes, sayings and reminders (Karim, 2013).

“the footprints of Urizen”

I am indicating the popularity of these designs as the footprints of Urizen, for the left hemisphere constructs its own self-image in spite of the facts. Dawkins’ concept of the meme as a unit of culture is Urizenic and has relevance here. McGilchrist describes this operation as “a perfect example, incidentally, of the left hemisphere’s way of construing its own history, not least in its way of breaking a culture into atomistic fragments devoid of context”. The fragmentation of images is a theme of left hemisphere influence.

The individual relies on signifiers to provide some semblance of meaning to their world. Without these signifiers, the individuals would fall into a state of psychosis, unable to fix meaning to their surroundings (Lacan, 2006).

Benson’s study also corresponds with McGilchrist in that she sees body marking as an attempt to fix and control the sense of self, seeing the body as manifesting the subject’s will. In contemporary body marking, control is exercised through “the body as a thing to be bent to the will of the self” and tattooing gives “assertions of permanence to ideas of the body as property and possession”. The left hemisphere baulks at its inability to control the impermanence of the body (McGilchrist, 2009). Blake, in developing the figure of Urizen, perceived that for the faculty of Reason, “to accept the reality of the natural world is automatically to be plunged into despair and paranoia about the status of the self” (Quinney, 2009).

“In contemporary body marking, control is exercised through ‘the body as a thing to be bent to the will of the self’.” Illustration: from the film of Red Dragon, with Dolarhyde standing before Blake’s picture. In a sense, the reflected image on his back suggests how Urizenic patterning operates in wider society, as unconscious echoes, imitations, or ‘footprints’ of fragmented, power-based left-brain forms of thinking.

 

CCGs:Redefining Illness to suit the Remedy

The abstraction of people into data in psycho-social healthcare leads to alienation but it is handled by forcing NHS CCGs to demonstrate effectiveness by analytics, not by the individual patient’s sense of what they need to solve their problem, which may not involve psychological treatment.

The CCGs are forced to collude in the deception because if they fail, they are punished by the withholding of funds from NHS England. Under this pressure, the PCTs (the Primary Care Trusts which were later changed into CCGs under statute) would not accept patients who were unlikely to recover or whose illness could not fit easily into a measurable category.

The problems identified by Dorling (2016) as key factors in happiness are not recognised by IAPT because they are social rather than psychological, and the areas important to his work relate to problems inherent to the dominant liberal ideology such as inequality, social mobility and income.

The sickness of the soul can be manifested in the emotional health of those who live within a society built along Urizenic lines.

Sundquist, Frank and Sundquist (2004) identify a link between urban living and psychosis and I believe that the stresses faced by such populations are one of the mechanisms by which Urizen thrives: people treated as isolated units to be densely packed and managed en masse by a remote management structure. Eckersley describes a state of “cultural fraud” by which the individualism being promoted as beneficial to the economy is having a deleterious psycho-social effect, such as with increased suicide rates.

“The rate of schizophrenia is two and a half times higher in urban metropolitan areas than it is in rural areas. So, it ain’t genetic” – Christopher Bollas, psychoanalyst and author of When the Sun Bursts: The Enigma of Schizophrenia.

 

Urizen Goes Global

Tweedy (2012) observes how the negative influence of British imperial expansion in the eighteenth century was depicted in Blake’s work and I will look at how Urizen projects itself onto the world stage. To trace Urizen’s outward growth requires a look at the conditions in which it is incubating. The first area to consider is how Western liberalism copes with its failings. Žižek describes ideologies concealing their internal antagonisms and McGilchrist warns that the left hemisphere does not recognise its errors as its own.

When scaled upwards as national policy, these mindsets produce a system that applies rules but which refuses to be open about their negative consequences. This extends from areas such as wellbeing into foreign policy, a process I will now show. Using the analogy of an infection, in this section I will describe how Urizenic tendencies are incubated in a domestic setting and how Urizen’s cultural impact influences domestic politics before it spreads internationally. For Blake, the analytic mindset represented by figures such as Isaac Newton, Francis Bacon and John Locke promoted unrest in many settings. According to Damon, Blake felt that “the cruel philosophy of materialism has spread from England over the world” (Damon).

In the field of wellbeing there exists the mythology within the liberal system that it possesses cures for its own antagonisms. Problems which stem from lack of social mobility are seen as psychological responses within the individual, not deficiencies within the system. The New Economics Foundation (NEF) promotes the Five Ways to Wellbeing:

The concept of wellbeing comprises two main elements: feeling good and functioning well. NEF has developed a set of five evidence-based actions to improve personal wellbeing. The 5 ways to wellbeing are: connect, be active, take notice, keep learning, and give (NEF Publications, 2016).

It is Urizenic in that it has abstracted various ideas away from their original context in the belief that their simple re-application in a modern setting, without accounting for the effects of twenty-first century approaches to technology and economics, will paper over the problems of high-density living in post-industrial inner cities where those without access to key opportunities early on are unlikely to improve on their prospects for employment or upward social movement. As with IAPT, further speculation about alternative causes for emotional distress, such as the system itself, is omitted.

Not so NICE: “Papering over the problems of high-density living in post-industrial inner cities where those without access to key opportunities early on are unlikely to improve on their prospects for employment or upward social movement. In the field of wellbeing there exists the mythology within the liberal system that it possesses cures for its own antagonisms.” (Photos from Kids Company’s right-brain welfare campaign, See the Child, Change the System).

 

They Shoot Horses, Don’t They?: Zumba as solution to NHS stress

Urizen, as manifested via the NHS, does not regard itself as something that may create or amplify the difficulties within an ideological structure. In 2015, NHS England’s chief executive Simon Stevens announced that staff would be offered Zumba classes to reduce sickness rates (BBC News).

This occurred two months before junior doctors threatened strike action related to pay and working conditions. Stevens’ proposal is reminiscent of the way that patients with right hemisphere damage will adopt the left hemisphere’s strategy of misrepresenting facts which are demonstrably wrong, such as claiming to be able to lift an incapacitated arm but suddenly announcing that it is not really their arm after all when challenged on why they have not done so (McGilchrist, 2009) – a phenomenon known as hemispatial neglect. By framing the problems of staff absenteeism as one that needed only a facile solution, the NHS does not have to openly discuss other potential causes of sickness absence such as poor management and debilitating work stress.

They Shoot Horses, Don’t They? Scene from the classic Sydney Pollack film with Jane Fonda about how dance and financial incentives are used by the system to mask the brutality of the system forcing people to dance for it.

The IAPT programme is the equivalent of these Zumba classes. Urizen’s success in delivering wellbeing – whatever that actually is – can be proved by the metrics that Urizen creates to define the term. The most recent example is the vanguardism of the cognitive behaviourist lobby in claiming to be the bow wave of improving wellbeing while limiting it by only approving a fraction of what is available and restricting who can access it by stringent criteria that are designed around their model of illness rather than a collaborative formulation with the patient of their wider needs beyond that specific psychological viewpoint.

One is left to question what IAPT’s true purpose was because it has been a successful model for channeling millions of pounds into the psychology departments of select establishments, strengthening the careers of those who publish and develop courses which reinforce the approved paradigm, and invigorating the career structure for the field of psychology at the expense of sociology, social work and children’s services.

“Margaret Thatcher’s much-cited view that ‘There’s no such thing as society, only individuals and their families,’ finds an unacknowledged echo in almost all approaches to therapy, including those that continued throughout the second half of the twentieth century to wrap themselves in the mantle of ‘science’. For example, in asserting its claim to ‘evidence-based’ credibility, cognitive behavioural therapy (CBT) takes no more note of social influence in the generation of distress than do the ‘humanistic’ therapies. CBT—in fact more a kind of rhetorical construction than a serious, theory-based practice—is perhaps the least convincing of all therapies from the standpoint of a critical onlooker. In combining the ‘scientific rigour’ of behavourism with the mentalism of, essentially, popular psychology, CBT is par excellence the product of professional interest.” – David Smail, Power, Interest and Psychology

Yet if we judge IAPT by its declared original purpose – improving wellbeing to reduce unemployment in a manner that will pay for itself (Layard et al., 2006) – it has failed. An investigation by Pulse in 2013 found that targets were not being met and recovery rates were slipping.

Two years later a report by the Health Foundation found that the figures for 2015 had elements of both success and failure, based on information which showed that IAPT had changed its data sets in the second quarter of the 2013/2014 period (Dormon, 2015). In other words, because the project was failing, it simply changed the criteria by which it judged itself and even that did not work. Layard has allowed an elite to benefit but a decade later we have a failed system propped up by massaged figures. This response to problems is like the earlier example of hemispatial neglect.

“In other words, because the project was failing, it simply changed the criteria by which it judged itself and even that did not work”. IAPT’s creative solution recalls Sheldrake’s humorous observation at how the department of Metrology responded to the awkward discovery that the speed of light – considered to be a constant in the scientific community – actually seemed to fluctuate (for example, it dropped between 1928 and 1945 by about 20 kilometres a second). Intrigued by these empirical and rather exciting findings, Sheldrake went to see the Head of Metrology at the National Physical Laboratory at Teddington, who gave him the classic left brain response: ‘Oh, we’ve solved the problem. We fixed the speed of light by definition in 1972″ – i.e., they simply redefined it to mean what will make the statistics more plausible, and to preserve their conceptual belief in it as a ‘constant’.

An Urizenic system is broadcasting a series of guidelines at an Urizenic population and the possibility of alternative perspectives about the issues is never featured in the documents. Urizen shapes a society by promoting ways of being that foster its worldview.

“IAPT was Blair’s domestic equivalent of the 2003 Iraq invasion: neoliberalism’s passage a l’acte based on a closed view of the problem and its solution. Our crisis arises from Urizen and the same mindset is used by political authorities and social planners in an attempt to solve it.”

 

Conclusion: Urizen versus the Spiritual

In response to an ideology built on Urizenic principles, McGilchrist infers possible solutions which point towards the esoteric, those areas of spirituality and art which defy analysis and integration. In the following passage I interpret him as not only endorsing the esoteric, but also recognising that an Urizenic system is inherently vulnerable to what may erupt from the real:

My theme may seem pessimistic. I do think that there are, nonetheless, reasons for hope. As will be obvious, I think we need, for one thing, urgently to move on from our current, limiting preconceptions about the nature of physical existence, spiritual life and art, and there are some small indications that this may be happening. Art and religion should not become part of the betrayal. Another reason for hope lies in the fact that, however much the left hemisphere sees progress as a straight line, it is rarely so in the real world. The very circularity of things as they really are, rather than as the left hemisphere conceives them, might be a reason for hope.

McGilchrist, as part of his argument about left hemisphere influence on culture, points out the ways that religions can be highly organised and abstracted from their spiritual origins but does not go much further beyond documenting the popularity and decline of religious movements alongside other cultural indicators.

Tweedy’s development of McGilchrist’s themes through the works of Blake includes Blake’s conception of God. Tweedy (2012) helps to differentiate the ideas of the divine from those of a deity. According to Tweedy, Blake’s God is closely linked to the human experience and is not a remote entity requiring intercession: “for an abstract and impersonal God, Blake maintained, is the invention of the rationalising Spectre, and is the sort of God invoked and adored by all Urizenic religions and philosophies”. Urizenic religions “are founded on the belief that God is more than man”. Blake, an opponent of religious orthodoxy, also saw the human as divine. “Priesthood, according to Blake, did not originate in the belief that God was human, but in the belief that God was not human”.

Urizen as God, with his book of laws, regulations, rules, dogmas. As Urizen himself proclaims in Blake’s Jerusalem: “I am God O Sons of Men! I am your Rational Power!” Urizen’s mistake, as Blake sees it, is not that he is rational, but that he has become hyper rational and domineering, not allowing for any other way of seeing. In McGilchrist’s terms, the Emissary has made himself Master, with catastrophic results.

Parallels between Blake and Žižek can be seen in the refutation of a God outside of man and the idea of an internal authority figure (the big Other). Blake’s rejection of a priestly caste also aligns him with Žižek who regards the community as the Holy Spirit.

Zizek suggests that “meditation is the ideological format most suited to global capitalism”.

Žižek is critical of the transcendental techniques which have increased in popularity in the West, designed around certain types of spirituality. He uses examples from Victoria (1997), based on the teachings of Suzuki, to illustrate how meditative detachment can enable a combatant to psychologically distance themselves from the act of killing. Žižek writes that “spiritual meditation, in its abstraction from institutionalized religion, appears today as the zero level undistorted core of religion” (Žižek, Milbank and Davis) and argues that such an intimate experience through meditation is the ideological format most suited to global capitalism.

This version of spirituality encourages its followers to avoid trying to cope with the demands of technology and instead “renounce the very endeavor to retain control over what goes on … while retaining an inner distance and indifference”. When viewed under McGilchrist’s rubric, Žižek is saying that a certain element (in this case, meditation) has been taken away from its original context, abstracted into a new entity and then utilised to make money, another form of abstraction.

In his recent book CBT: The Cognitive Behavioural Tsunami: Politics, Power and the Corruptions of Science (Routledge, 2018), psychotherapist Farhad Dalal also warns against the third wave of CBT which includes the promotion of Mindfulness-Based Cognitive Therapy (MBCBT). Although the evidence of this approach as an efficacious remedy for depression has been embraced by NICE and the IAPT, he points out that it is not the CBT success story that it may appear to be on first glance.

McGilchrist’s views on the co-opting of spiritual traditions complements Žižek’s: “Thus 15 minutes Zen meditation a day may make you a more effective money broker, or improve your blood pressure, or lower your cholesterol”. McGilchrist’s theory also links the detachment identified by Žižek with left hemisphere processes:

The relative detachment from the body displayed by the left hemisphere, and its tendency to abstraction, normally serve its purposeful striving towards individual gain. The left frontal lobe, however, brings distance, and allows the experience of the peaceful detachment from the material realm and ‘emptying out’ described by experts in meditation as a mystical experience (McGilchrist, 2009).

The Urizenic subject compensates for an absence of holistic meaning by filling their world with piecemeal signifiers. McGilchrist provides us with the themes, such as novelty and abstraction, that this mindset adopts. The esoteric subject recognises the void within their view of the whole and accepts the separation they feel from an ideal, whether that means the Sufi’s separation from God, the Lacanian self-division, or the acknowledgement by both of their sense of the real.

Some of the key intellectual figures and fighters in the pushback against Urizen, generating new ways of thinking from within a culture dominated by instrumental reason and calculating processes.

It is possible to resist Urizenic tendencies. McGilchrist describes points in time where certain cultural movements, such as Romanticism, were able to emerge and how even outside of those periods, a minority of artists were still able to generate new ways of thinking from within a culture dominated by the sort of problems I have explored above. In Blake’s cosmology, there is a reconciliation when Urizen realises the damage he has caused and begins to work in harmony with the other figures included in his myth, not forgetting that these figures, including that of Urizen, represent emanations of the psyche.

“Under Urizenic conditions, the therapist is alienated from the results of their work.”

One step towards changing healthcare policy would be to alter the relationship between the individual entering the health system and the system itself. Under Urizenic conditions, the therapist is alienated from the results of their work. The IAPT coup has created a new form of indentured worker: people trained to deliver therapy a certain way and needing continued employment within that narrow field in order to live.

One of the implications of the changes that I am proposing would be a direct correlation between psycho-social treatment and the challenging of the ideologies which have played a part in the distress of the patient.

Atomised, quantified, and compartmentalised: “there is a direct correlation between psycho-social treatment and the challenging of the ideologies which have played a part in the distress of the patient.”

With CBT there is no critical enquiry into the surrounding culture and the sociological setting of CBT is regarded as an ideologically free neutral space. There might be any number of variables beyond the psychological but the Urizenic mindset present within the current healthcare system fails to recognise what does not fit its worldview. There is no space for an exploration of society or ideology in a CBT session.

Someone’s anger at an unfair system that disadvantages them can be pathologised as a psychological problem about their inability to regulate their emotions. Under my proposals, the system would recognise the part played by the social structure itself in contributing to violent reactions and it would also consider its inability to formulate a response. Instead of classifying the subjects as psychological patients, the system would seek to alter how it classifies people and accept that it may have no way of accommodating a new social phenomenon.

Traditions that embrace non-doctrinal thinking have existed within the ideologically driven social structures that McGilchrist and Žižek describe and offer a form of response to those systems. Ideas found in doctrines that can be labelled as mystic or esoteric represent features that are on the margins of what is accepted or understood by the mainstream and with elements that escape full capture by the prevalent ideology. These spaces permit unusual situations to occur, the potential for an event (Badiou) or act (Žižek) that can reset the co-ordinates of what went before.

In the field of psycho-social healthcare, this means that people can have an opportunity to alter the circumstances which have created or contributed to their distress.

“Under my proposals, the system would recognise the part played by the social structure itself in contributing to violent reactions and it would also consider its inability to formulate a response.”

This invitation will not be welcomed by the current social apparatus because it places the emphasis for treatment on the questioning of the social structure itself and because it invites those within it to challenge it as part of their means of recovery. If one accepts the arguments put forward by McGilchrist and Žižek, the problems that industrialised capitalist societies face are deeply rooted within our individual and collective mental frameworks. Changing them will require people to relinquish strongly held views. Until this is possible, psycho-social care can at least create the conditions for change by placing the weight of investment in future generations rather than attempting to resolve a swathe of social and cultural difficulties that are beyond the reach of the very system that is creating them. I am advocating interventions from a range of disciplines, ones that go beyond the treatment of symptoms, ones that interrogate the society that is not only permitting psycho-social problems but is also corrupt in the claims it makes for the alleviation of that suffering.

Malcolm Hanson is a psychotherapist and was a manager within the National Health Service (NHS) from 2008 to 2017. The above article is an edited version of his 2018 thesis Can the Theories of McGilchrist and Žižek Help in Understanding and Responding to Ideological Influences on the State Delivery of Psycho-Social Care? To read the full thesis, please click here

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