Can talking make you better?

CBT does not cure cancer, schizophrenia or arthritis, but it does improve mood, coping and quality o

Professor Ravetz is right. Cognitive behaviour therapy is Labour's new therapy of choice. But why is it suddenly popular in government circles not previously noted for their interest in psychological treatments?

Talking therapies are nothing new, but despite their long history many have struggled to prove themselves in a health service dominated by the economists. Psychoanalysis looks at deep-seated reasons for why we are the way we are - but even if it can answer questions about the human condition, it has not proved a success in treating specific disorders, and often takes years not doing so. In contrast, counselling is usually brief and cheap, but is sometimes not much more than sympathetic listening and empathy. Neither is much good when it comes to treating well-defined conditions such as panic disorder, phobias, obsessions and compulsions.

Cognitive behaviour therapy does represent a genuine advance in the treatment of many conditions. Unlike psychoanalysis it does not depend upon searching inquiries into childhood or early life, or speculative forays into the unconsciousness. CBT is about identifying conscious thoughts - thoughts about dying when having a panic attack, for instance, or about being useless when in the presence of other people. And then it is about how we react to these thoughts and how these behaviours in turn impact back on our thoughts and feelings. Perhaps I was in a road accident some years ago. Now I refuse to get into a car in case it happens again, and get tense and anxious even thinking about it. What I need is to identify my fearful thoughts, understand how they relate to my experiences, and then start a cautious programme of overcoming these fears by gradually spending more and more time in cars, as I learn that it is not inevitable that history will repeat itself. CBT is directive - it is not enough to be kind or supportive, although CBT therapists should be both - what is also needed is clarifying the thoughts which are determining our reactions and planning new behaviours as alternatives to these previously unsuccessful ways of coping or managing symptoms.

CBT has one further advantage over its predecessors. Because it is easier to describe, monitor and evaluate successes and failures, and because it deals in measurable outcomes, it lends itself to the empirical approach. And so there is now a wealth of evidence sufficient to satisfy even the most sceptical health economist that CBT can and does improve outcomes in various disorders.

Randomised controlled trials, which remain the gold standard of evidence, have shown that CBT is effective not just in the classic psychiatric disorders such as post-traumatic stress disorder, major depression, agoraphobia or schizophrenia, but also physical disorders such as cancer or rheumatoid arthritis, and even disorders such as irritable bowel syndrome or chronic fatigue syndrome that lie somewhere in between. Of course, CBT does not cure cancer, schizophrenia or arthritis, but it does improve mood, coping and quality of life.

CBT is not a panacea. And yes, it is trendy. Too trendy - since in the largely unregulated bear pit that are the psychotherapies virtually anyone can, and many do, claim to be carrying out CBT. To become a skilled CBT therapist takes about the same length of time as it does to become a doctor. That raises legitimate questions about the new "Improving Access to Psychological Therapies" initiative. Sometimes known as the Layard initiative, after the economist who has steered the scheme through government, this is intended to add 3,500 new CBT therapists to the NHS workforce.

A predecessor, the "Graduate Psychology Programme", which gave GPs access to psychology graduates who had not completed any clinical training and who became known colloquially as "barefoot psychologists", ran into difficulties since many GPs found that these willing but unskilled personnel lacked the experience and qualifications to make any meaningful impact. The Layard scheme has learned from the past, but will need to ensure that improving access is not at the expense of standards.

Finally, is this really a sly scheme simply to reduce the staggering costs of disability benefits? The answer is no, not directly. The aim is to give everyone who is suffering from clinical depression or an anxiety disorder the option of an effective psychological treatment, regardless of whether they are on benefits or not. However, if that also means that some are able to re-enter the world of work, then so much the better. If there is one thing that has been established by a generation of psychiatric research, it is the strong relationship that exists between mental health and unemployment.

Simon Wessely is head of the department of psychological medicine at the Institute of Psychiatry, King's College London

This article first appeared in the 05 May 2008 issue of the New Statesman, High-street robbery

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“It was the most traumatic chapter of my life”: ex-soldier James Wharton on his chemsex addiction

One of the British Army’s first openly gay soldiers reveals how he became trapped in a weekend world of drug and sex parties.

“Five days disappeared.” James Wharton, a 30-year-old former soldier, recalls returning to his flat in south London at 11pm on a Sunday night in early March. He hadn’t eaten or slept since Wednesday. In the five intervening days, he had visited numerous different apartments, checked in and out of a hotel room, partied with dozens of people, had sex, and smoked crystal meth “religiously”.

One man he met during this five-day blur had been doing the same for double the time. “He won’t have been exaggerating,” Wharton tells me now. “He looked like he’d been up for ten days.”

On Monday, Wharton went straight to his GP. He had suffered a “massive relapse” while recovering from his addiction to chemsex: group sex parties enhanced by drugs.

“Crystal meth lets you really dig in, to use an Army term”

I meet Wharton on a very different Monday morning six months after that lost long weekend. Sipping a flat white in a sleek café workspace in Holborn, he’s a stroll away from his office in the city, where he works as a PR. He left the Army in 2013 after ten years, having left school and home at 16.


Wharton left school at 16 to join the Army. Photo: Biteback

With his stubble, white t-shirt and tortoise shell glasses, he now looks like any other young media professional. But he’s surfacing from two years in the chemsex world, where he disappeared to every weekend – sometimes for 72 hours straight.

Back then, this time on a Monday would have been “like a double-decker bus smashing through” his life – and that’s if he made it into work at all. Sometimes he’d still be partying into the early hours of a Tuesday morning. The drugs allow your body to go without sleep. “Crystal meth lets you really dig in, to use an Army expression,” Wharton says, wryly.


Wharton now works as a PR in London. Photo: James Wharton

Mainly experienced by gay and bisexual men, chemsex commonly involves snorting the stimulant mephodrone, taking “shots” (the euphoric drug GBL mixed with a soft drink), and smoking the amphetamine crystal meth.

These drugs make you “HnH” (high and horny) – a shorthand on dating apps that facilitate the scene. Ironically, they also inhibit erections, so Viagra is added to the mix. No one, sighs Wharton, orgasms. He describes it as a soulless and mechanical process. “Can you imagine having sex with somebody and then catching them texting at the same time?”

“This is the real consequence of Section 28”

Approximately 3,000 men who go to Soho’s 56 Dean Street sexual health clinic each month are using “chems”, though it’s hard to quantify how many people regularly have chemsex in the UK. Chemsex environments can be fun and controlled; they can also be unsafe and highly addictive.

Participants congregate in each other’s flats, chat, chill out, have sex and top up their drugs. GBL can only be taken in tiny doses without being fatal, so revellers set timers on their phones to space out the shots.

GBL is known as “the date rape drug”; it looks like water, and a small amount can wipe your memory. Like some of his peers, Wharton was raped while passed out from the drug. He had been asleep for six or so hours, and woke up to someone having sex with him. “That was the worst point, without a doubt – rock bottom,” he tells me. “[But] it didn’t stop me from returning to those activities again.”

There is a chemsex-related death every 12 days in London from usually accidental GBL overdoses; a problem that Wharton compares to the AIDS epidemic in a book he’s written about his experiences, Something for the Weekend.


Wharton has written a book about his experiences. Photo: Biteback

Wharton’s first encounter with the drug, at a gathering he was taken to by a date a couple of years ago, had him hooked.

“I loved it and I wanted more immediately,” he recalls. From then on, he would take it every weekend, and found doctors, teachers, lawyers, parliamentary researchers, journalists and city workers all doing the same thing. He describes regular participants as the “London gay elite”.

“Chemsex was the most traumatic chapter of my life” 

Topics of conversation “bounce from things like Lady Gaga’s current single to Donald Trump”, Wharton boggles. “You’d see people talking about the general election, to why is Britney Spears the worst diva of them all?”

Eventually, he found himself addicted to the whole chemsex culture. “It’s not one single person, it’s not one single drug, it’s just all of it,” he says.



Wharton was in the Household Cavalry alongside Prince Harry. Photos: Biteback and James Wharton

Wharton feels the stigma attached to chemsex is stopping people practising it safely, or being able to stop. He’s found a support network through gay community-led advice services, drop-ins and workshops. Not everyone has that access, or feels confident coming forward.

“This is the real consequence of Section 28,” says Wharton, who left school in 2003, the year this legislation against “promoting” homosexuality was repealed. “Who teaches gay men how to have sex? Because the birds and the bees chat your mum gives you is wholly irrelevant.”


Wharton was the first openly gay soldier to appear in the military in-house magazine. Photo courtesy of Biteback

Wharton only learned that condoms are needed in gay sex when he first went to a gay bar at 18. He was brought up in Wrexham, north Wales, by working-class parents, and described himself as a “somewhat geeky gay” prior to his chemsex days.

After four years together, he and his long-term partner had a civil partnership in 2010; they lived in a little cottage in Windsor with two dogs. Their break-up in 2014 launched him into London life as a single man.

As an openly gay soldier, Wharton was also an Army poster boy; he appeared in his uniform on the cover of gay magazine Attitude. He served in the Household Cavalry with Prince Harry, who once defended him from homophobic abuse, and spent seven months in Iraq.


In 2012, Wharton appeared with his then civil partner in Attitude magazine. Photo courtesy of Biteback

A large Union Jack shield tattoo covering his left bicep pokes out from his t-shirt – a physical reminder of his time at war on his now much leaner frame. He had it done the day he returned from Iraq.

Yet even including war, Wharton calls chemsex “the most traumatic chapter” of his life. “Iraq was absolutely Ronseal, it did exactly what it said on the tin,” he says. “It was going to be a bit shit, and then I was coming home. But with chemsex, you don’t know what’s going to happen next.

“When I did my divorce, I had support around me. When I did the Army, I had a lot of support. Chemsex was like a million miles an hour for 47 hours, then on the 48th hour it was me on my own, in the back of an Uber, thinking where did it all go wrong? And that’s traumatic.”

Something for the Weekend: Life in the Chemsex Underworld by James Wharton is published by Biteback.

Anoosh Chakelian is senior writer at the New Statesman.

This article first appeared in the 05 May 2008 issue of the New Statesman, High-street robbery