The Ableism of CBT
Cognitive Behavioral Therapy is sold as the solution for just about everything, with it’s “evidence based” claims wildly exaggerated. To see it thrown about as the end all be all for every ailment and human hardship is disheartening and hurtful. It has been offered to me as the best tool in the tool box by therapists, social workers, physicians, and psychiatrists. And yet it has remained, alongside its sibling “mindfulness,” as one of the more harmful tools offered, like giving me a hammer and asking me to hit myself with it over and over again and calling it help. Because that is precisely the direction it goes, asking me to turn against myself again and again, assuming that my own thoughts are incorrect and faulty and just need to be brought into correct alignment. What a terrible offense to my own self worth and integrity.
According to the American Psychological Association, Cognitive Behavioral Therapy is “based on several core principles, including:
- Psychological problems are based, in part, on faulty or unhelpful ways of thinking.
- Psychological problems are based, in part, on learned patterns of unhelpful behavior.
- People suffering from psychological problems can learn better ways of coping with them, thereby relieving their symptoms and becoming more effective in their lives.”
Treatment involves changing the thinking patterns, because it is, after all, faulty. One does this primarily through “Learning to recognize one’s distortions in thinking that are creating problems, and then to reevaluate them in light of reality.”
But whose reality exactly? Who anointed themselves decider?
There are other words for this recognizing of distortions that come to mind: gaslighting, denial, displacing your discomfort of my own lived experience onto me so you don’t have to deal with it, victim blaming, complete and utter bullshit.
I come from a history of Complex PTSD and as a result, the kind of contents in my brain are a bit like the haunted version of a playground, where fun things can suddenly become scary things and it’s best to go in gently and with respect for what lives there. My life is also more than past tense trauma from a childhood or a singular event that changed my understanding of the world. I am autistic and live in a world that is not just neurotypical but believes that being neurotypical is superior and more human, and asks me to conform every day in ways large and small if I want to work, have relationships, survive in a grocery store to get food. I live with chronic illness and dynamic disability which means that there is never a point in time in which I am not in pain and there are some points in time in which I am in the kind of pain which means I am unable to do anything but lay in bed. There are significant and real losses which accompany being a sick person, such as loss of identity, loss of relationships, loss of capacity, loss of feedback in the world, loss of socialization, loss of income, loss of autonomy and agency, loss of connection. Ableism means that the world is not meant for me, set up for me, created to include me, or all that kind to me.
When placed in the container of cognitive behavioral therapy, the implications are insidious.
It is not my thinking that is distorted or faulty but the backwards world of blaming me for the harm that happens to me.
What really happens is that my life is uncomfortable for others, including the therapists and social workers who are meant to be helping. Because they don’t know what to do or say I suppose when there is no other “cheap turn it back on the most impacted instead of feel out of my own depth” option for what I bring into a room.
It is uncomfortable to be in the reality that there is no stop to the pain and there is no way to think differently about the pain to make it not be, well, painful. I can meditate. I can find comfort measures. I can make some adjustments that aid in mobility. But that does not ever mean I am not in physical pain. There is no way to change a thinking loop that makes my body not broken, my symptoms magically disappear, and my pain a mirage that I only imagined. It is challenging for myself to accept, let alone others, that there is no way out of this and no way to make it better, any more than there is a way to suddenly get doctors to behave better simply through right thinking. So yes, I am sad and depressed and anxious. I am afraid it will get worse and I am devastated at everything it has taken and I am resentful that I can’t participate in life as I want and what would be useful is to have space to be in these experiences as they are, without denying them and to receive genuine compassion instead of telling me they are in my thoughts which I only need learn to change into better thoughts.
It is awkward to say the least for someone who is neurotypical to sit there and listen to and grasp in the smallest of ways (if they are even willing to do so, which most are not) that being autistic in this world means that most people want who I am to be different, and I am not just thinking this so I cannot simply change the thinking. They want a part of me killed off, dead, gone, altered, and they are sad and offended by my brain and personhood. There is a very real reason autistic folks have a higher rate of dying by suicide, and it is not because of faulty thinking. It is because others want this part of us dead, and that is a difficult way to want to be alive. It is not just a “my brain is different” experience. It is having to translate every part of myself in order to try to connect with others, and still being misunderstood most of the time. It is having everything in the world set up for people who have brains different then my own, and then being told in ways large and small, again and again and again, that it is some kind of tragedy that I am this way.
CBT would have me sit there and tell myself I am safe, I am believed, that my experience is only temporary, that my pain will go away or that my pain is a distortion of thinking. But who is the decider here? Who decides if this pain is distorted thinking of my actual body in pain? Who decides if I am safe or people really do want my brain to be entirely different than it is and treat me accordingly? Is my thinking the problem or is the medical industrial complex, my very real broken body, ableism, power imbalances, poverty, discrimination, and chronic sorrow the problem?
I cannot CBT my way through the eugenics happening right now with disabled people and Covid policies. I cannot CBT my way through all the ways I am not safe when I go to the doctor because they have all the power and very rarely do they believe me and sick people like me because they like to have answers and the second they don’t, they turn against the one who is confusing. I can’t CBT my way through my inability to support myself, receive the care I need, or keep myself safe in this world. I am not catastrophizing. I am being in reality. And that others, especially those who are claimed to be helping, cannot seem to cope with this reality, creates a victim blaming that asks me and others like me to carry the stigma of being uncooperative and unwilling to heal.
I want support, care, and even good therapy. I want places where who I am is not seen as faulty thinking, catastrophized thinking, or a problem to be solved at all, but is rather the human reality of being a chronically ill neurodivergent disabled person living in a terrible ableist world. Which means much of my suffering comes from social issues that cannot be “cured” through the individual, and my life is still my life and I am here to live it as fully engaged as I am able within the confines of my limitations and the fullness of my capacity.
Keep your Cognitive Behavioral Therapy to yourself. If you want to change faulty thinking, please start with your own.
