Therapy’s Delusions, by Ethan Watters and Richard Ofshe (New York: Scribner’s, 1999).
The subtitle of this book is “The Myth of the Unconscious and the Exploitation of Today’s Walking Worried”. It is the aim of the authors, in their exploration of the above, to dismantle not only Freud and all his works, but to rip apart the Freudian legacy as well. This means not just Freudian therapy revolving around proprietary ideas of the unconscious, psychodynamic theory and psychoanalysis (or simply analysis), but essentially the whole world of talk therapy regardless of origin or approach. In other words, anything which does not suit the biogenetic model of mental illness.
Ripping apart Freud takes no great skill, as the authors readily acknowledge. The man’s theories were at best ineffectual, at worst pernicious (and often surprisingly so), and baldly invented out of whole cloth—it can never be emphasized enough that there is absolutely nothing scientific in the entire Freudian oeuvre. It is thus no surprise that institutionally Freud breathed his last some time in the ‘60’s, and that actual psychoanalysts working today form no more than an insignificant rump, akin to the impecunious and inbred royal family of some formerly great European power. The clinical model employed in hospitals and forensic settings has been exclusively biogenetic for decades; no clinician, for example, would even dream of proposing anything other than meds as a frontline treatment for catatonia or schizoaffective disorder. The authors contend, however, that the real issue is not the treatment of the severely mentally ill, but the exploitation of the “walking worried”—those who seek mitigation of their day-to-day troubles from proponents of techniques that are not strictly anchored in medical practise, but have been inspired by Freudian psychoanalysis.
This strictly reductionist viewpoint denigrates the models and efforts of almost everybody involved in mental health care except for psychiatrists and medically-oriented research psychologists. Worse, it arrogantly and arbitrarily divides people into two camps: the legitimate (pathological) and frivolous (consumerist). Finally, it also denies not just the validity but the very existence of one’s personal, subjective narratives, despite the fact that these are integral to our sense of identity. And it is here I have a skull to pick.
The background assumption that mind is merely a function of brain is a pervasive one in science. Observation of medicated, injured or lobotomized people and examination of brain activity through various kinds of scanning equipment seem to have led with apparent inevitability (or at least scientific predictability) to the conclusion that it’s all in the wiring and chemicals. And yet the more philosophical proposition, that mind could be an emergent property of brain, is ignored even though it accords better with lived experience. Mind may be quite possibly the best example of something that is more than the sum of its parts; the complexity and activity of those wires and chemicals allow for a threshold to be crossed (for a property to emerge) into something not properly definable in the terms of its origin. Moreover, all the elements of mind might not necessarily be internal—or at least, they require the internalization of external experiences and cultural elements. Our personal narrative is formed to a real but indeterminate extent by acute incidents or chronic series of events, and by the “memes” (animating ideas) and social, political and economic threads of the cultures in which we live. This is the stuff which happens to us, and which provides a framework, and often a cause, for what we feel and how we think.
Watters and Ofshe have little time for narratives, despite the fact that all therapies are themselves narratives, whether they are verbal or chemical, and we get the therapies we create for ourselves. If these are the therapies we deserve—and if they work—then so much the better. But if, as Watters and Ofshe do, one decides to dismiss as charlatans William Doherty, Rhea Almeida, Don Campbell, Jaime Inclan, Kenneth Hardy, Barbara Goodrich-Dunn, Mark Epstein, Andrew Canale, Thomas Moore, Jean Shinoda Bolen, and even beloved “Martian” John Gray—one should be prepared to disassemble, bolt by bolt and strut by strut, the whole set of cultural paradigms they share with their readers and which are part of their readers’ narratives.
One should also remember that the medical model is only one narrative amongst many, and it is emphatically one in which the average reader usually can not partake beyond assiduous consumption of meds: popular techniques, however, require no knowledge of biochemistry. This connects to another dominant thread in the narrative of contemporary popular therapy: empowerment of the individual, a thing which the medical model does little to address; indeed, the establishment often seems to be designed around the enforcement and promotion of a strict, disempowering physician/patient hierarchy. And let us never forget that the scientific establishment has over the course of its history produced more charlatans, sadists and all-out monsters than have the pseudo-medical Freudians or contemporary pop psychologists: lobotomizers such as Walter Freeman, pioneers of electro-convulsive therapy such as the Nobel Prize-nominated Ugo Cerletti, proponents of cold-packing (still used in France as a front-line treatment for autism), adherents of insulin-shock such as Manfred Sakel and not to mention generations of researchers who have inflicted harsh medications on captive populations of unwitting volunteers.
I would maintain that the force and viability of a therapy strongly reflects how it accords with our own narratives, whether it arise from the hard sciences, the social sciences, religion, popular belief or superstition. And none of us can successfully pronounce on its fitness in any individual circumstance. One can not pretend to know precisely how or why any therapy should work, only that they are extensions of one’s cultural framework (the biogenetic no less than the religious). And for those of us with a positivist bent who seek as scientific a form of therapy as possible, there is surprisingly little out there that truly accords with that narrative. The bulk of clinical practices (aside from medication) are not products of the hard sciences. In fact, they are not particularly empirical, based as they are on frequently sloppy or cursory testing. But then, how could it be otherwise? For therapy emphatically deals with individuals, which means constantly shifting variables against which it is impossible to control. Moreover, neurochemistry is poorly understood and the functioning of most psychoactive medication less so, and proponents of medication who claim otherwise are at best overconfident, at worst irresponsible. Indeed, there is growing evidence that many SSRI’s, for example, perform little better than placebo.
The authors make much of how talk therapists employ suggestion and subtle coercive techniques (that the practitioner may even be unaware of) to create for the patient artificial clinical narratives which determine in advance the entire course of treatment—not only Freudian absurdities such as childhood sexual and scatological anecdotes, or such bizarre contemporary tropes as alien abductions, satanic cults and repressed memories, but any developmental experience which the therapist, in his position of authority, can use to convince the patient of the rightness of his opinion. But is the DSM-IV-thumper’s construction of ailments any different, as he checks boxes on a list, pigeon-holing his patient into a different set of a priori constructs? The checklist-pathologized patient is not subtly persuaded as to his ailment, he has a diagnosis thrust upon him, and has little or no room to maneuver short of reporting back to his physician on the progress of his medication. This isn’t science, it’s bean counting.
Finally, talk therapists are rightly criticized for an overconfidence that is partly due to one of the hallmarks of pseudoscience, a lack of self-criticism. And yet, pace the authors, pharmaceutically-based psychiatry has an appalling record of admission of error: witness the litany of lawsuits against Big Pharma and highly respected psychiatrists who have abused their positions of authority to serve as little more than shills for industry. And note that many of the reprehensible treatments mentioned above still have their adherents in the medical community. In theory, the scientific method has the advantage of built-in self-analysis and automatic rejection of the useless and incorrect. In practise, it is at the mercy of very human beings who import to it a lot of their flaws and failings.
In the end, killing the Freudian straw man, overstating the case for biomedical models of therapy, and classifying those who seek alternative therapies as dupes all do little to advance the dialogue of therapeutic criticism. The best parts of this book are the chapter end-notes and bibliography, which allow one ample scope for a more advanced and nuanced contribution to the narrative. I haven’t been thoroughly turned off Watters, for his new book, Crazy Like Us (on the exporting of DSM-IV-“created” mental illnesses throughout the world) is bang-on. Review forthcoming.