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IllnessUnderstanding Treatment Without ConsentUnhingedUnprincipled VirtueUnsanctifying Human Life: Essays on EthicsUnspeakable Acts, Ordinary PeopleUp in FlamesUpheavals of ThoughtUsers and Abusers of PsychiatryValue-Free Science?Values and Psychiatric DiagnosisValues in ConflictVegetarianismViolence and Mental DisorderVirtue EthicsVirtue, Rules, and JusticeVirtue, Vice, and PersonalityVirtues and Their VicesWar Against the WeakWar, Torture and TerrorismWarrior's DishonourWeaknessWelfare and Rational CareWhat Genes Can't DoWhat Have We DoneWhat Is a Human?What Is Good and WhyWhat Is Good and WhyWhat Is the Good Life?What Price Better Health?What Should I Do?What We Owe to Each OtherWhat Would Aristotle Do?What's Good on TVWhat's Normal?What's Wrong with Children's RightsWhat's Wrong with Homosexuality?What's Wrong With Morality?When Is Discrimination Wrong?Who Holds the Moral High Ground?Who Owns YouWho Qualifies for Rights?Whose America?Whose View of Life?Why Animals MatterWhy Animals MatterWhy I Burned My Book and Other Essays on DisabilityWhy Not Kill Them All?Why Punish? How Much?Why Some Things Should Not Be for SaleWisdom, Intuition and EthicsWithout ConscienceWomen and Borderline Personality DisorderWomen and MadnessWondergenesWould You Kill the Fat Man?Wrestling with Behavioral GeneticsWriting About PatientsYou Must Be DreamingYour Genetic DestinyYour Inner FishYouth Offending and Youth Justice Yuck!
This book consists of 15 chapters
about various trends in mental health. With one exception, all of the
chapters are written by psychologists. Contributors contend that a herd
mentality has emerged in the field that often harms those seeking treatment.
They especially focus on the influence of political ideology. By merely
skimming, some progressives could glibly dismiss this as a right-wing rant,
which is simplistic. Many who identify with the left, such as this reviewer,
might see some clinical merit. While there is a conservative theme, some
chapters are hardly ideological, like ones on continuing education and
desperate measures on the part of therapists to remain in practice. It is only
regrettable that describing each of them is not feasible in the space
In the introduction, Rogers Wright
eloquently highlights issues that are later explored in depth. He touches on the
propensity of therapeutic techniques that are "free of judgment"
which "sentences us to a life that lacks direction." More simply, if
one's behavior is injurious to one's self or others, should the clinician's
opinion always be suppressed?
Nicholas Cummings and William O'Donahue
succumb to an overused term: Political Correctness. It is used here to
contend that liberals dominate the terms of most clinical discussion and even
research parameters. As they see it, individuals belonging to certain groups
are viewed as innately beyond reproach. These include women, gays, atheists
and persons of color. Just as some careers could be destroyed 50 years ago by
branding colleagues a communist, the authors believe that there presently can
be a similar outcome in this profession if one is branded a sexist, racist, or
homophobe. Like the McCarthy era, the burden of proof is on the accused rather
than the accuser. They go on to suggest that these unquestioned 'truths' can
have a chilling effect on how therapists provide and document treatment as well
as what questions can (not) be posed when applying for research grants.
Notable evidence is cited to support their contentions. However, some of their
examples are extreme. They hypothesize that efforts to reduce sexual
harassment are less attempts to empower women than expressing hostility toward
Three chapters are written by Ofer
Zur. In the "Psychology of Victimhood", he focuses on those
experiencing domestic violence. Specifically, he cites the interplay between a
husband and wife "and how their behaviors contribute to the maintenance
and escalation of violence." He goes on to highlight multiple factors in
deciding which form of intervention would be most effective in reversing
abusive patterns. He cites intellectual capacity, financial resources, length
of abuse, and whether the criminal justice system has already gotten involved.
He laments that a sizable number of 'experts' perceive nuance as 'blaming the
In another chapter, Zur writes
extensively about what is traditionally known as 'boundary crossing', and why
this phenomenon is not as inherently harmful as some insist. Zur contends that
boundary crossing, such as visiting a client in their home, is not identical to
a boundary violation, in which a client is physically, financially or sexually
violated. He goes on to question whether the former inevitably leads to the
Zur finds risk management to be
another force that deters innovation. He insists that "science and decency"
will soon be supplanted by malpractice attorneys and licensing boards.
Supposedly, therapists are now refraining from certain methods, not because
they are clinically adverse, but because they may appear so in court.
Consequently, client well-being can become a side issue. This is to the extent
that those most in need, such as those inclined toward violence or suicide, are
the ones most likely to be turned away from multiple settings.
Overall his chapters are
compelling, but some details can be questioned. What Zur describes may not
indicate destructive changes so much as a failure to change. Regarding
risk management, he may be a little unfair in suggesting that attorneys and
licensing boards are identical in intent. The former are largely motivated by
an understandable profit motive, while the latter are established in states to
deter some historical patterns when consumers were exploited. But
perhaps it is time to overhaul policies that were established 30 years ago. As
for boundary crossing, the time to reconsider dogma established 60 years ago is
way past due.
In Chapter 10, multiple authors
focus on what is referred to as "Pseudoscience, Nonscience, and Nonsense
in Clinical Psychology". They perceive the emergence of a "reversed
burden of proof, in which the skeptic must show why the claim has little or no
merit." They zero in on various treatment theories and techniques. While
popular, they contend that many techniques have not been empirically
validated. Increasing in frequency is 'debriefing' individuals after a
disturbing event. They cite one study suggesting debriefing has no significant
effect and two that it harms when interventions are compulsory. The authors
suggest how disaster victims process what they experience is highly individualized.
Whether a flood, tornado, or terrorist attack, victims with avoidant tendencies
and high sensitivity to intrusion could well recover better in solitude. They
go on to say that such interventions could instill trauma in individuals who
were not experiencing it previously. Even practices that do not directly harm
recipients are questioned. Regarding grief counseling, survivors experiencing
relatively normal bereavement reactions can be indirectly effected by time,
money, and emotional energy expended on treatment that was not clinically
indicated in the first place.
Psychiatrist William Glasser
contends that his specialty is "hazardous to your mental health."
Unlike other chapters, this one focuses less on allegations of misguided
liberals than a profit-focused alliance between pharmaceutical companies and
the broader medical community. Completing this axis has been managed care's
attempts to reduce costs of mental health treatment. Glasser contends that
while 15 minutes of medication monitoring may appear less expensive than 60
minutes of psychotherapy, much of the yielded 'savings' have been plowed back
into the staggering costs of these prescriptions. And unlike psychotherapy,
which most individuals terminate after a year, the same individuals are told
year in and year out, even absent symptoms, that they must stay on medication
lest they 'deteriorate'. Glasser writes that 95% of all psychiatrists are now "biological"
who have reduced all thoughts and emotions to the ebb and flow of neurochemicals.
Twenty years ago, the burden of proof would be on those who believed medication
should be considered. The opposite is now the norm. The few psychiatrists who
include psychotherapy are inclined to convey to patients/clients that the medication
prescribed is imperative to their level of contentment, with therapy being a
Glasser surmises what has fueled
this trend. He cites pharmaceutical-funded seminars boldly declaring that all
clinicians, psychiatrist or otherwise, should get on board with the newest
diagnosis and newest prescription to go with it. He is unmerciful regarding
such funding ("Once one is diagnosed, he or she becomes one of millions of
geese who lay golden eggs."). To him, another important variable is that
continued subsidies for career researchers are contingent on steadily
increasing the number of identifiable mental conditions in general, and those
treated with medication in particular. When an article in the mainstream media
refers to a treatment breakthrough, the reporters are essentially being
stenographers for the latest press release of a drug manufacturer. Also
subsidized are patient/client advocacy groups. To a large extent, such groups
will insist that all emotional distress are symptoms of a pure and simple 'medical
condition'. The soothing conclusion is that individual or family
responsibility for maladjustment is zero. Freud reportedly contended that it
is always the parent's fault. Thanks to the drug companies, we now know that
families can only be faulted when they discourage their relatives from getting
He provides an alternative theory
and intervention ("Unsatisfying relationships are the main cause of
unhappiness".). While animosity is often unavoidable, we can try to
understand what is wrong. From this understanding, attempts can then be made as
to how to get along better with significant persons in our lives. What he
calls "Choice Theory" is targeted toward the vast majority of
dispirited souls who do not require psychiatric care or psychiatric drugs.
Glasser is optimistic about the capacity of most of us to become content with
others and within ourselves.
In a later chapter, O'Donohue and
Christine Caselles reiterate how politics is trumping everything to include
those with strongly held religious beliefs. While legitimately discussed in a
free society, these authors also suggest this it is not the proper role of
mental health to suggest "as irrational a belief in God and specific
beliefs regarding what God has revealed." Inconsistencies in a book this
ambitious are unavoidable. One is revealed in this chapter. On its head, they
have conveniently flipped a progressive cliché ("Who are we to judge?").
This same cliché was taken to task during the Introduction.
In the next to last chapter,
multiple authors cite 'social justice' as another harmful trend. They are
especially critical of individuals in the profession who advocate for a social
safety net. In fact, they believe that most client level of functioning could
increase if they and their therapists would simply vote Republican. They
contend that liberals view tax dollars as a cure for all disturbances.
It could be said that these same
authors are equally guilty of viewing supply-side economics as a magic bullet
for individual and societal ills. On the contrary, for every client that has
been enabled by the social safety net, there is another with emotional
difficulties exacerbated by tax shelters for the upper ten percent. These
shelters are essentially subsidized by reducing revenue for government programs
that may in fact help the lowest 20% out of poverty, and away from dependency
that the authors deplore. Such programs include Medicare, subsidized rent,
tuition grants and public transportation to commute from urban homes to
suburban employment. When these programs are affected, they have a way of
making someone emotionally troubled a little more so. And this may be the most
plausible answer to the book's repeated question as to why mental health
professionals often lean left: As an alternative treatment plan, the free
market is pretty weak. All of the chapters are worth reading, including this
one, even when it falters under scrutiny.
Nonetheless, this preceding chapter
easily shifts into the last one. Richard Redding states that a certain liberal
dogma in the profession is self-reinforcing. Evidence he cites of at least a
bias is substantial. Whether this is troubling depends on how one looks at it.
To this reviewer, Redding may be confusing cause with effect. It could simply
be that after some years in the field, clinicians may conclude that liberal
policies harm the average client less than conservative ones. Redding's more valid worry is that those who stray from the majority could be intimidated
from offering their knowledge and experience. Consequently, this could
eventually deter talented individuals across the spectrum from entering the
field. Eventually, the profession will become less robust, with universities
and treatment settings becoming mere echo chambers.
This book is difficult to compare
to others in that few have been written from this angle. There is a tone of
frustration in many of the authors. While clearly a minority in the
profession, conservatives might feel a little less isolated. This book
challenges liberals to sharply justify deeply held beliefs. This book should
also satisfy, those between the extremes, who have a healthy curiosity about
new ideas. Finally, it should be of equal interest to consumers who are intrigued
about some forces that influence how their practitioners engage them. Hopefully,
the authors will be satisfied that some readers will reexamine viewpoints that
were previously held, and might even grow in the process.
© 2007 Eric Lindquist
Eric Lindquist, LCPC, CADC has
worked in mental health for 18 years. His employment has included a group home
and psychiatric hospital. For the past 12 years, he has worked in an
outpatient setting in Chicago, where he also resides.