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Destructive Trends in Mental HealthReview - Destructive Trends in Mental Health
The Well-Intentioned Path to Harm
by Rogers Wright and Nicholas A. Cummings (Editors)
Routledge, 2005
Review by Eric Lindquist, LCPC, CADC
Jan 2nd 2007 (Volume 11, Issue 1)

 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 available.  

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 heterosexual men.

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 victim'

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 latter. 

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 useful aside.  

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 prescriptions refilled.

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.


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