The tyranny of therapism

In 2000, five Canadian psychologists published a satirical article about Winnie the Pooh entitled 'Pathology in the Hundred Acre Wood'. At first glance, say the authors, the hero of AA Milne's 1926 children's classic appears to be a healthy, well-adjusted bear; but on closer and more expert examination, Pooh turns out to suffer from attention deficit/hyperactivity disorder, binge eating, and borderline cognitive functioning ('a bear of very little brain'), to name just a few of his infirmities.

Pooh's friends are similarly afflicted: Rabbit fits the profile of narcissistic personality syndrome; Owl is emotionally disturbed, which renders him dyslexic; and Piglet displays classic symptoms of generalised anxiety (a diagnosis that is admittedly difficult to dispute).

The Canadian spoof makes a serious point: the propensity of experts to pathologise and medicalise healthy children en masse has gotten way out of hand. The past decade has seen a cascade of books and articles promoting the idea that seemingly content and well-adjusted American children are emotionally damaged.

Adults are said to be miserable, too, as various experts and popular writers have been telling us for more than three decades. For example, in 1993 the prestigious Commonwealth Fund, a New York philanthropy concerned with public health, released the results of a poll on women's health. This 'important' study, as then US secretary of health and human services Donna Shalala called it, reported that in any given week, 40 per cent of American women are 'severely depressed.'

But then, in 1999, feminist author Susan Faludi, a veteran of the bestseller lists, called attention to the devastating emotional problems of yet another group of fragile Americans: adult males. In Stiffed: The Betrayal of the American Male, Faludi contended that American men cannot live up to the conventional stoic ideal of manliness and so they lose their sense of self. 'No wonder men are in such agony', she says.

What we oppose is the view that Americans today are emotionally underdeveloped, psychically frail, and that they require the ministrations of mental health professionals to cope with life's vicissitudes.

And no one has been more successful in making a career out of an alleged national anguish than Daniel Goleman, a former New York Times science writer. His bestselling 1995 book Emotional Intelligence described a nation suffering from profound 'emotional malaise' and in the grip of 'surging rage and despair'.

In an article in the Wall Street Journal, Jim Windolf, editor of the New York Observer, tallied the number of Americans allegedly suffering from some kind of emotional disorder. He sent away for the literature of dozens of advocacy agencies and mental health organisations. Then he did the math. Windolf reported, 'If you believe the statistics, 77 per cent of America's adult population is a mess.... And we haven't even thrown in alien abductees, road-ragers, and internet addicts.' If we factor in the drowning girls, diminished boys, despondent women, agonised men, and the all-around emotionally challenged, the country is, in Windolf's words, 'officially nuts'.

Our new book One Nation Under Therapy offers a more sanguine view of American society. It points out that there is no evidence that large segments of the population are in psychological freefall. On the contrary, researchers who abide by the protocols of genuine social science find most Americans young and old faring quite well.

Of course, we are not suggesting that everyone is perennially happy or possessed of an abiding sense of wellbeing. Many, if not most, human beings are mildly neurotic, at times self-defeating, anxious, or sad. These traits or behaviours are characteristic of the human condition, often emerging in different life circumstances they are not pathological. And they are certainly not new. What we oppose is the view that Americans today are emotionally underdeveloped, psychically frail, and that they require the ministrations of mental health professionals to cope with life's vicissitudes. The crisis authors offer only anecdotes, misleading statistics, and dubious studies for their alarming findings. Yet they are taken very seriously.

  

'Therapism' in practice

These would-be healers of our purported woes dogmatically believe and promote the doctrine we call 'therapism'. Therapism extols openness, emotional self-absorption, and the sharing of feelings. It encompasses the assumption that vulnerability rather than strength characterises the American psyche and that suffering is a pathology in need of a cure. Therapism assumes that a diffident, anguished, and emotionally apprehensive public requires a vast array of therapists, self-esteem educators, grief counsellors, work-shoppers, healers, and traumatologists to lead it though the trials of everyday life. Children, more than any group, are targeted for therapeutic improvement. We roundly reject these assumptions.

Because they tend to regard normal children as psychologically at risk, many educators are taking extreme and unprecedented measures to protect them from stress. Schoolyard games that encourage competition are under assault. In some districts, dodgeball has been placed in a 'Hall of Shame' because, as one leading educator says, 'It's like Lord of the Flies, with adults encouraging it'. Tag is also under a cloud. The National Education Association distributes a teacher's guide that suggests an anxiety-reducing version of tag, 'where nobody is ever "out"'.

It is now common practice for 'sensitivity and bias committees' inside publishing houses to expunge from standardised tests all mention of potentially distressing topics. Two major companies specifically interdict references to rats, mice, roaches, snakes, lice, typhoons, blizzards and birthday parties. (The latter could create bad feelings in children whose families do not celebrate them.) The committees, says Diane Ravitch in her recent book The Language Police, believe such references could 'be so upsetting to some children that they will not be able to do their best on a test'.

  

Harmful effects on children

Young people are not helped by being wrapped in cotton wool and deprived of the vigorous pastimes and intellectual challenges they need for healthy development. Nor are they improved when educators, obsessed with the mission of boosting children's self-esteem, tell them how 'wonderful' they are. A growing body of research suggests there is, in fact, no connection between high self-esteem and achievement, kindness, or good personal relationships. On the other hand, unmerited self-esteem is known to be associated with antisocial behaviour even criminality.

Young people are not helped by being wrapped in cotton wool and deprived of the vigorous pastimes and intellectual challenges they need for healthy development. Nor are they improved when educators, obsessed with the mission of boosting children's self-esteem, tell them how 'wonderful' they are.

Therapism tends to regard people as essentially weak, dependent, and never altogether responsible for what they do. Alan Wolfe, a Boston College sociologist and expert on national mores and attitudes, reports that for many Americans non-judgmentalism has become a cardinal virtue. Concepts of right and wrong, good and evil, are often regarded as anachronistic and intolerant. 'Thou shalt be nice' is the new categorical imperative.

Summarising his findings, Wolfe says: 'What the Victorians considered self-destructive behaviour requiring punishment we consider self-destructive behaviour requiring treatment.... America has most definitely entered a new era in which virtue and vice are redefined in terms of public health and addiction.'

We do not advocate a return to a harsh judgmentalism. Wolfe may have a point when he says that an emphasis on tolerance has made Americans 'nicer'. However, this emphasis also induces a moral inertia that can be the opposite of nice. Consider, for example, the supposedly enlightened, compassionate view that drug and alcohol addiction are 'brain diseases'. We challenge the brain disease model on the grounds that treating addicts as morally responsible, self-determining human beings free to change their behaviour is, in the end, more effective, more respectful, and more compassionate.

We also reject therapism's central doctrine that uninhibited emotional openness is essential to mental health. On the contrary, recent findings suggest that reticence and suppression of feelings, far from compromising one's psychological wellbeing, can be healthy and adaptive. For many temperaments, an excessive focus on introspection and self-disclosure is depressing. Victims of loss and tragedy differ widely in their reactions: some benefit from therapeutic intervention; most do not and should not be coerced by mental health professionals into emotionally correct responses. Trauma and grief counsellors have erred massively in this direction.

  

The trauma industry

The trauma industry operates on the assumption that the principal lesson to be learned from suffering is that one must exorcise it. But suffering is sometimes edifying.

In the wake of mass tragedy, therapism's 'grief brigades', as Time magazine calls them, swoop down on victims. Helping professionals many with questionable credentials have become fixtures at scenes of disaster. The trauma industry operates on the assumption that the principal lesson to be learned from suffering is that one must exorcise it. But suffering is sometimes edifying. In his profound and moving book, Man's Search for Meaning, psychiatrist Viktor Frankl, himself a survivor of the Nazi death camps, wrote that, 'Suffering is not always a pathological phenomenon.... Suffering may well be a human achievement, especially if it grows out of existential frustration.'

It was in the same spirit that Time writer Lance Morrow wrote in the wake of 9/11, 'For once, let's have no "grief counsellors" standing by with banal consolations, as if the purpose, in the midst of all this, were merely to make everyone feel better as quickly as possible. We shouldn't feel better'. Finding solace and strength after grief without professional help has become an anachronism like setting one's own broken bone.

The trauma industry routinely flouts Morrow's wise injunction, and applies with abandon the diagnosis of 'post-traumatic stress disorder'. PTSD is a legitimate clinical condition marked by intense re-experiencing of a horrific, often life-threatening event in the form of relentless nightmares or unbidden waking images. PTSD is not to be applied to people who are acutely distraught a perfectly normal reaction after a terrifying ordeal, but to the minority who go on to develop disabling, pathological anxiety because of it. Worse, clinicians often diagnose PTSD in individuals who have not even been exposed to horrific events but are simply upset by troubling incidents. For example, professional journals are rife with examples of 'PTSD' patients who have been sexually harassed on the job, moviegoers upset by seeing The Exorcist, and motorists involved in minor accidents treated as if they were survivors of the Bataan Death March.

  

The rise of therapism

Where did it come from, this current preoccupation with feelings? It has many roots. One is the eighteenth-century Romantic philosophy of Jean-Jacques Rousseau. For Rousseau, the expression of emotion is crucial to any moral and spiritual development. It can also be traced to nineteenth-century evangelical movements that offered nostrums for liberating their followers from negative emotions. Its more immediate and familiar progenitors are the new psychologies that flourished and were popularised in the USA after the Second World War notably, Freudian psychoanalysis and a successor that came to be known as the 'human potential movement'.

Colourful academic psychologists like Abraham Maslow and Carl Rogers introduced into American life their ideal of 'self-actualisation'. Their work and that of colleagues seems at first optimistic, positive, and suitable to a dynamic and energetic society like postwar America. But a closer look shows that both these thinkers were precursors to today's crisis writers. They were of the opinion that the vast majority of Americans led 'unactualised' lives in spiritual wastelands from which they needed to be rescued. Said Maslow, 'I sometimes think that the world will either be saved by psychologists in the very broadest sense or it will not be saved at all'.

We reject the idea that psychology, however humanistic and liberationist, can be a general provider of salvation. This is not to say that psychology has not made impressive progress. We understand very well that the same half century that incubated an unwholesome therapism also saw remarkable developments in the knowledge of the brain and in new medications for severe mental illnesses such as schizophrenia. And we appreciate that the various talk therapies have real value for many patients. But this approach can be, and has been, taken too far. The popular assumption that emotional disclosure is always valuable, and that without professional help most people are incapable of dealing with adversity, has slipped its clinical moorings and drifted into all corners of American life.

We are not the first to notice these encroachments. Social critics such as Philip Rieff, Christopher Lasch, Allan Bloom, and, more recently, Charles Sykes and Wendy Kaminer, have chronicled many aspects of what Rieff called the 'triumph of the therapeutic'. Our work builds on their insights and shows how the growth of therapism continues apace, affecting contemporary culture in ways that might surprise even these observers.

Our book, One Nation Under Therapy, describes the incursion of therapism and the growing role of helping professionals in our daily lives. It rejects the presumption of fragility and challenges the dogma of self-revelation; it exposes the folly of replacing ethical judgment with psychological and medical diagnosis, save for instances where individuals are severely mentally ill. The book contends, in other words, that human beings, including children, are best regarded as self-reliant, resilient, psychically sound moral agents responsible for their behaviour. For, with few exceptions, that is what we are.