By Richard Handler
Has Therapy Gone PC?
Some Distinguished Psychologists Critique the Field
Destructive Trends in Mental Health: The Well-Intentioned Path to Harm
Edited by Rogers Wright and Nicholas Cummings.
Routledge. 346 pp. ISBN: 0-415-95086-4
Nobody wants to be called "politically correct." The term has become the universal, all-purpose insult, used by both the Right and the Left as the definitive put-down. And perhaps no field gets such a bashing for its alleged "political correctness" as psychotherapy.
On the Right, therapists are ridiculed as ersatz mommies and daddies with professional degrees, who've turned us into a nation of victims and squirmers, whiners and wimps. Critics like Christina Hoff Sommers, in her book One Nation Under Therapy, bemoans the overpsychologized, pathologized nation that America has become.
On the Left, one hears a variation on the same theme. In Therapy Culture, Frank Furedi, an old-fashioned British lefty, rails against therapists as active agents of psychic dispossession. According to this critique, it's in therapists' interest to keep us passive and blinded to the problems in the wider social context that form the roots of our individual malaise.
So the Right castigates therapists for individuals' loss of autonomy, while the Left lays the blame for our loss of community connection to the same culprits. Both agree that we're being infantilized by a new Nanny State.
Now, in Destructive Trends in Mental Health, two distinguished psychologists long associated with progressive political struggles within the field, Rogers Wright and Nicholas Cummings, have edited a book that echoes many of the charges that up to now have come from outside the therapy profession. This isn't a book that can be dismissed as just another ideologically inspired, partisan attack.
So who are Wright and Cummings and why do they have the right to
lecture us this way? Cummings is past president of the American Psychological Association; Wright is the founding president of the Council for the Advancement of Psychological Professions and Sciences—psychology's first independent organization dedicated to public policy and political advocacy. In the 1950s, both men took on the American Psychiatric Association and helped establish psychology's legitimacy as a profession on a par with psychiatry. Both also helped lobby a reluctant insurance industry to provide third-party payments for psychological, as well as medical, services. For half a century, both men have worked relentlessly, and by and large successfully, to raise the professional and economic standing of psychologists and social workers.
In their book, Wright and Cummings make some of the same overall points as do the PC critics. They, and the other authors in their book, contend that psychology, like the culture it serves, enforces politically correct attitudes that squelch research into verifiably effective treatments and curtail the range of help clients can receive. They, too, excoriate victimology and accuse psychologists of promoting it. In spite of "the impressive record of promoting racial, ethnic and cultural diversity in its membership and organizational structure," Cummings writes, "self-interested destructive trends have permeated the mental health professions, threatening harm to the patients who seek their help and betraying the society they are sworn to serve."
Their charges of runaway political correctness add up to an exhausting critique. Research into intelligence, for example, no matter how valid, is now career suicide—researchers risk snubs and pickets for being undemocratic, elitist, and even racist just by presuming to measure it. Many lesbian and gay activists want to forbid the right to treatment for troubled clients who come into therapy wishing to change their sexual orientation. The seemingly irrepressible urge to invent new psychological pathologies has produced the expanding-syndrome phenomenon: witness the wholesale application of diagnostic labels to kids, with ADD and AD/HD being the worst offenders.
Still, you have to wonder what all these oft-repeated complaints about the culture of therapy have to do with what goes on in the average therapist's office. The therapists I know certainly don't intentionally encourage dependency and victimhood. Managed care even limits the client's reliance on treatment—the one dependency a therapist might be tempted to encourage. Nobody can get third-party treatment anymore for endless psychoanalytic-style visits. So what's at issue? Why are these men so angry? And why, in a heated preface, does Cummings call psychologists politically "clueless" and downright "stupid"?
What seems to bother Wright, Cummings, and the other contributors to this book more than the content of political correctness is its baleful effect on the scientific foundations of psychology. They believe that political correctness is behind the shortsighted view that science is somehow irrelevant to what psychologists do. For instance, Cummings says that he supported the 1974 American Psychological Association resolution stating that homosexuality isn't a psychiatric condition. What's often forgotten, however, is that further resolutions were passed, prescribing the need for more scientific research into the issue. But none has ever been done. In short, writes Cummings, "the two APAs had established forever that medical and psychological diagnoses are subject to political fiat."
This de facto dismissal of science has set the standard—or lack of one—outlined by four authors in the chapter titled "Pseudoscience, Nonscience and Nonsense in Clinical Psychology." Writers Scott Lilienfeld, Fowler, Lohr, and Lynn argue that, in a field that shows insufficient respect for scientific evidence, questionable therapies, like Rebirthing, Critical Incident Stress Debriefing, Thought Field Therapy, and the infamous and destructive Recovered Memory Intervention (now discredited), have been allowed to proliferate. Since the profession has no established code of "best practices," there's no assurance that science will dictate what works and what doesn't. According to the authors, the effectiveness of too many popular approaches still remains unproven.
Similarly, syndromes are named and renamed, apparently on the basis of social trends, rather than any particular scientific merit. Thus, what was once called multiple personality disorder is now given the stiff, scientific-sounding term dissociative identity disorder (DID), though precious little more scientific study of this pathology has been done in the process. According to critics of DID as a diagnostic entity (like its forebear, multiple personality disorder), the growth in the number of people who are said to suffer from this condition has always seemed to depend mainly on fashion and media exposure. According to the authors, these lapses provide a rich breeding ground for public cynicism about the whole profession. However, it should also be noted that many practicing clinicians consider the position taken by Lilienfeld et al. as so extreme that, if their approach became the standard, it would probably do away with much of the range of clinical practice, leaving only the barebones of "empirically validated" cognitive-behavioral specialties. Coincidentally, these are the authors' own specialties.
These four writers, and the editors of the book, also contend that too many psychologists with Ph.D.s are scientifically illiterate and poorly trained in empirical technique. They assert that a student could spend years in graduate school and earn a doctorate in clinical psychology without becoming scientifically competent. As a remedy, they recommend "the APA and other accrediting agencies must insist that clinical psychology training programs require formal training in critical thinking skills," and that doctoral students become "scientifically discriminating consumers of the psychological research literature."
But the real anger of this book's authors isn't only about the squandering of professional reputation: it's about the impact of money and the mental health marketplace on sound therapeutic practice. Cummings and one of his coauthors observes that "Psychology is not only the most politically correct profession in the health care field, but it's lowest paid and most economically depressed . . . managed care has decimated psychology independent solo practice." According to Cummings, psychotherapists have seen their practices "spiral downwards" towards a "fifty percent decline in their incomes beginning in the early and mid-nineties."
Cummings argues that the manufacture of syndromes, the explosion of ADD and AD/HD, DID, and even the proliferation of depression diagnoses, reflect the field's implicit use of pseudoscience to recover its own economic fortunes. Psychologists aren't just PC by inclination and liberal leanings: they need the new therapeutic cover to recoup their wages.
To drive this point home, Cummings has fun with disorder inflation—if you're bored with your job, you might qualify for the diagnosis of "EED" or "employee ennui disorder, " he writes The trouble is—and this is key—the jig is probably up. There's only so much erroneous science and fakery the public (and insurance companies) will stand for.
Yet Cummings offers salvation to the truly repentant. You don't have to make up syndromes to earn a living, nor do you have to cater to the latest "societal trends." And the socially and ethically responsible alternative is as close as the office of your nearest primary health-care provider. "The healthcare system," writes Cummings, "is burdened by the sixty to seventy percent of patients visiting primary care physicians whose symptoms reflect psychological distress rather than disease." The solution to the problems of both the primary care doc and the psychologist is to give the former his or her very own "behavioral primary care provider"—in other words, a psychologist or social worker standing shoulder to shoulder with the beleaguered physician at the family-practice center. After the usual seven minutes with the MD, the doctor accompanies the patient down the hall, to his colleague, the Ph.D. or M.S.W.
Such a revolution is already under way in the United States—at Kaiser Permanente clinics, at 167 installations of the U.S. Air Force, at Veterans Affairs, and at various community health centers around the country. If this keeps up, writes Cummings in an expansive mood, the flow of patients into the mental health field can expand by "an astounding nine hundred percent." You don't need lots of fancy diagnostic labels. People are distressed, suffering psychic pain along with their physical woes. Tend to the hordes of people coming to doctors with psychosomatic symptoms—what in the Freudian days was called "hysteria," and now, conversion disorder—and you're doing something real and necessary; no need to concoct new diagnostic entities.
Such a shift in the health care system isn't yet even in its infancy—it's still a tiny embryo, requiring a long time and lots of labor before it emerges into the full light of day. But, insists Cummings, it can't come too soon for the health of the psychotherapy professions. According to the authors of this book, without this correction, One Nation Under Therapy may decide it's cheaper and more honest to disregard therapy altogether.
Richard Handler is a radio producer with the Canadian Broadcasting Corporation in Toronto, Canada. Contact: rhandler@sym
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