Review in
The Guardian Newspaper - August 28, 1999


A sickness called therapy

Manufacturing Victims: What the Psychology Industry is Doing to People by Tana Dineen, with a foreword by David Smail 265pp, Constable, 14.99
There are two things that everyone should know about psychotherapy. The first is that almost every study ever done has shown that it is no more effective than a placebo, or even no treatment at all. The second is that most people who have had therapy feel that it has benefited them in some way.
Most books about therapy emphasise one of these facts to the exclusion of the other. Critics of therapy - patients who haven't got better, partners of patients whom therapy has changed beyond recognition, and the occasional disillusioned ex-therapist - all point to the damning scientific evidence and ignore the subjective reports of happy cures. Meanwhile, practising therapists and contented therapy junkies cover over the scientific evidence against therapy with the simple argument from personal experience.
Tana Dineen's new book, Manufacturing Victims , has the merit of drawing attention to both sides of the story. Dineen does not fail to mention the surveys that have shown "consumer satisfaction" to be quite high among the users of psychotherapy. However, her sympathies are clearly with the opposition. Her book is a forthright attack on what she dubs "the psychology industry". This is somewhat of a misnomer, since the targets of Dineen's criticisms are clinical psychologists, psychiatrists, psychoanalysts, psychotherapists, counsellors, and all the rest of the motley crew of mental health workers. A more appropriate name would be "the therapy industry", since there are many psychologists who have nothing to do with treating mental disorder. There are, for example, a significant number of business psychologists, forensic psychologists and developmental psychologists, not to mention all those academic psychologists engaged in pure research. By directing her criticisms against psychology in general, Dineen lumps these respectable professionals together with their more dubious therapeutic cousins and so risks obscuring the real villains of the piece. Pure psychology is a science; it is only the attempts to apply it that are still largely in the land of make-believe.
Nevertheless, it is applied psychology that has the most impact on people's daily lives, and Dineen does everyone a service in exposing its flaws. As is clear from the biting tone of her language, she sets about her attack with the venom of an apostate. Indeed, she describes the book as her apology for having practised as a clinical psychologist for several decades. But, as she piles case upon case of quackery and psychobabble, it is hard for the reader not to feel that her anger is justified. From the array of examples she cites a damning indictment emerges of one of this century's most pernicious industries.
The word "industry" is appropriate, since psychotherapy now wields all the tools of a successful trade, replete with devious marketing strategies, political support, and a sophisticated "technology of victim-making". In order to survive, therapists need patients, which they "create" by labelling every quirk of personality a "disorder". According to this perverse logic, everyone ends up being "abnormal". The potential market for therapy thus becomes the whole world.
Dineen finds the same logic at work over and over again in the countless works of pop psychology that litter our bookshops. "Trauma", a word which used to refer to grave physical injury, now covers anything that upsets us. "Addiction" is no longer about heroin and cocaine; it is about anything from sex to chocolate, or even love. Thomas Szasz aptly referred to this process as "semantic inflation". But, with words as with money, inflation leads to devaluation. The words lose their meaning, and the suffering of real victims is trivialised. By comparing a hostage's experience of captivity with the minor upsets of everyday life, therapists belittle the hostages and exaggerate our normal woes. By putting verbal threats on a par with physical assault, the therapy industry turns us into a nation of sissies who can't survive without an army of shrinks.
This is bad enough, but it is just the tip of the iceberg. Dineen goes on to discuss the immense damage caused by Recovered Memory Therapy, which led many ordinary people to believe, falsely, that they had been sexually abused as children. She also exposes the cultish nature of the twelve-step program, which presents itself as a single cure-all for every problem imaginable. Dineen is not the first to point these things out, but it is a message that bears repeating.
Therapists tend to dismiss these stories as extreme cases. Unfortunately, however, they are not unusual. Dineen shows that abuse is endemic in even the most well-respected and highly regulated sectors of the therapy industry. Neither is such malpractice restricted to the US; it is rampant in the UK too. The problem is not just an accident of history; its roots lie buried in the very idea of therapy itself.
Therapy is based on the idea that there are "experts in living". It is this idea that must be chal lenged. Therapists have assumed the position formerly occupied by gurus and priests, pretending they have access to the secret of health and happiness. It is high time, Dineen argues, that we called their bluff, and regained confidence in our own capacity for self-direction. Dialogue and advice can certainly help us, but these can usually be provided just as well, or better, by friends and family.
To support this project of "taking back our private lives" from the hands of the therapy industry, Dineen recommends the following salutary measures: stop state funding for psychotherapy, disallow psychologists from testifying in court as expert witnesses, and hold therapists legally responsible for any damage they cause. Unfortunately, even such drastic measures as these will not rid our society of the therapy plague. There will always be gullible people, and there will always be plenty of quacks, "healers" and New Age frauds to exploit them. Ultimately, of course, we all have the right to waste our money on such rubbish if we want to, but we should at least know that that is what we are doing. This is why we must insist on strict standards in the advertising of psychological services.
To judge by the reception accorded to it when it was first published in the US, the UK edi tion of Tanna Dineen's book will be dismissed by therapists here as the ravings of a bitter woman. There are too many careers at stake for the therapy industry to welcome such a probing critique. However, there is a chance that it will be taken seriously by those without so much to lose. It should be read by anyone interested in therapy, especially by those who are thinking of trying psychotherapy, and those who are thinking of training as therapists. At the very least, it might save them a lot of time and money.
The book is not brilliantly written, and it is cluttered with unhelpful and uninformative jargon. However, this should not be allowed to detract from what is an extremely important and timely message; the therapy industry is big business, and - like all big business - it is more interested in profit than helping its clients. One might question Dineen's motives in choosing to couch this message in such melodramatic language; perhaps writing books against therapy is becoming big business too! Nevertheless, the message itself is sound. Whether or not people will listen to it is another matter.


by Dylan Evans is the author of Introducing Evolutionary Psychology , which will be published by Icon in October.

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