A sickness called therapy
Manufacturing Victims: What the Psychology Industry is Doing
to People by Tana Dineen, with a foreword by David Smail 265pp,
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
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 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.