The book, “American Therapy”, by Jonathan Engel.
The basic intention of this book is to describe the history of psychotherapy, from its birth in Europe with Charcot, Breuer, and Freud, to whatever it currently is in America. Insofar as the author confines himself to history, the book is useful. For instance, I never knew how much influence Breuer had on Freud. (He was Anna O.’s sole physician, and came up with the basic idea that talking about memories alleviates hysterical symptoms.) But the author, while positioning himself as a social historian, refuses to confine himself to the discipline required as a historian. He ought to question the veracity and objectivity of his sources, which he hardly ever does. It is therefore a crucial mistake, in fact a mistake which invalidates the entire enterprise of the book, implicitly to assume that the findings of a modern study always invalidate past findings, and that what modern psychologists believe is always more true than what people thought in the past.
As a Freudian, I take offense to sketchy, unsupported statements like, “Studies repeatedly demonstrated that psychoanalysis did not work.” Engel makes no effort to examine how the structure of or the assumptions of these studies might have led to such a conclusion, and he brushes past the question of what it means to be ‘cured’. Orthodox psychoanalysts are described as “clinging to their dogma in a mixture of denial, professional fear, and blind belief.” The author attempts to argue against the existence of an Oedipus complex by quoting Jane Goodall’s observation of chimpanzees! In the epilogue, he justifies the unpopularity of psychoanalysis by appealing to patriotism! “Our can-do nation, often skeptical of intellectualism and scholasticism, was unlikely to embrace an ideology [!] born of fin-de-siècle European angst.”
Is he not aware we are living in another fin de siècle?
Moreover, the author has a rather happy-go-lucky attitude towards institutionally sanctioned medication. (He repeatedly quotes a pro-medication writer saying that Prozac makes people ‘better than well.) Contrast his uniformly condemnatory attitude towards people finding their own medication. His chapter on alcohol is the A.A. philosophy, chapter and verse. No opposing point of view is presented. He even quotes, with approval, some guy who published a study arguing that no one who drinks regularly is psychologically healthy--!--we’re all either alcoholics or future alcoholics, and the ‘social drinker’ doesn’t exist. His chapter on narcotics is similarly subservient to the public health official’s overcautious point of view. (On the first page, he introduces the concept of ‘psychological addiction’--but never does he bother to define this problematic idea or differentiate it from, say, a ‘choice’.)
More crucially, the author repeatedly says that we ‘now know’ that mental illness has an organic basis. What justifies this assertion? Most of the time, he doesn’t bother to tell us. When he does attempt an explanation, it’s insufficient or bafflingly irrelevant. For instance, schizophrenics and control subjects responded differently when given antipsychotic drugs. “The discrepancy in response to the drugs indicated that the brains of schizophrenics were physiologically different than those of healthy people. Schizophrenia was very much a biological condition, even if rooted partially in environmental stressors.” Now, people who have already been categorized as schizophrenics are in a much different emotional and social environment than people casually engaging in a medical study. Might that not produce different responses to any drug in the two groups?
Then, scientists find that schizophrenics’ brains are different from healthy people. Therefore their brains were different when they were born, and they subsequently became schizophrenic because their brains made them. This is the only possibility discussed. But I remember reading that the brain continues to develop long after birth--that’s why malnourished infants are often retarded. Couldn’t a person’s harmful experiences in the womb or as an infant affect the development of his brain, so that psychological traumas à la Freud might precede the organic change in a person’s brain?
Engel’s consideration of psychiatric skeptics like R.D. Laing and Thomas Szasz is confined to four pages. He starts off by calling them names-- “kooky”, “radical”, “pernicious”. “[Alcoholics who quit drinking] would take offense at the accusation of the antipsychiatrists that they had simply stopped drinking because they no longer felt like drinking. In their minds, they had conquered a dreadful disease...” So, when people find it convenient to believe they have a disease, they do? And look at this--Jesus Christ, the blindness--Engel says,
“Many mental illnesses...responded well to medications and shock, further validating an organic understanding of mental illness. Szasz’s worldview, predicated on the assumption that mental illness simply did not exist, could not stand up to clinical and laboratory inquiry.”
First off, has he read Szasz? If he has, he hasn’t read him well. Szasz doesn’t deny that what we call mental illness exists---instead, he says that metaphorically describing this phenomenon as an illness is a harmful and deceptive linguistic strategy. His example is the contrast between a person with a brain tumor and a depressive. We know how the brain is supposed to work (in general...), and we can objectively say the brain tumor gets in the brain’s way. That’s an illness. But on the other hand, we don’t really know how the mind, or the whole person, is supposed to work. Rather than calling certain people sick lunatics who have no control over their actions, it’s more scientific to describe them in neutral terms, as people who act in unusual ways, only some of whom think they ought to change. (And, if we were to go back to Freud, these people might be described as people who _think_ they are slaves to their own minds, while in fact all their actions are freely chosen by the unconscious.)
Second, let’s decode that first sentence. Many mental illnesses responded well to medications and shock. By ‘mental illnesses’ here, he means ‘people’. By ‘responded well’, he means, ‘started acting differently’. So people who acted unusually were imprisoned, drugged, and shocked, and subsequently began to act more in accordance with their keepers’ wishes. In what way does that validate “an organic understanding of mental illness”?
Then he presents, without comment, directly contradictory evidence. If mental illness is organically determined, how does he explain the finding that “spontaneous remission of psychiatric symptoms was observed consistently in a third of all patients”? Doesn’t this suggest that people have some amount of control over their actions, even if those actions are what psychologists prefer to describe as ‘symptoms’?
On the second-to-last page, the author leaves us with his most infuriating mot yet. The psychiatric skeptic Peter Breggin wrote, truthfully I might add, that “[the psychiatrist] can prescribe drugs or shock, lock you up against your will, talk behind your back with your husband, wife or parents, and make plans for your future without consulting you.” Szasz might add a criminal’s being deemed insane might make the difference between a prison sentence of a few months and being committed to an asylum for life. But to Engel, all concern with institutionalized persons’ civil rights and the distrust of institutional authority it stems from is ‘bizarre’. And on the very last page--I didn’t think he would go there, but he did...Those who argue people shouldn’t be locked up and drugged against their will are “among the Neville Chamberlains of the psychological world...willing to surrender hope, standards, and the civic enterprise for the lure of psychic autonomy.”
No one concerned with what life is really like should be a damn shill for the damn system. This book, cursory and easy to read, will be more popular than it deserves.
Well, at least I feel better now.
