April 29, 2005

HATS OFF TO SATEL AND SOMMERS

Jules Romains’ 1923 comedy “Knock, ou le triomphe de la medicine,” is a satire in the tradition of Molière on the power of doctors to impose upon human credulity. The character of Dr. Knock, contrives, with his long and serious face, scientific double-talk, ominous pauses, and frightening graphs and charts, to convert a group of robust villagers into devoted hypochondriacs. There is, in fact, a movie made in 1933 based on the play and called “Dr. Knock” who is played brilliantly by the great Louis Jouvet.

Of snake oil and snake oil producers there is no end and modern America has its own types. Fortunately, philosopher Christina Hoff Sommers and her co-author Dr. Sally Satel, a psychiatrist, are on the lookout for Dr. Knocks and warn us about them in their smart, straight-shooting new book, “One Nation Under Therapy: How the Helping Culture is Eroding Self-Reliance.” (Click HERE for more information.)

The cover of “One Nation Under Therapy” shows an analytic couch covered in red, white, and blue. The inner contradiction expressed in this symbol is explored in the book but requires some elaboration.

Horsefeathers has been keenly mindful of the abuses of psychology and psychiatry in the modern world, especially as these have been co-opted by members of the liberal left to rationalize their values and the policies derived from them. On the many occasions that we have touched on these abuses we have referred to them as manifestations of the “Therapeutic Culture.” Ms. Sommers and Dr. Satel have their own name for the same phenomena—“Therapism.”

According to Ms. Sommers, “Therapism is a philosophy, a way of life, that views humans as centers of fragility. It believes that vast segments of the population under duress are in need of experts—such as self-esteem educators, traumatologists, crisis counselors—to take them through the vicissitudes of everyday life.”

Sommers and Satel are not against people who have problems and seek professional help for them. What they object to is imposing the therapeutic mentality, uninvited, on others.

Horsefeathers, with its combined total of ninety years of practicing and teaching psychoanalysis and psychotherapy, is happy to concur with much of Sommers’ and Satel’s good sense and criticism of the mischievous and misguided uses to which psychiatry and psychology are put by modern ideologues and cultural exploiters.

Psychotherapy (and psychoanalysis, a more intensive and extensive form of psychotherapy) is, in many ways, like surgery. 1) It is more of an art than a science, although both are rooted in empirical science. 2) The quality of the treatment is based on the experience and skill of the treater. (When you want that tumor removed you want the guy who has done it a zillion times before. Whereas it doesn’t much matter who prescribes the antibiotic for your bronchitis.) 3) Where and by whom the surgeon or the psychotherapist was trained matters greatly in the outcome of the treatment. 4) It is very difficult to do research in both surgery and psychotherapy because you cannot randomize patients (you must take whatever patient comes along), there is much variation from patient to patient, and the numbers one deals with are low compared to outcome studies of medicines where the numbers of patients can be in the thousands.

Contrary to the philosophy of “therapism” as described in “One Nation Under Therapy,” the best practitioners would say that psychotherapy is and should be the treatment of last resort. Why? Because it is so labor intensive, expensive, and difficult for the patient. (If the patient is not experiencing tolerable but significant quantities of emotional pain caused by the intervention of the psychotherapist then the therapist is not doing what he is being paid to do—make the patient aware of his or her conflicts.) Then again the success rate is not great. Depending on the degree of pathology, the skill and experience of the therapist, the motivation of the patient, and a little bit of luck, studies show on average that one third of patients are not helped, one third of patients get some help, and one third are helped a great deal.
As in surgery, there can be spectacular successes and many failures—ask your friends who’ve had hip or knee surgery.

Psychotherapy or psychoanalysis should be prescribed only if the patient has chronic symptoms that interfere with the patient in a significant way—they can’t work, can’t relate to people, can’t get relief from anxiety or depression using any of the multitude of self-help remedies that are used in everyday life. And even under the circumstances just described there are those who are not motivated to seek psychotherapy, even if offered at no charge. Psychotherapy will not be effective unless the patient really wants to work at it, but this is no different from any other form of treatment—if the patient does not collaborate with the doctor the treatment doesn’t work.

Contrary to what the “therapism” counselors believe, the human mind is extremely resilient—or has been until the new therapeutic culture started its attempts at psychological engineering of the minds of our schoolchildren. It takes a great deal to overwhelm the human mind. Some military psychiatrists during the Second World War have estimated the breaking point to be 200-240 combat days.

But everyday life is different and clinical observation of adults suggests two consistent facts—there is no single situation that is invariably “traumatic”—illness, accident, death of a relative, job loss, divorce, marriage, childbirth. There is no experience in life that invariably overwhelms the mind. Furthermore, clinicians usually find that those who become overwhelmed by an illness, or accident, or death of a loved one, etc., have been harboring some secret or not so secret psychological problem which makes them vulnerable to a “traumatic” trigger event.

The normal resilient mind has many ways of dealing with the frustrations, disappointments, challenges, losses—“traumas”—of life.They are, so to speak, the psychotherapy of everyday life. They are free, generally accessible, remarkably effective as folk medicine goes, and have stood the test of time. These techniques utilize some of the same techniques used by the so-called experts of the therapeutic community. They are based on four mental tendencies: emotional ventilation through talking; forgetting/avoidance/distancing; distraction/keeping busy; self-comforting/regression/eating/ intoxication.

As anyone who has lived for more than a few minutes knows, life is full of pain. And when we encounter it we automatically or intuitively find one or any combination of the above methods of pain mitigation. (Churchill self-treated his depressions—the Black Dog, he called them—by endless talking, writing, building walls on his estate, oil painting, and, of course, drinking Pol Roger 1928.) And what is best about this array of self “treating” methods is that they are self-regulating; they do not require a therapeutic establishment to find the right dose of pain relief.

Satel and Sommers deserve a special vote of thanks for making a valiant attempt to save the children—especially the boys. The latter have been special targets (as Sommers in another book [click HERE] has demonstrated) of the feminist/therapism movement. The main aim of this movement is to take aggression and competiton out of the school environment and to replace them with self-esteem-building programs that lack any degree of authenticity.

Most mothers who have tried to suppress their children’s murderous impulses by disallowing toy guns find that it is useless. Sooner or later they see their little boys making guns out of their forefingers and their imagination. It seems that it is difficult for the therapeutic culture to accept that life cannot be pain-free and that aggression and competitiveness are part of human nature and cannot be amputated. It is hard for some feminists to accept the notion that rough-and-tumble play is hard-wired in children—a little more in boys than girls probably—and that even if you take away dodgeball and replace it with knitting you will not take the aggression out of the boy.

For centuries educators, when they were still mostly men, knew that the best way of dealing with the competitive spirit was to channel it and not try to supress it. So sports were built in to the school program. They also knew that competition entailed winners and losers and that becoming a winner resulted in pride and a heightened sense of accomplishment and self-esteem. What about the poor little losers? Well, children have much to learn from losing. They can be taught how to be good losers, how to use losing as a motivator for greater achievement, and how not to give up when you want to achieve something.

One of the things that school is about is allowing children to experience failure in a non-catastrophic environment. School is a place to experience failure and periods of low self-esteem in order to learn how to cope with them in the future with the help of teachers, parents, and the models of their older sibs and classmates. Competition doesn’t weaken children; it strengthens them. And robbing them of these opportunities only interferes with this process.

In the last few years the American people have been weighed and found overweight and psychologically flabby; it’s time for them and their kids to get off the analytic couch and start pumping iron.