Many years ago, when I first opened my private practice, I saw a husband and wife, separately, for individual therapy. Many times, if I hadn’t known they were married, I’d not have figured out that they were talking about the same event, so different were their accounts.
I sent them to a colleague, far more experienced than I, for couples counseling. When I conferred with him, his stories of their sessions frequently bore little relation to how they each described to me their marriage.
Over the years, I’ve learned a couple of very troubling things that this situation exemplifies.
The first is obvious: a therapist cannot reasonably assume a client’s reports to be accurate.
The second is a bit more subtle: “supporting” a client’s perceptions can easily wreck lives. In this instance, supporting the husband’s understanding probably wouldn’t have worked out well for the wife, and vice versa.
In the twenty-five-plus years I’ve been in practice, I’ve often had therapists refer the spouse of one of their clients to me. Almost invariably, they’ve given me an account of what they understand the spouse’s issues to be—based entirely on conversations with their own client. I’ve learned just not to expect these accounts to be accurate. These accounts aren’t always terrible (though sometimes they are), but they’re often enough off in significant ways.
I’ve also occasionally had the parents, siblings, or significant others of my own clients come in for consultation. In almost every case, I’ve had to revise my surmises about those people—sometimes in a more positive direction, but sometimes in a negative one. One case in particular stands out in memory. A client brought in her older sister, whom she’d generally portrayed as a stalwart supporter. I was stunned to watch the sister systematically undermine, contradict, and control my client, while my client willingly submitted to being demeaned.
I remain puzzled that therapists, all of whom have some sort of graduate degree, think they can understand someone they’ve never met, based on the pained accounts of suffering clients. I’m excruciatingly vexed that therapists are routinely willing to support, encourage, or exhort their clients to actions based on such questionable views.
Even the most by-the-book, “correct” therapy can be dangerous: the client’s changes impact people outside the therapy room, who have no say in shaping the therapy. A therapy that makes a client very happy can easily wreck the lives of those he or she influences.
The direct relevance of these observations to “Mad in America” is this: The psychotherapy and counseling industries have themselves played a significant role in our culture’s willingness to embrace biological psychiatry. We will not win back the hearts and minds of the public if we keep repeating the mistakes that made people willing to leap into the arms of the pharmaceutical companies.
Many people, both people who need help and their significant others, quite rightly fear therapy. The possibility of getting relief without falling prey to the influence of therapists offers those people hope.
Two major historical phenomena illustrate the problem: NAMI, and the False Memory Syndrome.
While NAMI is sometimes portrayed as a front for the pharmaceutical companies, that’s not how it started. It started with families of the seriously mentally ill who were sick to death of being portrayed as causing the problems of beloved family members. While we can, and should, decry the perfidy of the pharmaceutical companies for many things, we can hardly blame them for supporting an organization that needed an alternative to therapists who blamed them for their own heartbreak.
And the False memory Syndrome, which was almost entirely manufactured by the therapy industries, simply disgraced talk therapy and proved that even the most highly trained therapists, at prestigious institutions, could not be trusted to abide by basic principles of logic and evidence.
While we are rightly aghast at the machinations of psychiatrists and pharmaceutical companies, we do not often enough ask why our culture has been so ready to embrace biological psychiatry. After all, “drugs” face a generally negative bias in our culture, and we have historically tended to see “facing your problems” as a moral imperative. As the most religious culture in the industrialized West, America is not naturally inclined to embrace materialist explanations of human suffering.
If biological psychiatrists have lied to us, we need to ask why, as a culture, we have been so willing to embrace those lies. Generally, we’re most apt to be conned when the con men appeal to our hopes and fears. We know that people in pain hope for relief, and the people in their lives hope that for them. What we don’t like to admit is that they fear the influence of therapy, and often rightly so. If we want to defeat biological psychiatry, we can’t just show its lack of integrity. We have to offer alternatives that deserve trust.