Decreasing suffering often means “comforting the afflicted, and afflicting the comfortable.” However, AlterNet’s recently republished Psychotherapy Networker article, “The 14 Habits of Highly Miserable People,” authored by psychotherapist Cloe Madanes, instead appears to have afflicted many of the afflicted. Perhaps Madanes was attempting to afflict those comfortable enough to afford her and her professional partner Tony Robbins, but that comfortable group excludes many readers.
While some of the article’s voluminous reader comments were positive, concurring that many unhappy people have chosen to make themselves miserable, the majority vilified Madanes, calling her: “condescending,” “shaming,” “asinine,” “insensitive,” “pompous, “judgmental,” “violent,” “a narcissistic, manipulative, abuser,” and a long list of even nastier invectives.
In the 1980s, Madanes achieved some fame among mental health professionals as a family therapist who wrote about interpersonal/interactional strategies. In the 2000s, she teamed up with Tony Robbins to form Robbins-Madanes Coach Training and the Robbins-Madenes Center for Strategic Intervention. Robbins—whose estimated net worth is $480 million—has been a guru to the rich and famous and to those aspiring to become more successful; they pay big bucks to hear Robbins’s version of the positive psychology gospel of “you have total control over your happiness.”
While Madenes talks about the benefits of altruism, gratitude and satisfying relationships, it is her sarcasm and lack of empathy for those who can’t so easily be transformed by the Robbins-Madanes approach that enraged people. The reality is that we human beings can sometimes become so trapped by overwhelmingly oppressive forces—financial, interpersonal, and otherwise—that lecturing us into behaving more joyfully only creates more pain. This leads to the first of 10 Ways Mental Health Professionals Increase Misery in Suffering People:
1. Preaching Positive Psychology Attitude-Adjustment Approaches to Trauma and Abuse Victims. Abuse comes in many forms—physical, emotional, verbal, nonverbal and neglect—all imparting the message: You are not worthy of respect and caring. While no small number of Americans have been traumatized by abusive parents or spouses, many more of us are financial victims of the abusive authority of the ruling corporatocracy (comprised of the wealthy elite, giant corporations and their politician collaborators).
The trauma and shame of chronic abuse is painful, and one normal human reaction to overwhelming pain is depression, which is really a “strategy” for shutting down overwhelming pain. Whether one is abused by a parent, spouse, or the corporatocracy, the pain of it can be anesthetized by depression, drugs, and a wide range of diversions.
People beaten down into a state of immobilization do not need positive-thinking advice, as they routinely know what they should be doing but lack the energy to take constructive actions. Condescending advice, which assumes inaction stems from ignorance, creates only more pain. Instead, people need compassion, love, and various kinds of support.
2. Depoliticizing Human Suffering. Madanes’s #1 “habit of highly miserable people” is to “Be afraid, be very afraid, of economic loss.” The reality is that the majority of Americans have every reason to have anxiety over financial loss, as many are already suffering or on the verge of suffering from unemployment, underemployment, a house underwater, staggering student-loan debt, and other financial nightmares.
But Madanes says, “In hard economic times, many people are afraid of losing their jobs or savings. The art of messing up your life consists of indulging these fears.” Are most people in financial misery because they are stupidly indulging their fears? Or do some people, unlike Madanes, have debilitating financial anxiety because they see no viable options?
3. Not Respecting and Not Celebrating Maladjustment. Martin Luther King’s 1963 speech addressed the problem of mental health professionals’ uncritical compulsion for “adjustment.” Here’s an excerpt:
Modern psychology has a word that is probably used more than any other word in modern psychology. It is the word “maladjusted”. . . There are certain things in our nation and in the world which I am proud to be maladjusted. . . I never intend to adjust myself to economic conditions that will take necessities from the many to give luxuries to the few. I never intend to adjust myself to the madness of militarism, to self-defeating effects of physical violence… I’m about convinced now that there is need for a new organization in our world: The International Association for the Advancement of Creative Maladjustment.
4. Medication Abuse. Adults with truly informed choice can wisely utilize a psychiatric drug to catch a night’s sleep after a week of sleeplessness threatens a breakdown. However, wise informed choice is not exactly the standard of care in psychiatry. The high-profile case of Tufts-New England Medical Center (a bastion of the psychiatric establishment) and Rebecca Riley reveals that standard of care in psychiatry includes medication abuse.
Covered by “60 Minutes” in 2007, when Rebecca was 28 months old, her psychiatrist Kayoko Kifuji diagnosed Rebecca with attention deficit hyperactivity disorder and prescribed clonidine, an anti-hypertensive drug with significant sedating properties. When Rebecca was three years old, Kifuji added a bipolar disorder diagnosis and prescribed two additional heavily sedating drugs, the antipsychotic Seroquel and the anticonvulsant Depakote. At the age of four, Rebecca died due the toxicity of these drugs. After Rebecca’s death, Tufts-New England Medical Center, Kifuji’s employer, told “60 Minutes,” “The care we provided was appropriate and within responsible professional standards.”
Investigative journalist Robert Whitaker in his book Anatomy of An Epidemic documents how, for many children, psychiatric medications results in episodic and mild emotional/behavioral problems becoming severe, chronic and disabling ones.
5. Maintaining Drug Hypocrisy. Not only are prescription psychotropics and illegal psychotropics chemically similar, affecting the same neurotransmitters, they are used by people for similar reasons, which include taking the edge off misery so as to function.
In the Vietnam War, some U.S. soldiers used heroin to dampen their misery, and this worried the U.S. military establishment, weakening its resolve to continue the war. But in Iraq and Afghanistan—where according to the Navy Times in 2010, one in six U.S. soliders were taking psychiatric drugs, many in combat zones—since soldiers are being “medically treated,” the U.S. military establishment and general public can more easily deny war-horror realities.
Drug hypocrisy also results in Americans being misinformed about the realities of prescription psychotropic drugs, which makes it more likely Americans casually take them and give them to their children. Moreover, this drug hypocrisy also increases suffering by enabling unfair criminalization and incarceration of people who are medicating themselves with illegal psychotropics.
6. Pathologizing Normal Dimensions of Our Humanity. No different than those religions that shame sexuality as sinful, mental health professionals who pathologize grief, shyness, stubbornness, rebelliousness, and other normal dimensions of our humanity can alienate vulnerable people from their very selves and cause increased suffering.
In 2013, the DSM-5, the American Psychiatric Association’s revised diagnostic bible, patholologized normal grief. In 2008, Christopher Lane (Shyness: How Normal Behavior Became a Sickness) described how shyness became social anxiety disorder. And in a February 2012 AlterNet article Would We Have Drugged Up Einstein? How Anti-Authoritarianism Is Deemed a Mental Health Problem, I detailed how anti-authoritarianism is psychopathologized; for example, in 1980, the American Psychiatric Association added opposition defiant disorder (ODD) to its then DSM-3. ODD symptoms include “often actively defies or refuses to comply with adult requests or rules” and “often argues with adults.”
Since 1980, ODD has become an increasingly popular diagnosis, with an increasing number of these kids being drugged for this “condition.” In December 2012, the Archives of General Psychiatry reported that, between 1993-2009, there was a seven-fold increase of children 13 years and younger being prescribed antipsychotic drugs, and that “disruptive behavior disorders”—which includes ODD—were the most common diagnoses in children medicated with antipsychotics, accounting for 63% of those medicated. Antipsychotics are among the most dangerous psychiatric drugs, causing obesity, diabetes, and “life-shortening adverse effects,” reports the American Family Physician.
7. Absence of Professional Humility. The most important aspect of helpful psychotherapy is a positive relationship between therapist and patient. There is copious research on this documented in Great Psychotherapy Debate, which shows that the nature of the relationship is far more important than any technique. Mental health professionals—like all human beings—have limitations, and they are routinely mismatched with a patient in terms of personality, values, or other significant variables, resulting in relationships lacking affection, trust, and respect.
Because of an absence of professional humility around one’s ability to form positive relationships with all patients, two damaging events often occur when patients are not making progress: (1) a relationship that may consist of a mutual lack of affection, trust, or respect is allowed to continue, and patients become even more hopeless about their ability to make progress; or (2) patients will be needlessly referred for medication, and needlessly risk drug adverse effects. Too few professionals say, “I think the problem is that we are not hitting it off, and you are better off trying to form a therapeutic relationship with someone else.”
8. Creating the Stigma of Biochemical Defect Which Isolates Suffering People. In 2007, the director of the National Institute of Mental Health (NIMH) discarded the theory that an underproduction of serotonin causes depression, but the NIMH and the psychiatric establishment continue to spend billions of dollars trying to prove that mental illness is primarily a brain disease. In the mental health establishment, it has long been thought that reducing mental illness to a brain disease—and minimizing psychological, family, social, and spiritual reasons for emotional suffering—would result in less stigmatization. But is this true?
The Canadian Health Services Research Foundation (CHSRF), in “Myth: Reframing Mental Illness as a ‘Brain Disease’ Reduces Stigma,” reported in 2012: “Despite good intentions, evidence actually shows that anti-stigma campaigns emphasizing the biological nature of mental illness have not been effective, and have often made the problem worse.” One example is a 2010 study in Psychiatry Research that reported for the general public, the acceptance of the “biogenetic model of mental illness” was associated with a desire for a greater social distance from the mentally ill.
The CHSRF review states: “The evidence shows us that while the public may assign less blame to individuals for their biologically-determined mental illness, the very idea that their actions may be beyond their conscious control can create fear of their unpredictability and thus the perception that those with mental illnesses are dangerous. . . .leading to avoidance.” The authors believe that, “Biological explanations can also instill an ‘us vs. them’ attitude, defining individuals with mental illness as fundamentally different.”
9. Exclusive Focus on Patients’ Symptoms to the Detriment of Their Humanity. In 2011, the New York Times (“Talk Doesn’t Pay, So Psychiatry Turns Instead to Drug Therapy”) reported, “A 2005 government survey found that just 11 percent of psychiatrists provided talk therapy to all patients.” As the article points out, psychiatrists can make far more money primarily providing “medication management.”
A typical medication management session consists of checking symptoms and updating prescriptions, and patients are usually in and out with a new prescription in five or ten minutes. It’s common for medication managements to be scheduled every two or three months, and patients tell me that during these appointments, the doctor often needs to peek at their files to remember their names. In such assembly-line treatment, there is virtually no chance of a relationship forming, and gone is even the accidental possibility of healing through another’s humanity. And by focusing exclusively on what’s wrong with patients—their symptoms—patients can suffer more.
“Depression is partly defined by, and largely maintained by, self-focus,” reports psychologists and researcher Jill Littrell, and medication management is not the only way that mental health professionals cause greater self-focus and symptom-focus. This problem can also be caused by some psychotherapists, Littrell reports in her 2013 article “Talk Therapy Can Cause Harm, Too.”
What is most helpful for many depressed and emotionally suffering people is morale, healing from trauma, and learning to focus outside of one’s symptoms to activities, external events, and other people. Suffering is reduced by increasing satisfying relationships and increasing self-respect—not by increasing self-absorption. Unfortunately, too many mental health professionals create increased self-absorption, which is often accompanied by increased isolation, dissatisfying relationships, and greater misery.
10. Hypocrisy over Conflict of Interest. Professionals have great power to “maintain their cash flow.” They can, for example, sell patients on the idea that their episodic depression is a chemical-imbalance disease like diabetes, and that they need to be on medication for life. They can sabotage patients’ other relationships by focusing on—and helping exaggerate—minor frustrations with friends or intimates, resulting in patients becoming isolated and totally dependent on the professional.
The professional’s job ceases when treatment is successful, and so professionals who are doing their job well are working against themselves financially. If that’s not a conflict of interest, what is? Certainly the same is true for divorce attorneys, auto mechanics, and others who make a living off the problems of others. This is not to say that many people who make a living off the problems of others don’t transcend this essential conflict and do the right thing—but not if they are in denial about this inherent conflict of interest.
These 10 areas are not the only ways that mental health professionals can increase misery in suffering people. Too often, professionals don’t value emotional crisis as a vehicle for spiritual discoveries and a path to connect to new people. Also, patients not only have severe long-term adverse affects from psychiatric medications but from electroconvulsive therapy (ECT), which continues to be used in America. And there are other physical, psychological, spiritual, and societal adverse effects caused by mental health professionals.
I am often asked, “Don’t your colleagues get angry with you for speaking out on what’s problematic with your profession?” The short answer is not all of them get angry. Those mental health professionals who are embarrassed and afflicted by what has happened to their profession often tell me that what I say helps them feel validated and less alienated. However, it is true that the mental health establishment, including the American Psychological Association and the American Psychiatric Association, which focuses most on maintaining professional prestige is not at all comforted by what I have to say. But isn’t it the job of those who care about reducing suffering and injustice to “comfort the afflicted, and afflict the comfortable”?
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.
A superb summary of what’s wrong with the profession. Thanks. I have to say that, unlike you, I was not so lucky to encounter colleagues who would see what you described and what I have been seeing for a long time and who would feel validated and supported in their perceptions. It’s been quite a contrary. I was shunned by virtually every colleague who heard me expressing the same thoughts you expressed in this article. Thanks again.
Thank you. Yes, I’ve heard from many professionals who feel completely professionally alienated, as certainly I did earlier in my career until I discovered others who were also dissenting. Best of luck — Bruce
Thank you Bruce for your honest understanding.
Another great post. Thank you.
IMO, the inability of professionals to appreciate the value of suffering people is due to their not being seen as equals.
This failure adds insult to injury.
To clarify – I was not referring to all mental health professionals.
Thanks, Duane, and I think you’re making a good point–Bruce
Thank you for the stayed and sober commentary. Yes, we as professionals have to monitor and modulate ourselves to improve our work. Concerning the “14 habits” article, I have been concerned about the push in the media (Psychologist based TV shows) and self-help literature of ‘finding happiness is just a matter of changing your attitude.’ There is the insinuation that if you aren’t able to improve your state of being through ‘7 easy steps’ then it is somehow YOUR fault – you aren’t trying hard enough or ‘you don’t really want it’ (which is clearly untrue). As a Social Worker since 1986, I have noted that what works for one does not work for another. Treatment is custom – not pigeon holed. Our job is to work WITH our clients and find what works for them – not impose a dogmatic schema on them. Thank you again.
Thanks Geoff. I agree, and I have found that many others agree with you — Bruce
The one that spoke to me was, “Depoliticizing Human Suffering.” Mental distress, which at it’s extreme end is called madness, is usually the outcome of the abuse of power. That’s why madness is found disproportionately amongst the poor, ethnic minorities and the LGBT population. The mad have experienced high levels of childhood sexual assault and family violence, as well as other traumas.
To say people get something out of being miserable and distressed is true, it is the blessed relief of seeing how badly we have been treated, realizing how frightening that is and working out the moral complexity of it all. Without acknowledging that the Alternet article gets dangerously close to blaming victims of abuse and is perhaps colluding with abusers and the abusive political and social systems that we live in. But those attitudes are the norm in the mental health world – blame the victim for their response to abuse and avoid at all costs looking for what distressed someone
“Mental distress, which at it’s extreme end is called madness, is usually the outcome of the abuse of power. That’s why madness is found disproportionately amongst the poor, ethnic minorities and the LGBT population. The mad have experienced high levels of childhood sexual assault and family violence, as well as other traumas.”
I call it what it is: hell and evil.
“blaming victims of abuse and is perhaps colluding with abusers and the abusive political and social systems that we live in. But those attitudes are the norm in the mental health world – blame the victim for their response to abuse and avoid at all costs looking for what distressed someone”
I call it what it is: sadistic torture
too true, I was being a little mild in my language. I apologise
Thanks John and MJK. Yes, “Depoliticizing Human Suffering” is a major way that mental health professional have increased misery not only for individuals but for the entire society. The good news is that I’ve found that many people “get it” — Bruce
Interesting column. I was glad to hear that Cloe Madanes is alive and doing well. I remember going to her workshops on family therapy when she was married to Jay Haley, whom I was saddened to learn had passed.
I agree with you about people suffering from oppression as the common trigger for mood issues. I also, however, believe that other adjustments are possible. Back 50 years ago, when I was a Sociology major, I remember the lecture on Robert Merton who developed a theory about when the goals and the means to goal attainment are blocked for a group (a form of oppression), some people develop a form of alienation in which they attack themselves-drugs, depression etc. Of course, an alternative adjustment is getting mad and fighting against oppression. I think this adjustment has its own misery: frustration and disappointment. However, with defiance, life is always interesting, although contentment proves elusive.
With regard to psychotherapy and whether the psychotherapist should lecture on positive psychology, I like David Burns’ (The feel good book) approach. He talks about clients who view “living happily ever after” as tantamount to saying that the abuse they suffered was “ok”. Like other therapists who know that therapeutic alliance (agreement between the therapist and client on the goals and the strategies for reaching the goal) is paramount, David Burns listens for the client’s scenario for when and how they can change.
Thanks Jill. Yes,I remember in graduate school liking a lot of the stuff that Cloe Madanes and her then husband Jay Haley were talking about with respect to interpersonal, interactional therapies. . . I was aware that Haley and Madanes were divorced, but I was not aware that Haley had died — Bruce
Bruce your articles are some of my favorites, and they have been such a profound influence on my own development personally and professionally. I thank you very much for this new contribution.
Thank you, Andrew, for your kind words. I am glad to hear that my work has been helpful for you — Bruce
Thank you for this. Thank you a lot. I am a patient and have been trying to explain to professionals that a lot of what they do has actually hurt, rather than help, me. I get it, yes, yes, a lot of these things do help a lot of people, but they also hurt people and the professionals seem to be willfully blind to that hurt. Really really big thank you for this article.
Thank you, Jessa. Yes, what is great about Robert Whitaker’s work and the Mad in America web site is that is takes very seriously what patients and ex-patients have to say, giving them an equal voice with mental health professionals. . . It is very sad that the mental health establishment has not historically taken seriously the feedback of people such as yourself who have NOT been helped by the profession. Best of luck, Bruce
The feature of the coersive psychiatry that enrages me strongly is its violent conformism; its stance that the current social, political, economic and cultural system is a priori right and “healthy”; any form of deviation from it is a priori wrong and “unhealthy” – a problem to “solve”, a pathology to “cure”. And virtually never coersive psychiatrists ask themselves whether the ruling system is so right after all, whether it would be more “pathological” to support it than to rebel against it.
But what enrages me even more is coersive psychiatrists’ permanent denial of their inquisitoral and opressive role in society, their wild (or should I say “crazy”?) insistence that the initiation of violence and infliction of torture that they practice is for their victims “own good”, that they are “helping” them!
And what not even enrages, but, actually, horrifies me is the fact that many of coersive psychiatrists really think that they are helping their “patients” by torturing them! Sometimes I feel myself simply weird when talking to them… How one can be SO blind to the cruelty of one’s own actions?!!
Could you imagine what it’s like to go to college and get a job, working in the “field” and being so slow to wake up to what the WHOOPS ye did? lol
Further reasons I decided, last year, to give up identifying myself as a psychologist, once I came to a late enlightenment of the toxicity and destructiveness inherent in professional practice.
Excellent post. And it looks like nothing has changed in the two years since it was written!
Liz Sydney, Parent of a difficult, undrugged child
Though I’m happy for any exploration of harm in psychotherapy, there are infinitely more reasons therapy can be detrimental. Just as a novel idea, has anyone in the mental help profession ever considered discussing this topic with actual consumers?
Some ways might be harmful:
-Creating the attitude that therapy is more important than living life
-Treating the client like a child.
-Letting the client believe the therapist will solve her problems
-An unspoken mandate that the client gratify the therapist’s voyeurism, neediness and savior self-image
-By creating the impression that therapist is a mind reader or nearly omniscient, understanding people he never met or events he never witnessed
-A surrender of privacy and adult privilege
– Inaccurate “material” based on distorted memories and recounting
-Leaving the client obsessed or dependent.
-Imparting the client’s perpetual inferiority, through the asymmetrical boundaried relationship the therapist’s control of the narrative, the rules and agenda
-Dismissing concerns about therapy by insisting it’s resistance, transference or therapy-is-painful
-Using diagnosis or analysis as a weapon
-Superseding the client’s interpretation of her own life.
-Keeping a client indefinitely or far too long
-Threatening grave consequences if the client wants to leave
-By setting up a fictionally intimate relationship that is unequal and limited. Time is up!
-By encouraging the client’s alienation from her real-life community through self-pity and self-obsession
-By magnifying the unfairness that is part of every life experience and encouraging clients to blame and label those who hurt them
-By focusing on negativity, failings and disappointments–a grand habit to encourage depression, powerless and stagnation
-By excavating trauma that the client successfully compartmentalized when she originally lived it
-By making the client feel more disabled through the paternalism and dependency of therapy
-By stoking an idealized, infatuated or even eroticized view of the therapist to which no mere mortal in the client’s life will compare
-Encouraging a detached experience of self and life
-Nurturing fixation and lingering on defects and slights
-Pathologizing the normal–stoking a belief one’s imperfection is special
– Magnifying the insignificant such as the client’s irrational thought stream
-Tacitly encouraging the client to expect from others the same focus, indulging and entitlement she may receive in therapy
-Encouraging rumination rather than action
– A pseudo-scientific culture i.e. buried emotions can be released like a steam valve; there exists discoverable seminal events giving rise to anxiety, prescribed rituals will lead to “healing,” etc.
-Encouraging deference to an externalized authority
-Encouraging impulsive change for the sake of change
– Creating of a pseudo-world
-Fostering a belief in the client’s superiority, having received the special “anointment” of therapy.
-Creating a poor relational example for a client to emulate: i.e. the condescension of diagnosing, labeling and ascribing hidden motives.
– Role playing by both practitioner and client
– A paid artificial relationship substituting for real ones
– The implied promise of magical transformation that therapy never can deliver
-The promulgation of fable, speculation and pseudo-science cloaked as truth
Well, that’s a start. And if the therapist is unethical, more can go wrong.
This is a really great list!