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Over the last few decades, the profession of therapeutic psychiatry has steadily gained wider popular acceptance as a respectable science, especially in North America. As skepticism and distrust toward psychiatrists have diminished, increasing multitudes of people from all social and economic backgrounds unashamedly seek professional counseling for an ever broader variety of reasons. Curiously, the practice of psychotherapy has achieved cultural legitimacy at a time when the theoretical coherence of psychology has declined considerably, as Freudianism and other overarching theories of the psyche have been picked apart, leaving only a mass of conflicting hypotheses with few commonly held principles. Most contemporary psychotherapists have effectively de-intellectualized their practice, eschewing technical jargon during treatment and replacing the intimidatingly detached scientific “psychoanalysis” with a more conversational, patient-oriented “therapy.” As we examine the intellectual origins of humanistic psychotherapy, we will find that much has been borrowed from older traditions of psychology, including the now-maligned Freudian system of psychoanalysis. By studying the cultural origins of contemporary psychotherapeutic practice, we can identify its normative assumptions and show that it is far from being a “culturally-neutral” medical practice or science, but is instead a form of counseling that encourages people to abide by culturally-specific social expectations.
According to the National Institutes of Health, “Conventional psychotherapy is conducted primarily by means of psychologic methods such as suggestion, persuasion, psychoanalysis, and reeducation.” Psychotherapy is a much broader concept than psychoanalysis, as it can refer to any method of psychological treatment. Some of these other methods - suggestion, persuasion, and reeducation - sound disturbingly manipulative and are susceptible to abuse. These rhetorical techniques might be legitimized as “psychologic methods” if they are subordinate to an ethical, scientifically informed method. Some psychoanalysts of the older schools would find the use of persuasion and suggestion incompatible with the proper conduct of psychoanalysis, which requires the analyst’s scientific detachment from the patient. Freud and others warned repeatedly of the dangers of the psychiatrist becoming a charismatic figure in the patient’s mind, yet modern therapeutic methods practically require the therapist to use his personal charisma to some extent as a healing tool. Later, we will examine some of the effects of this emotional involvement, but first we will focus on how psychoanalysis is integrated into psychotherapy.
By packaging cold, cerebral psychoanalysis behind the softer face of psychotherapy, therapists may have compromised the intellectual integrity of the psychoanalytic method. This tension is often articulated by therapists themselves, who express disdain for the older psychoanalytic methods, and make conscious attempts to distinguish their practice from the Freudian or Jungian models. They may do this in superficial ways, such as not using a couch, or in more substantial ways, such as avoiding Freudian-sounding questions about childhood and sexuality. The trick is to analyze the patient without making him feel that he is being analyzed.
Yet it is unclear how anyone should be able to analyze a mind without having a reasonably well-defined theory of the mind. If we are to believe that Freud, Jung, and Adler were all fundamentally mistaken, then what is the current theoretical framework of psychology? A review of the current literature reveals a complete chaos of theory; even college textbooks exhibit an astounding lack of uniformity in opinion on even the most basic principles. Most books will discuss theories as historical background, but few will advance any theoretical system as an operative paradigm. In any developed science, there is a generally accepted (though not infallible) system of established principles, such as general relativity in physics. This is why science textbooks in a given subject usually discuss the same material. No such agreement on principles can be found in psychology; there is no body of generally accepted knowledge in psychology analogous to well-developed theories in science or medicine.
The theoretical diversity among psychologists is paralleled by an even wider disparity of practice among therapists, many of whom combine holistic medicine and other “alternative” techniques with conventional psychotherapies. Most psychotherapists have modeled their practice after medical doctors, rather than scientific investigators. Abandoning the conceits of “analysis,” therapists instead merely “diagnose” their patients, but a good medical diagnosis requires a medical theory that explains the causes of the symptoms. We would be very skeptical of a physician who subscribed to his own pet theory of medicine, but most psychiatric patients do not even ask their therapist to what school of psychology he belongs. By downplaying the importance of theoretical psychology, therapists have created the impression that they are a unified profession practicing the same science, when in fact their practice depends greatly on their personal theoretical predilections. Since contemporary psychotherapy has discarded the visible trappings of psychoanalysis, the patient is usually unaware that he is being analyzed in the context of some theoretical principles that may or may not have wide scientific acceptance. Medical diagnosis, if it is to be truly explanatory and not merely descriptive, requires the application of some theoretical principles, held either consciously or unconsciously by the therapist.
For this discussion, we will focus on “humanistic” psychotherapy, and its conscious assumptions. The “humanistic” approach is by far the most popular class of therapeutic methods, owing to its humane, unintimidating style. Even therapists who subscribe to other theoretical models will employ humanistic techniques in order to better engage patients, by assuring them that the therapist will not “judge” them, morally or scientifically. Humanistic assumptions, as we shall see, are averse to the notion of objective morals, thereby undermining the possibility of achieving a coherent theory of mental health. Without morals, that is, normative principles about what a person “ought” to do, there can be no definition of mental health except in a strictly functional sense, which would reduce psychology to neurology.
In practice, of course, the therapist cannot avoid surreptitiously imposing his (or society’s) moral structure on the patient, whether he means to or not. We can see how supposedly value-neutral humanistic psychotherapy is informed by some very specific cultural assumptions, by analyzing some of the principles of this method. Here is one sympathetic description of the tenets of humanistic psychotherapy:
Few would dispute the first principle; it has been a mainstay of Western thought for millennia. The second principle, however, requires qualification. As is evident from human experience (and formal reasoning), the only thing, if anything, that is free in a human being is the will, so only the will might, in any sense, be considered self-actualized. Intellect and cognition are dependent on received input, and the emotional and physical faculties are even more obviously dependent on extrinsic circumstances. Self-actualization pertains only to the will, so emphasizing the importance of self-actualization effectively focuses attention on the will. Humanistic psychotherapists will commonly ask patients to articulate their wants and then find a means to realize these desires, sometimes with little regard for intellectual and moral criteria. There is an implicit assumption that self-actualization is intrinsically desirable, as though this were the principal means of improving the self. In fact, most, if not all, of our experiences of personal betterment come from extrinsic sources, such as being exposed to some new idea or experience, even if it is only contemplated internally. It is not obvious that greater self-actualization would facilitate constructive experiences. In any event, the point is moot, since there is no way to attain or improve self-actualization. We already have it; the will is free. (Some serious mental disorders might impede the free use of reason by the will, in which case we might speak of potentially attaining self-actualization. Even in these cases, the will might be considered free to choose, yet the lack of cognitive abilities makes the person unaware of most possible choices.)
Notwithstanding these philosophical considerations, most psychotherapists would agree that even normal people could stand to improve their self-actualization. Our objection that the will is already free is circumvented by conceiving external circumstances as constraints upon the will. Self-actualization, in this understanding, is imposing one’s wishes upon external reality. There is an obvious moral danger in promoting strength of will as a sign of mental health. The strength of one’s will is morally neutral; it can be used either for great good or great evil. Yet the desire to impose one’s will on reality is essentially prideful and egocentric. The problem is particularly acute when internal circumstances, such as moral convictions, are viewed as obstacles to self-actualization. There are many possible ways to encourage the development of self-actualization, both constructive and destructive. The methods favored humanistic psychotherapy are summarized in the third and fourth principles:
Person-centered counseling creates an environment free of defensiveness, thus conducive to self-actualization. When a patient knows he will not be criticized or judged negatively, he feels free to express his will without inhibition. The therapist’s role is not to judge whether the object of the patient’s will is morally good - though a moralist would consider this essential to the health of the (psyche) (“soul” in Greek) - but to help the patient see himself as the prime mover in his life, and act accordingly. Of course, the therapist will not take this too far; for example, he would not nod approvingly if the patient were contemplating murder. Yet he might not intervene for dubious matters that are approved by his society, such as spousal desertion or abortion. By selecting when to intervene and when not to do so, the therapist implicitly projects a set of values onto the patient. The fact that he feels obliged to intervene in violent cases belies the myth that failure to intervene does not give the patient a sense of moral approval. Person-centered counseling is not neutral, but affirmative of whatever the patient sets out to do.
Whereas Freudian psychology identified neurosis as a regression to childhood sexuality, humanistic psychotherapy may actually promote a regression to childhood by creating an environment favoring self-gratification. We should perhaps not be too surprised by this reversal. Without a coherent, unified scientific theory, therapists have little choice but to draw upon the values of their society as operating assumptions. It is almost certainly not mere coincidence that the rise of humanistic psychotherapy coincided with the increasingly self-indulgent materialism of the 1980s and beyond. Since psychotherapeutic treatement is usually voluntary, therapists must employ methods that appeal to the masses if they are to succeed as a profession. Consequently, there is considerable engagement between therapeutic precepts and popular culture. The rise of moral egocentrism, the infantilization of entertainment, the retention of adolescent attitudes on sexuality, and the infatutations with personal empowerment and emotional gratification that have become increasingly characteristic of modern North American culture, all have their parallels in modern psychotherapeutic methods. Humanistic psychotherapy tells patients what they already want to hear.
The concept of “congruence” was defined by Virginia Satir as a “condition of being emotionally honest” during the heyday of humanistic psychology in the 1970s. It is transparently informed by the culture of middle class America, which at the time adhered to the popular psychology of “getting in touch with your feelings.” Using congruence as a standard of healthy relationships arbitrarily pathologizes people who are emotionally reserved. This form of psychotherapy is favored only by certain personality types, especially women, and certain cultures. It is oblivious of other cultures, such as those in Asia, where emotional reserve is considered essential to healthy social relationships. As with the focus on self-actualization, a psychotherapy of congruence upholds personal desires, perceptions, and feelings as determinants of healthy behavior, irrespective of objective considerations.
More broadly, the assumption that "healthy" social relationships are essential to a mentally healthy individual uncritically incorporates current social mores into the definition of mental health. While mental health certainly requires that the patient’s worldview should conform with external reality, it is also true that understanding reality does not necessarily mean accepting it. We should not require, as a criterion of health, that a person should not necessarily “fit in” or “be at peace” with his social environment. A mentally sound person might find his society to be fundamentally flawed in its values or structure, and so willingly suffer ostracism rather than assimilate its values. The humanistic model leaves little place for such melancholy or choleric souls, having defined social disengagement as “unhealthy,” while egomaniacs might be found healthy if they are sufficiently sociable. This bias toward a sanguine, sociable temperament also reflects the current culture, which is considerably averse to unpleasant confrontations in social discourse, as evidenced by its emphasis on sensitivity and inoffensive language. Insisting on sociability as a standard of health effectively codifies current societal values as truths, ignoring the possibility that society may be ill.
On the other hand, the humanist has no problem criticizing other societies that do not sufficiently emphasize personal autonomy. As an example, when a Hindu expressed his anxieties in the context of his belief in fate and reincarnation, his therapist encouraged him to see himself as the proactive force in his life. The therapist claimed that he had treated the Hindu while respecting his religion, when in fact he had undermined the fatalist philosophy upon which most forms of Hinduism rest. The same is true when humanistic psychotherapy's premise about men being basically rational and forward-looking is presented in a way to suggest that humans are inherently morally worthy, a claim contrary to Christianity. Further, the belief that man is forward-looking can be conflated with the idea that he actually does progress, contradicting many worldviews. Humanistic psychotherapy is far from being culturally neutral.
Humanistic psychotherapy has an underlying philosophical worldview, which may be broadly described as an immanentist, secularized Protestantism with a strong emphasis on personal autonomy and the creation of meaning through work. This ideology is no novelty, but merely absorbed from the society in which North American psychotherapists are immersed. It conveniently serves to rationalize the existing social and economic power structure, since low social status or economic failure is only the result of a failure to self-actualize, not the product of unjust external circumstances. Needless to say, this “can-do” philosophy is unrealistic, as it ignores the utter dependence of the individual upon the society in which he is enmeshed (on both conscious and unconscious levels), not to mention his complete dependence on the natural world and its Creator. Immanentism is aesthetically man-centered, tending toward practical atheism. It is not accidental that disbelief in God predominates among psychologists and psychiatrists more than any other scientific profession. The approach of modern psychology is to isolate man as if he depended on nothing outside himself, and to measure all things by their utility to fulfilling his wishes. Thus he seeks a religion or spirituality that best meets his personal “needs” (actually “wants”), rather than judging belief systems by objective criteria.
Emphasis on human will can create an inversion of certainties in the patient. Normally, a person might be certain of universals but uncertain of particulars. An example in ethics: I am certain that murder in general is morally wrong, yet I could be uncertain whether morally culpable murder was committed in a particular case. The egocentric illogically thinks oppositely. He may deny that any general moral principle is certain, yet he nonetheless is certain that his particular actions are not immoral. This is the absurdity of the moral relativist; he will assert no moral as absolutely true, yet he is certain that he has done no wrong. It would be as if I said, “I don’t know what murder is, but I’m sure I did not commit it.”
The psychotherapist enjoys a luxury that is denied to the physician: he is allowed to define what constitutes “health”. This luxury essentially enables him to determine his own success rate. We have seen that humanistic psychotherapy is based on precepts that ignore any notion of absolute moral good, so it is only to be expected that emotional pleasure, falsely called “happiness,” is made the criterion of mental health. This is consistent with the therapeutic philosophy and with the patient’s expectations, and it is much easier to provide than a truly healthy soul. The patient-centered therapy of ego gratification, also known as “empowerment,” naturally generates pleasing emotions. Of course, this is a gift such as the Wizard of Oz might give, for empowerment is nothing more than the enthronement of the already free human will. Psychotherapy has increased its success rate and its prestige by redefining success from actually curing neurotic behaviors to simply making people emotionally happy.
Encouraging and self-enabling words are not enough for most patients to achieve even this mediocre standard of happiness, hence the millions of prescriptions for increasingly effective antidepressants that are the real key to the success of the psychiatric profession. Psychotherapists enjoy a second luxury denied to medical doctors: they get to diagnose an organ, the brain, without examining it. A patient is deeply depressed emotionally, so the therapist prescribes antidepressants to correct a “chemical imbalance” without actually measuring the serotonin levels in the brain. This represents the worst in medical practice: treating the symptom rather than the cause, without considering that the same symptoms may arise from different causes.
Antidepressants do not correct “chemical imbalances;” they create chemical imbalances. The evidence linking depression to serotonin deficiency is remarkably weak. In all but the most extreme cases, such as serial killers, severe emotional depression is not correlated to a decrease in serotonin levels. In the case of some serial killers, serotonin levels have been found to be 30-40% below normal. Yet normal dosages of antidepressants, which stop serotonin inhibition, increases serotonin levels hundreds of times. This is not correcting an imbalance, but creating a severe imbalance. Serotonin is a basic neurotransmitter that serves hundreds of functions; obviously anyone deficient in it would not be able to function well mentally. Lack of dopamine, blood, or oxygen would also make someone depressed, because basic brain functions could not operate. By recklessly increasing serotonin levels, too much neurotransmitter is secreted throughout the brain, affecting hundreds of brain functions. Antidepressants do not “cure depression” in the sense of correcting a neurological malady. Serotonin is not specific to emotional depression, and depression has no neurological correlate: there is no specific region of the brain that is a “depression center.” Antidepressants “cure depression” only in the sense that alcohol, marijuana, opiates, and cocaine do the same: they abolish the sensation of depression by masking it with a chemically-induced artificial “high.” Antidepressants are simply “happy pills” that do not cure any underlying medical phenomenon, but, like their illegal counterparts, can be chemically addictive, requiring increasing dosages to achieve the same effect.
The rising credibility of therapeutic psychiatry is paralleled by increasing popular belief in what may be called “the medicalization of behavior.” In popular perception, there is little distinction between psychological disorders and neurological disorders; a crude materialism fosters the belief that every psychological or behavioral malady must be the result of some “chemical imbalance,” neural damage, or genetic predisposition. In reality, even the most basic psychological “diseases,” such as depression and schizophrenia, have no widely agreed upon symptoms to allow consistent diagnosis, much less are they consistently correlated with neurological phenomena. Such is not the case with genuine neurological disorders.
An unfortunate consequence of the medicalization of behavior is that certain temperaments are unfairly deemed “unhealthy,” particularly those that were classically known as melancholic and choleric. Depression and anger are now illnesses to be treated rather than an important part of human existence. The religious ascetic’s willingness to suffer has little place in the current therapeutic ethos. Though not all therapists go to the same extreme, the tendency to diagnose sadness and anger as illnesses has become increasingly broad. Such a hedonistic standard of health is viable only in a pampered society; it would be impossible to apply this standard in countries filled with real suffering, without prescribing heavy medication. By branding choleric and melancholic temperaments as unhealthy, the therapist, much like the society in which he lives, favors the development of sanguine personalites, which are often docile, complacent, and willing to submit to the social status quo. The energies released by self-actualization are devoted to economic and social pursuits within the existing social structure. If sanguinity is the only form of mental health, then normalcy and moral mediocrity are practically inevitable results. Emotional happiness, unaccompanied by other emotions, encourages complacency, docility, and effeminacy. Anger and melancholy have played valuable productive roles in the course of human history. No nation would have ever achieved its liberty if the fires of outrage did not prod men to arms. Some of the world’s greatest artists, philosophers, and religious thinkers, while brooding over the tragedy of life, discovered some of its deepest and most beautiful truths.
Psychotherapy is especially successful in North American society, which is increasingly filled with egocentric adults seeking no happiness beyond emotional pleasure, which psychotherapy is well-designed to provide. North Americans are also much more willing than Europeans and other peoples to be medicated for just about anything. Nonetheless, therapists are aware of the fragility of their position, and many remember decades ago when psychology was subjected to scorn and widely regarded as pseudoscience, even though its theories then enjoyed favor among the New York literati. Now, in the absence of a coherent theoretical doctrine, therapists do not preach scientism too loudly, but instead present themselves as medical doctors, and emphasize their professionalism. The label “mental health professional” exemplifies a shift in emphasis from the more scientific-sounding “psychoanalyst.” Professionalism appeals to North Americans who, more than Europeans and others, are inclined to seek expert, professional advice on the ordinary matters of life. Most people fail to realize that “professional” merely means that someone is foolish enough to pay the professional in question, and that quacks, charlatans, and witch doctors have equal claim to the title. As cynics may suspect, those who proclaim too loudly that their field is a profession are the ones skating on the thinnest ice. Ironically, those strenuous advocates of personal autonomy, psychotherapists, benefit especially from the peculiar insecurity and lack of autonomy among North Americans that prompts them to seek professional help in managing their daily life. Even people who have no serious mental disorder, or any noticeable disorder at all, nonetheless seek regular therapy. Although modern therapy speaks the language of empowerment, in fact the North American population has become more docile and complacent before the existing power structure than overt repression could reasonably hope to achieve. Perhaps this is why the Soviets were the first to require a psychiatric division in every hospital.
It will be noticed that I have painted a picture of North American humanistic psychotherapy with very broad strokes. In fact many humanistic psychotherapists do conscientiously perform their practice in conformance with sound moral values, and many of them even encourage Christian values. There are other branches of psychiatry, closely related to neurology, that are grounded in real science and generate valuable insights into the workings of the human mind. Yet how the mind works does not tell us anything about how we should best deal with the stresses of living. Answering the latter question requires us to make normative judgments about attitudes and behaviors. It is dishonest for psychotherapists to pretend to scientific objectivity when they are in fact promoting a particular social philosophy with immanentist assumptions. When people are genuinely troubled, they will grasp at whatever worldview the therapist offers, even if it contradicts the values in which they were raised, sometimes resulting in moral ruin. Whether they intend to or not, those who treat the psychologically vulnerable wield great power, so it is imperative that the practice of psychotherapy be socially accountable, and this may begin with an open profession of its hidden assumptions.
© 2005 Daniel J. Castellano. All rights reserved. http://www.arcaneknowledge.org
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