The Reign of the Therapeutic–Someone’s Asking Questions

Something’s going on at The Los Angeles Times. On New Year’s Day, the paper ran not one, but two articles questioning America’s therapeutic culture and addiction to the latest psychological or psychiatric fads. When a major American newspaper publishes two articles in one issue making this essential point, we ought to take notice.

In “Psychiatry’s Sick Compulsion: Turning Weaknesses into Diseases,” psychiatrist and philosopher Irwin Savodnik of UCLA argues that his own field of psychiatry is infected with a preoccupation that focuses on illusory diseases. Referring to the holiday season, Savodnik explains that the American Psychiatric Association [APA] has now identified a new disease–seasonal affective disorder, or SAD–and this may explain why some people feel depressed, frustrated, or elated during and after the Christmas season.

“As Americans rush to return Christmas junk, bumping into each other in Macy’s and Best Buy, the psychiatric association ponders its latest iteration of feeling bad for the holidays,” Savodnik informs. “And what is the association selling? Mental illness. With its panoply of major depression, dysthymic disorder, bipolar disorder and generalized anxiety disorder, the association is waving its . . . flag to remind everyone that amid all the celebration, all the festivities, all the exuberance, many people will ‘come down with’ or ‘contract’ or ‘develop’ some variation of depressive illness.”

What Savodnik describes is part and parcel of what many observers identify as the diseasing of America. Problems large and small, real and imagined are packaged as new diseases to be treated with everything from seminars to pharmaceuticals.

Irwin Savodnik is a well-known critic of modern psychiatry. Last year, he traced what he saw as positive developments in Russian psychiatry, even as he lamented that his colleagues in America are “moving in exactly the opposite direction.” As he explained: “For the better part of the 20th century, psychiatry was dominated by psychoanalysis, so much that in the public eye the two were nearly synonymous. Five-day-a-week-on-the-couch treatment was de rigueur. Psychoanalysts authored most of the prominent textbooks in the field. Gradually, though, psychoanalysis, under attack from some sectors of the intellectual community, perceived as too expensive and unscientific, began to lose its grip on the psychiatric community.” Abandoning psychoanalysis, American psychiatrists turned to drugs. “In the past 30 years,” Savodnik suggests, “the overriding ideology of American psychiatry has shifted to a biological model. Psychopharmacology has become its therapeutic backbone.”

In his most recent article, Savodnik points to the Diagnostic and Statistical Manual of Mental Disorders [DSM-IV], published by the APA. He warns that ads have recently appeared in psychiatric journals proposing that shyness be diagnosed as a new “syndrome” that will be soon on its way to becoming a disease. Savodnik bets that the next edition of the DSM-IV will include shyness as a disease.

“As it turns out, the association has been inventing mental illnesses for the last 50 years or so,” Savodnik recounts. “The original diagnostic manual appeared in 1952 and contained 107 diagnoses and 132 pages, by my count. The second edition burst forth in 1968 with 180 diagnoses and 119 pages. In 1980, the association produced a 494-page tome with 226 conditions. Then, in 1994, the manual exploded to 886 pages and 365 conditions, representing a 340 percent increase in the number of diseases over 42 years.”

Are we actually to believe that Americans are now afflicted with 258 “conditions” that did not even exist (or were absolutely unknown) in 1952?

A quick look through the DSM-IV will reveal that almost every living human being is afflicted with one or more of the “conditions” described in this encyclopedia of mental and emotional problems. More than anything else, this just goes to prove the adage of the psychotherapeutic industry–you are either in therapy or in denial.

Most tellingly, Savodnik understands that more is at stake here than the professional concerns of psychiatry. His field, he acknowledges, “is a leading indicator, a barometer of social practice and political change.”

Political change is a big part of the equation. As Savodnik wrote in The Los Angeles Times, “It’s a natural step from using social and political standards to create a psychiatric diagnosis to using them to influence public policy.” Savodnik’s acknowledgement that politics plays such a big part in the development and diagnosis of psychiatric disorders is itself remarkable.

The “triumph of the therapeutic” so well described by Philip Reiff discounts personal responsibility and flies in the face of the Christian worldview. “Pathology has replaced morality,” Savodnik asserts. “Treatment has supplanted punishment. Imprisonment is now hospitalization. From the moral self-castigation we find in the writings of John Adams we have been drawn to Woody Allen-style neuroses. Were the psychiatric association to scrutinize itself more deeply and reconsider its expansionist diagnostic programs, it would, hopefully, make a positive contribution to our culture by not turning the good and bad into the healthy and the sick.”

In essence, Savodnik’s article is a shot fired across the bow of his own chosen profession. But The Los Angeles Times also published a second article on a related theme in the same edition. In “Self-Help’s Big Lie,” Steve Salerno, author of SHAM: How the Self-Help Movement Made America Helpless, argues that the overselling of personal empowerment and self actualization “may be the great unsung irony of modern American life, destined to disappoint as surely as the pity party that it was meant to replace.”

Salerno’s target is the self-esteem industry that, he suggests, has “been unambiguously disastrous” for the country. He describes this overselling of personal empowerment as “the hyping of hope” that replaces personal responsibility and achievement with the illusion of self-worth based upon nothing at all.

“Self-esteem-based education presupposed that a healthy ego would help students achieve greatness, even if the mechanisms necessary to instill self-esteem undercut scholarship,” Salerno explains. “Over time, it became clear that what such policies promote is not academic greatness but a bizarre disconnect between perceived self-worth and provable skill.”

Thus, Salerno blames self-esteem gurus such as Dr. Phil McGraw, Oprah Winfrey, and Tony Robbins for leading the nation astray by promising that self-esteem is the tonic for all problems. Salerno cites management consultant Jay Kurtz, who argues: “The most dangerous person in corporate America is the highly enthusiastic incompetent. He’s running faster in the wrong direction, doing horribly counterproductive things with a winning enthusiasm.”

Savodnik and Salerno write from a basically secular worldview. In their own way, each sees the modern therapeutic industry as a self-deluding mechanism for inventing illusory diseases, medicalizing problems with psychotropic drugs, and deluding Americans into thinking that their problems have nothing to do with their own personal responsibility and moral actions.

Christians understand an even deeper problem with the therapeutic industry and the self-esteem fad. As human beings, we cannot possibly understand ourselves by merely observing ourselves and our fellow humans. We are not autonomous creatures and our worth is not rooted in our own existence, or in any skill or quality we may possess or develop.

Instead, we find our worth in the knowledge that we are made in the image of God, and we find our health only in knowing Him and honoring Him. Of course, this is made possible only through the redemptive work of Christ, who willingly assumed human flesh and went to the cross as a demonstration of humility, not vainglorious self-esteem. As psychiatrist Paul Vitz reminds, “self-esteem is a deeply secular concept.” The essence of the Christian worldview is not self-esteem, but human dignity. But then, a confident belief in human dignity, and a dismissal of the cult of self-esteem, may soon show up as a “disease” in a forthcoming edition of the mental health manuals.