Bad Science

“Therapism” offers an unsavory salve for emotional trauma.

by Bruce S. Thornton


A review of One Nation Under Therapy. How the Helping Culture is Eroding Self-Reliance by Christina Hoff Sommers and Sally Satel (St. Martin’s Press, 310pp, $23.95).

After every disaster in America, we are used to seeing large numbers of “grief counselors” tending to the survivors and victims. After the terrorist attacks of 9/11, nine thousand counselors descended on New York in order to provide survivors the psychological guidance and treatments thought necessary to help them cope with their trauma and forestall future negative aftereffects. Indeed, so ubiquitous is this sort of intervention that we no longer even think about it, yet according to One Nation Under Therapy, this phenomenon is just one example of a larger set of questionable assumptions and theories that permeate many of our educational and mental health institutions.

The authors call this nexus of theories and treatment “therapism,” which is not the same thing as therapy per se; the latter, while occasionally descending into dubious ideas and treatments, just as often provides real benefits to patients. Therapism is something different: it “pathologiz[es] normal human emotion, promoting the illusion that we are very fragile beings, and urging grand emotional displays as the prescription for coping.” Christina Hoff Sommers is the author of Who Stole Feminism and The War Against Boys, both trenchant analyses of the baleful effects that some extreme versions of feminist theory have had on education. Sally Satel, like Sommers a resident scholar at the American Enterprise Institute, is a practicing psychiatrist and author of PC MD, which tracks how the practice of medicine has been compromised by identity-politics obsessions with race, gender, and poverty. Together they have written a biting exposé of the various theories and treatments that therapism has insinuated into much of our public life.

One Nation Under Therapy is organized around the several specific practices that have been incorporated into many of our public institutions, starting with our schools. Dodge ball and tag, for example, have been eliminated in many schools because they inflict esteem-killing competition and exclusion on the “fragile child,” as Satel and Sommers call him, that helpless creature who wilts at the slightest breath of criticism, judgment, or failure. This widespread assumption of children’s psychic vulnerability is enshrined in school programs and curricula despite the fact that, as the authors point out, “the prevalence of depression among children and adolescents has not significantly changed in the past thirty years,” and that no scientific evidence exists that elevated “self-esteem” makes for success or happiness.

The authors next link these practices in the schools to the influence of the so-called “human potential movement,” offspring of psychologists Abraham Maslow and Carl Rogers, which teaches that self-knowledge and fulfillment can be obtained “through a regimen of self-preoccupation, self-expression, and psychic release.” Non-judgmental acceptance, empathetic understanding, and the eager gratification of everyone’s emotional “needs” in order to build self-esteem are now the keys to happiness and healthy development. The ideal self awaits inside each of us, “buried under a lot of wreckage put there by a judgmental, emotionally withholding, unforgiving, and oppressive society.” We all just need to discover that more authentic self and feelings and accept them. But as the authors ask, quoting George Steiner, what if there is nothing to discover or accept?

This social determinism, which blames society for all psychic ills, has fostered as well the transformation of “sin to syndrome.” As the authors show, the imperative to be “nice” and non-judgmental has changed what were once venial or even mortal sins to “sickness,” and what were once sinners to “victims” who are now entitled to our empathy and compassion (and frequently our tax dollars). What we have lost from this transformation is the “capacity for appropriate moral indignation and a willingness to censure irresponsible and destructive behavior.” To Sommers and Satel, this medicalizing of moral failure has had its most destructive impact in the case of the pedophilic Catholic priests, several of whom were “treated” for their “sickness,” and then once “cured” sent out to prey again on children in their parishes. So too with addicts and murderers exculpated by those the authors call the “champions of therapism,” who speak of “ailment, dysfunction, and brain disease” rather than in terms of wrong choices, moral failure, and bad character.

The notion that public emotional expression has therapeutic benefits has also created the authors’ next topic, “emotional correctness,” a whole set of public expectations about what constitutes the proper responses to tragedy and trauma. Despite substantial research showing that the “expression of feelings is not a sure pathway to fulfillment” and instead “often leads to unhappiness,” people who have suffered tragedy are looked upon as somehow inadequate if they don’t publicly obsess over their experience. In fact, most people rebound from tragedy quickly, especially if they have support from family, friends, or their religion. Indeed, “when people are distraught, ruminating about their pain may only intensify the pain: repression and distraction can be the best remedies.”

The final expression of therapism involves what Sommers and Satel call the transformation of “pathos to pathology,” visible everywhere in the idea of “post traumatic stress disorder” (PTSD). The notion, unsubstantiated by empirical research, that traumatic experiences necessarily leave hidden dysfunctions in the psyche was invented by anti-war activists to pathologize Vietnam veterans. Since then, it has been extended to anyone who has suffered a traumatic experience, becoming “an archetype for the experience of adversity in our culture.”  Like emotional correctness, PTSD “confuse[s] pathos with pathology” and “presume[s] fragility in the face of adversity.”  People who suffer tragedy are then assumed to need treatment administered by health care professionals who know better than the person, his family, his religion, and his cultural traditions how he should respond to misfortune. Contrary to what our great literature and religions teach, PTSD ignores “how frequently survivors find sustaining meaning in heartbreak and how often they persevere nobly.”

Sommers and Satel finish with the best evidence of our resilience and strength, the response to the terrorist attacks on 9/11. The nine thousand grief counselors and therapists of various stripes that gathered in New York ended up with very little to do, as most people had their own resources for coping with that disaster. The authors draw several valuable lessons from the victims’ responses to 9/11: minimizing “disorder, uncertainty, and economic devastation” benefits people the most; many victims of trauma “can point to ways they have benefited from their struggle to cope” with life-shattering disaster; and the mental health profession “must find a balance between offering its services and promoting them too eagerly,” being careful not to assume that “people are fragile” or to “underestimate our natural fortitude.”

One Nation Under Therapy provides powerful and convincing evidence not just of the inroads therapism has made into our public institutions, but also of the destructive consequences for a political order dedicated to autonomy and freedom, for as Sommers and Satel rightly point out, “Only a society that treats its members as ethically responsible and personally accountable can achieve and sustain a democratic civil order.” The American political order in particular is dependent on the “American creed”: “self-reliance, stoicism, courage in the face of adversity, and the valorization of excellence.” Unfortunately, the authors conclude, “Therapism is at odds with them all.”

My main reservation with this book regards its grounding in social science and social psychology, for I’m not sure that the real problem Sommers and Satel address doesn’t have its ultimate origins in the modern illusion that there can even exist a “science” of human identity and behavior, given how complex, quirky, various, and unpredictable we are all. Thus Sommers and Satel answer a flawed study of well-being with one presumably more accurate, but it seems to me that both are vitiated by the subjectivity and fuzziness of terms like “happy,” “anxious,” etc., psychological states notoriously difficult to define, measure, and assess consistently just in one person, let alone in a group. And their discussion of free will — traditionally the key to the ideas of freedom and self-reliance and justice and much else in our American creed — is much too brief and unsatisfactory, ending as it does with the utilitarian compromise that free will might not even exist, but it’s socially useful to think so. Then what happens when it is no longer socially useful to think that free will exists, when public order and well-being can be achieved by discarding that idea? Political freedom has ever and always depended on the belief in the reality of free will and personal responsibility, but if neither exists, then democratic freedom is a mere delusion that ignores human nature, and social order should be handed over to the elite guardians who can manipulate and control all the deterministic forces afflicting us.

Sommers and Satel, however, are not writing as philosophers, and their attack on therapism in its own social-scientific terms is more likely to be effective than the complaints of cranky humanists. Their well-documented and clearly written tour through the bad science, shaky assumptions, and simplistic nostrums of therapism gives us powerful empirical evidence for resisting the attempts of the those in the “helping culture” to turn us into fragile children dependent on their advice and treatment — and subjected to their power.

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