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Therapy, Critiqued: A Modern "Myth of Mental Illness"

a constantly questioned profession endures a necessary critique

Published in NY Times Magazines this past week was an eloquent and underhandedly scathing attack of therapy by Daphne Merkin, an off-and-on consumer of therapeutic services for more than 40 years. In an article entitled "My Life In Therapy" she recounted useful, odd and counterproductive therapuetic experiences while pondering its efficacious nature. Her pondering tended to focus on personal improvement but she also speculated about the degree to which any individual can improve their health, happiness and fulfillment through therapy.

For as long as the field of clinical psychology has existed so too has an opponent viewpoint of significant skepticism, criticism and wariness. And rightly so. After all, therapy is a billion-dollar industry in which institutionally-proclaimed experts charge consumers a great deal of money to sit and talk. The provided services are often guided by speculative theories, generalized manuals and intuitive research findings, and the outcomes are often difficult to identify, let alone concretely measure. Finally, surprisingly meager regulation creates a quality-control issues in which practitioners of significantly varying talents and training operate freely in the marketplace.

Given the life or death stakes of therapy as well as the inherent fallibility of the mind in efficiently responding to human suffering, any and all constructive critiques of the field should be embraced, and incorporated into an ongoing process of disciplined reflection and thoughtful revision. Thomas Szasz's "The Myth of Mental Illness" is one of many highlights of this anti-therapy movement. His account was that of an industry insider (a psychiatrist) who believed that therapy unnecessarily pathologized problems that were not real (brain-based) and, in general, mislabeled common individuals who simply deviated from the norm and needed a kick in the butt as psychological sufferers in need of treatment.

The latest critique of the therapy field comes from an outsider whose lifetime of experiences have led to a mixed bag of thoughts and feelings on the issue.

Merkin's patient-perspective memoir of subjective successes and failures in therapy provides, in particular, a rich account of two foundational elements of therapy:

a. the expression of psychological suffering (she endures a lot and describes it well)

b.the description of therapy's rationales and aspirations (she shows a firm grasp of what some therapists are trained to do, theoretically).

However, there are at least two fundamental concerns with her article that, in turn, complicate her dissection of the therapeutic process and warrant grains of salt to her findings.

In Therapy Merkin Exhibits Minority Status

There is a spectrum of mental health and functioning on which we all exist. On the low end are individuals afflicted with severe and persistent mental illness like schizophrenia in which life experiences tend to be profoundly and concretely limited. On the opposite end are individuals known as the worried well - high functioning individuals who possess an acute awareness of consistent though tolerable difficulties.

For individuals on the low-end of the spectrum, therapy can provide as critical a function as anything, as skills, support, medications and insights can quickly and significantly improve quality of life in permanent ways. Merkin's personality seems to reside on the high-end of the spectrum. Hence her premise - that therapy is an indulgence - may be true for her, but it also neglects the millions of more mentally troubled consumers that are likely to more easily exhibit relatively greater gains.

Psychoanalysis Is a Small Piece of the Therapy Pie

The other major issue with Merkin's experience and perspective is that she limits her discussion of therapeutic treatments to psychoanalysis. For 40 years she experienced a treatment that has not only undergone significant revamping in recent years but competes with dramatically different treatment approaches like Cognitive-Behavioral Therapy, Dialectical Behavior Therapy, Mindfulness and numerous others that continue to rise to prominence behind sound clinical theory and research. Much of Merkin's disappointments and downfalls with therapy seem to relate to the ways in which old-school psychoanalysis stops at insight. The theory assumes that connecting the dots - whether between the past and the present or the self and problematic patterns - need only be verbalized in therapy for tangible, meaningful changes to translate into real life. This, quite often is not enough, and most contemporary theories including updated versions of psychoanalysis continue to seek more direct and effective means of tranlating the learned in-session material to real life in the long run.

The bottom line: there is much about therapy that must be improved upon and it is all too easy to receive treatment that is far from the best available treatment. However, a fair appraisal of the system to date is that modern theories of therapy, if applied thoughtfully by well-trained, thoroughly-supervised clinicians, can significantly alleviate extreme symptoms of pathology and can potentially enact positive, sustainable growth in many cases.