Sunday, February 13, 2022

Has Therapy Failed America?

Readers of this blog will not find the news surprising. For nigh unto fourteen years I have been arguing that mental health care, aka, therapy, is largely ineffective. We have built a massive institution and have expected it to treat mental illness. In large part, it has failed at its task.

Of course, there’s mental illness and there’s mental illness. A normal individual suffering from anxiety or depression ought not to be classed with schizophrenics and paranoiacs, people who are generally considered to be suffering from a brain disease. And then there is bipolar illness, which has lately been considered a metabolic disorder. And it seems a bit much to say that psychopathy and sociopathy should be treated as mental illnesses.

Be all of that as it may, I was struck by these two paragraphs from a Wall Street Journal op-ed about a new book by one Thomas Insel, former head of the National Institute of Mental health, currently employed by Google.

The article opens with the fact that the more progress we have made in treating mental illness, with better medications and more insights-- the more mental illness we have seen. We have seen more depression, more anxiety, more suicides, more undertreated schizophrenics, and so on.

For your edification, here is the argument:

As the director of the National Institute of Mental Health (NIMH) from 2002 to 2015, Thomas Insel, a neuroscientist and psychiatrist, oversaw more than $20 billion in grants for research on human behavior and the brain. “The scientific progress in our field has been stunning,” he observes. 

“But the public-health outcomes got worse.” Although breakthroughs in other areas of medicine have led to plummeting death rates from heart disease, stroke and most infectious diseases, he notes that new insights into the mechanisms of mental illness have done little to help the mentally ill.

In his new book “Healing,” Dr. Insel, 70, writes that during his tenure as the “nation’s psychiatrist,” the U.S. suicide rate climbed 33%, overdose deaths tripled, and rates of poverty, homelessness and incarceration among people with brain disorders went up. Today suicide claims more than 47,000 lives a year, three times as many as homicide, and the rate continues to rise in the U.S. even as it is falling in nearly every other country. He recalls a presentation of the institute’s research in 2015 when he was chastened by a man whose son had schizophrenia and was living on the streets. “Our house is on fire,” the man told Dr. Insel, “and you are talking about the chemistry of the paint.”

For my purposes I will limit myself to mental illnesses, that is, depressive and anxiety disorders. And I will point out what seems to me an obvious fact, that much of what Dr. Insel describes as new insights into the mechanism of mental illness are not really insights. They are narratives we use to cover up a problem, while not solving it.

Allow me to point out that the first discoverer of these insights, Sigmund Freud himself, did not create a treatment that cured or even attenuated emotional distress. Freud was leading a movement, not producing an effective treatment. One does well to examine the studies of Freud’s cases  by my friend Mikkel Borch-Jacobsen, to see the extent to which Freud was concocting fictional cures that merely masked his clinical failures.

I would add a reference to my own book, The Last Psychoanalyst, where I argued-- hopefully persuasively-- that the famous talking cure has always been more talk than cure. Or better, as Jacques Lacan himself, dubbed by me the last psychoanalyst, once announced, psychoanalytic practice is basically a scam. For those of us who know too much about it, it is closer to a cult recruitment than a mental health treatment.

You might also want to glance back at a post I wrote two days ago about the nation’s mental health crisis. Lockdowns and social distancing, mask mandates and the general social disconnection has produced a mental health crisis in America. 

Therein I pointed out that knowing the cause of the problem-- that being, social disconnection-- does not solve the problem.

Where therapists whine on about the "why" of it all, they have failed miserably to see that knowing why something went wrong does not tell us how to make it right. Understanding that social disconnection caused your depression does nothing for your disconnection. The cure for disconnection is social connection.

One remarks that in the Freudian treatment model, social connection is strictly forbidden. The supine patient lying on a couch, unable to look his therapist in the eye or even to face him, is not going to establish anything resembling a social connection.

Today’s therapists are not quite as off-putting as classical psycho analysts, but, are they really connecting with their patients? Dare I say, some are and some are not. Surely, that covers it.

Of course, there’s connection and then there’s connection. Today’s therapists, if I don’t miss my guess, are more concerned with offering a warm bath of empathy than any consequential social connection. They believe that shared feelings constitute connections. In that they are wrong and they alienate their patients even more.

So, therapists who are afraid to connect, coupled with theories that arise from pagan myths and legends, have failed their patients. It might be the legends of Oedipus or Narcissus, but, it does not really matter. Therapists seem to want to fit everyone’s life into some sort of narrative structure, to create a simulated meaning by pretending that they can provide understanding. 

And yet, if the mental health problems we are seeing today derive from social distancing and lockdowns, blaming it all on your mother or on the sexual abuse you suffered at the hands of a soccer coach, seems largely off the mark. Surely, those things might have happened. The problem is, this might work, up to a point, as a dramatic device. It is a staple of television and movie dramas and has been for decades now. And yet, knowing it does not produce consequential connections with other people. If you advertise your victimhood you are likely to lose friends and to alienate people. 

Getting in touch with your past trauma, or even with your emotionally withholding parents, does not connect you with anyone. It warns you against getting too close to anyone. Besides, if depression and anxiety have been pervasive at a time when our government has instituted social disconnection, that suggests that infantile antecedents are less important than current circumstances. 

Connecting with other people requires a certain level of social skill. It requires conformity to customs and norms. If the world of therapy has decided to treat you as a unique individual seeking independence and autonomy, not to say, complete self-actualization, the least we can say is that it is militating against mental health. It is treating people as disconnected and detached individuals, and has taught them to define themselves outside of their social roles. 

Therapy, as I have been wont to point out, becomes the problem more than the solution. If we limit ourselves to everyday neurosis and depression, we can easily see that detaching people from their social networks-- a staple of Freudian treatment-- does not make them better. It makes them worse.

The institution of therapy has failed America, and not just America. It is going to take more than a Hercules to clean out its Augean stables.


Kansas Scout said...

I have been reading your blog for years now and value the insights you bring. I have been in Cognitive behavioral therapy for a year and it's helped me significantly. I have "adjustment disorder" and as a senior I got stuck in a bad place. My therapist and my faith gave me the keys to recovery. I'm in the closing chapter now. I always get my ears triggered by absolute statements about how therapy does not work. In Seminary I worked in a Psych unit for 2 years as a tech and saw a lot. I understand your point of view very well. I agree with many of the points you make about those with significant disorders like Schizophrenia and Bi Polar disorder. Talk therapy is there to provide support but not 'Fix" them. I belief that's appropriate and humane. I do agree a "Life Coach" is a better way for many to improve their lives by being shown better ways of thinking and options. They call this Cognitive Behavior therapy on the other side of the fence. In my experience that looks a lot like "Life Coaching" I had a classic Rogerian "therapist" in high school. Garbage! During a very painful divorce 30 years ago a retired Psychologist volunteering for my church gave me someone to talk to and that really helped. Of course, the underlying issues remained and you could say it was a band aid but it did stop the bleeding.

IamDevo said...

When one is shot or stabbed and bleeding out, one requires immediate, effective medical intervention, not someone to talk to. Likewise, acute mental crises require acute interventions. After the emergency is past, then one can (might?) benefit from talking to someone about it, not merely to prolong the emotional upset, but to gain insight into how the conditions leading up to the shooting/stabbing came about so as to avoid repetition. So, perhaps it is beneficial to understand that one was shot/stabbed because of a poor choice one made, and if so, to avoid such poor choices and make better ones. Otherwise, "therapy" is merely mental masturbation, producing nothing of substance. It's all well and good for the addict to understand why he is an addict, but useless unless he uses that insight to STOP BEING AN ADDICT! The useful part of CBT is its leading to actual change/improvement in behavior.

KCFleming said...

Excellent piece.

Stuart Schneiderman said...

Thank you!