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This is a book for anyone who has ever felt the slightest discomfort of doubt about psychotherapy.  It's sure to raise the ire of practitioners and patients who believe in the infallibility of the ever-evolving Diagnostic and Statistical Manual of Mental Illnesses (DSM).  But it's also guaranteed to find a friend in anyone who considers the critics of psychotherapy, like Thomas Szasz, to be on the right track.  

Laurence Simon vigorously joins the ranks of those who condemn what psychotherapy has become.  But while he details the internal political agenda, the profit-making motivation, and the methodological madness that form the foundations of the field, he does not argue for a total abandonment of the entire enterprise.  In fact he makes it clear that during the almost three decades he has been a practitioner he has come to appreciate just how much psychotherapy has to offer when it's done properly, that is, when it's not corrupted by internal politics, when it's not sustaining the profit margin of some giant pharmaceutical company, and when it doesn't try to imitate biology or medicine.

The book consists of nine chapters that carry a dominant underlying theme.  In fact the author admits that there is a certain amount of overlap.  In general these chapters deal with what it is that psychology has to do with human relationships--which the author reminds us is always political, how religion and science are historically relate to psychology, how psychiatry and psychoanalysis have produced a convincing myth which they call mental illness, and how mental illness is a form of political oppression of those individuals who see the world differently than either the majority or the mental health professionals.  Simon's main point is that the global consensus has it that democracy is the most humane and humanistic political system available today, but that psychotherapy is practiced in a totalitarian manner.  This makes it not only democracy's exact opposite but downright harmful to patients.  In the last chapter the author gives words of wisdom about what good therapy should be like, along with an admission of his own shortcomings early on in his professional career as a clinician.  I found this chapter particularly commendable in that Simon turns the critical gaze he has been directing at the entire field of psychotherapy back on himself in a demonstration of his belief that the psychotherapist's criticism of others should always also include an honest look at himself.  This is exemplary democracy.

There are thought-provoking passages throughout, such as  "Mental illness is modernity's dishonest and confused name for sin"  ([because Simon sees mental illness as a moral judgement rather than a medical condition] p.6),  "Psychology has gone forward with great confidence in creating one image of humanity after another that degrades and undermines its human subject matter"  ([by making individuals seem like animals or machines]  p.63),  "The peculiar politics of psychology states that negative results are not to be accepted for publication in mainstream psychology journals"  ([I didn't know this, but it's good to know]  p.75),  "...the drugs provided by psychiatrists and other nonpsychiatric physicians correct no chemical imbalances in anyone's brain and cure or ameliorate no known problems in brain functioning.  Rather they work in general ways affecting the mentally ill and the mentally healthy in highly similar ways"  ([the pharmaceutical companies have worked very hard to keep this from becoming public knowledge]  p.101),  "...psychology and the self are not reducible to the laws of other fields" ([meaning that emotional distress should not be defined in medical terms]  p.177), and  "I no longer try to cure mental diseases but teach individuals how to understand and better deal with their own unique way of seeing the world"  (201).  It's passages like these that make this book hard to put down.

Simon's approach to the critique of psychotherapy is both empirical--he refers to studies that have revealed serious flaws in twin research that claimed to have proven the genetic origin of schizophrenia--and very philosophical.  He talks about how important it is for both the patient and the therapist to use critical thinking, and about how the therapist is, and must be, a teacher rather than a totalitarian expert to the patient.  But it becomes painfully evident that Simon is not a trained philosopher when he says "morality is based solely on opinion and any adult's opinion is as equally valid as any other" (127).  This is the sort of belief in the subjectivity of morality I often hear from my undergraduate students that I wouldn't have expected from a professor and author in his mid-sixties.  This again shows how important it is for therapists of all persuasions to gain a solid background in philosophy before going into practice.

This book is easy to read and very informative.  I highly recommend it.  I can see it being an inspiration to all those who have doubted their own doubts about psychotherapy.  I have only two minor complaints:  the book suffers from a number of typographical errors that the word-processing spell-checker couldn't recognize, and it offers only a superficial index.

© 2003 Peter B. Raabe

Peter B. Raabe teaches philosophy and has a private practice in philosophical counseling in North Vancouver, Canada. He is the author of the books Philosophical Counseling: Theory and Practice (Praeger, 2001) and Issues in Philosophical Counseling (Praeger, 2002).

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