The Shrink Has No Clothes AGAINST THERAPY

By Paul Gray

Folklore has it that August is the time when all the shrinks go on vacation, leaving behind heat, humidity and the miasma of anxiety surrounding their patients. What are these abandoned psyches supposed to do for a whole month? This summer offers them a new option. They might pick up a copy of Jeffrey Moussaieff Masson's Against Therapy, turn to the preface and read the following: "This is a book about why I believe psychotherapy, of any kind, is wrong. Although I criticize many individual therapists and therapies, my main objective is to point out that the very idea of psychotherapy is wrong."

This is not the first time that Masson, a nonpracticing psychoanalyst, has published a book designed to drive mental-health professionals nuts. His The Assault on Truth (1984) attracted headlines and controversy with the charge that Sigmund Freud had fudged certain of his evidence and thereby left the whole foundation of psychoanalysis teetering. According to Masson, Freud had initially believed his female patients during the 1890s when they told him of being sexually abused, often by fathers or other relatives. But under strong pressure from a male colleague, and knowing how little his fellow Viennese cared to hear or to talk about incest, Freud later changed his mind: these women had not been molested or seduced; they had fantasized such experiences.

Masson harks back to this accusation fairly often in Against Therapy, but Freud is not specifically his target this time. Instead, the author is gunning for everyone who has ever had the gall to offer any sort of psychological treatment or aid to another person. His subtitle accurately indicates just how hyperventilating his argument is going to be: "Emotional Tyranny and the Myth of Psychological Healing." Readers looking for nuance or subtlety should probably go elsewhere. But Masson raises some intriguing points, even if he insists on doing so at the top of his voice. Psychotherapy is a big and largely unchallenged business in the U.S.; many of its practitioners wield considerable influence over personal lives and public policy. Once in a while, it does no harm to listen to an alarmist hollering that some of those shrinks have no clothes.

Actually, Masson goes much further than this. "The therapeutic relationship," he writes, "always involves an imbalance of power. One person pays; the other receives. Vacations, time, duration of the sessions are all in the hands of one party. Only one person is thought to be an 'expert' in human relations and feelings. Only one person is thought to be in trouble." Well, one is tempted to say, yes indeed, that is the way it happens. Masson, however, is an absolutist; he is of the persuasion that if something is not perfect it is terrible. This point of view rarely works well in the real world, but there are instances in which it can be helpful. And the author's point that the possibility for mischief is inherent in psychological counseling seems inarguable.

Masson readily admits that others have had this idea before him. In the early 1930s Sandor Ferenczi, a disciple of Freud's and an influential psychoanalyst, confessed his growing doubts about his profession to his diary, which has not yet been published in English. Masson quotes generously from this document, showing a poignant portrait of a man torn between increasingly rigid doctrine and what he saw with his senses: "We greet the patient in a friendly manner, make sure the transference will take, and while the patient lies there in misery, we sit comfortably in our armchair, quietly smoking a cigar." Ferenczi realized that worse things than indifference could grow out of this situation: "Analysis is an easy opportunity to carry out unconscious, purely selfish, unscrupulous, immoral, even criminal acts and a chance to act out such behavior guiltlessly."

Sure enough, Masson provides plenty of examples of abusive behavior on the part of psychotherapists, especially those who have access to patients in mental institutions. There is the case of John Rosen, whose "direct analysis" still receives attention in some textbooks even though he surrendered his medical license in 1983 rather than face charges by the Pennsylvania medical board. Rosen's specialty was the rough treatment of schizophrenics to gain their attention. And then there was D. Ewen Cameron (1901-67), a much lauded and honored psychiatrist who, at the behest of the CIA, used repeated electroshock treatments on a large number of hospital patients. Cameron's intent was to do research on brainwashing techniques; unfortunately, he never told his patients. Masson claims that the psychiatric profession was remarkably sanguine about this behavior when news of it finally surfaced, and he remains outraged: "Some psychiatrists might claim that what Cameron did is only an abuse of psychiatry. It is virtually impossible to find a practicing psychiatrist who can see that what Cameron did is the very purpose of psychiatry, that this is its use, not its abuse."

That is a slippery conclusion, in which Masson blames psychiatrists because they do not agree with him. Although the author's slash-and-burn style of argument can be entertaining, readers should keep their hands on their wallets. Assertions tend to be sold as established facts. Masson writes, for example, that before psychotherapy begins, a "moral judgment" must be made that potential patients "are not living well, or as well as other people, and are therefore in need of 'help.' We often claim that the people seeking psychotherapy make this moral judgment on their own, but this is almost never true." Almost never true, that mentally or emotionally distressed people seek help voluntarily? For his thesis to be persuasive, Masson needs to establish the notion of a vast, coercive system for bringing people into line and, if that fails, storing them away in cruel institutions. But his proof, to put it mildly, is highly subjective.

Masson notes that people who have heard his ideas have asked with what he would replace psychotherapy. "In reply I would note that, as one feminist friend put it, nobody thinks of asking: What would you replace misogyny with? If something is bad, or flawed, or dangerous, it is enough if we expose it for what it is." This analogy does not work. If ill-treatment of women disappeared, the world would be a happier place; if psychotherapy in all its guises suddenly vanished, some severely deranged and dangerous folks would be walking about the streets. That would be O.K. with Masson, who several times states his opinion that mental institutions should be emptied and that "patients should not be incarcerated." In fact, Masson calls schizophrenia a "specious medical disease" and announces that "there is no such medical entity as mental illness."

Ultimately, Against Therapy amounts to an impassioned diatribe against the very idea of society. Masson does not make this animus particularly clear, but it surfaces occasionally, particularly in his concluding chapter: "Historically therapists have never been in the forefront of the struggle for social change. It is not in the interest of the profession to create conditions that would lead to the dissolution of psychotherapy." This is dime-store utopianism: people would not be unhappy anymore if the world were nicer. And Masson bristles at the notion of control: "Once we give anybody the right to decide who or what is normal and abnormal we have abdicated a fundamental intellectual responsibility (to repudiate the very idea of making such distinctions) and we should not be surprised when it is 'misused.' " But people who gather to live in groups have always made distinctions, rules that impinged on their freedom: this is acceptable; that is taboo. Existing together without a code of conduct seems unimaginable. Deciding what is normal behavior is an act everyone performs all the time. Masson would like to see the day when such judgments have gone the way of the dunking stool and the rack. But the course he would follow means not just the abolition of psychotherapy but of thinking as well.