Letting the Cartesian cat out
of Healing: Correcting the Image of American Mental Health
H. Freeman, pp.
Scientifically Reappraised: Testing the Theories and
by Seymour Fisher and Roger P. Greenberg, John Wiley, pp.
MANY SCHOOLS OF PSYCHIATRY and
psychotherapy are perceived by adherents as being founded on a body
of scientific knowledge. In the view of Robert Fancher, himself a
psychotherapist, such claims should be treated with scepticism. For one of
the characteristics of the various competing approaches to mental health
is a tendency to claim scientific validity for ideas science has not
validated. A more accurate view, he suggests, is to regard the mental
health profession as being made up not of different forms of science, but
of competing ‘cultures’ of healing. If we are to evaluate these we must do
so not as clinicians but as social and cultural critics.
interesting and ambitious book is an attempt to do just this. It begins
with a lucid essay on the historical evolution of the idea of ‘insanity’,
in which Fancher traces the almost accidental emergence of the profession
of psychiatry out of the old asylum system in America and suggests that
psychiatry did not originate with medical discoveries being taken into the
humanitarian field; it originated with ‘humanitarian ideals over which
certain medical men came to exercise stewardship for economic and social
He goes on to offer critiques of
four of the most influential ‘cultures of healing’ in the mental health
profession today: psychoanalysis, behaviourism, cognitive therapy and
biological psychiatry. The most valuable of these critiques is the last,
where Fancher brilliantly tackles the logical fallacies on which modern
biological psychiatry is almost entirely based. The weakest is the first,
for, perhaps because he was himself originally trained in psychoanalytic
psychotherapy, Fancher's view of psychoanalysis seems to lack perspective.
His account of the relationship between the ideas of Charcot (whom he
describes oddly as ‘the great French hypnotist’) and the theories of
Freud, is simply mistaken and his general description of psychoanalysis
seems thin and lacking in depth.
turns his attention to behaviourism and behaviour therapy Fancher is, as
might be expected, more robust. A few critics of behaviourism have long
suspected that somewhere inside the bag of behaviourism is a Cartesian cat
trying to get out. Fancher helps it to do so by repeatedly and accurately
pointing to the hidden mentalism of behaviourism and to the muddles that
result when behaviourists attempt to ‘shoehorn mind into a theory based on
Fancher suggests that ‘contemporary behaviourists who
use ideas of mind sound like theologians who have accepted evolution’. The
objection to this formulation is that it seems to have turned the problem
upside-down. For some behaviourists bear much more resemblance to a
hypothetical evolutionary theorist who has accepted the literal truth of
Genesis. The point here is that it is the concept of mind which belongs
historically to the realm of theology. One of the main features of all
mentalistic approaches to human nature, including psychoanalysis and
structural anthropology, is their sweeping disregard for the extraordinary
complexity and richness of human behaviour.
One of the most
interesting features of behaviourism is that, originating as it did as a
kind of inside-out mentalism, it perpetuates this theologically
traditional contempt for human behaviour under the guise of subverting it.
Fancher's critique does not recognise this, and, by chastising
behaviourism for covertly embracing an impoverished concept of mind,
instead of recognising the deep impoverishment of its concept of human
behaviour, he keeps his critique firmly moored within the harbour of
relationship with orthodoxy, however, is never a simple one, as his
treatment of cognitive therapy suggests. Having accurately described
cognitive therapy as the ‘hot’ field among talk therapies and having
implicitly conceded its seeming therapeutic effectiveness, he goes on to
offer a sharp and revealing critique of what he calls in his
chapter-heading ‘The middlebrow land of cognitive therapy’.
In Fancher’s view the fundamental
value of the culture of cognitive therapy is ‘approval of and conformity
to the conceptual and social status quo’. Its basic norm is this: ‘Except
for how the patient thinks, everything is okay. Reality is not pathogenic.
Just think straight and life can be good enough.’ In the course of
contesting one of the central tenets of cognitive therapy, ‘that one
cannot rationally hold sweeping negative beliefs about oneself, one's
world and one's future’, Fancher produces an argument that is complex and
interesting and should be widely read.
All this and more needs to
be said loudly and clearly of the most valuable of all the sections in
Cultures of Healing – Fancher's critique of biological psychiatry.
It is here that his original training as a philosopher is put to its most
effective use, as he deftly dissects a series of logical fallacies that
constitute the foundation myths of modern biological psychiatry. Central
to his argument is the recognition that, even if it could be proved that
psychopathology is rooted in biological abnormality, it would not follow
that drugs are the treatment of choice. ‘Once we accept the falsity of
dualism, we have to accept that everything is physical – and that includes
talk therapy, new experiences and changes in one’s habits of life. All of
these have biological effects. There is no a priori reason to
think that the biological changes needed to treat psychopathology cannot
be effected by non-pharmacological regimens. Anyone who has fallen in love
(or felt betrayed by a lover) knows that psychosocial factors have
biological effects.’ And, as Fancher wryly notes elsewhere: ‘One does not
need to be a scientist to understand that drug companies do not want to
discover that the changes brought about by talk therapy include the
stabilisation of neurotransmitter regulatory systems.’
This is but one part of a complex
and perceptive argument about biological psychiatry that ought to be
compulsory reading for all those concerned with promoting clear thinking
about mental health. It should immediately be said, however, that, having run his marathon of
scepticism, Fancher almost immediately collapses into tired orthodoxies.
He recklessly toys with the possibility of prescribing psychoactive drugs
to relieve ‘normal’ people of the consequences of leading difficult lives.
He also makes bland and unhelpful generalisations about the probability
that therapy will augment our lives if we approach it in the right spirit.
Nevertheless, despite frequent relapses into orthodoxy and conformity,
Cultures of Healing contains enough genuine dissidence to make it
well worth reading.
The same cannot be
said of the latest book from the hands of Seymour Fisher and Roger P.
Greenberg. Their Freud Scientifically Appraised is, in effect, a
sequel to their 1977 work, The Scientific Credibility of Freud's
Theories and Therapy. Once again, they have failed to recognise that
Freud was at least right about one thing: that psychoanalytic theories,
being based on the psychoanalyst’s unique access to the hidden realm of
the unconscious, are not susceptible to empirical investigation. In an
attempt to gainsay this orthodox psychoanalytic position, Fisher and
Greenberg have trawled the literature for ‘empirical’ research on
psychoanalytic theories and invented a number of fiendishly ingenious
studies of their own.
In an effort to discover whether Freud’s
penis=baby equation was correct, and whether it is indeed true that
some women have babies to supply themselves with the penises that they
lack, Fisher and Greenberg tell us that they ‘reasoned that if pregnancy
is somehow a penis equivalent for women, they should have increased
unconscious phallic sensations or feelings at that time’. Omitting to
consider the equally plausible Freudian hypothesis that pregnancy, by
supplying a ‘real’ phallic substitute, might lead to a decrease in phallic
fantasising, our intrepid researchers go on to devise a ‘phallic scoring
system’ based on a count of responses to the Holtzman Inkblot Test
involving ‘projections, protrusions and elongations’ that Freud would have
Having administered this remarkable test to a group
of presumably puzzled pregnant women, they concluded that (though no data
are given) ‘the findings were nicely congruent with the hypothesis’. No
doubt they were also nicely congruent with all manner of other hypotheses
that Fisher and Greenberg, intent on looking at the world through Freudian
spectacles, never paused to formulate.
Those who find, in
the kind of experiment described here, a valuable contribution to our
understanding of human nature, will be pleased to discover much more of
the same in Fisher and Greenberg’s latest book. Others may prefer to take
a more Swiftian view and consign such investigations to the distant land
of Laputa where they seem to belong, and where, we need have no doubt, the
experiment to extract sunbeams from cucumbers has yet to be brought to a
This review first
appeared in the Times Higher Educational Supplement, 17
© Richard Webster, 2002