Letting the Cartesian cat out
Cultures of Healing: Correcting the Image of American Mental Health Care, by Robert T. Fancher, W. H. Freeman, pp. 355
Freud Scientifically Reappraised: Testing the Theories and Therapy, by Seymour Fisher and Roger P. Greenberg, John Wiley, pp. 353
MANY SCHOOLS OF PSYCHIATRY
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.
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.
Fancher's 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.
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.
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
� Richard Webster, 2002