Warning: Psychiatry Can Be Hazardous to Your Mental Health

"...Billions of dollars are being made with these drugs (like Prozac, Paxil, Zoloft); there are no corporate profits to be made with counseling..." --from page 35.

It's a pithy contrast William Glasser makes, considering the difference in scale and economy between pharmaceuticals and counseling. Seemingly as obvious as tautology, Glasser's point is, instead, intensely logical; it's a sharp blade knifing through all the baloney in advertising and medical marketing: drugs make billions, counseling nada. And given a vast population of extremely unhappy people who experience painful symptoms, how hard is it to sell them on the idea that a pill can be their savior?

Even though every good book should stand alone before its readers, it is sometimes essential to dig into an author's credentials and past writings in order to fully evaluate a new book. This is particularly true of non-fiction and so much more appropriate for books about psychology, psychiatry and the theories that drive these allied fields.  Glasser's latest book, Warning: Psychiatry Can Be Hazardous To Your Mental Health presents ideas and arguments tantamount to the revolution, so this reviewer was compelled to go back and study more of Glasser's writings. Is this really it--the revolution against the entrenched medical models of psychiatry? Can generations of psychiatrists have been misguided or just plain wrong about the nature, scope and treatment plans for mental health worldwide? Is such a possibility even itself a sane proposal?

These are difficult questions, ultimately beyond the scope of any review, so readers need first to know that Warning: Psychiatry Can Be Hazardous To Your Mental Health is no ordinary book. If what it claims is not true to the facts of human nature and human suffering, then it simply fails. But if what this book describes is true, it would embody a major manual for the alleviation of human suffering on a scale too vast to even gauge. Pretty high stakes for an unassuming paperback, and each reader will have to decide.

Before turning to Glasser's work as a whole, let's consider the main points found in Warning: Psychiatry Can Be Hazardous To Your Health.

 The first set of ideas are hopeful; they all center on the view that symptoms are caused by unhappiness not by any organic disease. Mental health and physical health are different, for the most part, and most psychological suffering is not, in the usual parlance, mental illness. Unhappy people, victims too of external control psychology in every walk of life, generate, that is create actively, their unfortunate symptoms. They do this for reasons that make sense to Dr. Glasser--trying to overcome the active pain of the life failures behind their unhappiness. People choose their symptoms.

The next set of ideas in Glasser's work, therefore, relate to choice. Patients can also choose to get beyond their suffering. And Warning:... is about Choice Theory and its use in therapy sessions and therapy groups designed by Glasser and available through allied practitioners around this country and elsewhere in the world (Note: Glasser's institute just had their international meeting in Dublin, Ireland in July of 2005). Much of the later chapters are concerned to show what a choice theory focus group looks like, how the meetings unfold, how they happen and how they work. In this sense, the book is practical manual of use both to those who suffer and those whose work is counseling.

The book also describes and applies the main points of its choice theory. For instance, people shouldn't use confusing locutions like "depression"--a noun. Choice Theory views choices as active, so the verb form "depress" means that a sufferer is choosing to depress. This philosophical change is more than mere word gaming, because it means that there really exists no steady state called "depression," for which treatment with brain-altering drugs is warranted. There exists, instead, only a human being making choices to depress (or obsess or anger or act crazy or whatever the symptoms involve, according to Glasser).  The book also describes the relation of depressing to angering (sic), and the important role both play in various psycho-somatic illnesses like arthritis or fibromyalgia.

Glasser in Warning: Psychiatry Can Be Hazardous...asks the reader to stop and ask herself or himself: Are you (or is your client) unconnected in some way you can see or define? Are you or is your client adrift? Does the person suffering symptoms have a close, satisfying relationship with at least one other person?

There are many other important ideas that comprise Choice Theory--too many to recount here. It must suffice to say, a meaningful and coherent theory can be found in Warning:... It is a challenge to the dominant medical models by psychologists and psychiatrists and a rebuke to their increasing use of pharmaceuticals and neglect of counseling. 

A philosopher would say, "What is the ontological status of this theory?" meaning, does it fit the facts?

This reviewer wants to know too. It's an ongoing investigation. People should buy this book and read it--and help us all evaluate its worth.

RELATION TO EARLIER BOOKS

I've gone back to a much earlier book of Glasser's, one I read two decades ago and was impressed with at the time--titled Positive Addiction. Basically, that was a book about the benefits of strengthening the will through running (and other so-called positive addictions),  and also containing his early theory about the effect that quitting--not facing challenges--has on mental health.

I don't know if Glasser himself has now rejected some or all of what is in that early book. Positive addiction is really about being weak and being strong, getting stronger--strong enough to overcome symptoms and negative addictions--in order to achieve mental health and recover from the pain of failure, specifically what Glasser called "the failure to achieve love and worth."

 Love and Worth are key concepts in that book--like the driving forces in everyone's life along with the basic idea of connecting, that is, having a satisfying/meaningful relationship with at least one other person. But it might be that the early ideas lent themselves easily to judgmental attitudes, to labeling people as weak when they are in psychic or emotional pain--not much better than saying, "snap out of it!" when you clear away the details.

 This is only background to Glasser's later books Choice Theory and Counseling With Choice Theory (see my review of the latter also at Metapsychology). This newer Reality Therapy and Choice Theory don't focus on quitting, being weak or strong, positive addictions or any of that.  Instead, the newer work is grounded simply in choice--as a key distinction--and in freedom from "external control psychology" which Glasser mentions again and again as the world's way of dealing with everything and the world's way of screwing up everything.

 Glasser appears to be saying that people get symptoms or create them--what the world calls mental illness--because they are in pain and unhappy. The pain is caused by external controls distorting relationships, by the failures of relating and by choices the sufferers make. Recovery is about making better choices now, not about finding out the past, about feelings or about mental disease or mental chemistry. Drugs are totally not indicated, for Glasser. He sees psychiatry and psychology as sold out to pharmacology and based entirely on a false model of the brain and its relation to "the symptoms."

 What people with symptoms need, he writes, is "at least one good relationship" with a human being, and also, therapy based on learning about Choice Theory, and lots of love and caring. Plus, people experiencing painful symptoms, need to be freed from  external control based in criticism, manipulation, rewards, and blaming. What sufferers need is to become reconnected since their basic problem is that they are not connected. Glasser asks if the suffering person is connected to at least one other person. That is an important touchstone.

"When we suffer any pain, mental or physical, our brain does not let us sit idly by and do nothing; we must try to do something to ease the pain. What is called mental illness is a description of the ways in which huge numbers of people...choose to deal with the pain of their loneliness or disconnection..." (Glasser, pp. 1-2, Counseling With Choice Theory)

 Also, Glasser talks about "passive pain" and "active pain" which gets somewhat complicated. What he means is that there is real world failure that gives us active pain, and there is passive pain of symptoms people choose like "depressing" or "obsessing" or " acting out." Real world pain of failing to get love or worth is worse than the passive pain associated with the symptoms, and therefore, the sufferers keep choosing the passive pain rather than facing (again) the real world pain of failing.

 Now it seems to me this thesis of choice, does indeed come down to strength and weakness as Glasser had written two decades ago--just that now he doesn't want to make this distinction explicit. I think he's avoiding that external control thing (criticism). And it does appear--after reading Warning:...--that  the impulse to focus just on choices is correct, finally, because we all know really crazy people who are incredibly strong in almost every way, and therefore, weakness of character may be quite beside the point. Some people are just their own worst enemies, making the wrong choices. Maybe.

 I think Glasser is still saying that the worst kind of choice sufferers make is to quit on life, quit on themselves, give up and give in rather than deal effectively with life's challenges, with the human search for love and worth in all their forms.

 We can all remember times we quit something, then felt relieved, and later came to experience real suffering as a result of that decision.  Psychological quitting leads to unforeseen difficulties and quitting often occurs when people make bad choices; people are less apt to give up when they have a feeling of being connected (like to a strong leader or teacher). Again, to make the point--it's all about relating, connecting, and not about external control.  And everything is a choice.

© 2005 David Wolf

David M. Wolf is the author of Philosophy That Works, a book about the practice of philosophy. His book page for orders (hardback & paperback) is www.xlibris.com/philosophythatworks ; readers can also see the first chapter there.