Can therapists be running out of talk?
AN announcement from Science 86, promising four articles on psychotherapy in the June issue, reported that the demand for counseling increased by 2,000 percent during the past three decades. A correction followed two days later. It seems that the figure should have been a mere 400 percent. On the other hand, the first announcement declared that counseling cost Americans ``more than $1 billion a year.'' When the magazine itself appeared, that figure had grown to ``over $4 billion annually'' -- a discrepancy that went unnoted.
The staggering swing in statistics may be taken as a cautionary sign. The very point of the special supplement -- ``Therapy Under Analysis'' -- is to measure the evidence and to determine: ``Does the Talking Cure Really Work?'' But nothing about the topic will hold still, and stats are the least of it.
Early on we are told that 20 percent of all Americans, at one time or another, have suffered from ``serious depression.'' Yet even if this statistic stands firm, what, a reader must ask, is ``serious depression,'' as distinguished from just plain depression? And what is depression as distinguished from ``acute anxiety''?
We are back with the psychiatrist Thomas Szasz, a disgruntled member of the profession, who has been arguing for years that ``mental illness'' and its myriad categories, from ``neurotic'' on up (or down), is a pin-the-label game -- inexact, impressionistic, and no science at all.
In the end, the label-question becomes, ``What is therapy?'' To the credit of the Science 86 supplement, it brings up the sticky issue, suggesting that the 160,000 therapists practicing today (as compared to 60,000 in 1975) are applying at least 250 different ``brands'' of therapy.
Here are truly dominating figures, along with the average cost of therapy -- $65 an hour.
If you innocently ask how we arrived at the Age of Therapy, the therapists, alas, are the ones to supply the answer. Those who control the vocabulary control the argument, and more and more, we all tend to talk the jargon of therapy. Modern living, it is agreed, produces increasing ``stress'' -- whatever that is -- due to . . . well, take your pick: the ``death of God,'' the ``breakup'' of the family, television, The Bomb.
We have come to a curious impasse. Advised by therapists to become hedonists, we who believe that the purpose of life is to feel good feel simply terrible. Everything in life has become a problem. There is the quintessential American problem of failure, of course, but there are also the problems that come from Success. There is the problem of lacking a ``relationship'' -- and sometimes worse, the problems of having one. There is the problem of being young. There is the problem of being old. There is the problem of being in-between -- crises of passage everywhere.
But never mind. Once we forget all the old-fashioned rubbish about truth and beauty and love that religion and philosophy and art taught us, once we reduce all the varieties of affection and aspiration to that unlovely it -- the ``id'' -- we can correct the situation clinically, through ``behavior modification'' that will make us stronger if not better people. All we have to do is get rid of our ``guilt,'' our ``hang-ups,'' and learn how to say, ``My will be done,'' and then, and then. . . .
But now, it seems, just at the peak of their popularity, therapists themselves are losing faith in their ``talking cure.'' The pages of Science 86 are filled with the sorts of statements of doubt and disillusion that 19th-century ministers confessed to after Darwin.
Unfortunately, everybody's second thought is not to explore for richer and profounder concepts of human nature but to switch the promise of a ``cure'' to drugs, thus fulfilling the prophecy made 20 years ago by the brilliant and humane psychiatrist Leslie Farber. He wrote: ``Out of disbelief [in God] we have impudently assumed that all of life is now subject to our own will. And the disasters that have come from willing what cannot be willed have not at all brought us to some modesty about our presumptions. Instead we have turned to chemicals, which seem to enhance our willful strivings. It was only a question of time before man, in his desperation, would locate divinity in drugs and on that artificial rock build his church.''
At one point, Farber defined madness as ``the sworn enemy of our capacity to be fully human'' -- to which we would do well to add, as he did, that in this respect madness has a way of resembling its ``cures.''
A Wednesday and Friday column