‘Psychiatry, in my opinion, has always been intrusive, destructive, and vicious.’
(Against Therapy, Introduction, page 39)
Why? because:
‘The therapeutic relationship always involves an imbalance of power.’ (p.290)
This is less a book than a sustained polemic – an impassioned, one-sided, take-no-prisoners exposé of the historical and modern abuses of psychiatry and psychotherapy, designed to support Masson’s simple, drastic proposition: that all forms of psychotherapy must necessarily be abuses of power and should be banned.
In Masson’s view, all forms of psychotherapy, no matter how cuddly and collaborative they make themselves appear, eventually boil down to the same basic power dynamic which is that – the therapist claims to know best.
Most of us who’ve been in therapy really want this to be true. We want the therapist to be wise and all-knowing and more experienced than us, a qualified professional, an expert in their field, who will sensitively tease out of us our life story and identify the problem points and help us understand our issues and resolve them so that we emerge from therapy less troubled, less depressed, less anxious, more able to cope with life.
BUT, says Masson, therapists are NOT superhumanly gifted magi, they are just people like you or me and they’re as prone as you or me to be bored, impatient, imperceptive, to let their own prejudices and assumptions cloud their judgement and so on. Moreover, psychotherapy, and the profession of psychiatry which preceded it, have historically been marked and limited by hair-raisingly anti-patient assumptions.
His book then sets out on a selective historical review of the professions (psychiatry and psychotherapy) to smack you in the face with examples of the appallingly cruel and inhumane ways they’ve treated their patients.
Introduction by Dorothy Rowe
The book kicks off with an introduction by the Australian psychologist and author Dr. Dorothy Rowe who puts the boot into the profession of psychiatry and psychology as she first encountered them on coming to Britain in the late 1960s. Dismayed at the male chauvinism, strict hierarchy and snobbishness of the professions she encountered, she was then appalled to discover the way poor suffering vulnerable people were treated at every level of the system.
She describes the way psychotherapy slowly entered the profession of psychiatry (long resistant to it as ‘unscientific’) and has proliferated during her time so that nowadays (at the time of writing, 1988) society is overrun with therapists and counsellors offering marriage counselling, grief counselling, family counselling, group therapy, depth therapy. But the fundamental fact has not changed – which is that psychiatry doesn’t cure people. In Rowe’s opinion, psychiatry is about managing people with mental problems. It is about power. One group of people set themselves up as experts and then try to impose their version of reality on the ill and unhappy and vulnerable. At which point she ends her introduction and so, over to Masson…
Chapter 1. The prehistory of psychotherapy
Masson starts his sustained flaying of psychiatry by going back to the nineteenth century and the treatment of women patients who were supposedly mentally ill, ‘hysterical’ and so on. Specifically, he considers the stories of two women patients who were consigned to mental institutions in the late nineteenth century and are rarities, because they left such thorough records of their treatment, being: Hersilie Rouy in France and Julie La Roche in Switzerland.
Masson shows that these women were incarcerated for the crimes of being strong-willed and independent, contradicting the wishes of their husbands or fathers, and how a sequence of male ‘doctors’, ‘psychiatrists’, ‘inspectors’ and ‘judges’ back each other up, even when they were obviously at fault.
If you doubted the existence of the ‘patriarchy’ in Western societies these are the kinds of howling historical injustices which will change your mind. (In fact, these two stories are by way of being extracts from Masson’s previous book, a study of the horrors of nineteenth century psychiatry, ‘A Dark Science: Women, Sexuality and Psychiatry in the Nineteenth Century’ 1986.) Time and again Masson finds that:
women were branded as ‘morally insane’ merely because they did not conform to what their parents or society or medicine expected of them. (p.78)
Masson uses the Hersilie Rouy and Julie La Roche stories to establish his principle that any form of treatment of mental illness is always, by its nature, coercive and controlling. The two young women in question had their own truths, their opinions and characters and behaviours, and a whole litany of male ‘experts’ lined up to deny their version of reality and to impose the male doctors’ version of reality upon them.
It is in the nature of therapy to distort another person’s reality. (p.247)
This, claims Masson, is what all therapy must always be like. Even if we go to the most liberal, fair-minded, progressive and feminist therapy imaginable, the therapist is still only human. They are subject to institutional pressures (NHS waiting lists and turnaround times and budget cuts) or, even if working privately, still need to manage their time and their cases in a cost-effective way.
They are shaped by the training they’ve had – if American, they’ll have had psychiatric training and be heirs to the terrible tradition of coercion, electroshock therapy, indiscriminate use of drugs which scar psychiatry as a profession; if European, they might only have had psychoanalytic training, which Masson then proceeds to demolish and excoriate in the following chapters.
Chapter 2. Dora and Freud
Freud published his case study of the patient he named ‘Dora’ (real name Ida Bauer) in 1905. Ida had been referred to Freud at the age of 16 by her parents because she had become depressed, moody, often silent and, in particular, had taken violently against close family friends of her parents, referred to in the case study as Herr and Frau K. Freud diagnosed Ida with hysteria and treated for about eleven weeks in 1900.
This was Freud’s first, longest and most detailed case study and has been pored over hundreds of thousands of analysts and scholars. It features in tens of thousands of scholarly papers and books. On account of its incredible detail and the subtlety of Freud’s interpretations it marked a complete departure in psychiatric practice. Masson calls it ‘a turning point in the history of Western man’ (p.112). It has been almost as pored over as the Bible and has given rise to radical criticism, most obviously from feminists outraged at Freud’s patriarchal assumptions and suggestions.
To summarise: Dora discovered her father was having an affair with Frau K and lying to her mother about it. When she was 14 and alone with him in his office, Herr K grabbed her and kissed her. Two years later, on a walk by the lake, again alone, Herr K grabbed her, kissed her and asked her to be his mistress. When Dora told her parents they both vehemently denied any such thing could have taken place. Among many other feelings, this left Dora speculating that her father, instead of protecting her, had offered her to Frau K as a quid pro quo for being allowed to continue his affair with Frau K. During Dora’s visits to Freud it further came out that Dora had learned that Herr K had also propositioned his family’s governess. This made her feel even more worthless, as if she was just an object to be seduced and discarded. And then she made another discovery. Dora’s family had a much beloved governess, who read to the children, loved them etc. One day Dora discovered that this governess was deeply in love with her father and that her ostensible affection for the children was merely a pretext to get closer to the father.
Thus Dora, a bright intelligent upper-middle-class Jewish 18-year-old woman had been profoundly betrayed by all the important figures in her life. Her father dragging her along to see Freud was yet another betrayal. At first Freud listened and was the first person to take the two seduction moments, in the office and by the lake as true. But in a way Freud’s betrayal was worse, because he then interpreted Dora’s disgust at being grabbed and snogged by a family friend, and then propositioned for heartless sex as signs of Dora’s hysteria. He actually writes in the case study, what healthy young woman would not be thrilled to be approached in such a manner by Herr K – who he happens to know and who he tells Wilhelm Fliess in one of his letters about the case, is a fine figure of a man?
Freud then went to town, combining his early ideas about infant sexuality with his theory of the unconscious. He told Dora that her problem was that she was in love with too many people. She loved her father, as all good girls should. But she also, despite all protestations to the contrary, loved Herr K as well. The most Freudian i.e. far-fetched and counter-intuitive interpretation, was the Dora was, deep in her unconscious, in love with Frau K! The cure for her nervous symptoms was simple. She must offer herself to Herr K on condition that he leave his wife. Then everyone would live happily ever after.
As all commentators and scholars remark, Freud’s case studies are more like short stories or novellas than scientific write-ups. His fans say this with awe, but there is another interpretation which is that Freud used the subtlety of his theory and ‘insights’ to do a more subtle kind of damage. Traditional nineteenth century psychiatry locked recalcitrant young women up in mental institutes. Freud is not as brutal; he locks recalcitrant young women up in subtle matrices of his theory, using concepts like the unconscious and the fundamental bisexuality of human beings, to produce interpretations which are every bit as controlling as the psychiatrists he sought to supersede.
And this, says Masson, is because psychotherapy is always a warzone between conflicting interpretations of reality where one side has all the power. As Freud himself put it in ‘On The History of the Psychoanalytic Movement’, psychotherapy:
‘is a situation in which there is a superior and a subordinate’ (quoted p.41)
The expert’s ‘reality’ always trumps the patient’s reality. It is a power dynamic. Right from its inception Freud’s psychoanalysis created an atmosphere of ‘denial and disbelief’, in the words of Judith Herman (cited p.265). Freud used Dora to flesh out evidence for his new theories, just as she thought Herr K wanted to use her body, and her father used her as a bargaining token in his own affair with Frau K. One more middle-aged man refusing to listen, talking over her, mansplaining her own motivations and feelings to her, denying her personhood.
This explains why Dora cut short the analysis before Freud thought he was finished. Freud gives this rejection a typically clever-clever interpretation, noting it as a prime example of patient transference, meaning that Dora was projecting onto Freud the feelings she had for Herr K which were, above all, revenge. By breaking off the therapy Dora was, in Freud’s terms, ‘acting out’ what she wished she could do in real life i.e. snub and spurn Herr K. A clever interpretation and one which gave rise to the concept of transference which is still used in many kinds of psychotherapy. But maybe just wrong. Maybe this plucky 18-year-old had had enough of being used and lied to by creepy old men.
I understand what Masson is aiming to do by going into the Dora case at such length – to prove that therapy is always one-sided and always provides the therapist with endless opportunities to abuse that power, that therapy allows the therapist to project their personal prejudices onto the patient, or force them to conform to conservative social norms, or both.
But as I read on, my heart sank. Part of Masson’s technique is a very close reading of the original German and thus he plays into Freud’s hands. This is just one more interpretation of Freud’s words, one more reading or misreading of a canonic text to be added to the vast pile of similar readings and interpretations which have accumulated over the past century. What would impress me a lot more in a book seeking to undermine the validity of psychotherapy would be facts, data and statistics.
Chapter 3. Ferenczi’s secret diary and the experiment in mutual analysis
Sandor Frenczi was a golden boy of psychoanalysis, one of Freud’s favourites, generally considered the best, most intuitive analyst/therapist among the first generation. But, in full-on debunking mode, Masson reveals that Ferenczi kept a diary in the last year of his life, from 7 January to 2 October 1932 (he died on 22 May 1933) in which he confided radical doubts about the whole idea of analysis. He recorded several recent occasions on which he had made snide or sarcastic remarks to patients or, worse, jumped to impose psychoanalytic interpretations onto patient admissions and confessions which he later came to realise were totally inappropriate. Thus he becomes increasingly worried with the temptation for the therapist to ‘entice, seduce and infantilise the patient because it can lead to abuse’ (p.171). He is the only one of Freud’s disciples to glimpse what Masson sees as the essential truth of therapy.
Chapter 4. Jung among the Nazis
Part 1. Jung and the Nazis
Masson dwells on Carl Jung’s involvement with the Nazis, namely that when the Nazis came to power Jung accepted the presidency of the International Medical Society for Psychotherapy, at the same time that Matthias Göring, cousin of the leading Nazi Hermann Göring, became president of the German branch. The main function of the society was to publish an academic journal and Jung became editor in chief of it, in December 1933, a post he was to hold until 1939.
At the time and for decades afterwards, when Jung came to justify this step, his argument was that the Nazis were on the verge of banning psychotherapy altogether, throughout Germany, and that the intervention of a Gentile with a good international reputation allowed him to save it.
Masson piles on the accusations by citing Jung’s equally contentious statements from this period, distinguishing between a ‘Jewish psychology’ and an ‘Aryan psychology’, as well as making very badly phrased references to ‘the Jewish problem’. He finds it impossible to believe that Jung didn’t know something about the acquiescence of the entire German psychiatric profession with the mass murder of up to 350,000 mental patients. And he goes on to quote Jung’s hair-raisingly racist comments on black people dragging down every culture they come into contact with (pages 155 and 156).
Colonialism:
‘The savage inhabitants of a country have to be mastered. In attempt to master, brutality rises in the master.’ (quoted p.156)
Black people:
‘…the American Complex, namely living together with lower races, especially with Negroes. Living together with barbaric races exerts a suggestive effect on the laboriously tamed instincts of the white race and tends to pull it down.’ (quoted p.156)
Obviously this looks catastrophic for Jung’s reputation, but, as it happens, I’ve just been reading the same subject, as covered in Paul Roazen’s book, ‘Freud and His Followers’ (1975). Roazen’s account is better because he puts Jung’s statements in a broader context, namely Jung’s beliefs about deep racial archetypes. Roazen makes the point that Jung also commented on the French or Spanish or Italian ‘races’, in other words he wasn’t focused solely on antisemitism, and his antisemitic statements were part of a wider theory of human nature.
It still sounds like attempts to ‘explain away’ his Jewish/Aryan remarks but Roazen comes over as more fair-minded. He doesn’t have the very obvious axe to grind that Masson does. In all these chapters, Masson’s narrative is continually undermined by his evident straining to get to the punchline. Every other paragraph seizes the reader by the throat and yells: ‘See? I told you! Therapy is evil!’
(Incidentally, Masson appears to have studied the subject of the Nazis and psychiatry in some detail and mentions having read over 25 books on the subject. He singles out, and so I’m passing on to interested readers, ‘Psychotherapy in the Third Reich: The Göring Institute’ by Geoffrey Cocks, 1985, and ‘Mass Murderers in White Coats: Psychiatric Genocide in Nazi Germany and the United States’ by Lenny Lapon, 1984.)
Part 2. Jung’s therapeutic technique
Doubts about Masson’s entire approach are revived when he makes a massive swerve from the huge panorama of the Nazi genocide and switches to part two of the essay on Jung, which is a detailed look at Jung’s practice as a therapist. The key fact, according to the witnesses Masson has lined up, is that Jung spent the therapeutic hour yakking on about his own bizarre hobby horses (Tantric sex, the racial archetypes, telepathy, UFOs and much more) while showing next to no interest in the details of the patient’s actual life story and problems.
If we skip the details the punchline is the same one Masson is at pains to make throughout the book, which is that therapy is always and everywhere a power struggle in which the therapist assumes the right to impose their version of reality on the patient’s version of reality.
Chapter 5. John Rosen and Direct Psychoanalysis
A 30-page chapter about John Rosen, a ‘pioneer’ of a technique he called ‘direct psychoanalysis’.
Direct analysis was based on the notion that serious disorders such as schizophrenia were the result of deficient, inadequate or harmful mothering. Therefore, the patient was to be treated like a baby, and given ‘the gift of unconditional love’. Contrary to the impression that gives, in practice Rosen’s treatment often included threats, threats of violence, and actual physical assault. In the late 70s patients began coming forward with horror stories which eventually led him to be hand in his medical license in 1983.
Masson then describes the appalling abuse Rosen subjected patients to, including threatening them, beating them, slapping and punching, and forcing them to have sex with him and others. Several long-term patients at his psychiatric facility were found dead. One was able to prove with eye witnesses, that she had on one occasion been stripped to her panties and held down by his associates while Rosen punched her in the face and breasts. One patient, Claudia Ehrman, was found dead with severe bruising to the face and lacerations of the liver caused by sustained punching and kneeing, and witnesses testified to seeing her being held down by Rosen’s associates and repeatedly beaten.
Only when one of the patients, Sally Zinman, many years later, hired a private detective to investigate Rosen, did evidence of the squalor and violence carried out at his ‘clinic’ come to light.
But Masson’s point is that the psychiatric and psychotherapeutic professions had known about him for 30 years. Rosen had published his most influential paper as far back as 1947. In 1959 he was made an Associate Professor of Psychiatry. In 1971 he won the Man of the Year Award of the American Academy of Psychotherapy. Masson cites numerous ‘experts’ and notable analysts who praised Rosen’s theory and practice.
Masson recounts a phone conversation with the ‘reputable’ psychiatrist who hired Rosen to teach at the Temple University Medical School, and then with another colleague at the same institution. They wrote books and papers about Rosen’s practice and still defended him to Masson, even after the full story of his therapy had come out and the man forced to give up his licence. (Rosen was never charged with an offence so none of these events ever came to trial.)
All this is shocking but Masson is alert to the obvious criticism of his position – that Rosen was obviously an extreme outlier, a rarity in the intensity of his abuse and brutality and that you can’t discredit an entire profession by picking on one crook.
Masson rebuts this criticism and tries to make Rosen stand for the entire profession of psychotherapy by pointing to 1) the many awards and plaudits Rosen won right up to the moment he was forced to quit; 2) the large number of fellow therapists who wrote admiring references and tributes; and 3) the phone calls Masson has with two university colleagues who, despite all the evidence of his barbarity, still refuse to condemn him or his techniques. I.e Masson tries to show that Rosen is not an outlier but a respected and admired theorist and practitioner from the heart of the profession.
I take the point but, as with his account of Jung and the Nazis, it feels as if Masson is cherrypicking the worst cases he can find to try and tar the entire profession.
Chapter 6. Sex and battering in psychoanalysis
Part 1. Another example of Rosen-style therapeutic brutality
Anyway, Masson refutes the claim that Rosen was a one-off, bad apple and outlier by describing the equally outrageous, scandalous, violent and sexually abusive treatment of patients at a mental institute in Pennsylvania run by colleagues and devotees of Rosen. At this place, severely schizophrenic patients were threatened, shouted at, repeatedly electrocuted with cattle prods. Their genitals were exposed to patients of the opposite sex, often in ‘group therapy’ sessions. The behaviour recorded and testified to by ex-patients beggars belief.
The most scandalous incident was when one of the supervising ‘psychotherapists’ forced one of the severely ill patients to eat the contents of several ashtrays. When she vomited it all back up, he ordered her to eat the vomit. Now Masson concedes that, in the investigation which followed, the ‘ashtray incident’ was described as unusual and the institute manager claimed to have reprimanded the therapist responsible.
What’s so hard to believe is that this level of abuse was not only be permitted but that, when it eventually came to light via various affadavits to police and state authorities, and increasing flow of newspaper articles, nobody seems to have been prosecuted, in fact the county district attorney’s office produced a critical 10-page report but allowed the institute to continue to function.
It is so incredible that you wonder whether, here as in the Rosen case, there’s more to it than Masson is telling us. Anyway, he uses the gobsmacking revelations to ram home his central point:
As Thomas Szasz has so often and so cogently argued, once somebody is declared ‘mentally ill’, you can do anything you want to them, including torture, as long as you claim that you are doing it for their own good. (p.204)
Part 2. Sabina Spielrein
Masson describes the three-way relationship between Jung, one of his earliest patients – Sabina Speilrein, who went on to become a noted psychoanalyst in her own right – and Freud. Basically Jung fell in love with Spielrein (despite being married), pestered her to have sex, and both of them wrote to Freud to intervene or explain or help. Both men come over as self-serving, sexist hypocrites and Sabina, like the women in almost all these stories, as the hapless victim of manipulating men, who make up the most preposterous lies, and use the most pompous psychoanalytical language, to justify crudely selfish behaviour.
It’s a bit of a puzzle why this passage about Jung and Freud didn’t come in the Jung chapter and had to wait until after Rosen, whose story goes up to the 1980s. Gives the impression that Masson struggles a bit to order his material
Part 3. Therapists and sex
Maybe it’s because he uses the Sabina story to introduce this section, about therapists having sexual contact with their patients.
A review of the literature about psychiatrists and psychotherapists who have sex with their patients. Although the official bodies disapprove, maybe 1 in 10 therapists have erotic contact with their patients (p.222). A 1984 survey said the number was higher, at 15%, and bear in mind that that’s the number who are prepared to admit it (p.224). Masson cites a number of critical books by feminists which have increasingly raised the issue of the power imbalance implicit in the psychotherapeutic situation and described cases of inappropriate sex between therapist and patient – and makes the general point that the statistics cited above are based on the admissions of practitioners. If someone did a big survey of patients, almost certainly the figures would be higher.
Part 4. The outcomes of psychotherapy
A bit of a shift of subject, again, as Masson tries to address the fairly fundamental question of whether therapy actually works.
There appear to be no studies of the outcomes of therapy which have produced knock-down, statistically significant, clear-cut, indisputable statistics on whether it works, whether it’s worth the time and money, at least when Masson was writing in the late 1980s. Instead there appear to be a multitude of small studies and papers which express a variety of views, all the way from crediting therapy with complete cures to the claim that it can contribute to a deterioration in mental health and, in extreme cases, suicide.
Masson enjoys citing the work of psychotherapy researcher Hans Strupp who, in one study, showed that friendly engagement with a college professor showed as much improvement in mental state as costly sessions with a ‘professional’ therapist. As if all people really need is an intelligent listener (p.227).
According to Strupp’s Wikipedia entry, he was ‘a prolific scholar and researcher who published 16 books and over 300 papers.’ All the odder, then, that the outcome of all this effort was the unsurprising conclusion that:
the attitude of the therapist toward the patient was the most significant ingredient for a successful psychotherapy; therapists who were supportive and empathetic were the most likely to have success.
A quick Google search of the subject shows that there appears to be a consensus that therapy helps patients to some extent in up to 75% of cases. This page cites specific research papers to that effect. The most noteworthy fact is that ‘the differences between established models of psychotherapy do not significantly alter outcomes’. It really does seem to be the mere fact of finding someone intelligent to listen to you, that works.
Chapter 7. The problem with benevolence: Carl Rogers and humanistic psychology
To address the criticism that he is only focusing on the most extreme and outrageous examples of psychotherapeutic abuse, Masson devotes a chapter to considering the good guy of American psychotherapy, the immensely popular and influential Carl Rogers.
Masson cites 18 quotes from Rogers’ teachings and subjects them to a systematic critique, pointing out how utopian it is to expect every therapist to have the kind of genuine and authentic empathy for every one of his clients which Rogers calls for, that 100% of the clients are capable of engaging fully in the therapeutic process, through to the more woolly utopianism of imagining that a ‘new America’ was being born at the end of the 1960s. Fifty years later we know better.
Masson then has a go at Rogers’ book, The Therapeutic Relationship and Its Impact: A Study of Psychotherapy with Schizophrenics, published in 1967. A cohort of psychiatrists descended on Mendota State Hospital in Wisconsin and subjected 32 chronic and acute schizophrenics to a barrage of tests and treatments over a five-year period. Masson quotes key passages which show that, far from being Mr Empathy as he liked to think of himself, Rogers in fact subjected patients to tests even when they hated it, even when it was visibly psychologically damaging to them.
At a deeper level, Rogers and some of his students carrying out the work were depressed by the patients’ apathy. Masson points out that there was a simple explanation: the patients knew very well that Rogers and his colleagues couldn’t get them released from the mental hospital, so had every reason to be unexcited and cynical about the whole exercise (p.242).
Masson uses quotes to demonstrate that even Mr Nice Guy worked to the same basically abusive, corrupting power imbalance implicit in all psychiatry and psychotherapy.
Once again, you get the sense that Masson is cherry picking the evidence and straining to make his case. A skim through Carl Rogers’ Wikipedia page suggests a figure who was really consciously humanistic and hugely influential. The book Masson so objects to, The Therapeutic Relationship and Its Impact, isn’t even mentioned in Rogers’s long Wiki article. Masson is cherry picking.
Chapter 8. And furthermore
The chapter about Rogers felt pretty dated, with Masson ganging up on a book from 1967. This chapter feels even worse, with him saying that psychotherapy has only ‘recently’ admitted the existence of child sex abuse and wife-beating, topics which have, from the perspective of 2023, received a growing drumroll of attention in the past 30 years or so. Masson appears to have been writing at a time when they were only just breaking through as subjects of discussion in the media.
Family therapy
In family therapy a large number of culturally sanctioned assumptions are brought into play as if they were brand-new insights. These assumptions are rarely more than prejudices of the time. (p.250)
On the one hand family therapy at least goes beyond Freud. Freud attributes everything to the individual and their fantasy life. Family therapy at least realises the individual exists within a family unit, with a number of psyches jostling for attention, power, love etc. But family therapy, in Masson’s view, is just a theatre where psychotherapists can come out of the closet and start bossing people around. Analysis needs to go one step further up the scale and look at society and its values. A different kind of analysis is required, a political analysis.
Gestalt therapy
An entertaining character assassination of Fritz Perls, the inventor and guru of Gestalt therapy. Masson makes him sound like a self-important ass. He freely admitted sleeping with many of his women patients (p.256).
Feminist therapy
For all that Masson is a feminist and conspicuously stands up for the many women who have been denied and diminished and mocked through the long sorry history of psychiatry – in the Dora case, in Ferenzi’s diary, in Jung’s behaviour with Sabina Spielrein, in the despicable behaviour of John Rosen, and so on – nonetheless, he makes the point that even feminist psychotherapy – well-meaning, intelligent and aware though it may be – is still psychotherapy and so imports the same corrupt power relationship implicit in all therapy, that between an arrogantly all-knowing therapist and a patient or ‘client’ whose reality and truth the analyst denies and overwrites.
He is upset that some ‘feminist’ therapists have changed the gender and are more sensitive to women’s issues or have foregrounded the importance of ‘mothering’ (Helene Deutsch, Melanie Klein) but have kept the fundamental power imbalance which Masson sees at the heart of psychotherapy. It may have feminist tweaks, but at bottom:
Most of the ideas of feminist therapy per se derive from traditional psychotherapy. (p.260)
Thus he agrees with the feminist writer Mary Daly that ‘feminist therapy’ is a contradiction in terms.
Incest-survivor therapy
Only very recently has therapy and counselling for incest survivors been developed. For the middle years of the 20th century the scale of incest and child sex abuse was denied, not least because of the baleful influence of psychoanalysis and Freud’s insistence that it was all fantasy and infantile wish fulfilment. Masson is dismayed that the very profession which denied and covered up child sex abuse has, in a very few years, made a 180 degree turnaround and now claims to be shiny experts.
Ericksonian hypnotherapy
Not the Freudian, Erik Erikson, but a figure much more mainstream and influential, Milton Erickson. Masson first cites authorities claiming Erickson to be a central figure and then does his usual schtick of lining up quotes from Erickson’s theory and case studies which demonstrate a hair-raisingly sexist attitude to women. An example of Erikson’s therapy is to tell a young woman to go home, strip off, and examine ‘the pretty patch of fur between her legs’. His aim is to help troubled young women meet a man, get married, have children and be fulfilled (p.272).
Erickson is, in other words, yet another example of stereotypical social values being imposed on troubled and vulnerable people in the name of ‘medicine’. The accounts of his treatments of young women have to be read to be believed. It is another amazing indictment. And yet the editor of his papers, Jeffrey Zeig, claims that Erickson was ‘the premier psychotherapist of the century’ (p.278). These aren’t freaks. Masson cites numerous authorities to claim they are central to the tradition.
Eclecticism
In the early 1980s about half of American therapists described themselves as ‘eclectic’. Masson cites Sol Garfield, editor of the Journal of Consulting and Clinical Psychology that all the evidence is it doesn’t matter what type of therapy is used, they all have comparable outcome rates – apparently backing up Hans Strupps’ findings.
Objections
Long before the end of the book the reader has thought of several objections to Masson’s approach.
The most obvious one is that each of the chapters, though they might be 100% accurate as far as they go, have clearly been cherry-picked and chosen to provide the most damning evidence possible.
Thus as early as the chapter about Dora I was thinking, you know what I’d like to read: a really solid statistic study which simply attempted to show whether psychoanalysis or any other flavour of depth therapy actually works. Just another semi-literary interpretation of Freud’s most famous case study – no matter how damning it becomes in Masson’s hands – feels a bit lame. It’s tackling Freud on his home ground, it’s giving the enemy the choice of battlefield. Taking down psychoanalysis as a theory and practice needs more than the demolition of one case study.
In the event, Masson’s book amounts to about eight case studies (Dora, Ferenczi, Jung, Sabina, Rosen and a few others). In each chapter he tries to generalise out from the therapist under discussion a general indictment of psychotherapy but, for me, doesn’t really succeed.
Insofar as any of this is meant to be scientific, I would have preferred a data-driven approach in which he proved his points statistically, which gave hard statistics about the number of abusive therapists, about court cases and lost licences, about the success and failure rates of therapy and so on. For me, Masson’s essentially ad hominem approach of rubbishing half a dozen famous therapists ends up feeling anecdotal, patchy and gossipy, rather than the sweeping demolition he obviously intends it to be.
What’s the alternative?
Quite early in the book, in fact in the introduction, Masson addresses the most obvious issue which arises from his polemical opposition to psychotherapy which is, very simply: If you abolish therapy – what would you put in its place?
First of all Masson says he doesn’t feel any obligation to propose an alternative. He’s reporting on abuses, not putting the world to rights. He quotes a woman friend who says the question is as silly as asking, ‘What would you replace misogyny with?’ The aim is not to replace it, but to abolish it.
But the question is not not that silly. After all, there really are mentally ill people, in fact an ever-growing number of them – on a spectrum from the florid conditions associated with hallucinations and severe dysfunction termed schizophrenia’, through a variety of specific mental problems and issues, from the obsessions and neuroses which Freud set out to treat, on to the mild depression or unhappiness which so many people seem to suffer from.
Something has to be done about them but, if Masson’s argument against therapy is taken literally, what? His tentative solution is worth quoting in full:
I have some ideas about how people could live without psychotherapy or psychiatry. I am thinking of self-help groups that are leaderless and avoid authoritarian structures, in which no money is exchanged, that are not grounded on religious principles (a difficulty with Alcoholics Anonymous and similar groups, since not all members share spiritual or religious interests), and in which all participants have experienced the problem they have come to discuss. I know that some women who have been sexually abused have been helped by getting together with other sexually abused women to share experiences, survival strategies, political analysis, and just their own outrage. What we need are more kindly friends and fewer professionals. (p.30)
Uh-huh. Reads OK till you start thinking about it. Where are these kindly friends going to come from, then? Are they available on Amazon? Not enough, is it? People go to therapists as they went to priests in the past, because they need help with big life problems from someone they can talk to in confidence. And this may explain why, despite its surplus of excoriating evidence, Against Therapy appears not to have had the slightest impact on the twin professions of psychiatry or psychotherapy. Masson’s argufying is an entertaining droplet in the vast oceans of unhappiness and need all around us.
Because in the final analysis, psychiatry and psychotherapy may be flawed in all kinds of ways, and implicated in terrible attitudes and behaviours in their pasts. They may be rotten. But they’re all we have.
Gurus and John Lennon
From time to time Masson repeats the assertion that ‘there are no gurus‘ (p.29). It helps to understand his insistence if you know that he was raised in an odd family whose parents were both in thrall to a literal guru, a self-proclaimed magi named Paul Brunton, and that Masson had to painfully extract himself from his parents’ unquestioning faith in this ‘wise man’, a process he only managed when he was a student living apart his family. The whole painful process was documented in a book that came out after this one, ‘My Father’s Guru: A Journey Through Spirituality and Disillusion’ (1993).
Seen from this biographical perspective, it’s easy to dismiss Masson’s attack on psychotherapy as a repetition of the intellectual and emotional rebellion he had to go through as a teenager and young man. As a man addicted to hero worshipping Great Men for a while, only to angrily reject them and rubbish them.
The connection is made explicit at one point, more than a connection, more of a template; beneath Masson’s rubbishing of psychotherapists he admits that his act of critique and rejection is based on his own, earlier rejection of his father’s guru:
How does a role model differ from the guru/seer model, the wise person who is part and parcel of all traditional psychotherapies? (p.260)
This would explain why his book is so focused on individual ‘name’ therapists (Freud, Jung, Ferenczi, Rosen, Rogers, Perls et al) rather than taking a more statistical, data-driven approach, and exudes a tone of disappointment; it’s because the book is, in a deep sense, about his own disappointment and disillusion with the whole idea of Great Men. As he writes, more than once, ‘there are no gurus’ And every time he I read the word, I heard in my mind the John Lennon line, ‘There ain’t no guru who can see through your eyes.’ All very 1970s, all very dated.
And today?
Obviously this book is 35 years old. I wonder what the state of current thinking is about psychotherapy? Did Masson’s polemic have the slightest effect? My sense is that there is more psychotherapy, especially in the form of counselling for every conceivable situation and crisis, than every before in history. Is that right? How do I find out? Where are the statistics?
Would reading this book stop me having therapy? No. If I felt I needed it, I’d still consider it. This book would just make me much more aware of the risks involved in the therapeutic relationship and more alert to the clash of ‘realities’ Masson sees at the heart of it. But then I’m reasonably sane and compos mentis; I’m not one of the legions of damaged, distressed people who so desperately need help and whose predecessors have been so horribly abused and exploited in the past, as this distressing book records..
Credit
Against Therapy by Jeffrey Masson was published in Britain by Collins in 1989. References are to the 1992 Fontana paperback edition.
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