Therapy's Delusions: The Myth of the Unconscious and the Exploitation of Today's Walking Worried [Hardcover]

Ethan Watters (Author), Richard Ofshe (Author)

Book Description

Publication Date: April 16, 1999

From the critically acclaimed authors of Making Monsters, a no-holds-barred critique of talk therapy that will forever change your view of the couch.

In this clearheaded and courageous book, Ethan Watters and Richard Ofshe expose the pseudo-science behind the twentieth century's most enduring myth -- Freud's theory of the psychodynamic mind. Despite the lack of credible evidence for a powerful unconscious that controls our behavior, a huge number of therapists continue to base their practice on the idea that only they can uncover their patients' unconscious motivations, luring thousands of Americans, from the mildly demoralized to the seriously ill, down dangerous and arbitrary paths of treatment.

Therapy's Delusions reveals how, over the years, talk therapy has masqueraded as a scientific discipline and has cost patients time, money, and their mental well-being. Waters and Ofshe demonstrate how patients, therapists, and society alike are fooled by the stories created in therapy. This back-and-forth belief-building process has popularized countless faddish and speculative notions, some of the most aberrant of which have popped up in recent years, including the recovered memory trend the authors exposed in Making Monsters.

Therapy's Delusions also makes a decisive case for the biomedical approach to mental health care. In addition to the celebrated success of drugs like Prozac, revolutionary advances are being made in genetic research and in the field of cognitive and behavioral counseling. This book is a powerful call to action for reforming the poorly regulated mental health profession, so that no more patients are misled by a myth that has held sway over American minds for far too long.

Talk therapy's tight grip on both its patients and practitioners is exactly why it deserve close examination. Brilliantly argued, Therapy's Delusions is a crucial addition to the dialogue about Freud's legacy and essential reading for anyone considering taking his or her troubles to a psychodynamic therapist.

Editorial Reviews

From Publishers Weekly

Following Making Monsters, their much-discussed attack on recovered memory therapy, Watters and Ofshe offer a rigorous critique of talk therapy of the Freudian variety and its many offshoots. In a broadside as withering as those by anti-Freudian critic Frederick Crews (Memory Wars; Unauthorized Freud), the authors assail psychoanalysis as a convoluted system of assumptions and anachronistic beliefs. Using cases from the psychoanalytic literature, they find troubling evidence of analysts' arbitrary diagnoses, misogyny, hubris and pretense of scientific authority. Ofshe, a sociology professor (UC-Berkeley), and freelance journalist Watters observe that with the psychotherapy profession in defensive retreat from its claim to reveal the secrets of unconscious minds, talk therapists have increasingly allied themselves with social movements and cultural trends, spawning feminist therapy, body/mind therapy, care of the soul (e.g., Thomas Moore's books) and so forth. The authors reject these approaches as fundamentally flawed because, in their view, Freud's notion of a dynamic unconscious that influences our everyday lives is nothing more than a culturally supported myth. The "biogenetic approach" they favorAcombining pharmacotherapy, research into brain dysfunction and rehabilitative behavioral/cognitive therapyAhas already made progress in treating schizophrenia and mood disorders. Ultimately, however, their wholesale rejection of the existence of an unconscious, and of the roots of mental illness in developmental or childhood factors, seems an article of faith as debatable as the exaggerated claims of talk therapists. Nevertheless, their provocative analysis of what happens in therapy sessionsAthe patient internalizing the life story that he or she creates in tacit collusion with the therapistAwill challenge patients and practitioners alike. An appendix dismantles the upbeat conclusions of an influential 1995 Consumer Reports survey, "Does Therapy Help?" Agent, Bonnie Nadell.
Copyright 1999 Reed Business Information, Inc.

From The New England Journal of Medicine

The concept of an unconscious mind is an old one, going back to speculations in the 12th century and articulated clearly by a Professor W.B. Carpenter of London in his lectures 25 years before Freud ever wrote his papers on the topic. Without reading a scientific article on the subject, anyone who has made an embarrassing slip of the tongue is well aware that our minds function outside our awareness.

Freud's contribution was to use the knowledge of these forces in the treatment of psychological difficulties. His explorations did for our understanding of the mind what Spallanzani did for biology in the 18th century and what Pasteur did a century later. They showed that there was no spontaneous generation but that things arose from causes. In other words, our mental functions do not result from random neuronal discharges from the cerebral cortex; instead, they have meanings of which we may not always be aware. This concept may be among Freud's most lasting contributions, and it has given rise to what is called psychodynamics -- the understanding of the meaning of mental life.

Written by a journalist and a sociologist, Therapy's Delusions attempts to prove that the concept of an unconscious is a delusion and that psychodynamic therapy is therefore a fraud. The authors cite stories of incompetent treatment, wild interpretations made years ago by analysts, recent forms of spiritual treatment, and even alien-abduction therapy -- all of which, for some reason, they include under the rubric of psychodynamic therapy. They constantly repeat the phrase "the myth of the unconscious," as though the repetition itself served as a proof.

The authors insist that because we have learned so much about the brain, the psyche is irrelevant in the treatment of psychological difficulties. However, although it is obvious that the brain mediates all mental functioning, in our present state of knowledge we cannot explain how it does so. Even major psychoses have not yet been explained in terms of brain function. For example, when schizophrenia develops in a monozygotic twin, in only 50 percent of cases will the same condition develop in the remaining twin, even though the twins have identical genes. This finding has been cited by geneticists as evidence that environmental, nongenetic factors play a part in the disease. We have a long way to go before we can be certain of the causes of psychological difficulties.

Although Freud founded psychoanalysis, many of his ideas have been enlarged, changed, and discarded by analysts, just as in any medical discipline. However, the importance of unconscious mental functioning is universally recognized, both within and outside the field.

In the field of psychiatry, the past 100 years have been marked by a conflict between psychiatrists who view all mental illness as caused by brain pathology and psychiatrists who focus on psychological issues. This either-or dichotomy is arbitrary and restricting -- it has been called "mindless versus brainless psychiatry." Clearly, both neuroscience and psychology contribute to our understanding of how the mind works and are certainly not contradictory. There is evidence that not only can brain difficulties affect psychological functioning, but also psychological events can alter brain structures and bodily functions.

Recent advances in neuroscience have shed much light on mental functioning, and some psychoanalytic training institutes have started to give courses in neuroscience and its relation to the mind. The authors complain that those in the field of psychodynamics do no research into their subject, but a great deal of sophisticated research is being carried out, much of which is sponsored by the major psychoanalytic associations.

Many books have been published recently that are critical of psychodynamic psychiatry, and some have been written by thoughtful investigators. I am afraid that Therapy's Delusions is not one of them. It is more a polemic than a serious study and is selective and slanted in its presentation. For the knowledgeable reader, it adds nothing new on the subject.

Reviewed by Richard S. Blacher, M.D.
Copyright © 1999 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

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Product Details

• Hardcover: 288 pages
• Publisher: Scribner (April 16, 1999)
• Language: English
• ISBN-10: 0684835843
• ISBN-13: 978-0684835846
• Product Dimensions: 8.5 x 5.7 x 1.2 inches
• Shipping Weight: 1 pounds
• Average Customer Review: 3.3 out of 5 stars  See all reviews (11 customer reviews)
• Amazon Best Sellers Rank: #1,132,165 in Books (See Top 100 in Books)

More About the Author

Ethan Watters is the author of Crazy Like Us: The Globalization of the American Psyche. Before that he authored Urban Tribes, an examination of the mores of affluent "never marrieds" and coauthored Making Monsters, a groundbreaking indictment of the recovered memory movement. A frequent contributor to The New York Times Magazine, Discover, Men's Journal, Details, Wired, and PRI's This American Life, he has appeared on such national media as Good Morning America, Talk of the Nation, and CNN. He is a co-founder of the San Francisco Writers' Grotto, a cooperative writing workspace in San Francisco.

Customer Reviews

Most Helpful Customer Reviews

40 of 44 people found the following review helpful:

3.0 out of 5 stars Tackling Freud while claiming to have tackled all of healing, April 21, 2000

By 

Todd I. Stark "Cellular Wetware plus Books" (Philadelphia, Pa USA) - See all my reviews
(VINE VOICE)    (REAL NAME)   

This review is from: Therapy's Delusions: The Myth of the Unconscious and the Exploitation of Today's Walking Worried (Hardcover)

This isa "debunking" style book that can be summarized very simply: (1) Freud was a fraud, (2) most talk therapies are based on Freud's ideas, (3) most talk therapies are a fraud.

The argument is fleshed out along the way by several main themes. There is a negative interpretataion of psychotherapy outcome research, showing that most therapies are effectively interchangeable (an old argument with some validity), and that most outcomes are equivalent to placebo (also having some validity, though perhaps not as far as the authors take it).

There are also several useful chapters explaining why clients (incorrectly) believe they are being helped, why therapists (incorrectly) believe they are helping, and why we continue to believe in things that don't really work. Those chapters are so good, in fact, that one wonders why the authors don't realize that some of their own beliefs could probably be explained away in similar terms, if that was all that was required to debunk a topic.

The authors' rhetorical purpose is pretty clear, to dismantle the immense tree of modern psychotherapies at its roots, leaving only a vague sort of professional counseling service involving a straightforward short-term comforting of the distressed, and perhaps some of the better validated forms of cognitive and behavioral therapy. The long term therapy whereby the client spends months or years seeking out childhood stories to explain their current difficulties is attacked thoroughly and without mercy.

Do the authors succeed in their task ?

Ofshe and Watters borrow heavily from Frederick Crews and other modern critics of Freud to make a persuasive case that Freud didn't know as much about his patient's minds, or even cure them as effectively as he claimed. I found their case compelling, also, (though not original) that psychoanalysis was never a scientific discipline in the sense that analysts once seemed to claim. So much for the Freudian roots of long term therapy.

However, the authors don't make the argument as convincingly that all of the many therapies are really so reliant on Freud specifically. Afterall, as the authors point out, so much of our culture has been influenced by the psychodynamic model that it is difficult to even identify the influences today. The aspects of Freud that the authors consider the biggest problem are (1) the unconscious mind that affects us while being hidden from view, (2) the way the unconscious mind is supposed to affect us through childhood trauma and (3) the privileged knowledge of therapists to uncover the unconscious mind. To the degree that therapies claim privileged access to the unconscious mind, Ofshe and Watters' critique probably applies to some extent. To the degree that therapies rely on uncovering hidden childhood trauma, likewise the critiques seem to apply.

The problem I had with this book's line of reasoning is the cases where therapies are not reliant in any straightforward way on psychoanalytic thinking. Some of these other forms of therapy have a growing body of empirical data behind them. The authors seem to dismiss all therapies in the same sweeping argument, even though the research they review clearly shows that some therapies are more effective than others for specific things. While pointing out the positive research results for various cognitive and behavioral therapies, the authors seem to dismiss the positive results with some therapies as unimportant because it isn't explained in a satisfactory way by current medical theories.

The weaknesses of the book are twofold. For one thing, the authors, whose background is social sciences rather than biology, hold an untenable and archaic view of human biology as solely chemistry and biology. Their assumptions are based on an older dualism, finding no relationship between thoughts and feelings and beliefs one hand and physiological processes on the other hand. In contrast, most modern biologists who specialize in human beings seem to find that information processing in humans is in fact a pertinent factor in how the brain and body regulates themselves. Thoughts, feelings, and beliefs are not irrelevant to health, they are simply not relevant in the bizarre way postulated by the Freudians. So the Freudian therapies may all be equally silly in some sense, as the authors suggest, but they apply their admonitions much more broadly than that, claiming that therapy never really influences more serious problems, which is demonstrably false, even within the data surveyed by Ofshe and Watters.

The second problem is that the authors' interpretation of psychotherapy research is consistently biased, to the point of rejecting data that most other independent reviewers consider either positive or ambiguous. The authors are so intent on showing that therapy can't work that they ignore a wealth of data showing that cognitive therapy, for example, and drugs can work equally well in a number of kinds of serious mental health problems, such as major depression. The authors posit a very simplistic model of mental illness, which (ironically) follows Freud's own model, separating serious illness (Freud's psychosis) from simple daily distress (Freud's neurosis). They claim that somatic treatments (drugs, surgery, shock) are more appropriate for the serious category, and that it doesn't matter what we do for the non-serious category. Not only is that kind of clear distinction not entirely supportable, but the overlap of treatments effective with both categories shows that the _treatments_ do not fall into such cleanly distinct categories either.

Giving the effective drugs, surgery, and shock treatments their due, we shouldn't limited by Ofshe and Watters' failure to consider the information processing dimension of human self-regulation. But I think we can certainly heed their admonitions about the fallacies we accept too easily about ourselves. They make a number of good points about how people form beliefs about their own problems that are not only not necessarily accurate but also may not have much to do with effective treatment.

However they dismiss the clear evidence that "simply" how we interpret our situation is actually a factor in mental health. They make the reasonable point that this interpretation can also go astray in a number of ways, without every being particularly therapeutic or accurate, and that is the strength of this book.

20 of 24 people found the following review helpful:

2.0 out of 5 stars The authors create an overgeneralized argument., September 14, 1999

By 

"slwheelock" - See all my reviews

This review is from: Therapy's Delusions: The Myth of the Unconscious and the Exploitation of Today's Walking Worried (Hardcover)

"Therapy's Delusions" is the second critique of the mental health community by the same two authors. The first book, "Making Monsters" was a well-defined argument regarding a specific issue (sexual abuse) and how the psychological community, specifically unqualified therapists, had become negatively influenced by cultural myths and fears.

"Therapy's Delusions" is their attempt to critique the entire field of psychology, or what they refer to as "talk therapy". The argument is overgeneralized and not well-defined. There are many forms of therapy, a multitude of illnesses and many different types of therapists. The authors do not attempt to explain differences, but rather make blanket statements which are often inaccurate and are used to mislead the reader. For example, they discuss the 'myth of the unconcious' and 'psychoanalysis' as if they are an integral part of the current treatment of mental illnesses... which, in reality, may be considered historical ideas and for the majority of clinicians are not a significant part of treatment of major mental illnesses in the late 1990's.

While the authors make very compelling statements that incite anger towards the mental health community (e.g., the need for scientific research rather than just 'intuition'), their logic and argument is so generalized that it is unclear where the anger could be most effectively directed to cause change. For example, they discuss the merits of understanding the biological underpinnings of mental illness & the necessicity of rehabilitation therapy. They refer to these as if they have found the panacea for "cures". The majority of the psychological community have long realized the strengths of understanding the importance of biology, medication, and rehabilitation. However, they do not offer cures as the authors state. Major mental illnesses are very complex and are still being studied. Often medication offers stabilization, not cures.

The authors inaccurately attempt to make arguments and relationships between major mental illnesses (e.g., schizophrenia, psychotic disorders, major depression) and other reasons people enter therapy (e.g., marriage conflicts, loss issues, personal growth). They misguide the reader to believe that therapy approaches these difficulties with similar treatments (e.g., their focus on Freudian psychoanalysis is an example of their ill-defined argument and lack of knowledge of the variety of treatments).

Overall, the authors have attempted to critique a very broad field and ignored the differences that are a part of the field. The generalizations used could definitely mislead readers who have no other knowledge regarding the issues addressed in this book. When reading this biased argument, readers need to realize that the authors have taken their biases and painted over all the issues to the point that they have lost any valuable and logical argument. Rather, their attempt has clarified their agenda to discredit the mental health and psychological community based on generalizations, misinformation, and ignorance.

11 of 13 people found the following review helpful:

5.0 out of 5 stars A challenging and important critique of psychotherapy, August 11, 1999

By A Customer

This review is from: Therapy's Delusions: The Myth of the Unconscious and the Exploitation of Today's Walking Worried (Hardcover)

This book forced me to rethink many ideas about psychotherapy and even 20th Century culture. Calling for increased accountability for psychotherapists, the authors document how psychotherapeutic techniques have damaged mentally ill individuals. They also present the process of psychotherapy as one of manipulation and delusion - storytelling that deliberately encourages the confusion of fiction with fact.

A critique focused on behalf of mentally ill and so-called "walking worried" individuals, Therapy's Delusions may prove difficult for functional people in crises (the walking wounded?) who need no reminder of the complexities of the human mind. Compelling, and challenging to many 20th Century assumptions, the book raises fascinating questions, for example whether it's a fool's game for humans to even attempt to understand themselves.