BOOK REVIEWS

Is psychotherapy a social anaesthetic?

Wahbie Long

Child Guidance Clinic. University of Cape Town. Cape Town

Madsen, Ole Jacob (2014) The therapeutic turn: How psychology altered Western culture. London: Routledge. ISBN 978-1-138-01869-3 pbk. Pages viii + 194

Moloney, Paul (2013) The therapy industry: The irresistible rise of the talking cure, and why it doesn't work. London: Pluto Press. ISBN 978-0-7453-2986-4 pbk. Pages 256

Ole Jacob Madsen's The therapeutic turn and Paul Moloney's The therapy industry offer arguments that, although different in their methods, draw the same conclusion - that mainstream psychology cannot account meaningfully for human subjectivity for as long as it continues to ignore social theory. Both books belong to a growing body of critical scholarship on psychopathology and psychotherapy, while going further than the standard reformist works such as Allen Frances' Saving normal or Gary Greenberg's The book of woe. Indeed, Madsen and Moloney's interventions are not only empirical, they are clearly political. Their contributions are also eminently readable, their democratic, unencumbered prose in keeping with their progressive-radical values - which is more than one can say of the French poststructuralists and their special brand of slow torture.

A largely descriptive work, The therapy industry advances two central claims: first, that psychological suffering has social determinants, and second, that psychotherapy - since it tends to overlook this basic fact about mental illness - proves largely ineffectual. There is nothing novel about either of these points. Origin-diving notwithstanding, Moloney's mantra that "suffering is social" (p 113) is an observation that can be traced back through generations of socially-minded psychoanalysts (Joel Kovel, Marie Langer and Erich Fromm are just some of the names that come to mind), and even to Freud himself. As for reservations regarding the efficacy of psychotherapy, such formulations have done the rounds for decades in the form of influential critiques by Hans Eysenck, Jeffrey Masson, James Hillman and many others. What is novel about Moloney's twin propositions, however, is that they still have not found a way into the heart of the discipline.

The therapeutic turn explains why. In this largely sociological account, Madsen frames the emergence of therapeutic culture as a substitute for the displaced wisdoms of religion, making it an indispensable feature of (late) modernity. But given its complementary relationship to a now hegemonic neoliberal rationality - Madsen defines the neoliberal ideal as "You shall govern yourself" (p 109) - the ideological bias of the therapeutic ethos is obvious. Conditions in the external world become attributable to the condition of one's inner world as structurally oppressed people come to be blamed for their own subjugation. For Madsen, unfortunately, the situation is irremediable as psychology is constitutionally incapable of auto-correcting. Blind to its own ideological impulses, the situation within the general discipline is comparable to that of an untreatable patient with an ego-syntonic disturbance.

Nonetheless, Madsen underscores the importance of what C Wright Mills once called "the sociological imagination": "the ability to shift perspectives back and forth between the political and the psychological" (p 170). Moloney does the same, recommending the "social-materialist psychology" of David Smail in which the cultivation of "outsight" into the external world becomes a necessary corrective against the obsession with insight into the workings of the internal world. In effect, both books return the reader to one of those never-ending debates in the discipline, namely, the individual-social divide, the reconciliation of which remains, surely, the grandest theoretical and practical challenge in all of psychology.

Madsen and Moloney come close to endorsing a Marxist psychology but, perhaps at pains to avoid a torrent of recriminations, stop just short of doing so. Citing The German ideology, Madsen confirms the Marxist pronouncement on the material determination of consciousness, observing that psychology's diametrical opposition to "this radical point of departure [is evidence of] a conservative bias in favour of the status quo," yet forswearing "the necessity to embrace Marxism" (p 164). For his part, Moloney affirms Smail's social materialism but uses the word "Marxism" just once in his book - in a quote from Orwell. "If only we are willing to listen" (p 179) is how Moloney chooses to introduce the quote, and that is about as far as he is willing to go.

Marxist theory's pariah status is understandable, being in part the result of "really existing socialism" or, more pointedly, "the problem of Stalin". But Marxism has fallen out of favour for other reasons too. The rise of postmodernism was a major factor - Fredric Jameson calls it "the cultural logic of late capitalism" - as the academy proceeded to demote the question of class, first through the discursive turn, now via postcolonial theory and other iterations of identity politics. And yet, despite the popularity of these anti-universalist and anti-humanist forms of theory and practice, a growing awareness of worsening global inequalities is facilitating a return to more materialist accounts of human functioning. In the case of psychoanalysis, for example, Lynne Layton (2004) concedes that relational psychoanalysts - who represent perhaps the most politically progressive school in psychoanalysis today - are guilty of the same error committed by most psychotherapists, namely, the psychologization of patients' social-material worlds. Similarly, in her new book Joanna Ryan (2017: 171) attests to the importance of "speaking class to psychoanalysis". Madsen - rightly - never underestimates the scope of the challenge, but his repudiation of psychology as a force for social change seems a little premature.

To be fair, neither he nor Moloney give up on the discipline entirely; both, after all, are trained clinicians. But they leave the reader - the clinical reader in particular - with the unanswered question of how to proceed in the consulting room, today. Then again, Erich Fromm never answered the question either - not anywhere in The sane society, at any rate - and nor do most other critics. Presumably, this is why Madsen feels it necessary to defend himself against the retort, "What is the alternative?" (p 155), the lack of which he explains as "a general theme that is connected to the postmodern era as a whole and to late capitalism in particular, which has neither a clear exterior nor a clear alternative" (p 156).

That is as good an answer as one can expect, although the early history of psychoanalysis does offer some pointers too. Russell Jacoby (1983), and Elizabeth Danto (2005) describe how a concatenation of social and political processes galvanized the social conscience of a generation of psychoanalysts in Berlin, Vienna, Budapest, London and Chicago. Specifically, it was the European youth movement, the Great War and the postwar revolutions that bequeathed to the second generation of analysts - among them Otto Fenichel, Edith Jacobson and Wilhelm and Annie Reich - their most formative experiences. In Red Vienna and Weimar Berlin especially, progressive social reforms provided the backdrop against which this generation pursued the ambitious project of a genuinely social psychoanalysis. They gave concrete expression to the radical potential of psychoanalysis - until the Nazis put an end to their compelling social vision.

Of course, psychotherapists of the twenty-first century inhabit a rather different world. If there is anything to be learnt from this relatively neglected episode in the history of psychoanalysis, it is that a facilitative milieu is essential for the development of socially responsive theories and practices. For now - since there is no telling how many crises capitalism will yet survive - Marie Langer's example is possibly the best there is on offer: assist patients to distinguish between aspects of their suffering that are socially rather than personally determined, and build class consciousness through the appropriate conduct of group work. Such advice will make sense to practitioners who have an understanding of the world beyond psychology; for those who do not, Madsen refers the reader to Aldous Huxley's Brave new world and its allegory on the dangers of specialism.

Both The therapy industry and The therapeutic turn are essential reading. Their contents will appeal to senior psychology undergraduates as well as practitioners, while Madsen's contribution will also be useful to historians, sociologists and critical psychologists. Both books can be read independently, although they do complement one another superbly, explaining to readers what has gone wrong with psychology, and why. Whether they can slow the scientism that has overrun the discipline today, however, is a different matter altogether.

References

Danto, E A (2005) Freud's free clinics: Psychoanalysis and social justice, 1918-1938. New York: Columbia University Press.         [ Links ]

Jacoby, R (1983) The repression of psychoanalysis: Otto Fenichel and the political Freudians. Chicago: Chicago University Press.         [ Links ]

Layton, L (2004) Dreams of America / American dreams. Psychoanalytic Dialogues, 14(2), 233-254.         [ Links ]

Ryan, J (2017) Class and psychoanalysis: Landscapes of inequality. London: Routledge.         [ Links ]