[ Medical School Resources | Appendices | Discussion ]
"So much of what is called 'mental illness' is really a consequence of our troubled society - one that promotes loneliness and conformity in a world whose gods are money and power." - Patch from his latest, House Calls
From "The Futility of Psychotherapy," a revolutionary article published 1990 in the Journal of Mind and Behavior:
Nowhere is the futility of psychotherapy as obvious as among the poor and powerless whose suffering, crowding, and despair will yield only to social and political solutions.... Psychotherapy is an expensive oddity to the poor, but their taxes will help the affluent obtain prepaid care.
Changing the incidence of emotional disorders will require large-scale political and social changes affecting the rates of injustice, powerlessness, and exploitation, none of which is affected by individual psychotherapy.... It does not seem to matter whether or not mental health benefits are available to... 'blue collar'... or 'no collar' people. They do not find therapy available, appropriate, or understandable. Auto workers with coverage for mental health benefits do not use them and the poor, like the migrant farm workers without benefits, are not even aware of them....
It is clear that psychotherapy is restricted largely to segments of the middle and upper classes while the most serious mental and emotional disorders are more prevalent among the poor. The likelihood of migrant farm workers or homeless people receiving psychotherapy is about the same as the likelihood that they will receive artificial hearts or liver transplants: zero.
Neurotic anxiety is less common among the poor who exhibit 'reality anxiety.' The real problems of poverty, unemployment, homelessness, exploitation, powerlessness, discrimination, poor housing, etc., are more urgent than interpersonal relationship problems or guilt over impulses.... Only with radical social changes leading to a just society will there be a reduction in the incidence of emotional problems.
Psychotherapy is a window on the damage done to the children by uncaring thoughtless, hostile or disturbed parents, and the damage done to everyone by a social system that encourages mindless competition.... Psychotherapy often reveals the human effects of an economic system that produces jobs of incredible boredom and meaninglessness and that periodically throws out of work millions of people that want to work.... One out of four preschool children in the United States are poor....
Only when the findings of psychotherapists are translated into well-formulated preventive actions to correct or change the social and economic structure will it have made a significant contribution to prevention. But most therapists, like most professionals in other fields, have a major stake in defending the social order, not attacking it.
Therapists get gratification from their high social status, their generous income, and their satisfaction with seeing the positive results of their efforts in many clients. If therapists also face and accept the fact that they are having no effect on incidence - that not being part of the solution defines them as being part of the problem - and choose anyway to continue, they may not merit our unqualified admiration, but at least we can respect them for their honesty.
Psychotherapy is not unique in this regard; the same applies to the rest of medicine. See Appendix 46b .
 Adams, P. House Calls: How We Can All Heal the World One Visit at a Time San Francisco : Robert D Reed Publishers, Oct. 1998.
 Albee, GW. "The Futility of Psychotherapy." Journal of Mind and Behavior 11(1990):369-384.
The efficacy of psychotherapy is still debated; a review of numerous studies on the efficacy rate of psychotherapy have failed to show it to be more effective than spontaneous remission or placebo treatment (Eysenck, 1994).
Eysenck, H. (1994). The outcome problem in psychotherapy: what have we learned? Behavior Research and Therapy. 32, (5): 477-95.
This article is a meta-analysis of previous empirical research re: a widely ambiguous field (esp. its goals and outcomes). Eysenck could be thought of as one of those "dissidents" often ridiculed for his "radical" ideas. His research, among other things, made me re-think my early-college career aspirations. This book (Heart Failure), however, makes me enter my first semester of Physician Assistant training with trepidation and possible regret (and has made me put more effort into finding a job with truer ties to social justice). I guess while we're at it, if anyone has any suggestions for a guy with a Bachelor's in psychology / neurobiology (and a strong interest in audio engineering), please contact: firstname.lastname@example.org Thanks!
-- Patrick Klem, December 22, 2001