by Izzy Kalman (December 2007)Are you a mental health professional? If so, you probably became one because of idealism. You wanted to help people solve their problems and become happier (and maybe figure out how to solve your own problems in the bargain!) And do you feel disillusioned? Have you discovered that helping people (and yourself) in the real world is not as easy as you learned in university?
The goal of the mental health sciences is to help people become happy and get along with each other. And we seem to be getting nowhere. A higher percentage of people are taking psychiatric medication for anxiety, depression and behavior problems than ever before. The country has legions of licensed Marriage and Family Therapists, yet the divorce rate remains around 50%. The divorce rate among the therapists themselves is probably no lower than among the general population. The majority of couples going to marriage counseling with the hope of saving their marriages end up getting divorced. Despite eight post-Columbine years of massive efforts to reduce bullying, bullying is said to be escalating in the country and schools are having to pay millions of dollars at a shot to parents who sue them for failing to stop their kids from being bullied.
Every other field of science has had the most amazing accomplishments. They sent men to the moon. They mapped the human genome. They developed medicines that enable people with AIDS to live an almost normal life. They split the atom. Why can’t we have the same levels of success that carpenters and plumbers and farmers and electricians and dentists and biologists and physicists have in their professions? Despite endless research and programs, why are we still trying to figure out how to get people to be happy and to get along with each other?
There is no good reason that the mental health sciences shouldn’t have had more success in promoting emotional and social well-being. The paths to happiness and harmony have been known for thousands of years. But to advance these paths, the mental health sciences need to be saved from a bias that has blinded them in recent decades–a bias so pervasive that no one is aware of it though it is right under our noses. And it is this bias that has veered us away from the road to advancing mental health.
Before I continue, I want it to be clear that people aren’t intentionally biased. Everyone honestly believes they see objectively. However, people, including scientists, cannot see their own biases. They are not being stupid or evil. They are simply being blinded by their biases. Someone else is required to reveal our biases to us.
Clues to the bias
I have never seen this bias identified anywhere else, though others have had an inkling of it and clues can be found elsewhere. A year-or-so ago, Psychotherapy Networker magazine (sorry, I can’t locate the issue) carried an article about their recent annual convention, attended by about 3,000 mental health professionals. That convention featured the old guard of psychotherapy, the greatest living psychotherapists that are still able to speak. The article said that these pillars of psychotherapy are disappointed by the lack of progress in the field of psychotherapy, with their general complaint being that the field has become “bureaucratic.” The article gave no other explanation for this–only a one-sentence statement about the field becoming bureaucratic.
The most recent issue of Psychotherapy Networker (November/December 2007) contained an article called The Accidental Therapist, by Mary Sikes Wiley, eulogizing the great Jay Haley on his recent passing. It spoke of the influence on Haley of Milton Erickson, one of the most highly revered and revolutionary therapists of all time. Wiley writes, “These days, a therapist as freewheeling as Erickson would give the risk-management industry a collective stroke.”
“Bureaucracy.” “Risk-management.” What do these things have to do with hampering the progress of mental health? The answer is that they both are related to the bias I will be revealing in this article.
Revealing the bias
To lay the foundation for recognizing this bias, I’m going to ask you a few questions.
1. To which discipline do the mental health professions belong? A. Law B. Science
2. Which discipline is more likely to reflect objective reality? A. Law B. Science
3. A professional has just told you to do something, and you immediately obeyed. Of the following two, which professional is it more likely to have been? A. Law enforcement officer B. Mental health professional
Chances are you answered “B” on items #1 and #2. Though mental health professionals are often involved with the legal system, we consider ourselves practitioners of science. Science is concerned with understanding objective reality. Science is supposed to stubbornly search for ultimate truth and should not be afraid of its discoveries.
Law, on the other hand, is an artificial product of human beings. Governments of people make rules called “laws” they hope will help the man-made social organization function. Governments may try to be objective when they pass laws, and they may look to science to help them with their decisions and judgments, but law is ultimately a man-made field directed by the subjective political interests of the people in power.
What did you answer for item #3? Probably “A”.
In terms of objective truth , science is a higher-level discipline than law. However, when it comes to influencing our actual behavior, law is on top! Newspapers, radio and TV bombard us daily with fresh scientific studies documenting the dangers of fast food, but gun-toting police officers will do nothing to stop you from eating three meals a day at McDonald’s, Taco Bell and Dunkin’ Donuts. Your body will ultimately pay the price, as will the family members and others who depend upon you. But government gunslingers will protect your freedom to ruin your health at these fast food establishments.
On the other hand, get caught running a red light at a deserted intersection, or choosing to have your mood altered by peace-enhancing marijuana rather than aggression-enhancing alcohol, and those same gunslingers will swoop down to fine you or put you in jail.
And this is the bias I’m referring to: THE LEGAL BIAS. Our thinking and behavior as mental health professionals is supposed to be guided by science, but once the law is involved, obeying the law comes first. If you have to make a decision between doing what you believe is scientifically correct or doing what’s legal, you had better do the legal thing or you’re going to get in trouble.
Why don’t we see through this legal bias? Because we don’t want to! It would threaten our livelihood. Who pays our salaries? More and more, it’s the government. Almost all mental health research is government funded. Mental health in schools is paid for by the government. Much psychological treatment is funded by the government or regulated by the government. As a result of Columbine, our government spends hundreds of millions of dollars a year on anti-bullying research and programs.
The government’s immediate concern is the safety of its citizens. However, there is a big difference between promoting mental health and promoting safety. Safety can be legislated to a large degree, but mental health can’t. Laws can take away people’s incentive to do things that hurt others, but no law can force people to become emotionally healthy.
It is impossible to grow emotionally if all we experience is safety. We would grow up being emotional marshmallows, unequipped to deal with difficulty. The experience of danger and adversity are necessary for the development of emotional strength and maturity. But because the psychological sciences are subservient to the government’s safety agenda, we have the absurd situation today of the psychological professions simultaneously trying to figure out how to increase children’s resilience while striving to create a school environment that is completely safe, meaning, an environment that deprives children of the conditions needed for the development of resilience.
So, from the combined factors of 1) fear of getting in trouble with the law and 2) our salaries ultimately being paid by the government, we devote our energies to the goals of the legal system instead of promoting objective truth. The government wants schools to be free of bullies, so we treat bullying like a crime and become anti-bully policemen while stubbornly ignoring the psychological research that shows that this approach is ineffective and often results in increased bullying.
The government dictates that marijuana must stay illegal, so we ignore the overwhelming body of scientific research that shows marijuana to be a safer and more benign substance than alcohol, and you therefore won’t find any mental health organizations advocating the legalization of marijuana.
The government passes a No Child Left Behind (NCLB) law, so our school psychology organizations ignore the endless evidence that this law is hurting education, and continue to promote NCLB.
The government, wanting to reduce violence in society, allocates million of dollars a year to research on violence. So our social scientists, failing to figure out how to actually reduce violence, blame the violence in society on entertainment. They design countless experiments hoping to prove that violent entertainment causes violence in real life, despite statistics showing that violence in society has been decreasing during the same period that violent entertainment has been increasing, and despite the simple observation that people don’t violently attack each other after indulging in violent entertainment.
The government mandates prison time as standard punishment and continues to build more prisons, even though prisons ultimately result in more crime. But you won’t see mental health organizations lobbying for dismantling of prisons.
The government embarks on a mission to promote ethnic diversity, so we make sure that every one of our programs “promotes diversity,” despite the fact that after two decades of intensive promotion of diversity our schools and neighborhoods are as racially segregated as ever.
We are a nation of cowards, afraid to lose our jobs or get in trouble with the law. Our allegiance is first to the law and only secondly to science, so we blindly support the law regardless of any damage the laws may be doing.
How the legal bias hinders mental health
You may wonder, nevertheless, how can the law actually hinder mental health? Permit me to explain.
There is a fundamental difference between the psychological profession and the legal profession. If I am a psychotherapist and you are my client, my job is to get you to take responsibility for your problem and lead you to a solution. If I hold someone else responsible for your problem, how can I possibly help you? I have to work with the other person and make them change.
On the other hand, if I am a lawyer and you are my client, my job is to hold someone else responsible for your problem, and let’s go sue them and make them pay. If I am your lawyer and I am holding you responsible for the problem, you should fire me and get yourself a good lawyer.
So these professions are diametrically opposed. The psychological profession is supposed to increase clients’ responsibility for their problems, while the legal profession takes responsibility away from clients and puts it on someone else.
But the only person who can make you happy and have good relationships is you. The government cannot provide you with happiness, and the government cannot force people to like you, respect you, and want to be nice to you. All the government can do is punish people when they are not nice to you. So that is a fantastic way to have good relationships: the government is going to punish us whenever we are not nice to each other!
And this is what happens when we take a legal approach to mental health. We fight for laws requiring the government to protect us from each other and to solve our problems for us. We stop seeing people as responsible for their social and emotional problems and think in terms of victims and abusers/bullies/offenders. Victims, of course, are innocent and can’t be held responsible for the problem. Instead, we blame abusers/bullies/offenders and try to make them change. The problem is that when you talk to abusers/bullies/offenders, they also present themselves as victims! So it becomes awfully hard to help our clients when the problem is always somebody else!
I can’t tell you how many times I’ve heard people in therapy tell me things like, “My therapist explained to me that my mother is bipolar/ my spouse is a bully/ my father is narcissistic.” Usually, the therapists make these diagnoses without ever meeting the “pathological” relatives. They make the diagnoses purely on the subjective information presented by the suffering clients. And I increasingly see this phenomenon of blaming in the professional literature as well. “Her husband was a bully,” is commonly popping us as a convenient explanation for the client’s marital problems. It sure makes the clients feel better because now they have someone else to hold responsible for their misery, and it means they don’t have to change because they are the good guys. It does nothing to help the clients get along better with their mothers/spouses/fathers, but it relieves both the client and the therapist from the need to do anything to repair the relationships. In fact, clients are often advised by their therapists to distance themselves from these “disturbed” relatives.
And that’s why so many people who go to marriage counseling end up getting divorced. The therapists tell them, “No one has a right to abuse you in any way,” (which is legal advice; “rights” are not a scientific concept, but a legal one) and that “You should not tolerate anyone abusing you!” So of course the clients become even more intolerant of their spouses’ abusive behavior and end up divorcing them.
How we brought this upon ourselves
Oddly, we have brought this state of affairs upon ourselves, and in two ways.
One way is by lobbying for laws against abuse/harassment/ bullying. Over the decades, the mental health professions have discovered that it’s not so easy to help victims. We do therapy with victims and counsel victims, and they continue to be victimized. So we figure, “But why should the victim have to change? The victim is the good one. Their problems are caused by abusers/bullies/offenders. Let’s promote mental health by fighting for laws against abusive behavior!”
But once we invite the law to help us, the law takes over. It makes the rules, telling us what we should do and how we should do it. In recent years, the mental health organizations have been requiring their members to take professional ethics courses, usually given by lawyers. In a recent issue of Psychotherapy Networker (July/August 2007), psychologist Ofer Zur, in an article called The Ethical Eye, shows how following the dictates of the lawyers actually often prevents us from giving our clients the help they need. And that’s what Mary Sikes Wylie meant about Milton Erickson: he could get in legal trouble today for using his groundbreaking techniques.
Another thing that happens when we combine law with psychology is that psychology stops being scientifically objective. Science recognizes that everything affects everything else. Psychology understands that if people treat us badly, our behavior has something to do with it. But we have replaced science with law, and instead of regarding everyone as responsible for their role in relationship problems, we think in terms of innocent victims, who have nothing to do with the way they are treated, and guilty bullies/abusers/offenders, who are the ones in need of punishment and/or therapy.
And in case you haven’t noticed, making abuse/harassment/ bullying illegal does not make it disappear. It would be wonderful if we could get rid of psychological problems by making them illegal. We wouldn’t need the mental health professions! Just pass laws and create Utopia! Rather than solving problems, these laws create new classes of criminals, and change who we deal with. So today, instead of doing therapy with victims, we are trying to do therapy with abusers/bullies/offenders. And you know what we discover? It is not so easy to help them either! “They are personality disordered,” we declare. “They have no conscience!” “It is very hard to help bullies/abusers/ offenders!” But our conscience feels better failing to help evil bullies/abusers/ offenders than failing to help poor innocent victims.
The second way the mental health professions have replaced science with law is by creating their own bureaucracies, making internal laws (or regulations) that control the way their members practice. This has become especially important to the professions since insurance has become the major funder of mental health services. Because most therapy and social/educational services today are paid for by the government, or by insurance companies that are regulated by the government, the mental health organizations enhance their power by obtaining the government’s approval to be the sole determiners of who is entitled to work in their profession and earn this government-controlled money. The professional organizations even battle each other over the right to get the government money. If you are a school psychologist, you may be aware of the current desperate battle of the National Association of School Psychologists (NASP) against the American Psychological Association (APA), which has presented the government with its Model Licensure Act. This Model Licensure Act would prevent the great majority of NASP members from calling themselves “school psychologists” and would limit the services they are allowed to provide, while transferring these services to the domain of APA members. The APA, which fervently opposes bullying, is bullying another professional organization with the help of the US government. How nice!
Our professional organizations don’t want us to get into legal trouble, so they mandate us to take “professional ethics” courses whose true purpose is to teach us to “cover our behinds” rather than actually provide our clients with the help they need. Our organizations tell us what the “best practices” are, even though these occasionally resemble “worst practices.” Our professional organizations insist that we use “evidence based programs,” where evidence is defined as a paper published in a peer-reviewed journal. It doesn’t matter that the “evidence” is often a research study showing that the program produced only a mild benefit, while ignoring all the negative effects of the program; it doesn’t matter that we are not talking about a reproducible technological device that can be relied on to perform a specified function, but a “program” that can be no more effective than the practitioner implementing it; it doesn’t matter that the study may be baised and reviewed by peers who all share the same bias; it doesn’t matter that research repeatedly shows that the success of therapy is more dependent upon the personality of the therapist and the quality of the “therapeutic alliance” than on the particular approach the therapist uses. If your efforts fail but you can show that you used an “evidence-based” program, you are covering your behind and reducing your chances of getting in legal trouble.
And this is what the old-timers at the Psychotherapy Networker convention meant when they said the field of psychotherapy has become “bureaucratic.” We have lost our freedom to look for creative, ground-breaking, revolutionary techniques because we don’t want to get in trouble with the government and with our own professional organizations.
In closing, I implore you to ask yourself, “Am I a law enforcement agent, or am I a scientist?’ If your answer is “scientist,” I suggest that you recognize the difference between law and psychology and seek the truth, regardless of the courage it may require. There is a higher truth than government. Take off your legal blinders, and realize that you represent a glorious discipline whose truth is above that of man-made law. This does not mean that we need to dismantle our mental health organizations; they serve important functions. But the organizations should always remember that their purpose is to use science to advance the best interests of mankind and the world, not the dictates of government. We need to encourage freedom and creativity, not bureaucracy.