Intended for healthcare professionals

Book Book

Manufacturing Victims: What The Psychology Industry Is Doing To People

BMJ 2000; 321 doi: (Published 07 October 2000) Cite this as: BMJ 2000;321:902
  1. Raj Persaud, consultant psychiatrist
  1. Maudsley Hospital, London

    Tana Dineen

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    Constable, £14.99, pp 332 ISBN 0094797900

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    Distinctions between terms such as psychotherapist, psychoanalyst, psychologist, and psychiatrist frequently ensnare preliminary discussions of mental concepts, and such disorientation extends to popular books like this. The subtitle, “What the psychology industry is doing to people,” is misleading as the real reference should be to psychotherapy or counselling and not the entire academic discipline of psychology, which includes many non-therapy branches such as developmental and comparative psychology.

    For a huge amount, if not most, of psychology has absolutely nothing to do with therapy. So the effect of the book's albeit justified criticisms of therapy would be akin to a psychiatrist mounting an attack on the whole of clinical medicine based solely on the sins of psychiatry. What is even odder about this thesis is that it is precisely within university departments of psychology that the evidence questioning the efficacy of psychotherapy and counselling is assembled. So to “frame up” psychology for the crimes of a linked field, private practice psychotherapy, seems unnecessarily offensive to the whole discipline.

    Certainly in the United States, the scene from which this book originated, the career of private practice psychotherapy is much more developed than it is elsewhere. Many more US school leavers take up psychology courses with the glint of the couch already in their eye than do their peers anywhere else in the world.

    But Dr Dineen's case histories are drawn from patients convinced that they need hypnotherapy to access their unremembered childhood satanic ritual abuse or those who demand healing for their “wounded inner child.” These anecdotes seem to illustrate the problem of psychobabble, as disseminated mainly by those without a good training in the science of psychology. The solution is to spread good university psychology training not strangle it.

    Also, if a book's references betray an author's influences then most here are to self help, pop psychology books with titles like You Can't Say That to Me! and I'm Dysfunctional, You're Dysfunctional. To tar psychology with these brushes seems unfair, but perhaps Dineen faced a genuine problem in what to designate the target of her attacks.

    She is right to draw attention to the growth of victim culture (she quotes figures that, by 1995, 46% of the US population had seen a mental health professional), but the basic problem is an ancient and universal one: who should decide what level of suffering really needs professional intervention? Clearly self referral in any private practice environment promotes exploitation, as clinicians prey on those who don't really need expert services, and the more professionals that qualify, the harder they work to generate more demand for their services.

    But, for all its well argued criticisms, this book is weak on proposing positive solutions. Ultimately it highlights the need within psychotherapy for a system rather like the relationship between British general practice and hospital medicine—that is, professionals acting in a gatekeeper role to assist lay people in deciding whether they really need specialist intervention.

    The problem for the professions of psychology and therapy is that they have yet to evolve a similar role to the general practitioner within medicine. But the paradox is that, should they do so, this would be yet another step towards a world where everyone has not only a doctor and a dentist but a psychologist as well. That day may be closer than is realised, if the rest of the world continues to follow the United States in cultural trends.

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