Book: Serious Shopping: Essays in Psychotherapy and ConsumerismBMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7297.1310 (Published 26 May 2001) Cite this as: BMJ 2001;322:1310
Ed Adrienne Baker Free Association Books, £15.95, pp 220 ISBN 1 85343 483 3
I have often wondered whether the BMJ should have a fashion column for doctors, giving tips on where to buy the latest in hospital chic. I was therefore thrilled to review Serious Shopping. Sadly, it is anything but a clarion call to Claridges. Instead, it attempts to establish shopping addiction as a major mental health problem and to describe its psychotherapeutic treatment. Shoppers can thus join the long list of addicts—gymaholics, dot.comaholics, sexaholics—initially identified by a media apparently addicted to identifying addictions.
The figures quoted by the lead author for the prevalence of shopping addiction—up to 10% of the population—would rank it along with alcohol and drug dependence and indicate a severe and enduring mental illness that is largely ignored by psychiatry. Although it is feasible that psychiatrists, being overworked, have ignored the condition through a vested interest in controlling their workload, it does seem odd that a troubled public is not clamouring for action.
The case for shopping addiction rather crumbles when the evidence is examined. The definitions of addiction used by the various authors are rarely explicitly defined but seem to be so broad as to stretch from “dysphoric repetitive shopping” at one end to the DSM-IV style “dependent shopper” at the other. The research base for a putative new disorder should be robust. The evidence presented here is based largely on results from questionnaires of unclear validity and reliability with low response rates from self selected samples. There is one piece of good qualitative research and ample case studies, but, though insightful, they aren't exactly sound epidemiology.
Progress in the treatment of addictions and dependence has been characterised by eclecticism and a multidisciplinary approach. A compulsive gambler is unlikely to benefit from cognitive-behavioural therapy if homeless and clinically depressed. It is disappointing to read the claim in this book that shopping addiction can only be treated “within an approach in which the therapeutic relationship is a pivotal part of the process.” The claim is untested, much evidence suggests it is wrong, and it is unlikely to encourage incorporation of psychotherapeutic approaches into the treatment of addiction in the public sector.
The psychotherapeutic tradition can, however, claim to be pivotal in its contribution to understanding the inner reality of the patient. Shopping is described variously as a futile struggle to fill a “cavernous emptiness” stemming from an early inadequate relationship with parents, as a tool for punishment or revenge in the complex interplay of human relationships, or as a strategy to deny our “primordial anxiety” of the reality of death (“I shop, therefore I am”).
Given the richness of these theories, it is perhaps unsurprising that an operational definition of shopping addiction is eschewed. While this approach certainly gives an impression of the phenomenological range of the “psychopathology,” it doesn't give the reader a feel for its magnitude or public health importance.