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Book Reviews   |    
Mind Games: Are We Obsessed With Therapy?
Reviewed by Robert Racusin, M.D.
Psychiatric Services 1998; doi:
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by Robert A. Baker, Ph.D. ; Amherst, New York, Prometheus Books, 1996, 477 pages, $29.95

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The exposé, in its various literary and journalistic forms, has long been a feature of American culture. Tenacious investigative reporting and careful attention to uncovering the truth by reformers from Upton Sinclair to Ralph Nader have had a profound and positive impact on social policy. Another niche occupied by this same genre is the entertainment offered by the supermarket tabloid, whose "revelations" appeal mostly to our wish to be titillated but rarely run the risk of being taken seriously by more than a few.

However, another, more problematic, type of exposé has superficial similarities to the work of serious social reformers but bears more resemblance to tabloid journalism in its use of hyperbole and exaggeration. Mind Games, unfortunately, is such a book.

This outcome is particularly disappointing because the author has focused on an area that deserves to be discussed critically, the plethora of unproved psychotherapies that have become the domain of incompetent and unethical practitioners. Rather than confining his topic to the abuses and misuses of psychotherapy, however, Dr. Baker has decided that all psychotherapy is potentially dangerous because it is used primarily as a tool of the "Psychotherapeutic State," a conspiracy that, under the leadership of psychiatry, seeks to "manage every aspect of our social lives" by creating "a nation of whining, self-pitying, irresponsible `psychiatric-drug' and `psychotherapy' addicts totally incapable of living free, independent and spontaneous lives."

What follows are 400 pages of sweeping and largely unsupported statements that become the "facts" used to prove that this conspiracy exists and that physicians in general, and psychiatrists in particular, are arrogant, greedy, and interested primarily in imposing their "god-complex" on their patients. To make matters worse, according to Dr. Baker, the illnesses that psychiatrists and most other therapists treat are not illnesses at all. He dismisses schizophrenia, depression, and anxiety disorders, among others, as "emotional problems not biological or medical problems." Cartesian dualism is apparently alive and well.

Almost lost in the polemics about the evils of psychiatry are two important points. First, there have always been, and probably always will be, charlatans eager to take advantage of human misery by offering magical cures, instant relief, and the secret to living happily forever. Many of these swindles have been promoted as "psychotherapy," which leads to the author's second valid observation. As consumers of mental health services, we must be vigilant and demand information about efficacy, safety, and alternative treatments. He is also correct that mentally ill people can do a great deal for themselves, including avoiding self-destructive lifestyles, becoming involved with helping others, and developing their own support networks.

However, these sensible ideas, which could have been the basis of a very useful book for patients and families, are overridden by another message that reappears throughout, namely that those who do seek professional help are probably themselves to blame for not trying hard enough. It seems that one of the "freedoms" that the author is inadvertently insisting on for the victims of the "Psychotherapeutic State" is the freedom to continue to suffer from the symptoms of untreated mental illness.

Dr. Racusin is associate professor of psychiatry at Dartmouth Medical School in Lebanon, New Hampshire.

Dr. Racusin is associate professor of psychiatry at Dartmouth Medical School in Lebanon, New Hampshire.




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