Book Reviews

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Smail, D. (1993) The Origins of Unhappiness: a new understanding of personal distress. London. Harper Collins.
This book offers the first comprehensive description and elaboration of David Smail’s environmentalist theory of psychological distress. The writer is a clinical psychologist, and he describes this approach as being founded upon observations derived from several decades of clinical experience within the NHS, as well as upon the sociological and critical mental health literatures. As such, the writer’s perspective may mirror the experiences of a (generally) less privilleged clientel than that which has informed the development of many of the hallmark therapeutic approaches that are currently in wide use.

Throughout, the author’s focus is on the relationship between social power and the genesis and experience of personal distress. David Smail seeks to show how the workings of "distal"economic power can remorsely distort the functioning of social and political institutions, leading to the abuse of power within the more "proximal" arenas of the community, the workplace, and family life: - and so ultimately resulting in the experience of individual malaise. In a key chapter, Smail demonstrates these processes via a series of composite clinical vingettes collected during the 1980’s. These reflect the surrender of many middle class professions (and the ethical values and practices that they sometimes embodied ) to the free market forces that triumphed in this period. Smail shows how, in most cases, individuals experienced the resulting malaise as an entirely personal failing, rather than the inevitable upshot of the malign situations in which they suddenly found themselves.

In the context of the practice of psychotherapy and counselling, the author suggests that a smoothly functioning but inequitous social system will require that people be schooled into blaming themselves for their ills. A task which may have been well performed by most of the mainstream talking therapies - though almost always without the awareness of their practitioners. Indeed, Smail argues for a fundamental re-think of the process of psychological therapy. He suggests that, paradoxically, practitioners of the latter may need to more overtly recognise its limitations, and to become much more concerned with helping people to make changes to the world in which they live. This is a task which the author also recognises to be an extremely difficult one in practice, and in the long run, much more about politics than it is about psychotherapy.

This book is highly reccomended for its wide theoretical scope, and for its compelling exploration of the (mainly detrimental) workings of social power within the lives or "ordinary" people.
Paul Moloney

Smail, D. (1996) How to Survive Without psychotherpay. London. Constable.
This is a companion volume to "The Origins of Unhappiness". The book builds upon the clinical observations and theoretical insights of the previous volume, in order to offer practical guidance to both the "lay reader" - and to the clinician struggling with the attempt to help distressed individuals whose difficulties may all too clearly reflect the interplay of harmful social and material power on the one hand, and the lack of buffering resources, on the other.

At the outset, David Smail is very clear about the limitations of individual therapy as a form of help. The author acknowledges that therapeutic change may be possible only to the extent to which the individual ia able to access external social and material resourcces. Though even here, it is strongly emphasised that such change may be limited, due to the organically embodied (and thus inerradicable ) consequences of the individual’s past experience. Indeed, David Smail argues that it is both ethically and scientificaly necessary for the practitioner to openly share this understanding with their client. The author perhaps underestimates the difficulty of this task, given the way in which the psychotherapies (and the mental health services in which they are embedded) continue to be widely (though falsely) marketed, as offering well founded and relaible technologies of personal adjustment and change. Nonetheless, David Smail is surely performing a useful service to his wider readership (and to community and critical psychologists) - in suggesting that practitioners should seek to find more ways of openly acknowledging the limitations of psychological therapies as a way of helping people in distress. It is certainly refreshing to read the work of an author who, as a result of many years of clinical experience, is prepared to "say the unsayable" about these very limitations.

Overall, Smail advocates an essentially personal and non-technical approach to helping, in which client and professional draw upon their own experiences and knowledge in order to negotiate a shared understanding of the former’s problems. In doing so, the writer suggests that therapy will have three broad components. These consist in the clarification of the likely nature and origins of the client’s problems, the provision of comfort - or the practitioner’s efforts to empathise with the client’s experiences and concerns, and finally, the attempt to encourage the client to begin to tackle their difficulties through obtaining the necessary powers and resources (where of course this is possible) .

In discussing these issues, the author usefully clears a lot of the conceptual confusion that often surrounds topics like "insight", "will power", "responsibility" and "blame" - all of which, as the author states, lie unacknoweledged, at the heart of most convetional psychotherapeutic approaches. David Smail suggests that a great deal of moral and psychological confusion can be removed - through the recognition that what most people think of as purely internal psychological strengths and weaknesses are really no more than a reflection of the social and material environments in which they have been (and continue to be) enmeshed. It is perhaps debatable whether or not the author quite manages to resolve these complexities, though this is hardly surprising in a book aimed at a general as well as specialist readership, and when it is remembered that the mind- body problem continues to exercise a large chunk of Western philosophy. However, the writer offers useful and pracitical guidance to any one attemptig to help another person who is expereincing psychological distress: espescially in rendering the operation of social power as a concrete factor within the client’s life history and present circumstances. The introduction of the visual device of the pie chart-like "power map" is particularly helpful in this regard (the map has since been developed and used by the Sheffield Psychology Service (cf. Hagan and Smail, 1997) ) .

In conclusion, this book offers a readable summary of the author’s main ideas and their application, it is also an invaluable resource for clinical and community work (offering a bridge between the two), and offers lessons in humility for professionals who claim to possess esoteric knowledge of techniques for personal change.

Highly recommended.
Paul Moloney

Nightingale, D. and Cromby, J. (Editors) (1998) Social Constructionist Psychology: A Critical Analysis of Theory and Practice. Bucs. Open University.
Attempts to explore the idea that dominant discursive trends in social constructionism (and therapies derived from them) have focused excessively on language to the neglect of the material world, embodiment, personal social history and power.

Points the way toward a critical social constructionism which seeks to reintegrate these neglected aspects of human experience. A thought provoking and (for the most part) readable overview of some of the key conceptual and philosophical issues in the field.
Paul Moloney

Pilgrim, D. (1997) Psychotherapy and Society: London. Sage.
Well written historical , philosophical and sociological critique of how - since their inceptioin with the work of Freud - the talking therapies have tended to gaze myopicaly into the individual’s putative interior world - while ignoring the malignities of the real world surrounding the person. Pilgrim covers the main social ineqaulties as they relate to the origins of distress and to the practice psychotherapy (which has of course a strong tradtion of essentially white and middle class values) - including gender, age, ethnicity and social class. David Pilgrim is perhaps more sanguine about the evidence for the possible effectiveness of psychotherapy as a form of treatment than are many other critical mental health writers. Nevertheless, this is a witty, incisive, and sometimes depressing reminder of how often more radical and socially aware approaches to therapy have been marginalised or suprressed, and then forgotten.
Paul Moloney

Pilgrim, D. and Rogers, A. (1999) A Sociology of Mental Health and Illness (Second Edition). London. Sage.
Critical and comprehensive overview of the social and cultural context of personal distress and of the psy professions which claim to manage and treat it. Second edition includes useful chapters on user perspectives on (and alternatives to ) current mental health treatments, and the link between social class position and psychological problems.
Paul Moloney

Prilleltensky, I; Nelson, G. and Pierson, L. (Editors) (2000) Promoting Family Wellness and Preventing Child Maltreatment: Fundamentals for Thinking and Action. University of Toronto Press.
This book offers a broad analytical framework for understanding how stressors and vulnerability factors at the individual, family, community and societal levels may interact to malignly shape the development of children from disadvantaged or oppressed social groups. The book also offers suggestions (based upon research evidence) for interventions at all of the above levels.

A possible limitation is that some authors retain a strong faith in traditional individualised therapy approaches (espescially CBT and other educative approaches) - albeit "suitably integrated" within a community psychology perspective: it seems that the authors cannot easily abandon the idea that beneficial psychological change can only occur through an intial process of working itself into the person’s head. Other writers have of course argued that when it comes to therapeutic change, what counts most is environmental input rather than personal insight.
Paul Moloney

Proctor, G. (2002) The Dynamics of Power in Counselling and Psychotherapy: Ethics, Politics and Practice. Ross on Wye. PCCS.
A thoughtful, wide ranging and clearly written analysis of the meanings of power and its role in therapy. Proctor explores these themes in relation to three approaches: CBT, psychodynamic and Rogerian therapy. Throughout, the author keeps the focus on the link between the person, their history, their social and cultural context, the inequalities associated with these, and the process of therapy itself. In doing so, Proctor shows how limited and one dimensional has been the analysis of power within most psychotherapy (where it has occurred at all) - to date. One possible limitation is that the author ( a radical person centred practitioner) may somewhat over emphasise the abiltity of therapeutic insight - or "power within" as she terms it - to produce significant and lasting psychological change.

A highly reccomended and timely book, nevertheless.
Paul Moloney

Vail, J. (Editor) (1999) Insecure Times: living with insecurity in contemporary society. London. Routledge.
Many worthy critical psychology texts focus on the issues of deprivation and / or social exclusion as key factors in the genesis of personal distress. However, the chapters in this book expand on this view, by focusing upon forms of economic, material and existential insecurity - as they relate to current conditions and social policies in the spheres of housing, income, employment, family life, local communities, and the natural environment. The contributors offer a wealth of evidence to show that while modern life may offer greater rewards and equality in some areas (and for some sections of the population), for many (and perhaps most) it may also be characterised by increasing uncertainty and instability in relation to all of the above. The contributors show how these effects can mutually reinforce one another to eventually undermine the person’s well being.
Paul Moloney

Wilkinson. G. (1996) Unhealthy Societies: the afflictions of inequality. London. Routledge.
Richard Wilkinson draws upon a vast range of comparative and historical data (including economic, epidemiological, anthropological and historical research) - in order to to show that , first, social and health inequalites within industrial societies may be intimately related, and second, that this relationship may be mediated largely by psychosocial mechanisms. The focus of the discussion is mainly on physical health problems and well being. However, Wilkinson does touch upon more overtly "psychological" topics - such as the likely origins of some forms of anxiety , the deleterious psychological effects of rigid dominance hierarchies (or bullying) within organisiations, and the influence of the social and cultural environment upon self esteem and health related behaviours. A strong implication of Wilkinson’s book is that the answer to these problems may lie not within inidividualised therapy - but in wide ranging changes to our community and political life. This volume represents good amunition for anyone who wants to make a strong case for a link between the nature of the social and material environment and personal unhappiness.
Paul Moloney

Barker, P. and Davidson, B. (Editors) (1998) Psychiatric Nursing: Ethical Strife: London. Arnold.
Brings together a range of professionals, including CPNs, Psychologists and Radical Psychiatrists - to focus on some of the ethical and practice dilemmas that face psychiatric nurses and allied mental health workers. CPNs are a neglected profession within the critical mental health literature, and the emphasis on questions of power and social inequality as practice issues is very welcome. Includes a thought provoking chapter on the limitations and potential dangers of a professionaly driven community psychology (as yet another disabling profession from the standpoint of the client) - by a community psychologist (Steve Melluish).
Paul Moloney

Crossley, M. (2001) Rethinking Health Psychology. Bucs. Open University
Crossley looks at the way in which health psychology has tended to individualise notions of illness, health, and health maintenance, while disregarding client views on the latter. Useful discussion of how clients and professionals can become locked in (an often covert) power struggle, over the definition of "good health" and the best means of achieving it.
Paul Moloney

Dallos, S. and Dallos, R. (1997) Couples, Sex and Power. Bucs. Open University
From feminist and social constructionist perspecitves, the authors examine the interplay between power, sexuality and distress within intimate relationships. Good attempt to link the most seemingly personal of issues with gender related strucutural and ideological inequalities. However, despite their trenchant analysis of the social and economic / financial origins of many couple problems, the authors retain an oddly unqualified faith in the ability of couple therapy to ultimately transcend relationship difficulties that, by their own analysis, are strongly rooted in extrnal (and much wider) social and material factors.
Paul Moloney

Davies, D. (1997) Counselling in Psychological Services: Open University Press
A good critical and philosophical analysis of the political and ethical issues encountered by the therapist working in NHS settings (ie. with cllient groups who are usually less than privelleged). The final chapter provides a highly readable (and sympathetic) overview of David Smail’s proposals for an environmentalist psychology. In this final chapter the author raises more questions about the helpfulness of psychological therapy and the role of the therapist than she answers - but she can hardly be blamed for that, and the questions are of course well worth asking.
Paul Moloney

Schmidt, Jeff (2000) Disciplined Minds: A critical look at salaried professionals and the soul-battering system that shapes their lives. Boston. Rowan and Littlewood.
In essence, this book is about the politics of professional qualification and practice. In this compact and well argued volume, Schmidt, an American physicist who was for nineteen years the editor of the international publication, “Physics Today”, draws upon his own experiences of professional training and employment in order to chart the reality of subordination that may all too often lie behind the rhetoric of the autonomous scientist, working at their freely chosen lab bench. While this in itself would be interesting, Schmidt’s claim is that his observations apply far beyond the world of physics to any form of professional labour, that is, to any mode of work in which the end product is the manipulation or manufacture of knowledge. In his introduction, Schmidt notes that he was sacked from his editorial job for admitting that he used time stolen from work in order to complete the manuscript for this book, and despite his being two months ahead of the magazine’s production schedule. It would be hard to find a better capsule summary of the author’s thesis, and Schmidt argues (with some plausibility) that his ousting occurred for political reasons.

There is of course a sizable social science literature on the ideological role of the professions, and it is both a strength and weakness of this book that the author largely ignores this literature.

On the plus side, the book is written in a clear, direct, and often amusing style, assisted by occasional wry cartoons (borrowed from such hallowed sources as the Wall Street Journal), which pay due regard to the pecking orders and absurdities of much professional working life. (Schmidt observes that these publications, aimed at the mediating / executive class, are in fact more attuned to the coerciveness and posturing that are often inherent to office politics than are many erstwhile liberal journals: Schmidt indicates that this has to be so – after all, the managerial class need to have a realistic grasp of what is happening at the bottom of the food chain that they help to control). As a result, Schmidt’s text has a feeling of immediacy and a freshness that would almost certainly escape the writing of an academic sociologist. Indeed, a major strength of the book is that the author is prepared to acknowledge and make use of his own experiences to illumine the world around him. Almost every other page (especially in the first section of the book) offers an arresting social-psychological observation in which a new window suddenly opens upon the taken for granted everyday world. At the same time, Scmidt’s observations strike the reader for the truthfulness, leaving them to ponder (often uncomfortably) upon their own daily experiences both within and outside of the workplace.

For example, in the first chapter, the author describes a change in his habitual daily commute to work, in which he is required to suddenly to board a subway train in an upmarket suburb where many executives and professionals live. Schmidt is struck by the thought that “everyone dressed the same, in suits, sitting silently in neat rows and columns, each holding up a large newspaper, absorbing the same information.” On debarking from the train, the author muses that … “The people who showed the greatest diversity in their dress, behaviour and thought – the non professionals – would be asked to do the least creative work, while the most regimented people would be assigned the creative tasks. This seemed just the opposite of what one might expect. And even more disturbingly, it indicated that people who do creative work are not necessarily independent thinkers” (9 – 10).

Schmidt suggests that ideological discipline is the key to the professions, so that, “whatever the field, the willingness and ability to maintain “correct” [i.e. governmental or corporate] priorities makes the professional.” The author contends that, as a result, professionals in very different fields have more in common with one another in terms of attitudes and values than they do with their non-professional colleagues encountered daily within their own field of work. Schmidt suggests that it may therefore be easier for a professional to move into an entirely new field than for a non-professional to acquire accredited status in an area with which they are already very familiar.

Indeed, the author argues that the primacy of values and attitudes in professional work is confirmed by the many cases in which unqualified impostors have carried themselves off in supposedly highly skilled professional roles, the masquarade being discovered only after many years in some instances. Echoing the French social theorist Bourdieu, though without mentioning him, Schmidt notes that the requisites for conducting this kind of role are a middle class upbringing (and the implicit knowledge of key social and institutional mores that goes with this), plus the familiar tendency for employers to disregard the shortcomings of incompetents who show the “right” - i.e. unquestioningly conformist - attitudes to their work.

On this analysis, it might be supposed that the professionals and amateurs in a given field of endeavour are very different beasts, and so it proves: “When hobbyists encounter one another at a social gathering, before long you will find them talking eagerly about the content of their subject of common interest, showing an excitement, enthusiasm wonder and curiosity that is reminiscent of beginning professional students. This rarely happens when professionals talk casually with their colleagues. Unlike the amateurs, professionals don’t talk much about the work itself. They often appear detached from their subject, as if they don’t derive much satisfaction from it [and yet ….. ].Their gossip is by no means idle [….] for the politics are central to their work as professionals.” ( 145). How many conferences for professional psychologists, I wondered, would fit this description, and how many psychologists have felt able (or been willing) to write about the very interesting (and in essence psychological) question of why this might be so?

In regard to the process of professional training, the author describes an iniquitous education system, in which competition for graduate school is intense, and in which selection is achieved by means of aptitude tests that covertly select for the willingness to think unquestioningly (i.e. obediently) within a preset agenda which, in this context, will consist of the exam paper, and later on, in managerially defined workplace goals. In accord with this analysis, Schmidt argues that graduate and particularly post-graduate training is much less about cultivating a spirit of open enquiry, and is in fact closer to the process of indoctrination observed within religious and political cults. On first reading, my reaction was to dismiss this statement as hyperbole, and then I remembered how, in my own training, for example, it was often almost impossible to publicly question the consensus that supposedly well established techniques of counselling and psychotherapy “work” as effectively as technical procedures for personal change - without being completely dismissed out of hand.

Schmidt suggests that this kind of training process is aided by (and indeed cultivates) a tolerance for boredom and a preoccupation with abstractions or minutiae that are often remote from both the real world concerns and ethical imperatives of many students, and indeed from the interests and commitments that drew them into their chosen field in the first place. Schmidt therefore suggests that training progressively erodes creativity and ethical thinking (especially in regard to wider questions of social justice), and in doing so, professional training eventually discriminates against minority applicants (such as non-white and female candidates) in particular. Whatever the difficulties of the selection process, in the end, those who are denied entrance may well reproach themselves for what they see as their entirely personal failure. The author suggests that this process will be smoothed along with the help of campus counsellors and therapists, on hand to provide a suitably proximalised explanation of the student’s difficulties which will rarely extend to a critique of the education / training system itself. Similar arguments have of course been made in relation to the selection and training of applied psychologists, which may favour individuals who are more at home with abstract theoretical models than they are with questions of meaning, or of the messy vicissitudes of their own and other people’s real world experiences and feelings (Chadwick, 2004; Kline, 1987).

Unlike many critical texts, Schmidt’s book does offer some suggested solutions however, including ways of sustaining self-esteem in the face of a system that will undermine the critical thinker. In the main, Schmidt favours the creation of solidarity with other oppressed students, colleagues and even the wider public. Refreshingly, Schmidt does not argue strongly for the use of essentially individual cognitive therapeutic strategies in this context, as has been suggested even by some critical psychologists (and in apparent contradiction of their own seemingly materialist analysis of the genesis of personal distress (see for example, Prilleltensky and Nelson, 2002)).

Of course, the discipline of physics gave us the nuclear bomb, and the field in many of its aspects continues inevitably to be tied up with the military-corporate complex. Surely the same analysis cannot hold for academic and applied psychology? Yet, even a brief consideration of these fields suggests otherwise.

For example, the historical alignment of organisational and occupational psychology with the interests of the state and the employer at the expense of the employee is well documented (Baritz, 1963; Wright and Calnan, 2002). As are the many dubious psychological behavioural genetics studies that purport to show the mainly hereditary basis of many human characteristics and problems (Joseph, 2003). Closer to home, the origins of the scientist practitioner role within clinical psychology may have in large part reflected the professions’ need to compete with (and sometimes accommodate) a positivistic psychiatry on its own terms (Pilgrim and Treacher, 1992). While a similar trend can be observed in Counselling Psychology’s more recent claims that professional training instils a unique capacity for empathic / reflexive thinking in its practitioners: a pitch that implicitly positions the former discipline in an advantageous market niche in comparison to its clinical competitor (Howard, 1996). Likewise, Scmiddt’s descriptions of “assignable curiosity” – or the tendency of professionals to direct their thinking and attention only within the frame desired by their employer – is surely an accurate description of the way in which clinical research has tirelessly sought to confirm the fundamental importance of technical / trainable elements to the process of therapy, while disregarding the complementary evidence that the most helpful parts of “talking treatment” are largely the non-technical and personal ones (Howard, ibid.).

On the negative side, the perspective offered by Schmidt’s volume is inevitably a partial one, despite the writer’s claims to the contrary. To begin with, the book is written from an American standpoint. Despite the recent corrosion of traditions of scholarship and intellectual freedom within European (and perhaps particularly British) education, it may still be the case that a residual independence from the interests of corporate and state power has been preserved in some quarters, at least in comparison to the United States. Indeed, Britain has a tradition of critical public health scholarship and research that, although often besieged by powerful political and commercial interests, has nevertheless just about managed to sustain a critique of the negative health impacts of the more or less untrammelled free market capitalism within which we have been living for the last quarter century (Clegg, 1998).

Furthermore, Schmidt’s examples of professional working are primarily drawn from the world of professional physics. Some of his analysis may therefore not fit so well with the worlds of the humanities and social sciences in which the practice of research, for instance, may to some extent have a more independent cast, conducted away from the immediate ambit of the supervisor and hence less prone to dogged policing and even bullying of the kind that the writer describes so vividly for his own training. More specifically, the disciplines of clinical and counselling psychology have enjoyed some success (although not unalloyed) in attracting minority and especially female applicants in recent years. Though of course, to what extent this ethically essential step has so far, and in itself, been enough to make these professions significantly more critical endeavours remains open to question (see for example, Jillian Proctor’s trenchant critique of the neglect of the issue of social power within conventional psychotherapeutic training).

A further drawback of Schmidt’s book is that he ignores the substantial bodies of critical social analysis and investigation into the workings of the professions, much of which could have served to bolster his case. There is for example, a sizable literature that documents in this context the rise over the last twenty years of managerial power and the erosion of professional autonomy and security – both within the private and public sectors. This literature points to the gradual breaking down of what (at their best) were ethically reflective values and creative practices into what amount to commodified units of “skill”, subject to supervisory control: - a process that has been aptly summarised by the term “Mc Donaldisation” (Ritzer, 2002). Much of this literature also points to the way in which professionals (and particularly managers and therapists) can mediate coercive power without their being aware that they are doing so, and indeed with noble intentions that are completely at odds with the wider effects of their actions (see for example, Smail, 1999 and Wainwright and Calnan, 2002). The use of this material would have added depth and richness to Schmidt’s argument, by for example, allowing a more thorough discussion of the way in which subtle (and sometimes contradictory) discourses help to shape and mystify the professional’s awareness of the many hidden ways in which they are being subjected in their work.

Finally, the mental health professions may have some unique features which distinguish them from their counterparts in the world of the physical sciences. Most obviously, the former exist within (and indeed are defined by) a set of extremely diverse influences that both overlap and compete with one another. These influences include the professional, lay and policy discourses on the nature and treatment of personal distress, and of course the fiscal and governmental policy arenas in which these interests are played out. In this sense, the knowledge base for any kind of mental health work is likely to be a heterogeneous and contested one, in which (arguably) there may always be at least some room for a more radical critique to emerge through the cracks in whatever the current consensus happens to be (see Pilgrim and Rogers, 1999). Indeed, the persistence of critical and community psychology down the years may itself be an indication of this process.

Despite the above caveats, this is a valuable book that opens the reader’s eyes to the hidden realities of professional work as all too often being shaped by (and sometimes entirely the product of) malign institutional and political power. For many, this volume will represent a discomforting and thought provoking read, that, by virtue of its clarity and relevance will deserve to take its place alongside (and on at least equal terms with) the more plodding more academic texts that deal with this subject.

References
Baritz, C. (1963) Servants of Power. University of California Press.
Chadwick, P. (2004) Positivism, Materialism and Scientific Psychology: The illusions of truth and certainty. Journal of Critical Psychology, Counselling and Psychotherapy. 3 (4) Winter 2004. pp. 185 – 189.
Clegg, J. (1998) Critical Issues in Clinical Practice. London. Sage.
Davies, D. (1997) Counselling in Psychological Services. Buckinghamshire. Open University.
Howard, A. (1996) Challenges to Counselling and Psychotherapy. London. Macmillan.
Joseph, J. (2003) The Gene Illusion. Ross on Wye. PCCS Books.
Kline, P. (1997) The Emperor’s New Clothes: Psychology exposed. London. Routledge.
Pilgrim, D. and Rogers, A. (1999) A Sociology of Mental Health and Illness. Buckinghamshire. Open University.
Pilgrim, D. and Treacher, A. (1992) Clinical Psychology Observed. London. Routledge.
Prilleltensky, I; and Nelson, D. (2002) Doing Psychology Critically. London. Palgrave.
Proctor, J. (2002) Power in Counselling and Psychotherapy. Ross on Wye. PCCS Books.
Ritzer, G. (2002) The Mc Donaldization of Society (Second Edition). London. Sage.
Smail, D. (1999) The Origins of Unhappiness: A new understanding of personal distress. London. Constable.
Wainwright, J. and Calnan, S. (2002) Workplace Stress: The creation of a modern epidemic. Buckinghamshire. Open University.
Paul Moloney

Howard, A. (2000) Philosophy for Counselling and Psychotherapy. London. Macmillan.
In this generous book, Alex Howard, a psychologist who has worked for many years as a counsellor, lecturer and manager within adult education, seeks to give an account of the key ideas offered by 32 major Western philosophers, and to then relate their work to the theory and practice of talking therapy. As such, this publication undoubtedly benefits from (and is evidence of) the author’s long experience of communicating complex and unfamiliar ideas to a lay audience. Howard’s summaries of each philosopher’s work are succinct, often witty, and written with admirable clarity. Indeed, for many, the book would probably be worth buying for Howard’s exposition and critique of the work of Freud and Wittgenstein alone. Throughout the text, the reader’s understanding of each chapter is assisted first, by a brief introduction which summarises the key points and the applications of each philosopher’s ideas to the practice of counselling, and second, by a section at the end of each chapter, offering reflective questions and exercises. The whole spirit of the book is one of open (and often radical) enquiry, kicking off with the author’s definition of philosophy as …..“What you end up with if you keep on asking questions about the basis of previous answers’ (viii). In this vein, Howard suggests that the reader take four questions with them as they work their way through the volume, namely: Who am I? What do I really know? Where am I going? Where should I go?

In part, the book provides an important historical overview of the development of many ideas and values that underpin contemporary therapy. As Howard observes, a good many of these themes can be traced to the major philosophical schools of ancient Greece, and particularly to the stoics, sceptics and epicurians, respectively. Howard’s perspective therefore reveals the antiquity of what are often assumed (even by their contemporary proponents) to be almost newly minted therapeutic approaches. More critically, this standpoint also highlights the way in which psychotherapy has from its inception been dominated by commercial and professional interests, which have led to a wilful a-historical blindness within the psy professions and to the consequent remarketing and repackaging of old ideas as the latest thing. Indeed, Howard convincingly argues that, in their application, many key classical schools of philosophy provide the troubled individual with a broader, more subtle and indeed more realistic view of the human predicament than do many current popular schools of psychotherapy. In comparison, the author shows that the latter are for the most part founded upon shallow and simplistic ideas of the nature of the helping relationship and of the self and its capacity for therapeutic change. In regard to the genesis of cognitive therapy, for example, Howard observes that….

“[Albert] Ellis originated a suitably contemporary presentation of stoic principles, but current versions [of Stoic philosophy, as expressed in the practice of CBT] tend to be overly individualistic, and shorn of the Greek apprehension of the tragic dimensions of human existence” (74).

For the critical psychologist, the main value of this book may lie in its providing a kind of shock therapy for any of us who have become rather too comfortably immersed in a taken for granted therapeutic orientation. Thus, the author takes some of the most cherished (and usually unquestioned) assumptions found within western counselling and psychotherapy and uses the work of key philosophers to subject these ideas to a penetrating analysis, which ultimately finds them wanting. Within his sights Howard includes such crucial topics as mind-body dualism; the widespread notion that the act of introspecting into our thoughts and feelings can be a straightforward and reliable process that is relatively uninfluenced by our preconceptions or by our milieu; the idea that the helping relationship can be cast unproblematically as a set of trainable technical skills; and, as a major recurring theme, the assumption that we are self contained individuals, supposedly able to act in isolation from our social and material context.

Time after time, Howard shows that these ideas have been successfully challenged (though never fully resolved) within Western philosophy, much of which predates the contemporary counselling movement. In regard to the idea of an autonomous self, for example, Heidegger argued in the first half of the twentieth century that, “we do not start with self and then venture into world. The everyday common-sense self, derived from Descartes, is a fallacious idea, torn out of the self-world engagement that we are (327).” As Howard observes, “If Heidegger is right, then the most basic common-sense assumptions within counselling about self, world, interaction and communication must be abandoned” (327)

Marxism is seen to offer a similar medicine, though by way of an analysis of social power, a topic which the author likewise shows to have been too long neglected within the discourse of the talking treatments: -

“[Marx’s] argument that we may be exploiting each other, not because of the contents of our consciousness, but because of the nature of our social and political organisation is surely well made. It is of particular value to counsellors with a penchant for individualising problems, and exploring them purely in terms of the intentions and conscious thoughts and feelings of personal clients (267)”.

As Howard notes…

“We interpret what we see of the social world around us, but much of it we do not see at all. We are not conscious of many social forces since we do not [in most psychotherapeutic approaches] have the concepts to isolate and analyse them. Consequently, the large “social waves” on which we are carried are largely invisible to us. They may make us sea sick, but we tend to see this queasiness as a personal problem and do not notice how far we share it with others (269)”. Of course, when it comes to the community psychology critique of its clinical counterpart, it would be difficult to frame a neater summary than this.

In the attempt to better understand the impact and workings of political and interpersonal power, Howard suggests that such baleful figures as Machiavelli may have much to teach the practising psychotherapist, whose training - especially in the humanistic schools - may too often rest upon a distinctly anodyne reading of the human condition. The writer suggests that Machiavelli’s work may help the therapist to gain a better grasp of the often harsh realities of their clients’ lives and to develop a fuller though perhaps even less welcome insight into the workings of their own profession: -

“Counsellors take a relatively optimistic view of humanity. People, they assume, are generally redeemable, loving and lovable if only misunderstandings and frustrations can be clarified, expressed and resolved. Individuals are blocked and stuck rather than boorish and bullying [….]. Machiavelli is therefore worth examining by counsellors since he, more than virtually any other philosopher, challenges the very foundations of such an optimistic view of society”. Indeed…“Contemporary counselling, I fear, tends to be naive about the more malevolent and selfish aspects of human existence, not least its own” (167).

In a similarly critical vein, Howard attacks the widely held notion that professional therapist training can confer a kind of impartiality that somehow raises the practitioner (and the practice of therapy itself) above the inherent value judgements and uncertainties of more “ordinary” or none professional forms of helping relationship: -

“Can we “just” listen? Listening is always a creative act, structured by experience, knowledge, values, priorities and purposes. You hear according to what you understand and value. We do not hear and then understand. More nearly, we understand, and then hear accordingly. The relevance of all this to counselling is, I hope, obvious and overwhelming.” (331)

Like other recent critics of therapy such as Furedi (2003) and Lasch (1985), the author identifies within its humanistic wing a narcissistic (and perhaps distinctly Californian) preoccupation with self-fulfilment that may prove to be unbalanced and unwise. As Howard observes, the trouble with this preoccupation is that … “it pays no attention to the role of guilt. Shame, remorse, contrition can all be disabling and masochistic. But sometimes we feel guilty for good reason.” (74)

Here the writer sees that current therapeutic and psychological theory pays scant attention to moral and social philosophy. Yet we may need moral philosophy to help us decide how we should best live our lives as individuals and as members of our communities, a theme that - as the author makes clear - was well explored by Aristotle and his near contemporaries.

While Howard charts the continuity in many philosophical ideas over time, he also does justice both to the way in which new concepts have come on to the scene and to the shear diversity of ways in which philosophers have tried to grapple with the givens of human existence over the centuries. In the context of counselling theory, one overwhelming effect of this long-range view is to suggest the historical and social contingency of many of the taken for granted ideas that currently operate within the field. A further implication is that many notions about personal distress that are now being promulgated within the mental health industry must be waiting their own turn to take up shelf space in the museum of interesting but defunct ideas. The value of this notion as an aid to critical reflection probably cannot be overstated.

In the final chapter of the book, the writer attempts to tie some of the main themes together, and to ask what may come next. In the 32 voices covered in the text, Howard does indeed hear music, often discordant, but rarely descending into atonal and meaningless noise. Alex Howard is no triumphalist however. Indeed, the author seeks to identify the possible limitations of recent Western philosophy, including its tendency to have excluded the voices and viewpoints of women and to have become stuck in an arid preoccupation with linguistic and logical analysis, or, less charitably, with wordplay. Yet consistent with his thesis that philosophy is still a vibrant and relevant topic, Howard is unafraid to offer his own view on the future of the subject. He therefore suggests that we are likely to see a rejection of prevalent nihilistic versions of post modernism and their replacement with a search for ways of understanding ourselves that heed both how our experience may be grounded in a (real and none negotiable) material world and the numerous (relative) ways in which this experience can be articulated and understood

In common with many other similarly able surveyors of philosophical thought, such as Passmore (2000), Howard suggests that the lessons of two millennia of intellectual struggle point away from the prospect of any easy understanding or perfectability of human beings: whether this is sought by psychotherapeutic or any other means. Nevertheless, the author clearly feels that moral, social and political progress is still possible on both the individual and societal levels. He suggests that in this task we will be helped rather than hindered by a broad and philosophically (and indeed historically) informed scepticism in regard to ourselves and to the world around us. The author thereby hints that some form of liberal humanism may still represent a sound basis for the helping professions, though this would have to be a chastened and cautious humanism that embraced the radical philosophical critiques mentioned in the text and that was therefore fully reconciled to its own limitations. Whether this goal might or might not be achievable is of course an intensely debated topic within current philosophy (see for example, Gray, 2002 and Archer, 2000, for opposing points of view).

Perhaps inevitably in a book so wide ranging as this there are things to criticise. For instance, given the current importance of transatlantic thought in Britain, there is surely a case for the inclusion of American pragmatist philosophy, since the ideas behind this movement (especially in regard to epistemology) may have helped to fuel and shape the recent expansion of the popular narrative therapies, even if this influence is not widely acknowledged. It could also be argued that the fundamental and still ongoing transformations in gender roles that have characterised life in Western society over the last generation - (and which have done much to influence the course of psychotherapy over that time span) - would surely have justified some discussion of at least one key feminist thinker.

Finally, the book is also of course about Western philosophy and it would be unfair to attack Howard too strongly for a failure to consider other cultural perspectives. Nevertheless, this volume might have benefited from some consideration of the ideas of none Western thinkers – many of whom offer a sophisticated analysis of the workings of consciousness and of the nature of the self which are as challenging and radically deconstructive as anything found within Western psychology, while intriguingly, overlapping with significant parts of it (see, for instance, Crook, 1980). Likewise, some discussion of Islamic perspectives might have added even greater relevance to the text, given the importance that cultural issues and conflicts (and the need to find ways of constructively resolving them) are likely to assume in the years ahead, and not just for counsellors. Of course, such additions would have made the book a very much larger one, and, given the protean scope of Howard’s learning, one wonders if the author might have further volumes waiting in the wings.

In sum, this is an extremely readable, comprehensive and well written work that manages to be both a valuable critically informed source book on Western philosophy in its own right, and a highly relevant tool for the reflective and critical practitioner of therapy. While the book provides few clear cut answers to the questions it poses, Howard’s gift is to show that the questions are well worth asking, and will continue to echo in the reader’ mind long after the volume is put down. It has often been said that the value of a publication can be gauged from the extent to which it is has become a dog-eared victim of repeated usage. By this standard, Alex Howard’s book is likely to need a far more sturdy binding than most of the canonical psychotherapy texts that, in this reviewer’s experience at least, are destined to remain sitting on the library shelf in near pristine condition once the period of the qualifying examination has passed. Highly recommended.

References
Archer, M. (2000) Being Human. Cambridge University Press.
Crook, J. (1980) The Evolution of Human Consciousness. Oxford University Press.
Gray, J. (2002) Straw Dogs: Reflections on humans and other animals. London. Granta.
Furedi, F. (2003) Therapy Culture. London. Routledge.
Passmore, J. (2000) The Perfectability of Man (Third Edition). Massachusetts. Liberty Fund.
Lasch, C. (1985) The Minimal Self: Psychic survival in troubled times. New York. Norton.
Paul Moloney

PRILLELTENSKY, I. & NELSON, G. (2002). Doing Psychology Critically. Making a Difference in Diverse Settings. Palgrave Macmillan, Basingstoke & New York: pp xiii + 206. ISBN 0-333-92284-0 (paperback).*

The opening chapter of this book identifies the social forces that so constrain the scope and legitimacy of orthodox practice in applied psychology (not to mention the lives of the general population): power and interest.

Its final chapter provides an excellent, succinct diagnosis of the most damagingly powerful elements of society at the beginning of the new millennium: those flowing from rampant corporate capitalism

The chapters in between cover assumptions and practices in a wide range of broadly clinical, educational, research and community settings. They focus in particular on ways in which psychologists—critical psychologists—may incorporate a socially widened perspective into their work which takes proper account of the workings of power. Almost every page overflows with enthusiasm and confidence about what can be achieved. The text is peppered throughout with references to the work of critical psychologists and others who are breaking new ground in challenging the status quo and seeking to liberate the oppressed.

Many readers, I am sure—especially psychologists who have already contemplated developing their role in this direction—will find all this encouraging and inspiring.

What’s more, the book indirectly endorses much of what I’ve been thinking and writing about for the past couple of decades (e.g. Smail 1991, 1995, 2001). Why, then, having just put it down, do I feel so uneasy?

I think, above all, it’s because of a lack of sobriety, modesty, due caution. The way human beings conceptualize, exercise and respond to power, is, after all, a story covering thousands of years. There are strict limits to be placed on a mere psychological understanding of issues which are among the most complex and disputed, both intellectually and ethically, that can be confronted. There is not enough self-doubt about Doing Psychology Critically. It is, in short, not nearly critical enough. It reads like a cross between a political manifesto and a business plan.

Consider, for example, the range of roles that a postgraduate course in critical psychology is thought to open up to the diligent student: direct service worker, participant observer, researcher evaluator, consultant, facilitator, trainer, interventionist-change agent, planner-conceptualizer (p69). Critical psychologists concern themselves with the health of disadvantaged groups such as children, low-income women, gays, lesbians, people with disabilities and citizens in developing countries (p107). The distribution of power and control within hospitals and work settings, advocacy, social criticism, community leadership (p118) are not beyond their remit, and they are ‘well positioned to break interdisciplinary barriers and address well-being in a truly ecological way’ (p119).

Not surprisingly, such a wide range of applications demands an equally impressive repertoire of skills: research, evaluation and grant-writing skills; skills in networking and partnership, communication and interpersonal skills (p69). ‘Intrapersonal growth’, furthermore, is ‘key to the development of competent practitioners’ and includes self-esteem, ways of coping with anxiety and irrational beliefs, creative self-expression, strategies for physical, emotional, cognitive and financial self-care (p69-70). Also needed are basic attending and influencing skills, assertiveness, leadership skills, the ability to set personal boundaries and avoid or deal with manipulation, effectively giving and receiving feedback and attending to diversity, good management skills including networking and partnership building, distributing power and decision-making throughout organizations (p71). Then of course there are skills in social action, coalition-building, political advocacy and social policy to create broader social change (p72). Further ‘vital’ skills are ‘the ability to recognize power dynamics, to enact values of empowerment and social justice, and to reflect critically on her or his role in perpetuating oppressive conditions’ (p142).

The ultimate aim of critical psychology is nothing less than the transformation of society.

‘The critical psychologist’ emerges from all this as a kind of caped crusader charged not only with analyzing but also with tackling just about every social abuse imaginable. And nowhere, beyond the odd routine disclaimer, is there any sober recognition that there are limits to what can be achieved. Class conflicts (and how many have fought and died over those in the last century alone?) are, for example, glibly presented (p130) as ‘opportunities for growth and change for everyone who is involved in the community development process’.

As I read of the qualities to be inculcated in and exploits to be accomplished by ‘the critical psychologist’, I thought of Marcuse’s definition (quoted in Maschino, 2002) of the intellectual as someone who refuses utterly to compromise with power, and the names of some of oppressive power’s heroic opponents began to drift through my mind. Among the living: Noam Chomsky, Aung San Suu Kyi, Harold Pinter, Daniel Barenboim, Arundhati Roy, Nelson Mandela, Susan George. Among the dead: Jesus Christ, Joan of Arc, Mahatma Gandhi, Charles Dickens, Karl Marx, Leo Tolstoy, Rosa Luxembourg, Emma Goldman, Bertrand Russell, Pierre Bourdieu. What is it about these people that made them effective resisters and critics of oppression? Could such qualities be taught on a ‘graduate program’? Should we add prison survival skills to the critical psychology curriculum?

Critical psychology ideology is linked in this volume to the writings of Gramsci, Fanon, Foucault and Freire, and all the better for that, I suppose, but there is a superficiality about it that misses the point, which is that challenging power is both extraordinarily difficult and extremely dangerous. There’s no shortage of pious aims; lots of declamatory statements are made about what ‘the critical psychologist’ does and doesn’t, should and shouldn’t do; the text is replete with anecdotes and aspirations. But at the end of it all there is a conspicuous absence of substantial and convincing achievement beyond the kind of proximal interventions that many clinical and community psychologists become involved in almost without thinking. I do not for one moment want to decry these achievements—they do indeed constitute an advance on much conventional academic and clinical psychology—but they do not really scratch the surface of the kind of oppression and injustice that, for example, the people mentioned above sought each in their own way to confront.

And I’m not sure that psychologists are the people to tackle such issues. There is, for one thing, always the danger of becoming—or trying to—a kind of super-disabling profession of the kind so brilliantly exposed by Ivan Illich (e.g. Illich, 1977) who, incidentally, is not mentioned in this book. I have the uncomfortable feeling that what we are witnessing here is a phenomenon already familiar from the practice of psychotherapy and counselling: having identified—accurately and illuminatingly—the social origins of our psychological ills, a profession is then developed to incorporate rather than merely critique territory that is in fact beyond the limits of its competence to penetrate. We cannot necessarily cure what we can diagnose.

Psychology needs to be kept separate from politics as far as possible, not because it should or can be value-free, but because of the danger of usurping the citizen’s role in its eagerness to expand its sphere of operations. Tana Dineen (Dineen 1999) has exposed the market ambitions of psychology generally, as do Hansen, McHoul and Rapley in a forthcoming book (Hansen et al., in press). In her critique of the expansion of ‘trauma counselling’ into the handling of refugees and asylum-seekers, Vanessa Pupavac (Pupavac, 2001) puts her finger on just the kind of professional disablement that threatens the clients of ‘the critical psychologist’. I would much prefer to see the term ‘critical psychologist’ reserved as a label for someone who reflects critically on psychology as a professional discipline rather than as the banner under which claims may be staked for the conquest of new territory.

The currently fashionable ‘postmodernist’ rejection in critical and constructivist approaches in psychology of ‘positivism’, preference for ‘narrative’ relativism over realism, etc., seem to me not as self-evidently virtuous as (along with many other texts) this book suggests. I’m not convinced that, as seems to happen here, epistemological issues can so easily be shoved aside by ethical enthusiasm, nor that we can afford to abandon ‘discredited’ notions of truth and evidence in favour of anecdote.

The authors do, to be sure, make an effort to define power and to indicate how their central construct of ‘well-being’ is affected by its operation at ‘personal’, ‘relational’ and ‘collective’ levels. Throughout the text they affirm the importance of influences operating at the collective level ultimately affecting individuals in their personal lives. These are valuable steps in beginning to think more fruitfully than has so often been the case about how subjective distress comes about.

But there is no real attempt to operationalize these constructs to the point where one can clearly envisage—let alone measure—how they work, beyond just knowing that they do. For this, I think, a far more materialist account would be necessary, in particular one that took factors of embodiment seriously (the work of Pierre Bourdieu—e.g. Bourdieu, 1977—would be helpful here). As it is, particularly in notions such as ‘agency’, the kind of psychologism that so bedevils therapeutic psychology (which has never really got rid of the idea of ‘will power’) is still much in evidence. At the centre of it all the disembodied, detached, evaluating—and scientifically impossible!—psyche is still very much in evidence. Above all, it is evident in the person of the critical psychologist him/herself: how, for instance does this paragon manage to extract him/herself from the structure of power sufficiently to critique its workings on everyone else?

I have no quarrel with the analysis this book offers of what’s wrong with the world. But I’m still not convinced that psychologists—critical or otherwise—are the people to put it right.

REFERENCES
Bourdieu, P. 1977. Outline of a Theory of Practice. Cambridge: Cambridge University Press.
Dineen, D. 1999. Manufacturing Victims. London: Constable.
Hansen, S., McHoul, A. & Rapley, M. In press. Beyond Help. A Consumer’s Guide to Psychology. Ross-on-Wye: PCCS Books.
Illich, I. 1977. Limits to Medicine. Medical Nemesis: The Expropriation of Health. Harmondsworth: Penguin Books.
Maschino, 2002. Les nouveaux réactionnaires. Le Monde Diplomatique, no 583 , Octobre.
Pupavac, V. 2001. Therapeutic governance: psycho-social intervention and trauma risk management. Disasters, 25, 358-372.
Smail, D. 1991. Towards a radical environmentalist psychology of help. The Psychologist, 4, 61-64.
Smail, D. 1995. Power and the origins of unhappiness: working with individuals. Journal of Community and Applied Social Psychology, 5, 347-356.
Smail, D. 2001. The Nature of Unhappiness. London: Robinson.

David Smail
* This review appeared originally in the Journal of Community and Applied Social Psychology, 2003, 13, 328.

Davies, D. and Bhugra, D. (2004) Models of Psychopathology. Berkshire. Open University Press / McGraw Hill Educational. Pp: 170.
In this concisely written and ambitious volume, Dilys Davies and Dinesh Bhugra –(a clinical psychologist and professor of mental health, respectively) - seek to chart the frames of reference and underlying concepts of the main models of psychopathology on offer within the Western mental health care system. The authors also endeavour to spell out the consequences of these models both for the practice of individual therapy, the mental health professions and for the wider society that sustains them. In line with these aims, this slim volume manages to offer a surprisingly comprehensive coverage of some of the main historical and contemporary currents within Western psychopathology. The authors identify these currents as comprising psychiatry and bio-medicine, psychodynamic and psychoanalytic theory (including attachment theory), and the behavioural, cognitive, humanistic-existential and socio-cultural traditions. While the writers recognise that none of these frameworks are mutually exclusive, they nevertheless show how each claims a set of core assumptions about human nature, the origins of psychological malaise and the therapeutic regimes that presumptively flow from these understandings. Davies and Bhugra indicate how rarely these notions seem to have been exposed to any serious questioning by the adherents within each school. A great virtue of this book, therefore, is the many succinct critiques of some of the main evidential, conceptual and even ethical limitations of each model that conclude almost every chapter.

In general, these appraisals are well targeted and incisive, and draw widely upon the mainstream research and critical mental health literatures - the authors’familiarity with which is well demonstrated in this text. This coverage is occasionally uneven, however, so that, for example the increasingly popular “post modernist”narrative therapies are not mentioned, while Davies and Bhugra’s discussion of the humanistic model is confined mainly to the naivety of Carl Rogers’assumptions about self actualisation and his neglect of aetiological social factors, but with little examination of the contradictions that have attended the humanistic camp’s efforts to turn ordinary human attributes into manufactured / trainable therapeutic skills. The latter issue may be particular important, because it has a relevance beyond the humanistic schools themselves and indeed extends to wide swathes of the current counselling industry and mental health practitioner training (see Clarke, 1998). Likewise, the discussion of ethological attachment theory offers almost no critical commentary, and might have benefited from at least some elaboration of the way in which this approach has at times underpinned the patriarchal surveillance and control of disadvantaged women by welfare professionals (see for instance, White, 1996).

Those readers familiar with Dhilys Davies’previous works will not be surprised to learn that the concluding sections of the book offer a socio-cultural critique of the theory and practice of the mental health professions. Here, the authors make the case for a social / environmental origin of much of the distress that brings individuals to the consulting room, and indeed of the ideas in which clients and therapists are likely to clothe the experience of distress and its treatment. These final chapters could therefore be said to both encompass and contextualise the models that are discussed in the earlier parts of the book. Davies and Bhugra point out that this insight becomes crucial when it is coupled with two key observations. These are first, that all theories of mental health are based upon implicit moral and political values, and second, that Western society employs notions of personal responsibility and blame as the chief devices for schooling many people into accepting the iniquitous circumstances of their lives. The result is that the scope for mental health workers acting as agents of social control becomes very real indeed. A strong argument is thereby made for the potential for psychological and psychiatric treatments to inappropriately (and harmfully) individualise personal unhappiness, through the act of transmuting the base metal of social pathology into what may often turn out to be the fool’s gold of purportedly faulty insight or learning on the part of the client.

The authors suggest that no approach to therapy can afford to ignore this argument, and therefore that all mental health practitioners should, at a minimum, make efforts to discover to what extent their clients’problems may be shaped by a lack of external resources and to think about what other forms of help may be needed beyond the “talking cure”itself. However, as Davies and Bhugra recognise, the issues go deeper than this, presenting difficult questions about the efficacy and relevance of favoured therapeutic models, professional and personal agendas, and indeed about the functions of mental health institutions that more and more are predicated upon upholding a steady rate of patient “treatment and throughput”. Accordingly, the authors argue for the value of a thorough going integrationism within mental health work, although the book ends upon a questioning note. Like the Greek sceptic philosophers who saw in the sheer number of competing cosmologies no reason to favour any in particular –the authors suggest that the existence of so many competing models of psychopathology must warn the practitioner against the temptations of dogmatism, and may indicate the value of humility and continual reflection in regard to the merits of their own chosen approach. Indeed, Davies and Bhugra comment that the “the socio-cultural model [itself] is a construct, and it may serve the interests of theorists as much as any other model of psychopathology (136)”. These observations will probably strike the reader as useful in many ways, particularly as such ideas have (arguably) not received the attention that they merit within the fields of critical and community psychology. And yet this seems to be an oddly deflationary ending, which, at least for this reviewer, to some extent erodes the resolutely (and soberly) critical realist stance toward the origins of psychological malaise that the writers seemed to have sustained throughout much of their previous text.

These minor floors notwithstanding, this is a cogently argued and well-crafted little book that largely succeeds in providing critical summaries of the main approaches and controversies in the current field of psychopathology, while providing a wealth of valuable source material and references for the interested reader.

Paul Moloney

Fancher, R. T. (1995) Cultures of Healing: Correcting the Image of American Mental Health Care. New York. Freeman and Co. pp: 285
In this thoughtful and perhaps brave dissection of the worlds of American psychiatry and psychotherapy, Robert Fancher (a practicing psychotherapist) sets out to show how the key approaches informing current American mental health care are painfully lacking in genuine scientific credentials, despite the strident claims to the contrary that are made by their acolytes. In his introduction, the author notes that this is a very personal work, which has resulted from his attempts to understand his own profession and to find ways of thinking more clearly about the causes and treatment of personal distress. Fancher tells us that he had trained originally as a philosopher, and this background is apparent in the careful dissection and sifting of ideas and truth claims that is so in evidence in this book, and which, refreshingly, acknowledges the frankly partisan nature of much of the thinking and research within the mental health industry.

As such, this volume is unlikely to be a comfortable read for anyone who has a strong belief (or investment) in the idea that the mental heath professions posses a sound scientific knowledge base and skills repertoire, and on these questions it is worth quoting Fancher in full: - “The distance between what we know and what wish we knew is too great to bear, we fill it with believing. To believing we add nothing, and to both we add institutions that elaborate, justify, enforce, and perpetuate these ways of ours. This book explores the believing that fills the gap in that area of life that we call psychopathology (3). The writer therefore suggests that we should think like social and cultural critics (rather than like clinicians) when trying to weigh the ideas and recommendations of the mental health care professionals.

Robert Fancher is thus one of the few thinkers in the mental health field to deal with the question of professional interest –a topic that runs throughout his discussion (although often implicitly) - like the faint letters that stretch through the length of a stick of seaside rock. Much of this tome’s value may therefore consist in the fact that it was intended for a general audience. As the author acknowledges, this made the book easier to write because he knew that the former would be more likely to take his arguments seriously, having little stake in the present academic and professional status quo.

Fancher identifies the main schools of the mental health system as comprising psychoanalysis, behaviourism, cognitive therapy and psychiatric drug treatment. In his opening chapter, the writer suggests perhaps somewhat naïvely that people’s lives may indeed be readily changed by the interventions offered by each of these approaches. Perhaps more usefully, he recognises that the direction of the change may depend most upon what is believed within the particular culture of healing that the client happens into. This is important, because mental health care is “fundamentally part of the public conversation that constitutes life in Western society”. And, as the writer astutely observes - its recommendations are essentially moral and social programs, which are more likely than not to serve the concerns of the dominant interest groups within our society. This thesis is well demonstrated in Fancher’s scene setting discussion of the origins of the psychiatric profession in eighteenth and nineteenth century America. Echoing the observations of the critical historians Andrew Scull (1976), the author notes that the emergence of psychiatry had nothing to do with persuasive medical findings or the development of authenticated treatments, but was instead the outcome of a constellation of economic, political and social factors, which enabled medical practitioners to gain ownership and control over an ostensibly reformist and humanitarian programme aimed at the “treatment and care”of the mad. With some plausibility, the author suggests that this picture may represent the hidden paradigm for the growth of the main cultures of healing and of their associated mental health professions over the last century.

Of the four cultures of healing, the author argues that psychoanalysis may give the richest interpretive repertoire, though its refusal to meet even minimal requirements of scientific investigation has led to a state of deserved disrepute. As a result, researchers still have no real idea of which parts of depth psychology should be taken seriously, so that it’s main value may consist - like the humanities in general - in suggesting hypotheses for future study and in providing a stance from which to critique the even more impoverished views of human nature that are on offer within some of the other cultures of healing. Although generally well placed, Fancher’s critique of psychodynamic culture is perhaps the most lightweight of the four. This is because his coverage is restricted largely to the main alleyways of the more popular and accessible forms of US psychotherapy, and therefore seems at times to be lacking in scope and historical depth. One wonders if this apparent reticence may have something to do with the effects of the author’s own training background (in psychodynamic psychotherapy) which perhaps inclined him toward a form of monochrome thinking of the kind that he implies throughout his discussion of the main mental health cultures.

By contrast, the author’s examination of behaviourism represents a more searching and comprehensive analysis of the theoretical confusions that will dog any therapeutic school that aspires to give too sweeping and monolithic a view of the human condition. Here, Fancher, shows how the behaviourists - in reluctantly having to confront the sheer complexity and refractoriness of human conduct - have been compelled in the end to cram what is really a notion of mind into a theory that was founded upon a complete refusal of the importance of subjective experience. As the author observes, this attempt has proved to be conceptually incoherent, and largely unsuccessful in achieving the stated goals of the “prediction and control of human behaviour”–outside that is, of some tightly circumscribed (and on occasion coercive) situations.

In distinction to the fading ambitions of the behaviourist legacy, Fancher notes that cognitive therapy and biological psychiatry are currently the market leaders in the field of individual mental health treatment. Yet each is seen to partake of many of the faults of the behaviourist school, including their assumptions about the unproblematic nature of normality versus abnormality, and in their common tendency to individualise suffering which may have causes beyond the ambit of the afflicted person’s immediate world and experiences.

Fancher’s attack on what he describes as “The middlebrow land of cognitive therapy”is especially perceptive, and deserves to have a wide readership. Here, the writer skilfully musters evidence from a wide range of disciplines in order to show how first of all, this school of healing may have far less scientific validity than its practitioners like to think, and second, how the methods of cognitive therapy may be inadequate for achieving lasting “cognitive change”in the real world, as opposed to the artificial laboratory settings in which most of its key premises have been tested. When it comes to ethics, the author convincingly shows that the fundamental credo of the culture of cognitive therapy is to view conformity to dominant social and political norms as both desirable and achievable. A position that is perhaps best exemplified in the insistence that a process of therapist inspired “inner psychological change”can readily overcome the effects of an all too real outer disadvantage. As the author remarks, this assumption can do nothing but harm when applied unreflectively to the most disempowered and oppressed members of our society.

Fancher’s critique of biological and self consciously “scientific”psychiatry represents a similarly careful scrutiny of what the author reveals to be a mishmash of conjectures and logical fallacies that - via endless re-circulation in the mental health literature and the popular media have, for many, assumed the status of unassailable truths. Like other critics such as the British neuroscientist Steven Rose (1985), the writer’s main target is the regnant pragmatist assumption (masquerading as high theory) which claims that the apparent “alleviation”of psychological distress via drug treatments must constitute prima facie evidence for both the existence and causal potency of discrete underlying biological disease entities. The problem here, as Fancher observes, is that even if we could show that psychopathology is demonstrably rooted in biological abnormality - (and the evidence is in most instances far from compelling) - we would not be shocked by this finding, living as we do in a world that has supposedly outgrown mind-body dualism. More importantly, such a result would show little about the ultimate origins of the putative pathology, and need not privilege drugs or other physical interventions as the treatment of choice - as many psychiatrists and indeed pharmaceutical manufacturers appear to readily assume.

In the closing chapter of his work, the writer attempts, reasonably enough, to create a synthesis of his main themes. And it is perhaps at this point that both the author’s implicit socio-cultural critique of the psy professions and his recognition of the social-environmental origins of much psychological malaise should have been brought to the fore, and then elaborated in the way that these themes so clearly deserve. And yet, rather than achieving the expected critical resolution, Fancher instead descends into a series of timid qualifications and disclaimers which seem to ill serve the provocative observations that he had set out to explore. The author thus concludes that careful research and development may some day uncover the active ingredients of the psychological and drug treatments, revealing many of them to have an inherent therapeutic value and a potential to reliably amplify the good life: but only- the author stresses - if they are approached in a sufficiently informed and sceptical light. Nowhere is there the expected recognition that, if the emperor of the mental health establishment is not entirely naked, then he is certainly looking threadbare to the point of abdication.

Despite this significant limitation however, this book is still well worth reading for its critical acumen, breadth of analysis and lucid intellectual honesty. All of which are likely to have the salutary effect of inviting the reader to reflect carefully upon their experiences of professional practice within the mental health system. The type of last minute reversal that this author shows in his arguments may be a common flaw in the writings of critical psychologists, and perhaps indicates only too well the baleful (and unacknowledged) influence of the kinds of professional interest that Fancher charts so ably in this readable and still timely book.

References:
Clarke, L (1998) Challenging Ideas in Psychiatric Nursing. London. Routledge.
Scull, A (1976) Museums of Madness. London. Allen Lane.
Rose, S (1985) From Molecules to Minds. Harmondsworth. Penguin.
White, M. (1996) Single Mothers and Welfare Surveillance. The Journal of Critical Social Policy. Summer 1996: 34 –56.

Paul Moloney

Philip Cushman. Constructing the Self, Constructing America: A Cultural History of Psychotherapy.
Da Capo Press, £15.50, ISBN 0-201-44192-6 [pbk]*

An ever expanding literature exists, critical of the role of counselling and psychotherapy in contemporary capitalist societies. In Constructing the Self, Constructing America Philip Cushman makes an erudite and novel contribution to this critique through a cultural history that charts the emergence of psychotherapy in modern America. If history is concerned with making an argument based on an interpretation of the evidence, Cushman’s argument is compelling. It is that the values, assumptions and eventual hegemony of American individualism and capitalism are responsible for unacceptable levels of socially induced misery. In response, psychotherapy emerged as a culturally determined healing profession, designed to treat the misery, and indirectly maintain a damaging status quo by screening out the historical, moral and political dimensions of anguish and despair.
Philip Cushman’s scholarship in history, philosophy, psychology and psychotherapy combined with his eloquence and deep humanity make this an accessible and engaging read. Indeed, all psychotherapists should read this book – but they wont. It’s argument is too persuasive; its truth too difficult to contest. My only criticism is its recommendation of yet another approach to psychotherapy, this one grounded on hermeneutics. Capitalism has dug a very deep hole for humanity, aided and abetted by the existence of psychological therapies. However informative and helpful hermeneutics may be in creating alternative horizons and defining new terrain, I’m not convinced that another approach to psychotherapy is the answer. When you’re in a hole you stop digging and dispense with the spade.

Chris Willoughby
* This review appeared originally in the Journalof Critical Psychology, Counselling and Psychotherapy, 2004, 4, 203.

Perelman, M.(2005) Manufacturing Discontent: The Trap of Individualism in Corporate Society. Pluto Press. London and Ann Arbour, Michigan.

As Andy Warhol famously said - “Buying is much more American than thinking” (Warhol, 1975:228)”. In this critique of American (and increasingly international) corporate culture - Perelman takes Warhol’s observation as a kind of lens through which to explore the ramifications of living in a world in which “corporate power makes idiots of us all – in the original Greek sense of the word, which referred to people concerned only with their own individual affairs and not those of the larger community (ix)”.

At the start of the book, the author– a professor of economics at the State University of California – shows how corporate business interests have waged a steady if covert battle against democratic institutions and civic society from the very earliest years of the last century, and that this battle has effectively been won. Perelman shows that the political agenda of present day America is now a mainly corporate one, in which “business leaders” enthusiastically push their ethically and intellectually impoverished commercial version of life into manifold sectors of society - such as education, welfare and health to name but a few – regardless of whether these areas can fit the corporate mould. As might be expected, the results tend to be iniquitous and destructive for the majority of ordinary citizens, and especially for those who cannot afford to opt out of public services that become more corroded with each year that goes by.

This situation not withstanding, company CEOs and their acolytes on Wall Street loudly proclaim themselves to be the bold inheritors of America’s pioneering spirit. Perelman shows that this is no more than a self-serving myth, and that the vast majority of corporate enterprises are conservative and risk averse organizations, supported and cosseted by government at every turn. While the current mania for downsizing and organizational merger may have severe consequences for some employees, these penalties are born almost entirely by lower echelon workers and indeed by the rest of society. As the writer acidly observes, this destruction of livelihoods, communities - and corporate enterprises themselves - has not prevented the widespread practice of executives awarding themselves multi-million dollar pay increases and other benefits packages: a story that would be familiar to many British readers. Indeed, Perelman suggests that the corporate sleaze recently revealed in the transatlantic media represents only the most visible part of a vast international conveyor belt of interest. Far from being held in check by America’s much vaunted democratic institutions, the author shows how this apparatus is in fact thoroughly greased by a whole range of supine academic and “regulatory institutions”, including a communications media that in recent years has moved into the control of fewer and fewer hands.

The author’s core argument is that the key weapon in this longstanding social conflict between capital and citizenship has been the promotion of an ideology of consumerism, the net result of which has been to keep the citizen firmly (indeed willingly) in their place, and to reinforce corporate power: - “No matter that [the average worker] toil[s] away at mindless tasks day after day. No matter that they are turned into dispensable and interchangeable corporate pawns. When they come home they can celebrate their freedom and unique identity by freely choosing whether to drink coke or pepsi (xi)”.

This ideology rests upon two unspoken assumptions. These are, first of all, that customers have genuine choices in the kinds of products and services that they receive and, second that personal identity and citizenship boil down to little more than the purchases that the individual can make in their lifetime. Armed with plentiful historical documentation, the author shows how the first belief has in essence always been an illusion and how the second has had damaging and far-reaching consequences for both individual and societal health.

This book leads to an unmistakable conclusion. Wherever they flourish, the implicit philosophies of individualism and consumerism stop people from acting together against the forces that oppress them, and even worse, blunt their capacity for critical thinking and for recognising the need for resistance through association with others. Yet this is the one form of power, the author suggests, that has any chance of being effective in this unequal struggle. And indeed Perelman offers some useful suggestions as to how such forms of opposition as currently exist might be developed and strengthened. The emphasis is inevitably upon American social movements, but many of the ideas in Perelman’s discussion seem to be readily applicable to the European scene.

Paul Moloney

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