Sally Satel &
Christina Hoff Sommers

One Nation Under Therapy:
How the Helping Culture is
Eroding Self-Reliance.
St. Martin’s Press, 320 pages, $23.95

A few days ago I attended a talk by a leading member of the British psychiatric bureaucracy. It was his proud boast that he and his colleagues had persuaded the government that hospitals and health authorities should have to explain why they refused psychiatric assistance to anyone who had asked for it. The idea that some people might actually be harmed by the desired but nevertheless ineffective and unnecessary psychiatric assistance was completely beyond his comprehension. He evidently believed in a neo-Cartesian dictum: I want, therefore I need.

It is not difficult to work out that such an attitude would serve the financial interests and appetite for power of the so-called caring professionals. The psychiatric bureaucrat also cited in his talk a frequently quoted figure about the proportion, 70 percent, of prisoners who had “mental health problems”—among them, of course, unhappiness at being locked up. That slippery phrase “mental health problems” was meant to imply, though it could not prove, that a giant apparatus of care was necessary to cater to the 70 percent. When it comes to therapy, evidently, there can never be enough.

What the authors of this book call “therapism,” the idea that man is psychologically fragile and can achieve mental stability only by means of professional assistance, is comparatively new, and is in antithesis not only to the traditional American virtues of self-reliance and sturdiness in the face of adversity, but also to a couple of millennia of moral reflection. Whereas fortitude was once regarded as a virtue, it has come to be regarded—at least by those who believe in therapism—as a kind of reprehensible and deliberate obtuseness, to be utterly condemned as treason to the self (there is no fury like a non-judgmentalist scorned).

As the authors show, sometimes hilariously, therapism now pervades society. This is true not only in America but in much of Europe as well. Education departments regularly scour books to ensure that they contain nothing that might bring a blush to the cheek of the Young Person. Modern Podsnappery is not so much prudish about sex as inclined to regard everyone as suffering from severe psychological allergies. Any adverse judgment about anything (except adverse judgment itself) will produce a reaction in someone, just as traces of peanut do in the susceptible. Therefore, in the interests of psychological safety, it is best to avoid such judgment altogether. As for games in which there are winners and losers, they should be avoided: the experience of losing could damage the Young Person’s self-esteem for life.

According to therapism, everyone who has ever witnessed anything unpleasant, or experienced loss or humiliation (which is to say, the great majority of humanity), is at risk of subsequent mental illness unless he expresses his feelings volubly and often, preferably as directed by a mental health worker. As the authors point out, there is no evidence that this is so—quite the contrary. As appetites grow with the feeding, so emotions grow with the expression. In fact, the evidence is very strong that most people are resilient, and that resilience is self-reinforcing. If, however, you persuade people that they are weak and fragile, that is what they will become.

At stake is our whole conception of what it is to be human. The common-law tradition is that everyone is responsible for his actions unless the contrary can be proved. Therapism, which has already subverted law to a considerable extent, believes that wrongdoing is itself a symptom. Man is a feather, blown on the wind of circumstance. There, but for the grace of my environment, go I.

It is easy to understand the appeal of therapism. At first sight, it is more compassionate than the common-law conception of man, which seems harshly moralistic by comparison. Therapism is all-forgiving, or appears so until, of course, you realize that there can be no forgiveness where there is no blame. In fact, therapism is dehumanizing, since it sees people as passive products of their past, as inanimate objects are. Since therapists do not, because they cannot, see themselves in the same way, but rather as fully evolved beings endowed with free will, they are inevitably inclined to speak to the objects of their ministrations de haut en bas. With the forthright shrewdness characteristic of Australians, the owners of a laboratory Down Under encapsulated this in their offer to their clients: HIV testing, guaranteed no counseling.

Therapism has caused a decline in the quality of our culture. People are now engaged in a kind of arms race, feeling obliged to express their emotions ever more extravagantly to prove to themselves and other just how much and how deeply they feel. This leads to the peculiar shrillness, shallowness, and lack of subtlety of so much of our culture.

Therapism has also corrupted large numbers of people. The assumption that people are easily and permanently damaged by various traumas has led many of them to act the part for the sake of receiving compensation. In this connection, I can’t help recalling a man I met who had been a torturer in the Middle East, but who had himself fallen out with the torturing authorities and had been severely tortured in his turn. When his torture was over, he fled to Britain. What really ruined his life, however, and made it impossible for him ever to work again, was a car accident in Britain, in which someone went into the back of his car at five miles per hour. You wouldn’t have to be a believer in the economic theory of history to spot the explanation of this particular story.

The thesis of One Nation Under Therapy is not entirely new, but it is stated uncompromisingly and with vigor, and brings the latest evidence to bear on the question. Particularly disturbing for believers in therapism was the fact that, after 9/11, the population of New York was not so traumatized that it required counseling en masse, though counselors descended on the city en masse, like bluebottles on a corpse. This would have been funny had it not been so macabre. The counselors needed clients far more than clients needed counselors.

I should declare an interest: the authors quote me with approval, and I naturally approve of anyone who approves of me (they boost my self-esteem). But the fact is that they have written a book, comparatively short and very easy to read, that touches on one of the deepest questions of human existences: how should we live? I do think, however, they are too kind about the motives of counselors and others who promote therapism: they reiterate, to my mind unconvincingly, that they are well-intentioned.

I am not so sure. I think they are largely driven by a desire to earn a living by voyeurism. I remember that when the first Gulf War broke out, the hospital in which I worked was designated as a receiving center for casualties. The counselors and other professional carers held a meeting in which they positively salivated at the prospect of compulsorily counseling scores of injured and burnt young soldiers (in the event, none materialized).

Once, when I worked in some distant islands in the Pacific, there was a road accident in which about twenty young women were thrown out of the back of a truck that was transporting them. They were brought to hospital, screaming and bloodied, and I shall never forget the struggle of the local population to get a good view. They literally climbed in through the windows and prevented us, the doctors, from reaching the injured on their beds.

In Britain or America, the climbers-in at the windows would have been counselors.