The End of Therapy
There are many pressing issues facing present and future therapists, and
the therapeutic professions seem to be in the throws of the most difficult
period in the history of therapy. Government, insurance companies, and corporations
are poking their heads into the consulting room, and not as patients, as
we might hope. More and more new laws are being written telling therapists
both what they can't and must do in the therapy room, and there is overwhelming
pressure on both patients and therapists to heal or fix psychological problems
as quickly and cost-effectively as possible and with increasing disregard
for psychology's original concern, the logos of psyche.
Many therapists feel that these problems are disruptive to the true work
of therapy but that they eventually will be worked through. I believe that
they are mere shadows of psychotherapy's inevitable fate, they are harbingers
of the doom looming ominously in the not so distant future of psychotherapy.
The field of psychology was originally birthed from the field of medicine
when medical doctors (most memorably Breuer and Freud) found that there
were certain symptoms which could not be medically explained and which did
not respond to any known medical treatment. However, in the last one-hundred
years the science of medicine has made tremendous progress, especially in
the areas of neurology and physiology, and the gaps in knowledge are rapidly
Now medicine is telling psychology that, because more and more of these
behavioral and emotional symptoms are being explained medically, psychology
is becoming a less and less appropriate system for treatment, as if psychology
were a temporary measure which modern science has now outgrown and has no
further need of.
A fantasy of medicine may be that one day in the not so distant future,
all DSM diagnoses will have been traced back to neurological or physiological
bases. We will have found the neurological malfunctions responsible for
Paranoid Personality Disorder (301.0), Kleptomania (312.32), Frotteurism
(302.89), Depersonalization Disorder (300.6), Exhibitionism (302.4), and
all the rest. The pervasively recurrent phrase "Not better accounted
for by physiological effects of substance or general medical condition"
will have been replaced by the appropriate pharmacological remedy, complete
with brand name and dosage.
The most obvious problem that the actualization of this fantasy would cause
for therapists is that we would be completely out of business. Psychological
writings would be removed from universities' science libraries and placed
in the literature section, and perhaps later, by future anthropologists,
in the primitive mythology section. Any therapeutic practice still daring
to exist would carry a stigma similar to that of modern palm reading or
the Psychic Hotline. The future physician would regard the modern psychologist
as the modern chemist regards the ancient alchemist: scientifically confounded
and pitifully naive. Our future does not look bright.
So what am I doing about this? I am giving up hope. I am accepting the fact
that the fantasy is real, there is no solution. So I am getting ready.
I am putting fiction into my psychology today, before Psychology Today
is put into the fiction section. I am taking fantasy very seriously, because
soon all psychology will be regarded as fantasy, and I want to be a leader
in my field. I am writing my psychology with a literary quality, trying
to make it appealing to the future literature lover, make it enflame passions
and inspire imagination, so that my book will be picked up from the shelf
instead of dry old Winnicot, or Bollas, or some abuse recovery manual, or
statistical analysis of behavior. I am also beginning to read the ancient
alchemists in order to get a sense of why, after so much time has passed,
and even bearing the shame of science's scorn, their work is still on the
shelf. Perhaps if I can put a little of what they had into my work, mine
will also stand the test of time - if only in obscurity.
The reader may have already noticed a thinly veiled desire for immortality
shining through my preparations for the future, but this desire is not only
mine. It is part of the inescapable medical fantasy which psychology is
heir to. I, as a psychologist, am indelibly involved with the promotion
of life, but since the future of my field will find itself only in fantasy,
it is fantasy life that my duty entreats me to promote.
Copyright ©1995 The Ares Press
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