Bad Therapy, Good Book

A short review

Children have access to more mental health services than any time in recorded history and yet their mental illness rates are higher than ever. That raises significant questions about the quality of the services and the nature of the disorders.

Abigail Shrier’s Bad Therapy: Why The Kids Aren’t Growing Up is a sustained case that modern therapeutic culture makes life worse for kids and their parents. It captures a trend that’s been going on for at least half a century in the United States: the of weaving neuroses into American's social fabric.

It’s often better to do nothing than to try to help. Despite the best intentions of everyone involved, therapy often makes things worse. It can be beneficial and powerful. However, anyone who looks at the trend has to ask why an increasingly therapeutic culture correlates with mental disorders, not harmony. The obvious answer is that the therapy and the culture it promotes is bad.

In many therapies, there’s this idea of experiential avoidance. The thought is that due to an unwillingness to face conflict and discomfort, many are prone to avoid it – to their detriment. The real cost of extreme social anxiety isn’t that it feels bad – it’s that one robs oneself and others of deep relationships.

In practice, experiential avoidance and rumination are encouraged. Discomfort and conflict are suppressed, while any negative feeling deserves to be “heard.”  Negative emotions are “seen”, which is to say that they’re affirmed and accommodated. Emotional suffering and oversharing are rewarded. Shrier writes:

In the minds of social-emotional learning advocates, healthy kids are those who share their pain during geometry. That is how a teacher knows they are emotionally regulated. They are willing to cry for the benefit of the class.

Vices are medicalized, instead of appropriately judged and reduced. People learn to be neurotic, transform negative experiences into trauma, and cede their autonomy to other people.

Of course, not all therapy does this. Sophisticated therapists avoid many of these pitfalls. Many parents have good reasons, given what they know, to send their children to therapy – especially since knowledge of the risks are not clearly communicated. Shrier is clear that she isn’t against all therapy and recognizes that many people benefit from mental health treatment. The question is – how much therapy is harmful? How prevalent are these issues?

Bad Therapy doesn’t sufficiently answer these questions. Yes, there are too many stories, conferences teaching bad therapy, and “experts” promoting it, but it’s not clear exactly how widespread it is. It seems like an issue largely for educated and middle/upper-class Americans. Moreover, although therapy and education are proximate causes for many children’s delayed development, there’s not much analysis of deeper causes – candidates like feminization, increased bureaucracy, wealth, and more depressive music and art come to mind.

However, unlike Shrier’s other work, I’m confident that she isn’t exaggerating the issue. I was exposed to some of this in school back in 2010, have read enough to know the ideas entered the cultural consciousness far before then, and can only imagine things have gotten worse. 

For anyone interested in these issues, I’d happily recommend the book. There are many important, underrated ideas expressed in an engaging and direct way:

• Therapy is risky

• There’s a sustained movement to reduce parental authority and providing therapy is a part of that

• Many parents are happy to cede parental authority for the promise of comfort and convenience

• Therapeutic culture is not a healthy culture

• We are resilient by default

One of the main questions is, what is going to supplant therapy culture? A slightly smarter stoic culture, I hope. There’s a distinction between state orientation and action orientation that’s useful here:

Adopting an action orientation means focusing on the task ahead with no thought to your current emotional or physical state. A state orientation means you’re thinking principally about yourself: how prepared you feel in that moment, the worry you feel over a text left unanswered, the light prickling at the back of your throat, that crick blossoming in your neck. Adopting an action orientation, it turns out, makes it much more likely that you accomplish the task.

Action orientation is necessarily closer to reality. The world gives us feedback on what we do. That said, focusing too much on action and ignoring the internal has its failures. Perhaps character orientation is superior. On the margin, however, getting out of the head and into the world would go a long way toward addressing the problems Shrier clearly lays out.

The diagnosing of ordinary behaviors as pathological. The psychiatric medications you aren’t convinced your child needs. The expert evaluations. Banish from their lives everyone with the tendency to treat your children as disordered. You don’t need them. You never needed them. And your kids are almost certainly better off without them. Having kids is the best, most worthy thing you could possibly do. Raise them well.