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There's been some buzz lately around Bad Therapy, by Abigail Shrier (also known "Irreversible Damage: The Transgender Craze").
The central thesis is that therapy, to the extent that it's effective even a little, comes with risks as well as benefits, and it's a bad idea to engage in recreational or mental hygiene therapy, in the same way that it's a bad idea to get unnecessary physical operations done. She argues that it's an especially bad idea to do this to children, who don't come into it with a fully formed self understanding, and that parents and schools have been engaging in way too much therapeutic activity without monitoring for harmful results. For most children, it's a better idea to try giving them as much freedom as is culturally reasonable and try telling them firmly to stop behaving badly and do better (and this is what better looks like), rather than trying to figure out if something's wrong with them psychologically. It probably isn't, unless adults introduce that. To back those assertions up, she conducted interviews with some psychiatrists, psychologists, other mental health professionals, as well as teens and their parents.
Caveat: the book is primarily about and intended for middle class, essentially functional families that are assumed not to engage in abusive behavior, and therefore doesn't spend a lot of time worrying that the reader, released from the constraints of the therapeutic model, will start escalating from naming feelings to hitting or starving kids or anything like that. I don't know if this is warranted, but do suspect that families who are practicing overly authoritarian child rearing (e.g. "To Train Up a Child" by Michael and Debi Pearl) are in an entirely different informational ecosystem. That seems likely.
There are three main threads: therapists, schools, and parenting practices. There's a lot of culture war fodder in each of these, especially an argument to massively downgrade the SEL components of schools -- that to the extent people actually go along with them, they aren't just a waste of time and money, but actively harmful. But more than that, to lay off the SEL inspired ways of talking about problems. Working in a public school, I find this somewhat convincing. There are kids who may or may not have psychiatric problems, I can't really tell, but as far as I can tell, the previously normal things (having to sit alone for a while, suspensions, ISS, noticing that other people are angry about the destruction of their concentration and personal property...) haven't ever been tried, in favor of treating the children as not entirely human (doling out pieces of candy one by one, each time they do a tiny positive thing, pretending like them terrorizing their peers can't be helped, organizing a bunch of meetings between six or so adults to consider ways to use behaviorist psychology on them). To the extent that the kid is basically a human being, this is counterproductive -- it's not actually helpful to become a raving lunatic that everyone else averts their gaze from. But there doesn't seem to currently be a path available for school personnel other than deeper and deeper into more and more therapeutic techniques, or for the parents of the other kids other than transferring schools entirely (something mentioned by some kids in relation to potentially complaining about an extremely bad classmate). There was a "mindset training" about how maybe when a kid who's known to be unreasonable throws a tantrum, maybe we should just instantly cave and find them what they want. "Bad therapy" is not very helpful there, since there's a legal apparatus built up around the problem. In my experience school staff understands that the procedures are stupid, but aren't really in a position to change anything, even up to state legislators.
I found the section on gentle, therapeutic parenting especially interesting. When I had my first baby, and had to sit around nursing the baby for an absurd amount of time day and night, said baby was very bad at sleep -- I hadn't previously realized that humans have to learn how to fall asleep -- so I would read parenting advice from generic online sources about my problems. There's a lot about "attachment parenting," gentle, gradual sleep training, and then as they get a bit older, a lot about gentle parenting. In my household, most of this was not so much tried and found wanting, but rather found difficult and left untried -- we both like our parents and come from stable households, so kind of just act similar to our respective parents. Shrier found people who had given gentle, therapeutic parenting a really hard try, but not been blessed with gentle toddlers. The most optimistic account was of an Israeli psychiatrist with a young ADHD son who didn't want to use drugs (at least so young), and spent a lot of time gardening with him as an outlet, and seemed to be enjoying the bonding and enjoying the son. "Raising Raffi" by Keith Gessen chronicles attempts at fatherhood by a highly educated man fully bought in to never yelling or punishing, and Shrier's read on the situation is that maybe some small amount of punishment was in order. An observation from both Shrier and Jordan Peterson is that parents who keep losing power struggles with their young children can, and sometimes do, go on to resent the children, and people more broadly don't like them either, since they're out of control much of the time. That seems plausible, though I can't think of any specific examples. She also thinks that the children in question tend to be the ones who go on to cut their parents off anyway, after all that effort, and not want children themselves, since it looks like such a terrible slog. She doesn't present a lot of evidence for that, just her gestalt impression from interviews. Shrier advocates for parents who themselves like their parents and come from functional households to follow their intuitions and ask their families for advice, rather than reading contemporary parenting books. She, again, doesn't have much advice for parents who come from dysfunctional households with traumatic practices.
In general I liked the book as a bit of casual sociology, it has some interesting anecdotes in it, and would tepidly recommend it to anyone interested.
I came to similar conclusions based on reading/hearing the thoughts of Mark Noble, a neuroscientist:
https://feelinggood.com/2019/11/18/167-feeling-great-professor-mark-noble-on-team-cbt-and-the-brain/
Basically, a good rule-of-thumb in neuroscience is "what fires together, wires together." So classic talk therapy (going over thoughts again and again with an interested but passive, unjudgemental or supportive therapist) might actually strengthen neural pathways that lead to depressed, anxious, angry, or otherwise undesired mental states.
This also explains why, if possible, just ignoring thoughts like "I'm useless" or "This is going to end terribly" or "It's SO unfair!" can be remarkably effective at avoiding the concomitant emotional problems; I think there was some research on this recently. It also explains why men's "just don't dwell on it" coping strategies are associated with lower levels of depression, anxiety, and suicide attempts than among women, despite the ideology that "repression" is a bad thing. Men have more successful suicide attempts, but this can be explained by higher levels of aggression. It also explains research suggesting that the behavioural activation methods in CBT are the most effective, since these are focused on rapidly removing negative thoughts/habits (e.g. by falsifying your hypothesis that holding a house spider will kill you with its venom or that your old friends will hate you if you get back in touch with them).
Mark Noble argues that approaches like David Burns's TEAM therapy, which aim at rapid recovery, will be more successful, partly because they minimise the amount of time spent on therapy or brooding outside of therapy. Noble also thinks there also reasons to think that each element of TEAM (Testing emotions/therapist performance before and after sessions, Empathising with the client, Agenda-setting to deal with client resistance to change, Methods for rapid and client-calibrated recovery) has a neuroscientific basis for effectiveness.
However, even if TEAM doesn't have these properties, I think that the idea of gradual change and the elevation of emotional expression have quite possibly damaged millions of people's mental health.
I thought the consensus was that it was because men used different methods, and women actually had higher numbers of suicide attempts.
A large proportion of attempts, for both sexes but especially for women, are cries for help/attention. But yes, the reason for higher male completion is probably both access to high-effectiveness tools (ie they’re more likely to own a gun) and higher male impulsiveness.
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Yes, I was going to add that but forgot. It leaves open the question of why men use different methods, but higher levels of aggression might explain that.
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This reminds me of the trend I saw of "Men would rather X than goto therapy". Although trying to dig it up now only shows people mocking it, by inserting the stories of great men throughout history and fiction into the format. But I thought I recollected women making earnest posts complaining about the men in their lives deciding to record a shitty album, or taking up intense study of trivial subjects, instead of going to therapy.
Presuming it was ever an earnest meme, and I wasn't just missing the joke...I was utterly agog that these people who never, ever, graduate from therapy would mock men for self actualizing. I can personally attest that whenever I feel any sort of transient depression creeping in, giving myself any sort of self actualizing goal and getting busy is the best and most immediate cure.
I'm actually reminded of the time I posted this funny bit by Denis Leary about therapy to a discord, and some crazy lady in therapy took it so personally they thought I was literally telling them to kill themselves.
And a lot cheaper than going to therapy. Even classically "useless" male coping mechanisms like chopping wood or fantasy football are cheaper, while potentially disproving negative thoughts like "I can never do anything right!" that people often experience when depressed.
Today, I passed a forest path that I cleared for a summer job as a teenager, when I was very depressed and almost crippled with social anxieties. Working on that path wasn't the whole story of how I got better, but it was one of the early moves in the right direction. Of course my work was sporadic, ill-organised, slow, and so on, but it was something where I made progress every day, received some positive feedback, and achieved something that looked impressive at the end.
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I don't know anything about Denis Leary, but reading his name reminded me of this article I read when I was in my undergrad, which talks about a clip of Leary appearing on a talk show with Greg Giraldo.
My favourite therapy sketch:
https://youtube.com/watch?v=jvujypVVBAY
This actually works very well in my experience, if you have the motivation to use it. And it costs much less than talk therapy.
That was great.
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Yeah, Denis Leary is... Denis Leary. He often revealed himself to be thin skinned. He allegedly cribbed his entire stage persona from Bill Hicks, to say nothing of lifting many jokes nearly word for word.
All the same, his No Cure for Cancer special is among the greatest comedy specials ever recorded. I can appreciate Bill Hicks material more, but I laugh far, far harder at a (probably coked up) Leary screaming and sweating on stage belting out the material at 3x the pace with less meandering.
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That certainly fits my anecdotal experience. First-hand. Lots of it. My wife's an overtherapied wreck who spends every waking hour re-heating her anxieties. Only ever gets worse.
Yes, it's hard to tell cause and effect, but I am amazed by how much many women (almost always women) spend on endless and unsuccessful therapy.
I think most of us have experienced a spiral at some point of our lives, where we go over and over some topic in our heads until e.g. we hit some object or some booze. As far as I can tell, from my experience, the general factor that works in any mental health method (if they work at all) is some way of preventing and/or stopping those spirals. Going over negative thoughts repeatedly, with someone who either validates your opinions or at least stays neutral, seems like a good way to get into the habit of such spirals.
Conversely, I like Albert Ellis's iconoclastic approach, which was to playfully mock e.g. "mustabory" cognitions ("I must be successful" "I must be loved" etc.) and challenging them by the same standards one would challenge a hypothesis or practical proposal. That seems to be one of the parts of CBT that actually works, but many people shy away from it, and cultivate their neuroticisms to the point of becoming an identity. The extent to which this occurs with some trans people is unclear to me, but I can't imagine it helps with e.g. autogynophiliacs or autoandrophiliacs.
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I've been wondering for a while now if this (generally - I'm not talking about your wife specifically) isn't an underappreciated disaster of the transition from a broad-based traditional Christian culture to a Oprah / Doctor Phil Therapy culture.
I know I've seen stats suggesting that it has long been the case that women are much more reliable church goers than men. I've likewise seen the claim that normie women seem more drawn to recourse to external "shared" social authority than most normie (non-alpha) men, broadly speaking, too, which goes hand-in-hand with that. Trotting out some folk evo psych, maybe it's all a consequence of their greater general social awareness, verbal communication skills, agreeableness, and neuroticism, as well as physical smallness and the general ambient threat of unchecked male risk taking and male libido and male strength? It's not hard to concoct just so stories about why you might expect exactly these dynamics to emerge, just based on biology.
I have to say, too, as a parent of elementary age kids of both sexes, watching their small social groups emerge and evolve, all the stereotypes are largely true. My oldest daughter, who is in 5th grade, is already having to navigate mean girl social power emerging, with a keen sense of "what is normal" and "what is weird" seemingly drawn from the ether and lots of social policing and exclusion. There's no shortage of girls in my other daughter's kindergarten class (including her, I am not happy to say) who have their "tattle to authority at the slightest imagined infraction" knob turned up to 11... and this emerges despite no shortage of unsupportive feedback about the behavior. The tattling urge is just real, overpowering, and pervasive. Meanwhile, my third grade son and his friends are almost literally small apes with almost no social awareness at all... and again, this despite no shortage of exasperated feedback. They wouldn't even think to tattle as a result of any of their messy interactions.
Anyway, if you go along with any of that, it's not hard to see how the Christian concepts of "faith" and a general "Let go, let God" orientation have a very specific role in easing the demons that beset anxious women who are prone to relitigating all the things that inflame their worst inner voices. One general read of the tradition might say, "There is an authority outside yourself, it can and must be infinitely trusted, it is the root of all reality, it is all benevolent and all knowing, you are a child of God and of infinite worth, you are not wise enough to stand in judgement of anyone or even yourself and humility and hope and forgiveness are thus commandments, despair and gossip are sins, trust God and do your best and turn to faith to come to internalize that all this suffering and anxiety and confusion and difficulty has meaning and has a point and will be bearable." The "Gospel" is literally the "Good News", right?
(I'm not well-versed enough in other traditions to make similar comparisons for other religions or cultures. And of course this is just one read of the tradition. I'm just interested in comparing a certain read of Christianity vs Modern American Therapy culture here)
I'm not saying "Christianity is folk CBT!" But it's not hard to see that at least one reading of the tradition seems very well oriented towards dampening those horrible, anxious, destructive inner voices in a great many women.
The women I know who are totally saturated in therapy culture seem to be marinating constantly in hyper-negative re-litigations of all the particular events in their lives, meanwhile, while loudly evangelizing it as a universal solution to everyone else's problems somehow. And it's clear that therapy culture has replaced what would have been a religious faith and practice previously, even for nominally religious people. And to top it all of, it's all straight up scientism - totally empirically unmoored and indifferently so, the worst kind of woo that the replication crisis (or hell, even Karl Popper in his original engagement with the relationship between Freud and Science) should have swept away long ago. It's all "The Music Man" style confidence games. It's treated with a very specific kind of "authority", and a lot of cash is being made, but the grounding of that authority is, it seems to me, entirely on a foundation of sand. Sticking with my biblical references, as Christ said and then William James reiterated, "By Your Fruits Shall Ye Know Them". And my subjective opinion of therapy culture is that the people most vocally invested in it seem like giant flash red warning signs about it.
I don't intend to evangelize Christianity here, by the way - rather, this is just one more comment in the genre of "I did the New Atheist thing and now I have deep reservations about how much baby got thrown out with the bathwater". Chesterton's Fence et cetera.
Christianity has its own expensive forms of therapy. Just look at pilgrimages, Hail Mary's, time spent talk to someone who never says a word in response (close to some psychodynamic therapists?). And it's easy for people to transfer their neuroticisms to hell, maintaining faith, or the disturbing fact that so many people think you are out of touch with reality. Any one of these concerns can lead to fear, depression, or anger, just as much as a therapist's unscientific speculations on "repression", "authenticity", and "self-esteem".
Here's an evo-psych just-so story: women usually like to be attended to, whether that's by friends, family, "the boyfriend who will always be there for you" (Jesus) or a therapist. This is important, because women who were attended to by many people were more likely to successfully raise children. Human children are hard to raise to raise to reproductive viability, even now.
However, compared to therapy or some other religions, Christianity is fairly cost-effective. A person looking to satiate their lust for attention and elevation of their feelings' importance could do much, much worse.
Not if you’re tithing. Becoming a Christian is probably more effective than going to the shrink down the street, but the shrink usually doesn’t make a claim on 10% of your income.
Good news (pun intended): neither does Christianity. You're encouraged to give what you can, not required to give 10%. 10% is just a decent reference point for "it hurts but is bearable".
Varies by sect, Catholicism requires that you ‘contribute to the support of the church’ in keeping with ability. Mormonism makes a strict tithe. Protestant denominations vary.
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The prudent investor will definitely seek a good bargain when purchasing a Christianity.
(I am not mocking Christianity, but the pragmatic approach to theism, where one adopts a religion based on its "cash value", to use William James's term. I admire the mind of a Thomas Aquinas or a C. S. Lewis, whereas pragmatism seems deeply cognitively corrupting.)
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Whenever I read stuff like this, my reaction is that we need each other. Both sexes need to work together and cooperate, to balance out our strengths and weaknesses. The boys can help the girls to not worry so much and to get things done without endless committee discussions seeking unity. The girls can help the boys become more, uh, "civilized," expressing their emotions and not hitting each other. Ideally we'd all be perfectly well-rounded individuals who are good at everything, but it's more realistic to just balance each other's strengths and weaknesses.
But instead we're increasingly split off into special interest groups, and put in competition with each other. Feminism seems to increasingly paint the world as a struggle between men and women, and then MRA groups react accordingly buy fighting back... it's just so tiresome.
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My god, you sound exactly like my evangelical mom when you say this.
Some of the most effective advice against mental demons actually comes from my mother -- she talks frequently using the exact language you've used here, about how we've got all these voices in our head that sound like one's voice but aren't. And in her mind, it's a choice to listen to them or to do something else that's important; focusing on them gives them more power.
What's funny is prayer also came up as a potential coping strategy (in a long list of coping strategies) that my definitely-not-religious therapist shared are helpful to some people when dealing with strong emotions. And I can share I do find it helpful at times.
If you allow me to be psychological instead of theological, I think it has the same effect as those mental excercises where people imagine their worry as physical object and then imagine getting rid of it. It unburdens the mind in a way it will accept. (And if you'll allow me to be theological instead of psychological, there was a thread not too long ago about why people believe in petitionary prayer, and this is it -- it's not about somehow bending the will of God towards something, but about releasing the concerns about which you can do nothing outside of yourself and putting it into the hands of God.)
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By whom? My impression is that therapists are broadly pretty middle class and their bosses aren’t exceptionally well off either.
One of Shrier’s points is that it’s much more appealing for therapists to treat an anxious but otherwise normal teen than someone with a worse condition, since they make the same money, the client is generally easier to get along with.
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My googling just now suggests that mental health services in America cost something like 200 to 300 billion dollars a year. You can decide if that sounds like a lot or not, I suppose.
Anyway, I imagine it's a combination of things. I'm going to be totally anecdotal here and make some guesses based on women in my life who seem heavily steeped in this culture, so take it with a massive grain of salt.
On the one hand, you have celebrities like Dr. Phil (net worth $460 million) who genuinely do seem to make a lot of money off of their national brands. Same thing, I suspect, with high profile therapy-oriented book authors who cycle through media targeting women. More than just the money they make, though, they soak up a huge amount of attention while cementing the public frame that everyone could and should use therapy, no different from going to a doctor, and that therapy works and can help anyone. Any time I find myself at a doctors office waiting room in the middle of the day with women's day time tv on, I'm constantly caught off guard by how utterly pervasive the therapy language is in the normal conversations of the (if I'm being mean) clucking hens on those shows. It's the water the fish are swimming in, to mix animal metaphors. This space seems to have a lot of really high profile shysters, to my eyes - it reminds me a lot of tele-evangelists for a slightly different subculture.
And on the other hand, there is the properly credentialed world of normal, local therapists out there who, I suspect, mostly believe in what they're doing but are also aware of how hard and fuzzy working with people is, aren't making huge bank, and are trying to do their best... not that different from, say, teachers. I actually had plenty of experience with such counseling in my teen years, as a matter of fact. And my impression is not that such people are bad people particularly - but like anyone, I think they kind of have to believe that what they do is generally helpful and a helpful part of a solution to other people's problems, even though often times people don't seem to get any better (but then, people really are enormously complicated, and change is hard, and people need to want to change, and you can lead a horse to water but you can't make them drink, and very often it is the social context of someone that is holding them back, and...) In all of this, they are just like the people I know in high frequency trading who kind of have to believe that by increasing liquidity in the system, they really making finance more efficient for everyone, and just like the higher up I know at Raytheon who kind of has to believe that national defense is obviously important and a net good and Raytheon is itself a net good in that space, and just like the literal DEI trainer I know (mom of my son's friend) who is a nice person who kind of has to believe that she's making the world a better place by running DEI workshops at our local bank. And all of them have mortgages that kind of depend on them believing that what they do is worth doing, even though it can be hard to tell when the world is so complicated, so they can keep their own lives afloat. But all of that eventually adds up to real money, in aggregate.
And yet, as I say, the women I know who seem most drawn to therapy culture and counseling seem... not great. Maybe they would be even worse if that was not a part of their life; there's literally no way I could know that. But I really, really do wonder.
This has the same vibe as “all the people I know who seem most drawn to oncologists all seem like they’re sick.” Um… yeah?
I don’t think therapy works for everyone. It works for some, and not very well for others. I’m rooting for myself being in the first group. But I hear testimonials from people who it has definitely helped, and I don’t see any reason to doubt them.
There might well be people of your acquaintance who went through therapy, found it helpful, and then moved on. They don’t talk about it, because it’s not an identity for such people, and mental health is very personal. The people for whom it is and identity and doesn’t work well are definitely the ones who are going to talk about it more. I’m not sure you can make a good argument about its effectiveness from the people who talk the most loudly about it. I think you need studies for that.
But I agree, therapy culture is toxic. It’s the equivalent of WebMD making everyone think they have cancer. It takes something private and useful and turns it into a very public weapon. Most people don’t need the tools of therapy, and I think the idea that they do is silly. It’s a condescension to the needs of a select group of suffering people. It’s like chemotherapy — it saves lives, but you shouldn’t give it to someone without the need for it.
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Any number of behavior healthcare organizations which aren't paying anyone very much but are employing a lot of people to handle all the paperwork.
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Is that just something you're going to have to live with the rest of your life? Does she have any interest in changing?
No. I've spent several days in a state of unabating rage about her having strangled everyrhing positive out of our lives. I'm escalating. Today I dumped her, myself and our daughter at her parents' house and we'll live here for the indefinite future. If retvrn to the multigenerational family model doesn't help, then my next step will be to be a very bad parent and ask my daughter to choose either mom or dad.
Only if it happens without any effort on her part, or by her doing more of what she's been doing so far.
Hello The Motte, thanks for hosting my vent.
Sorry man. I hope you get through this OK.
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