Cultures of Healing: Correcting the Image of American Health Care.

• Author: Torrey, E. Fuller

"The first quality we can ask of mental health professionals, then, is greater truthfulness," says Dr. Robert Fancher, a psychoanalyst, in the final chapter of his book. That being the case, I confess to having previously written a less-than-flattering book about psychoanalysis (Freudian Fraud) and to being a biological psychiatrist. I also confess to having indulged in the book reviewer's universal practice of checking the book's index and references for citations to my own pertinent work. Alas, there were none.

Despite this oversight, Dr. Fancher has produced a well-written and interesting book, as far as it goes. He claims that there is, in our society, a "culture of healing" in which "difficulties and miseries get classed as psychopathology when there is a market that will pay professionals to try to get rid of them." This "makes the United States far and away the most therapized country on earth." The reification of the problems of living into psychopathology, one of the hallmarks of contemporary American culture, thereby creates the industry of counseling and psychotherapy, and it is the mechanics of this industry which occupy most of the author's attention.

Counseling and psychotherapy, argues Dr. Fancher, are most often based on one of four cultures of healing: psychoanalysis, behaviorism, cognitive therapy, and biological psychiatry. He devotes a chapter to each, dissecting their assumptions and practices and demonstrating how each is a belief system rather than a scientific undertaking. Counseling and psychotherapy are effective, Fancher argues, not because of the specific theories or practices of any one of these "cultures of healing," but rather because of general factors which underlie all counseling and psychotherapy.

Fancher's failure to pursue these general factors more aggressively is one shortcoming of his book. He briefly describes the seminal work of Dr. Jerome Frank, whose Persuasion and Healing: A Comparative Study of Psychotherapy is the classic study in this field; but he fails to discuss related studies which have enriched this literature in recent years. Counseling and psychotherapy do work, but they work because of factors such as the personal qualities of the therapist and the expectations of the person undertaking therapy, not because of specific psychoanalytic, behaviorist, or cognitive therapy belief systems.

Fancher also devotes considerable discussion to the perpetual behind-the-scenes turf wars which...