Against Therapy
By Jeffrey Masson
London: Fontana. 1990
Final Analysis
By Jeffrey Masson
London: Fontana. 1992
Reviewed by Chris Slee
Jeffrey Masson is a former psychoanalyst who began to question the theory and practice. He was ostracised by his colleagues and eventually driven out of the profession. He subsequently developed a critique of all forms of psychotherapy.
Against Therapy expounds this critique. Final Analysis is the personal story of his break with the psychoanalytic profession.
Masson became disillusioned with psychoanalysis for a number of reasons, but the issue of child sexual abuse was central. He became critical of both Freud and present-day psychoanalysts for regarding their patients' accounts of childhood sexual assaults as fantasies rather than reality.
Freud had a number of female patients who told him of abuse, often by their fathers or other male relatives. Freud initially accepted that they were telling the truth. He gave the first published accounts of the devastating long-term effects of childhood sexual abuse.
But later he claimed that the patients were fantasising. The theories he developed to explain these "fantasies" became central to psychoanalytic doctrine.
Masson became convinced that Freud's initial belief in the reality of childhood sexual abuse had been correct, and that he had backed down under pressure from his psychiatric colleagues, who thought he was crazy to believe his female patients. Freud's own training in the conservative and sexist tradition of 19th century psychiatry pushed him in the same direction.
In Masson's view, Freud's initial belief in the frequent occurrence of childhood sexual abuse within
the family was rejected because its implications were too disquieting.
It was easier to deny reality. "By blaming the victim, Freud was able to unburden society of any need for reform or deep reflection."
Masson still considers that Freud, despite his errors, made a big contribution to human thought: "Freud's preoccupations, with dreams, with memory, with the primacy of emotions, with the importance of childhood and especially with human misery, are now our preoccupations for the better".
But Masson is scathing towards Freud's present-day followers. He considers that psychoanalysis is not only a "profitable and prestigious profession" but also a "cult". He refers to the "pressures to accept concepts handed down by the leader, no matter how irrational; xenophobic banding together against outsiders; and the punishment of anyone who poses questions or finally wants out".
In Against Therapy, Masson extends his critique beyond psychoanalysis to psychotherapy in general. He argues that most forms of psychotherapy, despite their differences, share certain features, including "a lack of interest in social injustice" and "an implicit acceptance of the status quo".
Furthermore, "the therapeutic relationship always involves an imbalance of power". He cites numerous cases of therapists abusing patients.
He acknowledges that "some psychotherapists are decent, warm, compassionate human beings, who sometimes help the people who come to them". But he argues that "they function in this manner in spite of being psychotherapists, not because of it".
Masson rejects the idea that anyone is an "expert" in understanding other human beings, and denies that a therapist can be "objective". He comments that when he was a psychoanalyst, "My life was in no better shape than that of my patients. Any advice I might have had to offer would be no better than that of a
well-informed friend (and considerably more expensive)."
Instead of "experts", Masson favours "self-help groups that are leaderless and avoid authoritarian structures", in which participants who have a common problem (e.g. women who have been sexually abused) "share experiences, survival strategies, political analysis, and just their own outrage".
I am not sure that I agree with Masson's total rejection of any role for professional expertise in helping people with emotional problems. Nevertheless, his critique is very powerful.