Psychotherapy as Religion. The Civil Divine in America.
William M. Epstein

Reno, Nevada: University of Nevada Press, 2006, pp 271.

This review first appeared in the Journal of Comparative Social Welfare, 2007.

This is, quite simply, a brilliant book, a tour de force.

The sad thing is that those who should most take its message to heart – researchers and practitioners of psychotherapy – will do their best to ignore it. But that will not surprise the author, whose whole argument is that psychotherapy is not a scientific enterprise supported by reason, but an essentially magico-religious undertaking which forms a central – perhaps necessary – pillar of US culture. That is to say, psychotherapy partly inspires and certainly reinforces the cult of what Epstein calls ‘heroic individualism’: the belief that we are self-creating subjects, responsible for our own destinies, able, with proper effort and the right kind of professional help, to overcome anything the world might throw at us.

Epstein’s method is to consider the principal approaches to present-day psychotherapy – i.e., psychodynamic, behavioural and cognitive-behavioural – and to review the recent research literature concerning their effectiveness in treating the range of ‘disorders’ to which they are commonly applied. If he is remorselessly scathing in his critique of the pseudo-scientific morass his enquiry reveals, this is no more than a refreshing antidote to the furious enthusiasm with which those with an interest in justifying their trade engineer the rejection of the null hypothesis.

William Epstein will make no friends in the psychotherapy field for having written this book; my guess is its practitioners will greet it in stony silence, or else maybe spread the word that he is crazy (a common line of defence ever since Freud). But his is not just a destructive critique. The book reaffirms and provides essential intellectual support for a profoundly important message: that heroic individualism in the end endorses only selfishness, cruelty and indifference to the suffering that is inflicted within our social organization. What we need to combat our current ‘psychological’ troubles is a rehabilitation of the whole idea of society and a painstaking analysis of the relations between those elements that go to constitute it:-

Heroic individualism is a form of pernicious liberalism, a blind faith in personal reinvention and the salvation of social adaptation rather than in the provision of greater institutional and material equality. True heroism requires self-sacrifice, courage under duress, perseverance, and leadership on behalf of others, notably those in need. In contrast, heroic individualism mocks the notion of personal sacrifice with its monomania of attention to individual ambition. Heroic individualism cheapens the recurring and deep problems of American society, requiring only shallow right thinking rather than the repair of failed social institutions.

That this is a profoundly unfashionable book in no way detracts from its worth – quite the reverse, in fact. Surveying the current neo-conservative, market-driven world, it would be easy to think that other writers in a great tradition of American social commentary (I think, for example, of C. Wright Mills’s The Sociological Imagination) needn’t have bothered. But that is not so; the value of such writing is, as much as anything else, in the solace, inspiration and encouragement it gives to those of us who are desperate for allies.

David Smail