Is therapy a waste of time (and money)?

The answer, according to the psychiatrist Richard Friedman in his recent NYT op-ed entitled “When Self-Knowledge is Only the Beginning,” might very well be “yes.” In the article, he argues (1) that insight into one’s past may be neither necessary nor sufficient for living well and, more polemically, (2) that such insight might actually make your suffering worse.

In order to make his case, he cites two examples. A young man who’s been seeing Friedman for years is well-aware that his separation anxiety can be traced back to his traumatic experience of being separated from his mother when he was 4. Despite his insight into his condition, he still feels separation anxiety. Hence, insight is not necessary for human flourishing (thesis 1).

Then there’s the case of the financial analyst who makes a lot of money but who wishes that he’d chosen to pursue his love of art instead. He realizes, Friedman tells us, that he went into finance in order to “please his critical and demanding father.” He therefore has no problem with understanding what has led to his depression. But this insight brings him no mental relief; on the contrary, it makes him feel worse (thesis 2).

Friedman believes that any lightening of the patient’s load is likely the result of what the British psychoanalyst D.W. Winnocott calls “holding.” The patient feels better because he has found a friend, someone who listens to his concerns, who takes him seriously, who provides a safe place for self-inquiry, who confirms what he is thinking, and so on.

At first blush, Friedman’s argument is compelling, yet his conclusions rest on a faulty assumption: namely, that insight is identical with theoretical self-understanding. To be truly insightful, however, is to strive to be wise. That is, insight combines theory and practice, knowing how such and such came to be (i.e., theory) with knowing how to modify one’s thoughts and actions (i.e., practice). It’s not for nothing that meditation traditions such as mysticism have stressed undertaking daily exercises in order to modify one’s understanding of one’s place in the world. One might also cite, on this score, Hegel’s odyssey of human and social development: running through the catalog of “forms of consciousness” also entails getting beyond those that have been unworkable. If this is right, then it is hardly puzzling that someone who becomes aware of the genesis of his condition would still not be far along on the journey of knowing how he should modify the beliefs he has in order to feel better. He stews; he gets angry and frustrated; he resents; he feels trapped. In a sense, he still doesn’t know himself.

To see what would be involved in the kind of insight I have in mind, consider a simple example. John feels resentment because he believes that his mother has treated him unfairly. She has, he thinks, put the well-being of his sisters above his own, and this has led him not to actualize his potentialities. He looks at his sisters, both of whom are successful, with a feeling of envy. After years in therapy, he has learned to recognize this about himself, but shouldn’t this recognition only be the first movement, the opening salvo, and not the thing in its totality? Shouldn’t he then go on to explore (to quote Lenin out of context) “what is to be done?”

1. Perhaps his beliefs are false or unhelpful. Perhaps his mother did the best she could do under the conditions she’d been thrown into. What would John need to do in order to cultivate the kind of fortitude that entails forgiving?

2. To what extent has John sought exculpation (excusing himself for wasting his life) in lieu of explanation (understanding what brought him to where he is today)?

3. And, in light of 1. and 2., what beliefs might John need to endorse about himself in order to determine what is within his power here and now? What capacities might he still need to develop, what skills learn, what values uphold, in order to have a shot at leading a flourishing life?

There is the taint of fatalism surrounding Friedman’s article, one that we would do well to remove. Once we attach the practical dimension to the concept of insight, the force behind Friedman’s objection diminishes considerably.

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