The Tyranny of the Therapeutic State

Presented at the First International Forum of Child Protectors and Clients at the Netherlands, June 28 - 30, 1995

Hollida and I are pleased to be here in the Nederlands to take part in the first international conference convened to allow to be heard the ". . . voice of clients/citizens . . ." who are deeply concerned with the actions of state child protection services around the world. It is altogether fitting that this conference be called together by citizens of the Nederlands and held here. It is here, in 1568, in this land, not far from where we are peacefully sitting in a pleasant pastoral surrounding, that a people, few in number, insecure in struggling with a difficult and hostile environment, began a revolt against the rule of Spain, the greatest and most powerful empire of the day. It was to be the longest war for independence ever fought and lasted for eighty years from 1568 to 1648 when the Dutch prevailed and gained independence from Spanish rule. Within one generation of their hard won freedom the Dutch became the greatest trading nation in the world. The cities of Holland were the commercial, cultural, educational, and financial centers of Europe. The Dutch empire stretched from the Indian Ocean to New Amsterdam on the Hudson river.

What drove the citizens of Holland to this unparalleled effort is presented in the petition addressed in 1548 to their ruler, Charles V, Holy Roman Emperor and King of Spain. They described the unending reclamation work needed to protect the land from the sea by dikes, sluices, millraces, windmills, and polders. "Moreover," they wrote, "the said provinces of Holland contain many dunes, bogs, and lakes as well as other barren districts unfit for crops and pasture. Wherefore the inhabitants of the said country in order to make a living for their wives, children, and families must maintain themselves by handicrafts and trades." In contemporary terms, it was family values that impelled the Dutch to persevere and win their freedom and their incredible success. It was the love of family that held the bickering, disparate, divided cities and states of Holland together in their hatred of Spanish tyranny. During the eighty year struggle there was a cauldron of infighting among sects, parties, competing interests, and narrow loyalties to city rather than country. In a deeply fragmented developing nation, what held the fragments together was a common will for the freedom, benefit and welfare of families and children.

In opposition, the King of Spain, believing that families must be subordinate to the absolute rule of the state and in the interest of their eternal welfare, they must conform to the dictate of the state. When 400 Dutch nobles demanded an end to the practices of the Inquisition, the Spanish governor ridiculed them and called them ". . . a bunch of beggars." They adopted the obloquy as a name for themselves, Beggars of the Sea. In 1574 it was the Beggars of the Sea that broke the seven month siege of Leyden by breaking the dikes, flooding the land, and, while engaged in hand to hand combat with the Spanish soldiers, pulled by hand heavily loaded barges of supplies through the mud and water to relive the city. In 1579, at Utrecht, just down the road a piece, the Union of Utrecht brought together the seven provinces that became the Dutch state. In 1581, the States General, meeting at The Hague, passed the Oath of Abjuration that was the Dutch declaration of Independence, preceding the American Declaration of Independence by almost 200 years. In it the Dutch asserted that Phillip II had violated the compact and duty of a ruler to deal justly with the citizens and given them good not bad government. The delegates claimed the inherent right of subjects to withdraw their allegiance and resist an oppressive and tyrannical government. There was no other way to preserve their liberties and freedoms. They continued to pay the price of liberty until the final battle and independence in 1648.

The Dutch, however, did not abandon their love of liberty but built a society that was vital, liberal, tolerant, allowing freedom to all alike, Jews, English dissenters, Protestants, and Catholics. Even the unorthodox American Puritans, who later formed a bigoted and punitive government in New England, had found shelter and acceptance in Holland. The intellectual ferment, the artistic creativity, and the nourishing freedom of Holland produced Pierre Bayle, Rembrandt, Vermeer, Van Dyck, Jan Steen, Ter Borch, and Ruysdael. The Golden Age of Holland led directly to the struggle for political liberty that was to take place in the American colonies. Even then, the Dutch paid a great price for the liberty of the United States of America.

November 16, 1776, on the tiny but rich Dutch Caribbean island of St. Eustatius the guns of Fort Orange returned the salute of an American brigantine flying the new red-and-white-striped flag of the Continental Congress. This was the first official recognition of the existence of an American state. In 1939, President Franklin Delano Roosevelt presented a plaque to St. Eustatius. Mounted on the ruins of Fort Orange it reads, "In Commemoration of the salute of the flag of the United States fired in this fort November 16, 1776, by order of Johannes de Graff, Governor of St. Eustatius, in reply to a national gun salute fired by the U. S. Brig-of-war, Andrew Doria. . . . Here the sovereignty of the United States of America was first formally acknowledged to a national vessel by a foreign official." The Dutch on St. Eustatius continued to supply absolutely necessary war materials to the colonies until the English conquered the island and punished the Dutch by reducing it to a desert. It was the support of the American revolution that led to devastating warfare with England and ended the Golden Age of Holland. Such may be the price of liberty.

Therefore, we think it is altogether fitting, proper, and of a piece with the history of freedom that, once again, the Dutch are leading a disparate group of troubled citizens in pursuit of the goal of tempering state intrusions into the liberty interests of ordinary people in their family life. This last century has seen more social transformation and more radical change than any other known era. Society, policy, work, work force, culture, economics, political structures, and available knowledge are qualitatively and quantitatively different than they were at the turn of the century, indeed, different from anything that has existed at any other time in history. One thing has not changed, however. The relationship of the individual to the group of others is the rock bottom conundrum of human life.

While today it is not an autocratic royal sovereign insisting upon conformity, it is the same basic struggle, the power of the state diminishing and limiting the freedom and responsibility of the individual citizen. The assumption is that the state has the power to determine individual lives and therefore it ought to do so in the pursuit of what the state determines is the individuals welfare. This firm belief in the ability of the state to order individual lives is put forth in this statement by President Clinton in criticizing Republican plans to reform the welfare system. "[They are going to be in] Stanford, Berkeley, or San Quentin, or some place in between . . . They are going to be in prison, they are going to be in university, they are going to be in some place in between. Whether they are or not is a part of what we do and how we behave." It seems more reasonable to believe that whether or not people wind up in prison or university is dependent on their behavior, not the governments. But the development of catastrophic social problems has been met with the answer that they must be solved by government. This is the led to the emergence of the therapeutic state where the mission of government is to heal problems.

In the year 430 B. C. Pericles spoke to the Athenian nation, the birthplace of western civilization and democracy, and described for all ages the core of a free democratic society.

"Our constitution is called a democracy because power is in the hands not of a minority but of the whole people. When it is a question of settling private disputes everyone is equal before the law; when it is a question of putting one person before another in positions of public responsibility, what counts is not membership in a particular class but the actual ability which the man possesses . . . And just as our political life is free and open, so is our day to day life in our relations to each other. We do not get into a quarrel with our next door neighbor if he enjoys himself in his own way, nor do we give him the kind of black looks which though they do no real harm, still do hurt people's feelings. We are free and tolerant in our private lives but in public affairs we keep to the laws. This is because it commands our deep respect. We give our obedience to those whom we put in positions of authority, and we obey the laws themselves, especially those which are for the protection of the oppressed, and those unwritten laws which it is an acknowledged shame to break."

By the year 416 B. C. the Athenian military invaded and laid waste the island of Melos. All males of military age were murdered. All women and children were sold into slavery. The Melians had simply wanted to maintain their freedom and neutrality between Athens and Sparta. The Athenian generals justified their brutality claiming it was in accordance with the laws of nature. "Our knowledge of men leads us to conclude that it is a general and necessary law of nature to rule where one can. This is not a law we made ourselves, nor were we the first to act upon it when it was made. We found it already in existence, and we shall leave it to exist forever among those who come after us. We are merely acting in accordance with it, and we know that you or anyone else with the same power as ours would be acting in precisely the same way." Thus the unrestrained exercise of brute power is conceived as nothing more than rational adherence to observed facts, the natural science or social psychology of the day. Here begins the transformation of democratic freedom into enforced compliance with what the bureaucratic institutions believe to be true about human behavior.

Since the second world war, modern government has everywhere become a huge welfare state seeking to solve all social problems, whatever they may be. The result is that trillions of dollars are spent to provide remedies that have not worked. In 1990, 106,000 firms with revenues of $40 billion provided social services outside of the mental health, health, and educational systems. They employed more than 1.8 million people. Within the US work force in 1990 the are reported social service occupations include 603,000 social workers, 203,000 psychologists, 222,000 counselors, and 106,000 recreational workers. In the US a conservative estimate of the cost of all social services, all schools and universities, all mental health, public health, and health care organizations is over one trillion dollars annually. These programs and institutions also employ the largest portion of the American work force (Epstein, 1993). Yet, rather than getting healthier, the social problems are multiplying. The society is getting sicker and sicker. As the institution to solve social problems, the therapeutic state has proven to be almost totally incompetent. The megastate of this century aiming at therapy of its citizens has not performed well either in its totalitarian or democratic version. It has not delivered on a single one of its promises. Government by countervailing pressure groups is not any more workable but leads only to paralysis.

When government occupies the position of therapeutic agent for social ills, it hits the first problem of deciding what problems are to be addressed with the finite, limited resources available. Inevitably, bureaucracies spring up to determine what problems are to be cured and what the remedies are. This is the knowledge of human behavior claimed by the Athenian generals. The politicians then distribute the available resources to put into action the solutions known by the elites who have studied the matter. Psychotherapy in some variant is the chief remedy for the social ills. When I taught at a small liberal arts college in the early 70s I was struck by the large number of students whose goal was to "work with people" to solve social ills. Apparently most of them managed to find a way to "work with people" who could not solve their own problems but needed a superior, better person to show them how to do it. Psychotherapy is the core technique of almost all strategies to remedy addictions, delinquency, job training programs, establish community service cooperatives, and to reduce child abuse. This is the program and outlook the US has exported to other countries and that is what brings us together in this place. The experience we share is that the therapeutic state, begun with the noblest of concepts, can readily become a tyranny.

The other strategy that leads to tyranny is to punish those who do not respond or conform to the psychotherapeutic regimen. The main problem with this approach is that psychotherapy does not work very well. The mental health professions have sold the public on the idea that what they do is effective whereas the scientific evidence shows the venture is built on myth and a house of cards (Dawes, 1994). All psychotherapy patients ought to be informed that they are participating in an experimental procedure of questionable value. The failure to obtain informed consent in standard treatment conditions may well be against the ethical standards and can easily lead to violation of the basic therapeutic principle, "Do no harm" (Campbell, 1994). But if the program does not work well and punishment is in store for those who fail, large numbers of people may be unjustly and unfairly punished.

Raspberry (1993) presents the failure of the social policies of the US as caused by the destruction of the link between foolish behavior and its consequences. "Our efforts to save particular people from the consequences of their immoral, careless, or shortsighted behavior has relaxed the sanctions against that behavior, and produced more of it . . . Most of our worst social problems in the '90s are a direct result of our efforts of the past 30 years to weaken the link between improvident behavior and its natural consequences" (p. 8A). Well intended but misguided compassion may lead to precisely what the compassion wishes to remedy. Raspberry (1995) draws a distinction between private compassion and public charity. Private compassion creates human bonds between giver and recipient and humanizes both. Public charity cannot accomplish this because its only eligibility requirement must be need. He quotes de Tocqueville from 150 years ago. ". . .the right of the poor to obtain society's help is unique in that instead of elevating the heart of the man who exercises it, it lowers him. From the moment an indigent is inscribed on the poor list of his parish, he can certainly demand relief, but what is the achievement of that right if not a notarized manifestation of misery, of weakness, of misconduct on the part of its recipient".

By denying and ignoring the failure of America's network of social services to solve any problems, the scholarly side of human services has made a Faustian bargain with the politicians but fails to measure up to the expectations and standards of scientific inquiry. Social service research is dominated by federal funding which sharply limits its scope and purposes. Research has largely become propaganda for the therapeutic state by allowing prevailing political fads to set the research agenda. Any challenge to received wisdom is silenced and the funded programs all succeed in marvelous ways (Epstein, 1993). I. F. Stone, independent journalist, remarked "All governments lie, but disaster lies in wait for countries whose officials smoke the same hashish they give out" (MacPherson, 1995).

Every society gets the kind of science it wants and tolerates (Ravetz, 1971). Science's communal value of doubt, skepticism, and challenge has not fared well in mental health and social services research. Instead, an ill-founded dogmatism and readiness to succumb to confirmatory bias replaces careful, rigorous scientific safeguards against error. Science protects the public but it cannot create the strength of will to resist premature closure and instantaneous diagnosis that then resists all disconfirming evidence, a peculiar weakness of the mental health professions (Meehl, 1959; Steen, & Rzepnicki, 1984; Weber, Bockenholt, Hilton, & Wallace, 1993). The idea of the interaction between the therapeutic state and science is expressed by Erich Fromm. "A sane society is that which corresponds to the needs of man - not necessarily what he feels to be his needs, because even the most pathological aims can be felt subjectively as that which the person wants most; but to what his needs are objectively, as they are ascertained by the study of man" (Fromm, 1955. p. 20)

Skepticism toward established practice supports openness to new ideas, encourages modesty, nurtures unpopular but defensible ideas, and controls the population of prophets. However, the price for scientific skepticism may well be violent personal attacks and vilification. When proponents of an erroneous view cannot discredit the disconfirming science they quickly turn to ad hominem attacks to discredit the person (Kolata, 1991; Anderson, 1991; Roberts, 1991). In the face of potential coercion, it is important to hear Albert Einstein. "The important thing is not to stop questioning. Curiosity has its own reason for existing. One cannot help but be in awe when he contemplates the mysteries of eternity, of life, of the marvelous structures of reality. It is enough if one merely tries to comprehend a little of this mystery every day. Never lose a holy curiosity" (MacPherson, 1995).

The reasoning of the therapeutic state is simple and straightforward. We know a better way to live. We know how to make a better world. Therefore we ought to make it happen. If anybody gets in the way, it is unfortunate, possibly even tragic, but they must be disposed of so we can get on with the task of building a better world. As Stalin declared, "You cannot make an omelet without smashing some eggs." In child abuse, the reasoning goes that we must reduce all child abuse to zero. There must be no false negatives. In order to reach that goal, we may have to put a few innocent people in prison or destroy some families. We will pay the price of some false positives in order to build the better world we know we can bring about. Nobody to my knowledge has made a statement as to how many false positives are acceptable nor is there much attention paid to the damage done to children when there is a false positive. Such questions are dismissed in the burst and flush of virtue. When you know you are the champion of a virtuous cause and you are fighting hard to pursue noble ends against an evil, reprehensible foe, you simply do not question yourself or your actions. As the Athenian generals, you are simply following the natural law.

In his Letter to Donatus, Cyprian, third century bishop of Carthage, wrote, "The whole world is wet with mutual blood; and murder, which in the case of an individual is admitted to be a crime, is called a virtue when it is committed wholesale. Impunity is claimed for wicked deeds, not on the plea that they are guiltless, but because the cruelty is perpetrated on a grand scale" (Coxe, 1957, p. 277).

The potential grand scale of error in the child abuse system is obscured by the confusion about base rates. There is little interest in attempting to assess what happens in the true state of nature. However, without knowledge of how frequently any phenomenon occurs, it is impossible accurately to know what level of error and what level of probability is applicable to a given phenomenon. This is evident in the wide range of assumptions as to what is normal and what is normative. Authorities, investigators, judges, all operate on the basis of assumptions about what is "good parenting", what constitutes abuse, what is normal sexual activity for children and what they know or do not know about sexuality. There is frequent application of concepts such as "appropriate" or "inappropriate" to behaviors of parents, children, friends, neighbors, and the like. The weasel words "consistent with" are used to cover up the lack of knowledge of base rates in medical examinations, use of lists of alleged behavioral indicators, and imposition of questionable diagnostic categories such as Post Traumatic Stress Disorder.

On the other hand, the possible base rates of false allegations are ignored or suppressed. Environments, such as divorce/custody disputes, that may be associated with a higher base rate of false allegations are not attended to in investigations or assessments. The circumstances in which putative disclosures were made are simply ignored. Inculpatory statements elicited under highly questionable circumstances are taken at face value. This leaves the door wide open for unchecked imposition of ideology and dogmatism upon any individual who happens to be involved. There is also widespread confusion about correlation and causation. When there is some reported association, often it is presented as a causative factor. Supposed risk factors become sure evidence of abuse. For some, just being a male is sufficient to conclude guilt.

Expert witnesses may offer testimony that is based on inadequate science or experience alone without offering any limits or qualifications. Ceci & Bruck (1995, in press) offer a summary description of what experts should testify to in trials. Children are more suggestible than adults and younger children are most suggestible. They can make mistakes about salient and central events when exposed to suggestive interviews. Some steps can be taken to reduce the risks of suggestibility. These involve the nature of the interview itself, frequency, degree of suggestiveness, and the demand characteristics of the interview. Finally, the complexity of the interactions of factors affecting accuracy of accounts must be recognized. A study by Prosser (1995, in press) of the investigation process in the United Kingdom demonstrates the same flaws and errors in the process there as those found in the US.

Summarizing the current state of knowledge about child abuse, Melton and Flood (1994) list the following as what appears to be fairly well studied. There is considerable knowledge about the consequences of child maltreatment. There is a strong link between poverty and child maltreatment. There are numerous studies of reliability of reporting and factors in the decision to report or not. Much is known about child witnesses. There is solid evidence to support the effectiveness of home-visitor programs in prevention of child maltreatment.

However, there is much more that is not known and for which there is little or no research evidence available. Melton and Flood (1994) identify the areas where there is lack of knowledge or data. Evaluations of neighborhood interventions are not available. There are few or no studies of neighborhood quality. There is little available on effects of different neighborhood factors. Nothing is known about the value of privacy in designing prevention programs. Few studies of cultural differences or cultural factors relating to race and ethnicity exist. Not much is known about the social isolation of maltreating families. There is little information on how families and children perceive the child protection services. There is little understanding of the subjective experience of maltreated children. Hardly nothing is known about the functioning of the child protection system itself. There is little awareness of the factors affecting the judgments of workers. There is not much known about male involvement in occurrence and prevention of physical abuse and neglect. No information is available about the relationship between economic change and child maltreatment. There is no experimentation on the effects of material supports. There is little information on culturally specific interventions. Intervention studies have not documented effects on children. There is little research on the relation of marital quality to child maltreatment. There is not enough information about treatment to make any decisions about treatment effectiveness. To this list, I would add there is no credible information on the treatment afforded those thought to be victims of abuse. There is no evidence for the effectiveness of the insight-oriented, feeling-expressive psychodynamic treatment that is invariably given to children when there is a suspicion of abuse (Wakefield & Underwager, 1988). What evidence there is suggests that the treatment vended to children thought to be victimized is harmful and iatrogenic (Weisz & Weiss, 1993).

There can be no dispute that increasing the accuracy of the decision making process when dealing with allegations of child abuse benefits everybody. This is a goal which can not be rejected by any person, institution, bureaucracy, or authority. The simple clear cut aim to make what is done the most accurate process possible benefits everybody involved. Toward such a goal, even the most bitter, alienated parties can agree to cooperate. Unfortunately, the major difficulty is likely to be financial. Increasing the accuracy of what is done would require much more money, research, people, training, and time. There may not be enough money available to finance the best and most accurate way to handle accusations of abuse. It may still be possible to work toward doing the least damage to the smallest number of people, children and adults.

It should also be the case that all policies and procedures of government that can conceivably assist in the development and maintenance of strong, effective, and happy families ought be enacted and pursued. It is scientific fact that the least likelihood of child abuse is associated with intact, good families. This brings us full circle to the declaration of the Dutch citizens fighting for their freedom and claiming that freedom as the best way for them to nurture and nourish their families. While the state may have the role of punishing the evil of child abuse, the positive side is best left to the families. "Governments hold no terrors for the law abiding but only for the criminal. You wish to have no fear of the authorities? Then continue to do right and you will have their approval, for they are God's agents working for your good. But if you are doing wrong, then you will have cause to fear them" (Romans 13: 3-4).

References

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