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
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
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).
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Campbell, T. W. (1994). Psychotherapy and malpractice
exposure. American Journal of Forensic Psychology,
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in the Courtroom: A Scientific Analysis of Children's
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Wakefield, H., & Underwager, R. (1988). Accusations
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Weber, E. U., Bockenholt, U., Hilton, D. J., & Wallace,
B. (1993). Determinants of diagnostic hypothesis generation:
effects of information, base rates, and experience.
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