The Collected Works of Dorothy Tennov

Chapter X The Trial

ick Price was a 30-year-old journalist assigned by the liberal magazine, Ragtag, to cover the Young trial. Although Nancy Mackintosh had free-lanced for Ragtag, the two journalists had never met. As the publicity mounted, other reporters were sent to cover the story, but no one covered it so extensively as Price, who attended every session from the beginning, and interviewed everyone connected with the case who was willing to be interviewed. He had a special interest in it, as he had previously interviewed Alan Browne and written about Love Two. At the outset, Price had had little association with psychotherapy, but from what he could see second-hand from friends, the only result of all those hours of self-indulgent naval watching, and all the expense, sometimes to the extent of unbearable debt, seemed to me to be a personality disturbance that therapy never cured and may even have brought on. He had read somewhere about a psychologist who said that psychotherapy can turn into an addiction. According to the office gossip, Marshall Evans, a former reporter who now worked in the Ragtag mail room, had consulted one psychiatrist after another, as each proved too expensive or otherwise disappointing. After twelve years of psychotherapy, it was hard for Price to imagine that man being worse off. When Evans money ran out, he saw a high school counselor with a somewhat illicit private practice on the side. At least the fees were lower. Except for Marshall, and Woody Allen movies, Price had had little contact with or knowledge of psychotherapy before the trial. Afterwards, however, he talked with many of the principals in the case. His final report was published in a series of articles. One of Dick Prices interviews was with Peters first lawyer, the one who was dismissed from the case before the trial began. Leland Wilson was a crude and portly man in his late fifties, a heavy drinker who mostly handled minor divorce and property cases. Wilson insisted that they meet at a bar across the street from his office over sandwiches and beer. He was happy to be interviewed and somewhat overgenerous with his time. Wilsons plan had been to maintain that Young couldnt control his action, that the intensity of his feeling for his patient had blinded him and that the Mackintosh woman had deliberately brought it on. She was the one who tried to seduce him. It was a strategy with which he had saved many a client from exorbitant alimony payments. Anyway, that was my plan. It didnt work out that way, of course, not in this case. The gentlemanly Dr. Young adamantly refused to allow me to impugn the young lady in any manner. He insisted that she was entirely innocent of any blame. I also thought it was a ridiculous case from the beginning and that it would never get to court. If the plaintive is blameless, then the defendant must be guilty. Thats the adversarial system. There always has to be blame on one side or the other. When it was all finally over, Wilsons local advertising of Peters support of the woman who was suing him provided an island of respect for Peter amid a sea of disdain. The publicity also brought additional clients to Wilson, proving once again that any publicity is good publicity for a person in his profession. That Ed Pervis, Nancys high-priced and famous lawyer, was prosecuting was what first drew public attention to the case. Price found out later that Pervis had been recommended to Nancy by her editor, Walt Harris. Unknown to Nancy, and discovered by Price only much later, Harris supplemented the attorneys fees with money supplied by a health insurance company that was interested in publicly exposing psychotherapy as unproven and, therefore, not a medical procedure entitled to reimbursement. Nancy knew, of course, that Walt was paying Perviss fee, but she learned about the insurance company backing of, and funding for, the publicity campaign only after the trial was over. As the young case began, Ed Pervis sent the following email to his brother, Desmond Pervis, who was also a lawyer:

A Scientist Looks at Romantic Love and Calls It Limerence:

Hi, Desmond, Im taking the Young case. There may be positive effects of psychotherapy, but if training in clinical psychology does not improve effectiveness, what are people doing? Paying for a dream? I know that I am being paid to destroy the image of the psychotherapy industry in the public mind. The trial is to be a showcase for exposure of the pressure that a self-appointed profession can exert, thereby wasting public and private money. I am aware that the trial will consist of critics and defenders of psychotherapy, not critics and defenders of Dr. Peter Young. The health insurance people operate according to the short-term goal of proving that psychotherapy is not a medical treatment because it is not based on science. Their aim is to establish a firm basis for ridding their books of psychotherapy expenses. They want me to demonstrate through expert witnesses that psychotherapy is an unverified procedure. When I looked over the documents they supplied, as well as those produced by my client, I saw that it would be easy to do. Several books highly critical of psychotherapy have recently been published. Its in the air. Some of the public have already turned against it, partly because they fear rising insurance costs. For years the field has been fighting a frantic, but losing, battle to redeem itself. It will be like shooting fish in a barrel. Duck soup. Criticizing psychotherapy does not meet the kind of resistance from the faithful it would have met twenty or thirty years ago, for the very good reason that the size of the faithful has diminished. I was most impressed by many separate studies that found either no evidence or only weak empirical evidence that benefits of psychotherapy are derived from specific ingredients. I know the case is weak as far as malpractice is concerned, but it is just silly enough on the face of it to attract media attention, which, after all, is the point for the health insurance interests and is always the point for lawyers. We both know well that medical malpractice refers to damage caused by negligent behavior, and that only if residual damage can be demonstrated is it a matter for the legal system. Clearly, Nancy Mackintosh had not sustained the kind of permanent harm that would hold up in court. But I also know that the strong evidence countering psychotherapy will ensure high profile in the media. I decided to take it on, provided I receive my usual fee, and also provided that I am free about how I present it. The target is a profession that did not prepare Dr. Young to deal with my clients problem. But it was also true that Young erred in promising to help when he should have known that he was unprepared. The case will hinge on misrepresentation, and victory will come from attendant publicity, whatever the judge decides.

At the trial, Pervis stated the accusation as follows: My client, Nancy Mackintosh, has been a victim of Dr. Youngs state of passionate yearning that not only erased his ability to help her, but, in fact, brought about the identical problem for which she had sought help in the first place. Dr. Young claimed not only that he could help her with that specific problem, but also that his methods were especially suitable for such problems. We contend that this was misrepresentation. Here was a professional, fully sanctioned and certified by his profession and by the community, who was acting in a manner contrary to what would be professionally appropriate. It is my contention that he misrepresented his ability to aid my client in pursuit of her clear objective. Pervis was aware that he was fudging. He knew that Young acted within the boundaries of what was considered ethical by his profession. But his promise to help Ms. Mackintosh could not be justified. That was where his real guilt lay. Young was also guilty of failing to recognize the significance of the Browne findings. Had he done so, he might have recognized his own condition for what it was and acted more appropriately. Pervis admitted that, in this, Dr. Peter Young did not differ from most of his colleagues, and had no trouble conceding that Young had high moral standards, that he was conscientious, and that he believed that he was acting in the best interests of his patient. That was not the point. Pervis contended that there were solid grounds for seeking retribution for emotional and other damages suffered by his client as the result of iatrogenic treatment that should not have occurred.

The Collected Works of Dorothy Tennov

Despite his honorable intentions, Pervis maintained, Youngs actions were both inappropriate to the situation and injurious to his client. Furthermore, in stating that he understood what he did not understand, and that he could help what he should have known he could not help, he misrepresented himself and his abilities to his prospective client. Although the main objective of those who were paying for the trial, and for the media hype, was not to sue a practitioner, but to publicly discredit his discipline, Pervis had wondered whether, when Nancys role changed from client to investigative reporter, the legal situation may also have changed. He searched, but he found no relevant precedent in the books. In point of fact, Pervis motive was not identical with that of the health insurance companies. He didnt like the way psychotherapy operated. It presented a fictitious face to the public. A case like this, he thought, if the media handled it well enough, would not damn psychotherapy, but would redefine it in a way that would make it more honest about what it is. Like Donna Payne, whose website he consulted, Pervis saw that counseling was a much-needed service closely related to health. He was sure that insurance would eventually be forced to cover counseling about how to carry out a medical regime, dealing with complaints, or providing instruction in self-management strategies. There were forms of counseling that could, Pervis believed, reasonably be considered an aspect of medical treatment. His target was not counseling; it was the so-called psychodynamic therapy aimed primarily at bringing the unconscious to consciousness. When Price mentioned to Ed Pervis that Young had fired Wilson because he was unwilling to subject Nancy Mackintosh to degradation, Pervis said, Good for the good Dr. Young. I know Leland; we used to play squash together, about ten years ago. Hes an old-fashioned, misogynist moralist. In his article, Price wrote that Attorney Pervis had approached the Young case warily. The message was in the details, and they certainly piled up. Before it was over, the lid was blown. Of course the explosion of public attention only occurred because of the financial support given by insurance interests. Although Price was not offered, and did not receive, any payment for his articles other than his usual Ragtag salary, other media people received money under the table for their efforts. Money buys. Neither Pervis nor the health insurance people cared whether Young was found innocent or guilty, as long as all of psychologys dirty linen would be exposed. And there was dirty linen there. Pervis knew it was a gamble to play to the world that way, instead of the relative privacy of the normal courtroom, but he had become convinced that psychotherapy could be dangerous and that the public had allowed itself to be misinformed. Pervis had won fame and fortune through other highly publicized cases. His motive in the Young case, he told Price, was to act in the public interest. During the trial, both sides lined up a powerful docket of witnesses. Many of them came from within the field of psychology itself. For example, there was past President of the American Psychological Association, Martin Seligman. Seligman told Price that he had not wanted any more publicity than it was already getting and, therefore, he had refused, at first, to testify. But as the press coverage mounted, he realized that since the story was getting so much public attention that was damaging to the image of the profession, he decided that it was his duty to answer the critics. In his testimony in support for Young, Dr. Seligman described the Consumer Reports study at length, from which he had drawn the conclusion that, although no specific modality of psychotherapy did better than any other for any disorder, patients benefited very substantially from psychotherapy. He pointed out the many cases in which well-controlled efficacy studies found a difference between some form of psychotherapy and no therapy. He had also decided that expensive, highly controlled studies were not, in fact, the only, or even the best, way to measure the effectiveness of psychotherapy. The Consumer Reports method, in which patients and former patients evaluated their therapy by anonymous questionnaire, was, Seligman believed, a superior measure of the real effect of psychotherapy. The conclusion, Youngs attorney, Nigel Ward, got him to say, was that a well-credentialed practitioner, such as Dr. Young, acted appropriately. Seligmans case for psychotherapy was strong enough, but he didnt really help Young very much, in the judges mind, because he was only saying that anything a professional did, unless it was explicitly contrary to ethical principles, was acceptable.

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Also testifying in favor of psychotherapy, although not strongly supportive of Young, was the view of Michael Lamport Commons, a psychologist at the Harvard Medical School. Commons insisted that medication plus psychotherapy, especially in cases of depression, was found to be better than medication alone, a view reinforced by Lynn OConnor of the Wright Institute. But Pervis placed in exhibit a statement by Benjamin Beit-Hallahmi, a psychologist at the University of Haifa, that expressed strong disagreement. In an email to the evolutionary psychology list, Beit-Hallahmi asserted that 99% of psychotherapy systems on the market today have not met any real test of effectiveness. Dr. Craig Welstein, another spokesperson from the psychotherapy profession, was adamant in his defense of Young. He said, We have strict rules about sexual relations with clients. Dr. Young did not break those rules. As he himself testified, his actions were entirely within our ethical guidelines. He had merely opened the door to having the client give expression to what he believed were repressed feelings. He had an entirely reasonable theory that Ms. Mackintoshs past relationships had been spoiled by repression, and, therefore, it was the repression that had to be worked through in the therapeutic relationship. I gathered from his testimony that he had considered his own feelings as irrelevant. He did not believe that he was acting on them, but rather that he was trying to achieve open expression of feeling. It was a matter of dealing with what the patient was not able to look at, and yet was the force behind her problems in sexual relationships. I fully support Dr. Young. Price felt that the testimony by Dr. Charles Cornwallis, Peters mentor, whom Peter had consulted prior to making his confession of love to his patient, was especially important in bringing out moral complexities. Cornwallis testified that he had listened carefully to Peters argument and had found it to be logical. When he suggested the possibility that Ms. Mackintosh might not in fact feel the way Peter thought she felt, Peter had countered that twenty years of clinical experience had made him expert in recognizing the meaning behind subtle overt action, even such actions as direction of gaze, angle of incline of the head, and general bodily orientation. Cornwallis found it hard to argue with that. Dr. Young had, after all, written a moderately well-received book on clinical intuition. Cornwallis believed that Peter had taken seriously everything he said, and, in keeping with his mentors advice, had decided on a plan that would be so tentative and noncommittal, that he would be able to backtrack if his judgment of his patient was in error. Cornwallis emphasized in his testimony, and later to Price, that he had found Peter Young to be a professional of outstanding quality and the highest moral purpose. Barry Allen. Ph.D., was a maverick therapist who combined hypnosis with a technique he called finger arching, in which patients pressed specific parts of their bodies while discussing particular subjects. Although he was not called on to testify, in an interview he told Price that he differed from some of his colleagues in that, as far as he was concerned, the man had exceeded his authority and committed an act contrary to the ethical guidelines of the profession. He therefore had no right to expect help from his colleagues. In his opening statement, Nigel Ward said, My client, Dr. Peter Young, is innocent of any unprofessional behavior. No one has disagreed with this. He has not, you realize, so much as touched the plaintive. He cannot, therefore, be accused of a sex offense. Pervis interrupted with, The defendant has not been accused of a sex offense. Let the record show that clearly. Furthermore, Ms. Mackintosh asserts that he did touch her, albeit it was briefly and only on her shoulder. Thank you, Ward replied. He continued: My client has been accused, not of a literal sex offense, but of behaving in a manner that was claimed to have been injurious and not in keeping with the role he was expected to play and or the help he had promised to give. We maintain that, on the contrary, Dr. Youngs behavior was entirely in keeping with his role as he defines it and as his profession defines it. Whatever the effect of his behavior might have been, and however mistaken it may have been in this instance, it cannot be claimed to be unprofessional when it has full backing and support of his colleagues.

The Collected Works of Dorothy Tennov

A surprising moment among many surprising moments in what Dick Price referred to as this weird trial came when Ed Pervis, Nancy Mackintoshs attorney, said he felt that Young should be found not guilty by reason of inadequacy of training that was beyond his control. In other words, while Youngs actions were the triggering incident, there was this larger issue. In his final report, Price wrote: It became difficult to tell whose side the witnesses were on. Both lawyers were attacking the profession, not the professional. The difference was that Pervis was contending that Dr. Young was guilty because he should have known better; Ward was contending that Young was innocent because he had not deviated from accepted practices of his discipline. To interested parties the stakes were high. The case was billed in the press as the one that would enable health insurance companies to avoid reimbursing patients for psychotherapy expenses, even when they had been recommended by a physician, and even when the diagnosis given was listed in the DMS-IV. To some, it was the case that would protect the public from a large scale scam. To others, it would prevent the public from receiving needed services. There was passion on both sides. Ward brought in several witnesses to testify that psychotherapy had been valuable to them, even lifesaving. It was said that Young was being used to destroy his profession. Pamela Cushing was a former professor who, thirty years earlier had published the book, Patient, Beware!, that made many of the same points that Nancy Mackintosh found concerning psychotherapy. Cushing had focused mainly on a critical analysis of psychodynamic psychotherapy from a scientific perspective. Ultimately, her opposition to the entrenched traditions of the time led to the end of her academic career. Price called her a pioneer who was ahead of her time and who paid the price of the whistleblower. During her interview with Price, she told the following story: I recall well the first talk I ever gave on the subject of psychotherapy. It was before a colloquium at the University of Atlanta. During the discussion period, several women expressed objection to my thesis that psychotherapy was not founded on science and was demeaning toward women, which it certainly was during that pre-feminist era. I realized later that those in the audience who objected to my thesis were all psychotherapy patients. Being analyzed did not then have the stigma that it later acquired. As we walked from the lecture hall to the reception room after my talk, a woman faculty member (whose name, unfortunately, has been lost to me) took my arm. She whispered that it was brave of me to say what I was saying and that she hoped I would not have trouble because of it. For years thereafter, I laughed when I told about the womans irrational concerns. I was cocky. It turns out that that very dear woman who gave me a warning that I did not hear, was prophetic. In the early days of arrogant Freudianism, those who criticized orthodoxy were branded as psychologically disturbed, themselves. From my vantage in social psychology, I had assumed those days were over. However, eventually, my academic competitors branded me, behind my back, with such effectiveness that I had to leave the university. I should also point out that the status of women at that time was not what it is today, and that I was also condemned for my sympathies toward feminism. But the point here is that, over the years, I have found much additional evidence that corroborates the conclusions I wrote about in that book. In essence, I denied the validity of the measures used to determine effectiveness. A strong rope ties patients to therapists and to the talking cure process. A few years earlier, a similar punishment had been visited on a psychology researcher named McClosky who had published a remarkable study, in which delinquent boys given psychotherapy were found in later years to have committed more crimes or otherwise more intensely misbehaved than the control group of similar youngsters who did not receive therapy. I recall a barrage of attacks against her and against her findings. Dr. Cushing continued: But I should also point out that my book, Patient, Beware!, received only one review in a psychological journal. Professor van Dauler of the University of Houston did not entirely disagree with my thesis, but he condemned me for, as he put it, throwing the baby out with the bathwater.

A Scientist Looks at Romantic Love and Calls It Limerence:

Indeed, Dauler apart, Cushing informed Price that her book was respected in important sources. It was highly recommended in the review journal of the American Association for the Advancement of Science, at the same time that an adjacent review of a book by a psychoanalyst was not recommended. A literary magazine editor agreed that psychotherapy is a dubious enterprise whose value is supported much more by faith than by evidence. That editor also anticipated, erroneously, that the book would be devastating in its impact. Perhaps it was for some people. Another reviewer said that the facts Cushing presented could not be denied. A distinguished social psychologist called it a book that counters the unsubstantiated pros of therapy with some of the documented cons, and past president of the of the American Psychological Association Leona Tyler called it a service to all of us who are trying to make psychology useful to people. Price was astonished. He said, Do you mean to tell me that your book, making the same points that witnesses in this case are making, and published over thirty years ago was highly praised by important people, and yet, not only did your career suffer as a result, but your message failed to reach the public? Its true. In fact, there were even more positive blurbs from important sources than those I have already mentioned. The late Joseph Wolpe, Professor of Psychiatry, Temple University School of Medicine wrote that I had performed an important service in showing up the iniquities of so-called dynamic psychotherapy. Other psychotherapy critics from within the profession, such as psychiatrist Thomas Szasz and psychotherapist Albert Ellis, made public statements of support. Barbara Seaman, feminist writer of semi-scientific books, predicted that psychotherapy would change as rational voices like mine clarify the sexist assumptions on which much of it is based and that she hoped that every therapist and of course every patient reads this important book. Anthropologist and popular writer, Marvin Harris, wrote that Patient, Beware! should be mandatory reading for anyone who is about to seek mental help for themselves or their loved ones. Others called me a very fine scholar and even a creative spirit. Anne Rosenfeld, senior editor of the magazine Psychology Today, said that she was impressed with my courage and determination, as well as my continuing spirit of scientific inquiry. I could go on. But, Price said, it seems that your message received an enormous amount of support from people within the field. I dont understand how you could have been punished for writing it. Part of the explanation was about money. When Patient, Beware! was first published, one of my clinical psychology colleagues expressed what I think was the most honest reaction. He said, Pamela, youll make paupers of us all. That certainly nailed it. Yes, Cushing replied. It was honest. You know, my sympathy actually goes out to the clinical psychologists who roam the land selling conversation and assuming that they are doing good. Peter Young is prototypical. He feels that he has been well-trained. Like the Germans in World War II, Ward said. There is a certain limited similarity, except that I believe that psychotherapists do not believe that they do harm to their clients. The only similarity is in the following of directives from immoral, or in the case of psychotherapists, erroneous, sources. With all the evidence in your book, as well as other books, I still find it hard to understand how the field can maintain its prestige and standing in the academic and professional community, Price repeated. Cushing continued: Its like the drug war. Its a question of demand. People desperately want help to exist with the kinds of problems they face. It doesnt take much to get them to believe that psychotherapy will help. Courts, schools, and parents need to feel they have some solution to the problems posed by troublesome people. Thats why various government agencies bought clinical psychology services. Peter Young and the others like him do not realize that they are in a field with clay feet. Nor does the fact that psychotherapy is unscientific mean that what happens in therapy sessions is necessarily without benefit. At the very least, the existence of psychotherapy conducted by professionals with impressive degrees gives people some hope that

The Collected Works of Dorothy Tennov

there may be solutions to otherwise intractable problems. I dont even think it would be a good idea to close them down completely. Price said, I think Ive lost you. What do you recommend? Cushing explained, Psychotherapists need to change their image, to make it clear that they are not based in science. Whether a given patient in a given situation with a given therapists will in fact be helped is not predictable. To remove the certification they now are awarded would automatically reduce their power to stigmatize. And, frankly, I dont think it would undermine what power they have to help. The problem is that too many people have vested interests. In my own, brief stint as a licensed psychologist, a parent was irate when I would not give his son a diagnosis that would enable him to be reimbursed by his insurance company for my fees. I tried to explain that it could send an untrue as well as damaging image of his son through his health, school, and perhaps, even employment, records. I said that it was not a label the boy deserved. But the father remained irate, and took his child to someone else who would do what he wanted. The image that emerged in Dick Prices mind was that psychotherapy was a slippery and subjective field filled with good people trying their best to do good, to earn their fees, and to learn on the job.

efore concluding his series of articles, Price also consulted Donna Payne, sister-in-law of the defendant and advocate of forms of talk treatment, which she distinguished from psychotherapy. Donnas position was that counseling could be useful, by providing information, suggesting possible actions, and helping those in need to evaluate the outcome of each possibility. In the interview, Donna gave Price other reasons why so little had been done to correct the faulty image of psychotherapy in the public mind, and why few people had done what Cushing had done, publish criticism openly. She said: Almost everybody falls into one or another of the following categories, none of which produce enough motivation to understand or to complain if they did understand. First, most people are as ignorant of the truth as they are remote from the problem. They vaguely assume that there must be some value to psychotherapy, although they had never had any direct involvement with it, personally. Furthermore, they have seen statements from mental health advocates that suggest that there is a pressing need for more, not less, help for the mentally ill. This is the position of most members of the academic community. It was a view staunchly advocated by First Ladies and Senators who pushed for a parity bill that would end the differentiations that HMOs used to award much more support to physical than to mental conditions. Most advocates of the bill had relatives who were mentally ill. They knew from first hand experience that schizophrenia, bipolar disorders, and depression were true illnesses in need of medical care. On the other hand, as Professor John F. Kihlstrom has advised, parity should be earned by a mental-health industry when mental illness is rigorously diagnosed on the basis of underlying pathology; when proposed new therapies are based on established scientific principles; when specific treatments have been demonstrated to be effective for specific illnesses; and when practitioners routinely choose the most cost-effective alternatives. Kihlstrom admits that progress toward such goals is being made, but slowly. A second group with a favorable view of psychotherapy is people who know of a friend or acquaintance who had claimed to be helped, or who as, say a teacher or judge had, themselves, referred people to psychiatry through conventional channels. Or they might have had a neighbor who was a clinical psychologist and who seemed like a nice guy. In any case, even if there were some problems with the scientific basis of psychotherapy, they believe that some sort of service is needed to handle misfits.

A Scientist Looks at Romantic Love and Calls It Limerence:

In other words, there are many people, perhaps most, who accepted the general view more or less uncritically, as their acquaintance with psychotherapy was minimal, but not negative, Price volunteered. Yes, Donna continued. And then there are also passionate advocates, the therapy addicts, sometimes derisively called lifers. These people cannot imagine life without psychotherapy, nor can they believe it is without value, at least for them. These are the last people who would want to criticize it. There are also persons for whom therapy may have brought adverse consequences, but who had made large investments of time, money, and effort; they may be disinclined to admit that it had all been in vain, or worse. They may rationalize that, although positive results were hard to see, things might have been worse without it. Others might admit to themselves, and possibly confess to intimates, that therapy had been damaging to them, yet they did not wish to criticize publicly a person to whom they had revealed intimate details and who held the power of diagnosis over their heads. And, Price added, we shouldnt forget those hopelessly in love with their therapists. Love Two again. Right, Donna agreed. And, as everybody knows, members of professions have an unspoken gentlemans agreement that disinclines one from criticizing another. Finally, of course, we mustnt forget the therapists, themselves, who may be aware of the weakness in their field, but who enjoy the personal power, prestige, and money that comes with being a psychotherapist. In the face of all this, who would raise the issue? Who would, indeed! Only the do-gooder, it would seem, Price conceded. Donnas contention, as something of an insider, was that the biggest obstacle to exposing the flaws inherent in the psychotherapy enterprise (and all its adjuncts, such as their assessment instruments) was the intricate network of associations and colleagueships among psychotherapists, businesses with vested interests, the courts, educational institutions, and other government agencies. Although they may not have endorsed it fully, they use it in various ways in furtherance of their own goals. In addition, Donna concluded, there are probably some instances of real help, although, in my opinion, it doesnt often bring help commensurate with the expense, time, dependency, and stigmatization. In other words, Price asked, you dont really condemn it completely. It depends on what it refers to. I suspect that much of what is called psychotherapy includes elements of what I call counseling. Lately, the professional journals make no real distinction, which is unfortunate, because I think that a distinction needs to be made, even if for no other reason than to stem the stigmatizing that receiving psychotherapy brings. The problem lies, as we noted, with money. If the insurance companies will pay only when there is a medical diagnosis, then the medical mystique will continue wielding its damaging effects on peoples reputations. On the other hand, counseling should, in my view, be paid for when it has medical value. I dont understand, Price said. How can talk have medical value? Many people need more than the kind of instructions physicians give if they are to carry out medical treatment instructions. You mean like making sure they take medications? Yes. Also how they manage exercise and diet. These things bear directly on health. But cant psychotherapists do that? Of course they can, they should, and sometimes they do. But the traditions of psychotherapy, derived from psychoanalysis, explicitly exclude giving the kind of advice and instruction that would be needed. Instead, the training such as Peter Young received, is geared toward diagnosis and treatment of conditions emanating from unconsciously driven pathology. But thats absurd! Price exclaimed. It really is, Donna agreed. I would like to see certain forms of counseling covered by health insurance companies, but not the so-called dynamic psychotherapy espoused by my brother-in-law, except,

The Collected Works of Dorothy Tennov

perhaps, in cases of mental illness in which it really helps. Unfortunately, research has not been able to figure that one out clearly enough to be useful.

ana Dineen was a vigorous critic of psychotherapy. In her book, Manufacturing Victims, first published in 1998, she stressed the largely successful efforts of the psychotherapy industry to market its various products. In an email to Pamela Cushing, Dineen admitted that she had not known of the older womans book, published three decades earlier than her own, a book that she considered not at all outdated. The fact was that the psychotherapy situation had not changed in certain basic ways. If Cushing had written her book 30 years later, some of the emphases would be different, but its basic message would be the same. Cushing had responded to Dineen that It was both interesting and disturbing to think of the number of years which have gone by between the publication of my book and yours. Although all motives are complex, Price believed Cushing when she said she saw writing of her original book as a way to meet a moral obligation. She realized that no one else would write it. It was not her field, but her research was extensive. She attended psychotherapy conventions where she witnessed firsthand how psychiatrists and clinical psychologists got themselves out of logical dilemmas of therapy that failed by placing blame on the patient. In the long period between Cushing and Dineens books, there were many other critics, but they tended to find fault with particular types of therapies or particular practitioners. Price found that Cushing and Dineen were among the very few to attack the enterprise at its core rather than merely blaming problems on a small minority of miscreants. The ethics of the American Psychological Association were, like those of most professional societies, self-protective. In a proposed revision of ethical standards, suggestions were solicited from the membership. Cushings recommendation that records be open to clients was patently ignored. Many of those whom Price interviewed agreed that psychologys imitation of medicine was a major problem, but also that the time might be coming for the bubble to be burst. Price noted that even strong advocates of psychotherapy, like Bruce Wampold, who asserted in his book, The Great Psychotherapy Debate, that psychology should give up the ghost and stop trying to be medical. Former APA President George Albee had been sounding the same message for decades. Albee said that adoption of the medical model places psychology in servitude under the yoke of another professions desires and restrictions. Psychiatrist J. Allan Hobson and journalist Jonathan Leonard, in Out of Its Mind: Psychiatry in Crisis, excoriated psychiatry by pointing out multiple problems in the current practice of psychiatry. They leveled their most acrimonious attack against clinical psychology for its essentially unscientific nature. They called psychology a refuge for intelligent people who are uncomfortable with hard science. David Smith, Director of the New England Institute, went even further. He wrote in an email to the evolutionary psychology Internet list that psychotherapy is conservatively, 95% superstition. The recovered memory debacle of the 1990s had also struck a serious blow to the image of psychotherapists as knowing and unbiased professionals. Furthermore, alternatives (effective medications, self-help groups, and lay counseling) developed in greater and greater profusion, to help with some of the things for which people might otherwise have sought psychotherapy. Price also quoted Harold Knight, the insurance company representative that Pervis had put on the stand. He directed Knight to explain the relationship between psychotherapy and his companys policies. The man was frank. He said, Because it makes a very large difference to our budget, we certainly do care. We do not deny a vested interest, an admitted preference toward finding convincing grounds for not including psychotherapy as a legitimate medical treatment. But the fact that we are motivated doesnt make us wrong in our judgment. We looked at the relevant reports in the scientific literature and we cite the words of psychotherapists themselves as well as the conclusions of persons biased toward psychotherapy. Although there may be a role for come forms of counseling as an aspect of medical procedures, there is no basis for considering psychotherapy to be a medical procedure.

A Scientist Looks at Romantic Love and Calls It Limerence:

Pervis brought up the issue of the biological basis of Love Two, using Thelma Holloway, an evolutionary psychologist. His point, supported by Holloways testimony, was that Love Two was the motive behind Dr. Youngs action, a motive that Young himself neither understood nor recognized. She explained that, in his book and other writings, the late psychologist, Alan Browne, had repeatedly emphasized that Love Two was an automatic subjective reaction, but that behavior remained volitional, completely under the individuals control. That was why it was not possible to detect the condition with certainty, however one might suspect its existence in a particular individual. In fact, Browne insisted that many, if not most, persons experiencing Love Two are able successfully to hide it from others. Holloway described the variety of actions taken by people while in the state of Love Two ranging from shy silence to overt appeals. She said, The first response by many evolutionary psychologists to Brownes thesis was that the Love Two idea doesnt fit the theories of evolutionary psychology because the individual, once caught in its spell, has little ability to choose. It seemed not, therefore, to be adaptive that is, it did not function as a positive evolutionary force. It seemed to be an inhibitor of fecundity. These people dont want children; they want candlelight and wine. The whole thing seemed a foolish cultural invention. At least, that was the initial, short-sighted, reaction to Brownes book and to Love Two theory. But now, a virtual deluge of reports from scientific laboratories around the world are showing that the various emotional states are being associated with specific observable biochemical changes in the blood. Antonio Damasio, in his book, Descartes Error, outlines the possible neurological and hormonal mechanisms that appear to underlie romantic love. Anthropologist Helen Fisher had reported that specific parts of the brain were active when people looked at photographs of loved ones. Furthermore, Love Two obviously permits sane and reasonable decisions. Although major love researchers as well as ordinary folk have referred to the state as a madness, they emphasized that observable behavior can range all over the place. In the future it might be possible to detect the condition independently of verbal reports, perhaps by a blood test, more likely through brain imaging. At present, since many people are successful in hiding it, neither action nor words are definitive. Furthermore, as far as evolution is concerned, not only is Love Two deep in the genes, it is a major force toward the development of monogamous unions that lead to families and inhibit sexually transmitted contagion. A few of evolutionary anthropologists have enthusiastically embraced Brownes theory, although the highly public Helen Fisher, does not include Love Two among types of love. She has made references to Brownes work, but she considers Love Two as infatuation thereby failing to recognize its specificity, its lengthy endurance, or its ability to be hidden. After the trial, an insurance company spokesperson issued the following statement:
Dr. Youngs style of psychotherapy should not be confused with counseling, which is limited in scope, not necessarily revelatory on the clients part, and aimed at specific goals; for example, to explain hospital proceedings and to hear complaints, to improve study habits, or to persuade people to eat more healthful diets. With medical costs rising, we dont need to waste money on unproven, wasteful, and possibly dangerous treatment methods. Psychiatry, at least most of psychiatry there are a few holdouts from the days when all psychiatry was Freudian is medicalized. Psychiatrists are having considerable success in locating physiological markers and in treating mental disorders with medication. Clinical psychology, on the other hand, is largely limited to conversations and verbal exercises. We want to see more money funneled into real treatments for real conditions.

Do you mean that health insurance companies will reimburse for counseling?

The Collected Works of Dorothy Tennov

He replied, I think it is a possibility. Of course, it would be counseling in the interest of improved medical treatment and, therefore, limited in scope and duration, as compared with psychotherapy. At a press conference, a medical doctor, Irwin Ramos, MD, said: A growing consensus is emerging that the best hope for understanding the mind and its aberrations comes from genetics, biology, and the neurosciences. In fact, biochemical explanations of human nature in some respects actually oppose the old-fashioned type of Freudian practice that Young engaged in. Furthermore, as far as love is concerned, it has not been entirely neglected by researchers. A researcher who found correlations between chemical imbalance and depression, coined the phrase, chemistry of moods. Case studies showed a relationship between romantic love feelings and the hormones present in the blood as well as the neurotransmitters in the brain. Other reports have raised endorphins practically to the level of Cupid himself. Then theres lithium carbonate for bipolar illness, and evidence of depression being associated with serotonin and norepinephrine. Are you implying that pills will be found to cure all psychic ills? asked a reporter from a tabloid. Ramos replied: Not exactly. I realize that these are, as yet, less than breakthrough advances, but they clearly point a direction opposite to that on which Youngs procedures are based, and there is too much supporting evidence for easy dismissal. The history of treatment of mental illness has been erratic and inconsistent, with one method following another after initially dramatic claims turned out to be less than anticipated. The Freudian revolution, now mainly viewed as inanity, endured in various strengths and incarnations throughout almost the whole of the 20th century, but, finally, the reign of psychodynamic psychotherapy is ending. Unfortunately, it is dying to the tune of fatal blow scandals, such as the McMartin Child Care Center case, in which children were led by therapists to report false accusations of sexual molestation. In other words, the reign of the couch is over? a reporter from the Washington Post asked. Despite the scandals and lack of scientific evidence, there still exist those practitioners of selfexamination of which Young is a prime representative. Their procedures are reminiscent of medieval religious practices in which the church was purged of heretics through intense and detailed confessions. Psychodynamic patients look for flaws in themselves. When therapy fails, the patient or client, not the therapy or the therapist, is often considered to be at fault. Some forms of therapy have even been criticized for being both ineffective and cruel. Even such troublesome behaviors as cigarette smoking seem to have a physiological basis, but what is particularly relevant to the Young case was that some researchers contend that sufferers of lovesickness have abnormal regulation of the neurotransmitter-like substance phenylethylamine that can be remedied by injecting the antidepressant phenelzine. In a final interview with Ed Pervis, Price asked, Did Dr. Young consider these findings in his many cases of lovesickness, especially those cases in which he, himself, was the object? By his own admission, he did not, the lawyer replied. Apparently his training in no way prepared him to deal suitably with cases involving lovesickness, which was, if not quite sickness in a medical sense, sickness in damaging other aspects of life. There were two ways of finding Dr. Young not guilty of lack of self-restraint regarding what was appropriate behavior to his role as therapist: First, his condition necessarily imposed an intense motivation that he could not fight. That was the strategy recommended by his first lawyer. But this defense fails because Browne and others were emphatic that, in normal individuals, Love Two did not prevent control over action, much as it affected feelings and motives. Second, Dr. Young acted in perfect accord with his training and in a manner that many of his most respected colleagues would have approved. He did what his training had him do. Do you think that Young acted immorally? Price asked. Not in the usual sense, Pervis replied. Young acted in a manner that he considered moral. He believed that he was acting in the ladys best interest. He was wrong, but the real fault lay beyond Dr. Young. He was, as the saying goes, only following orders.

A Scientist Looks at Romantic Love and Calls It Limerence:

And, Price persisted, he was certainly less at fault than when doctors take sexual advantage of their patients. I agree with that, Pervis replied. He continued: There have been documented cases of physicians taking sexual advantage of female, and even, in some cases, male, patients. Discovery was duly punished by revocation of license and even jail time. The problem with psychotherapy is that it is of a completely different order. It is fluid, unscientific, and essentially secret. A sexual encounter with a medical doctor is an encounter between persons with welldefined roles. The talking therapist, on the other hand, is privy to the most private aspects of the persons life, aspects unknown to any others. This alone places the therapist in a position of unusual personal power. It is common for patients and former patients of psychodynamic psychotherapy to be closed-mouthed about it (contra Woody Allen). They are especially reluctant to criticize either the therapy or the therapist, no matter what happened in therapy, even where sex reared its head, as it was bound and determined to do, given the intimate, comfortable setting of the psychotherapy setting. It is a setting quite unlike the public, sterile and gloved atmosphere of the typical medical encounter. Therefore, I do not think there is basis for comparing a highly structured and public set of interactions with the loose, secretive, personal, goings on in psychodynamic psychotherapy.

n a conversation with Nigel Ward some years after Youngs trial, when they happened to meet at a social gathering, Dr. Cornwallis, Peter Youngs mentor, said:

None of us accepted Love Two theory at that time, even though we faced it in one form or another almost daily as a factor in the lives of our patients, even in our own lives. It was only after considerable physiological data had been accumulated, that the attitude of the professionals shifted toward accepting that Love Two was very much as Browne had described it. What had been interpreted as mental disorder came to be seen as a normal, common, distinct, and unvarying state that could exist apart from other aspects of the personality in that before, after, and even largely during a Love Two episode, disorder might be entirely absent. By not understanding the nature of his condition, I have to admit that I had led poor Peter astray. But, at the time, I reflected the official view of the profession. In retrospect, of course, I should have listened harder to what Young was saying. But in my own defense and in defense of the profession, Brownes thesis had not been presented in a peer-reviewed journal, and therefore there was no obligation to take it seriously. During Prices interview, Youngs attorney, Nigel Ward, contended that Young was both innocent and nave, more victim than blameworthy. But of whom was he a victim? Price asked. Not his patient, who was sincere, trusting, and entirely honest, at least at first. Eventually, both Youngs behavior and what her research had uncovered convinced Ms. Mackintosh that the whole business was smoke and mirrors, and that Dr. Young had indeed fallen into a state of limited volition and disturbed perception. Thats true, Ward agreed. Therefore, Mackintosh had three choices. She could have quit. Maybe if she had it to do over again thats what she would do. Her second alternative was to disbelieve the critics and have greater trust that Young was, in fact, doing the right thing, the thing that would help her in the end. She tried that, but the accumulated evidence her research weighed increasingly against that route. And there was also what she perceived as his nonverbal, body cues. Finally, she could have chosen to continue as honestly as possible, but with the additional intention of getting a story about the field of psychotherapy for which her experience with Young was a valuable resource, since he was following the standard procedures of his profession. She did not intend to write about him, specifically, but about psychotherapy, using her personal experience only as background. That, of course, is what she eventually did. In his final article, Price wrote:

The Collected Works of Dorothy Tennov

When it comes to ridicule, psychiatry leads proctology. Clinical psychology has even lower status than psychiatry among physicians and scientists. Peter Young could have operated safely in almost any other field and spared himself. Hollywood has done its share of the damage, which is surprising since virtually everyone there is or has been a patient. Or maybe thats the reason. Comedian Woody Allen was virtually the only force holding up a dying profession, at least until the image of psychotherapy was lifted slightly by a gangster television series. Otherwise, psychotherapists were depicted either as fools or villains, not as they saw themselves. The one or two exceptions among movie scripts that overcame the resistance of the top brass were the result of persistent efforts of advocates. And those movies were box office and artistic failures, despite the presence of big budget major stars like Gregory Peck, Ingrid Bergman, and Montgomery Clift. In films, psychotherapy simply wasnt convincing because its slippery and subjective nature was too exposed on the big screen. Furthermore, in 1989, Glen O. Gabbord wrote that the lovesick psychotherapist is by no means rare. His book, Sexual Exploitation on Professional Relationships, portrayed such therapists as emotionally-dependent. All in all, the early glitter has now dimmed. People still go to therapists, and maybe some really need it, but the evidence presented in the Young case diminished confidence in its being able to help with the real problems of real people.

eter had often thought about how psychotherapy was portrayed in films. He had believed that the initial glamour of Freudian psychology had been demolished by the fact that the process was far from glamorous; it was mundane, commonsensical in many instances, and a lot of hard work. Furthermore, the action was in the mind, which made it hard to depict in dialogue without action. But now psychology had changed. It was no longer what it had been in the 1960s, when he received his training. In addition to the decline in prestige, patients had become clients, and, along with many others of his profession, Peter feared that unless psychologists were able to obtain the right to prescribe psychotropic medications, they would lose further ground to the psychiatrists. The psychology journals that crossed his desk were filled with attempts to survive, and the suggested strategies ranged from trying to get prescription privileges (a losing fight to most minds) to trying to redefine the field as one that provided supportive counseling to tragedy survivors, held anger control group sessions with felons, and acted as a kind of moral police force in service to educational and governmental agencies who have nonconformists to contend with. They rush in after school shootings or natural disasters and they write articles about how things ought to be. The world was no longer what it was. As strenuously as they fought back, the future looked grim. Although Stanley Moldawsky, who ran for the presidency of the American Psychological Association in the very year of the trial, maintained that he felt pride in psychotherapy, his remarks had a hollow sound in the context of psychologys increasingly frantic attempts to broaden its concerns or, for some, to become a more accepted member of a medical team. Peter wrote in his private journal:

A Scientist Looks at Romantic Love and Calls It Limerence:

If I were starting out today, Id persist in my original intention to complete a medical education, as Ruth wanted me to do. No one can say that my becoming a clinical psychologist instead of the more powerful, and, today much more powerful, psychiatrist was her fault. But back then it seemed a long and tedious route to achieve what I saw as the same goal, that of becoming a psychotherapist. But the disciplines of psychiatry and psychology have diverged. Psychiatry has become almost totally medicalized. There is even a resurgence of interest in psychosurgery. One psychiatrist is pursuing interest in schizophrenia as a viral infection. Another sees autism as genetic. Others are bringing Darwin in and claiming that the best way to understand mental dysfunction is to look for its evolutionary advantages. It doesnt help psychotherapys image that the major mental illnesses are generally believed to be untreatable by talk methods. Although many surveys report psychotherapy to be helpful when used along with medications, some find medications alone to do the job. Actually, talking therapy for schizophrenia was abandoned as long ago as Freud, himself. Thats nothing new. Over the years, I have treated a number of patients I guess I should call them clients suffering from the effects of having a family member diagnosed as schizophrenic. Several of them were referred to me by psychiatrists. I understand that referral from psychiatrists, who are medical doctors, to psychologists, who are not medically trained, are common.