Self-help Helpful

Heal Thyself

A new book argues that self-help – from AA and executive coaching to Dr. Phil and Tony Robbins – never leaves us wiser and often leaves us poorer. Lauren Slater takes issue with this sweeping condemnation and dares to say: I was helped by self-help!

For a while, I was a self-help junkie. I liked the secular, earnest, pathos-driven relationship books: books on how to love or not love, books on loving too much or on loving the wrong man, books on codependency, relationship addiction, and all manner of mental affliction for which there have never been any proven physiological bases, I didn’t tote around a teddy bear – and if I had I probably wouldn’t admit it – but I went to groups where women did, and I bought books upon books, and I loved the shiny-covered magazines with their multiple-choice quizzes on every imaginable emotional conundrum.

Sometime in my thirties, after I’d met the man to whom I’m now married, after I’d bought an adorable dog and then another adorable dog, after I’d signed the purchases agreement on my house and my life took on some steadiness, I tossed the beaten paperback guides or hid them out of embarrassment in the attic, where still they sit in boxes furred with dust.

Self-help. It elicits scorn from most of who consider themselves educated, sophisticated. Self-help. It is for the desperate, the poor suckers among us. And yet I was helped by self-help. Of course I have no study to prove this; it’s pure anecdote driven by a fallible memory – the mechanisms of which are known to conveniently reinterpret the past – but still, I think I really was. I especially remember Robin Norwood’s Women Who Love Too Much. I’d always turn to it at the hideous end of a love affair – there were many taken back then – and each time it described by anguish with an accuracy that assured me I was not alone. Self-help kept me company, for one, and for another, by offering its theories about the origins of my pain, it gave me what every human needs: a model, a means of explanation.

For these biased reasons I am skeptical of the claims made in business journalist Steve Salerno’s book, SHAM: How the Self-help Movement Made America Helpless. Salerno’s expose was inspired by an editing stint at Rodale press, where he says the power-that-be used marketing surveys to target potential customers’ worst fears and problems, then churned out books full of half-baked techniques purporting to vanquish them. In chapters that range from damning profiles of self-help celebs such as Dr. Phil and Dr. Laura to more general meditations on the current cultural obsession with disease and autopathography, Salerno’s tome joins what’s become nearly a genre of books and articles seeking to blow the lid off self-help, most of them written with sharp tongue and very high brow. There’s Wendy Kaminer’s I’m Dysfunctional, You’re Dysfunctional, Stanton Peele’s Diseasing of America, Gerald Rosen’s many articles on “pseudo psychology� – the list goes on. To all of these authors – Salerno included – self-help is offered up on the snake-oiled palms of tricksters who suck money from the suffering masses.

But there is more at stake than financial exploitation. By “actively fanning the fires of discontent,� Salerno says, the self-help movement actually makes otherwise hale people feel as if there’s something wrong with them, thus threatening the health of our citizenry – the whole fabric of society. To keep the customers coming, he argues, the self-help business model demands not only the identification of fears but also their inflation. “The core of the self-help movement is rooted in the 12 steps,� Salerno tells me in an interview, “and the 12-step programs tell people they are powerless and diseased.�

Perhaps SHAM is best described as a nonfiction version of a Don DeLillo novel. In both, the word is friable and we do outrageous things for psychological relief. We pray to false idols and worship the pretty and the plastic; the sicker we feel, the more toxins we ingest in the misguided hope of getting codependency, ADHD, OCD, or any other multisyllabic ditty – none is as dangerous as our reach for popular relief. The ultimate disease, in Salerno’s world, is the cure itself.

But there are serious problems with Salerno’s vision, depending as it does on a clear distinction between science and pseudo-science, the real versus the fake. While Salerno’s book is explicitly about the inauthentic, it implicitly endorses a “true� treatment that he never really names. For example, he scoffs that AA is one more puff piece of recovery: “At meetings of Alcoholics Anonymous and other support groups, the leader’s sole credential may consist of his being in recovery from whatever the specific addition is….Isn’t it possible that fellow sufferers are a bit too close to the problem to lead effectively and impartially? And if your problem was say, that the electrical fixtures in your home were acting funky, would you really want a workshop taught by some other home owner who couldn’t get his lights to work right (and who, by his own admission, still had the problem)? Or would you want a trained electrician?�

While the answer may seem obvious to Salerno, it’s less clear to me. First off, studies of AA and similar self-help abstinence programs show that while relapse rates are high – in one large recent report, just 36 percent of AA members were sober, after three years – some people obviously benefit. Anyway, what’s the alternative? Salerno seems to want us to eschew self-help quacks in favor of experts, but nobody out there has found a reliable, long-lasting fix for addiction.

More broadly, where treating cokeheads or depressives, clinical psychologist will never be like electricians; the latter follow consensually agreed-upon laws of the universe, laws of physics – that proton-neutron, positive-negative stuff. Psychology’s fluidity is perhaps best illustrated by the ever-changing drafts of the DSM—the Diagnostic and Statistical Manual of Mental Disorders: Homosexuality was a disease in the midtwentieth century; PMS became one in the 1980’s. We used to be neurotic; now we have anxiety disorders. In 1985, during one of the DSM’s revisions, a few committee members wanted to include a newly invented category; masochistic personality disorder. MPD, supposedly, was manifest in women who could not leave their abusive husbands, in bruised and black-eyed women who secretly needed a firm fist to feel right. Feminists expressed outrage at the notion, and eventually the move to include the disorder was shelved.

If psychological conditions are created and defined based in large part on the customs of the day, treatments must also be malleable, rooted as much in perception as in fact. If we believe negative thinking causes depression, we’re apt to try cognitive therapy. If we believe that a combination of chemical imbalances and negative thinking causes depression, cognitive therapy plus medication is the treatment of choice. If, however we believe that depression is caused by past trauma and that the past often needs to be remembered before it can be exorcised, we’ll give insight-oriented therapy a go. And in fact, research into the effectiveness of various types of psychotherapies throughout the ages has shown that one can be as good as another. Specifically, Carnegie Mellon psychology professor Robyn Dawes, the author of House of Cards: Psychology and Psychotherapy Built on Myth, compared paraprofessionals (your friendly, self-helped substance abuser whom Salerno deprecates) with doctoral-level clinicians and found no difference in client outcomes.

Despite these blind spots, Salerno’s book is a good read – it’s fun to slide down his blustery slopes and get all the dirt on Dr. Phil. And dirt there is: Dr. Phil is apparently bus unsurprisingly an egomaniac. His first wife, Debbie Higgins McCall, reports that during their marriage Phil was a control freak who insisted on monitoring her every move and required her to phone him before she left the house. Equally – if not more – disturbing, the good doctor is not above humiliating people for the sake of good TV. Salerno tells the story of Sally Smith, editor of Big Beautiful Woman magazine, and Maryanne Bodolay, executive administrator of the National Association to Advance Fat Acceptance. These women, as Salerno describes it, were naïve fans of Dr. Phil’s who readily agreed to be on his show, in part to challenge his contention that obesity is caused by bad habits. Once onstage, however, Dr Phil identified Smith and Bodolay as no more than a pair of “obese women,� ignoring their credentials and the thoughtfulness with which they approached their weight. Refusing to engage them in serious issues, he turned the whole thing into a freak show.

Toothy guru Tony Robbins also takes a beating from Salerno, coming off as shamelessly deceptive and greedy. For $129, he’ll sell you a special pendant that supposedly enhances your resistance to harmful ambient energy, Salerno reports; for $839, you can score a brushed-gold one and really rev up. And for a mere $6,995, you can attend a Robbins seminar in Fiji and “Awaken to Your Dreams in the Most Spectacular Settings…You Must Act Now! This Opportunity Will Vanish!�

Salerno attempts to discredit such hyperbole by highlighting supposedly real science. In one of many examples of this, he cites a 2004 National Institute of Alcohol Abuse and Alcoholism study that set out to document the frequency which alcoholism occurred in tandem with psychiatric disorders such as depression. After surveying a representative sample of 43,000 Americans, the NIAAA concluded that “the 19.4 million Americans who meet the diagnostic criteria for substance abuse disorders share many members in common with the 19.2 million Americans who meet the criteria for such mood disorders as clinical depression.� Sounds impressive, but think about it: Isn’t this something your grandmother could’ve told you?

SHAM portrays a black-and-white world. But surely, even if he is a slick salesman, Robbins must be doing some good, sometimes for some people. One need not be a saint, not even a mensch, to benefit his fellow man. In an effort to find out why so many people gravitate to his message, I ordered $39 worth of his audiotapes from Amazon.com. Their covers show a jubilant man preaching to a sweaty, adoring public. Robbins’ main point: There’s no need to be bored. You can live your life with passion and gusto. He provides the listener with a few cognitive tricks aimed at turning the thermostat of desire up or down (up: Think how good you will feel if you call your mother or exercise or pay your taxes; down: Think how bad you will feel if you don’t). While these methods lack originality, they’re harmless enough and in fact are drawn from “scientific� psychological interventions called cognitive restructuring. The major difference between Robbins and a therapist, in terms of the grab bag of tricks, is that Robbins is an unabashed proselytizer who’s charismatic and relentlessly optimistic – hence his appeal. A therapist, while using some of the same tactics, holds out a quieter, more tentative form of hope.

Gerry Coocher, a psychology professor at Simmons College in Boston, is someone Salerno would admire – he has conducted formal academic research throughout his career – and he says it’s a mistake to write off self-help as an undifferentiated mess of useless blather. Indeed, he and a colleague published a book that includes a list of the top 25 self-help books. Based on asking more than 3,000 clinicians nationwide to rate the self-help resources they’ve suggested to clients or with which they were otherwise familiar. (The top three were Reviving Ophelia by Mary Piper, Dinosaurs Divorce by Laurene Krasny Brown and Marc Brown, and Dr. Spock’s Baby and Child Care.)

Of course, just as self-help can’t be written off as worthless, the imprimatur of science is far from a guarantee of a treatment’s potential for success or even of its core integrity. Anti-depressants have been tested again and again in gold-standard clinical trials, yet flaws in the research designs have led many to doubt SSRI’s true efficacy across broad populations. And anyone who has watched the recent shenanigans of the psychopharm industry – the cover-ups, the overhyped advertising (take Paxil and you too will smile as you scrub) – knows what it means to be manipulated, if not frankly, lied to.

In the end, when it comes to help, we take what we can get and we use it as wisely as we can. The power of the mind cure, whether it’s shrieked from a stage by Robbins or delivered in a test tube with the blessing of the National Institute of Mental Health, is largely what we make of it. Intelligent, thoughtful people who have the privilege of education and its attendant skepticism might learn from the self-help gurus, in part because they know how to sort the wheat from the chaff. And on the other side of the equation, uneducated consumers are probably more likely to be confused by science because its language is designed to be exclusionary, which makes them only listen and believe all the more. In the end, if we feel we’ve been helped, does it really matter? Who cares whether your misery is lifted by Prozac or a placebo, by a Harvard MD or a guy with a single shingle? Who cares whether your get-up-and-go comes from Ritalin or Dr. Phil or some well-tested cognitive therapy? How you got help matters less than the fact that you were helped, that you found a hand; now you can move forward and live your difficult life.