Warning: Psychiatry Can Be Hazardous to Your Mental Health

There is certainly no shortage of self-help books targeted at improving society's mental health, one coffee table at a time. Many of these titles profess to provide readers with key insight into their problems, thereby saving them time and money over more traditional psychiatric care. Although many titles are written to augment current treatment, some books are antipsychiatry. This is certainly one of them, despite having been penned by a board-certified psychiatrist. Dr. William Glasser graduated from Case Western Reserve University with his M.D. in 1953 and became board certified in 1961. From 1956 to 1986, Dr. Glasser was a private practice psychiatrist. He created what he termed reality therapy and subsequently founded the Institute for Reality Therapy in 1967, which he later renamed the William Glasser Institute. The institute became his full-time occupation, where he teaches his own psychological theories. Reality therapy is a counseling method that focuses on the future by helping individuals take ownership of and responsibility for their actions. The fundamental precept is that the future is ours and success is based on the behaviors we choose now. The technique of focusing on one's choices is referred to as choice theory. This theory states that all human beings are driven to satisfy 5 genetically programmed needs: survival, love and belonging, power, freedom, and fun. According to Dr. Glasser, the behavior of most individuals is explained by external control psychology, which postulates that people, situations, and things outside of us cause our behavior. This external behavior control is destructive to relationships, so people become disconnected from those for whom they care. This disconnectedness causes psychic stress such as mental illness (including depression, anxiety, and schizophrenia), drug addiction, violence, and countless somatic complaints. Choice theory focuses on controlling one's own behavior. By realizing that all behavior is a choice, the issue becomes making choices that bring happiness. Dr. Glasser postulates that everything contained in the DSM-IV-TR is a result of an individual's brain creatively expressing its unhappiness. He suggests that by making all choices based on what will connect one to those individuals for whom one cares, one creates internal happiness by satisfying one's genetic needs. When one meets these needs, the brain should feel less psychic stress and stop manifesting what we refer to as mental illness. Although the extent to which psychiatric training programs should have a biological emphasis is controversial, none would go so far as to say there is no such thing as mental illness. Dr. Glasser demonizes the entire profession as charlatans who have been brainwashed by their predecessors or who simply misrepresent many of the psychiatric illnesses to patients as having a biological basis. He refers to all medications as “brain drugs,” and the book is full of statements comparing these medications to poisons. Rather than merely suggesting the advantages of conventional psychotherapy over medication, he claims there is never an indication for medication. The central tenet of the book is that if individuals would get together in small groups and utilize his choice theory as a text, then they would be able to heal themselves without the need for psychiatrists and their “brain drugs.” The book is built around a mock group of individuals with myriad psychiatric problems who meet as a choice theory support group. The group, with Dr. Glasser as facilitator, meets for a total of 5 sessions, and the members' dialogue is contained in the book. Dr. Glasser weaves his theory around their group sessions and then uses the group's dialogue to illustrate his points. The book develops choice theory in a progressive fashion, with each subsequent concept building on the first. The accompanying text is often phrased in a question-and-answer format in an attempt to anticipate the reader's likely points of resistance. The author makes it clear that the book is aimed at end consumers by encouraging them to start/join a group of their own. An obvious criticism of this book is that it is extreme in promoting choice theory as an alternative to conventional psychopharmacology. Despite claiming to have an appendix full of references demonstrating that there is no evidence that medications have a role in curing mental illness, the book simply relies on a core group of antiestablishment authors. The book reads like an infomercial, with the majority of footnotes suggesting that the reader buy one of the author's other books for more information. Additionally, the institute that bears his name is in the business of educating and promoting the dissemination of choice theory. However, what is noticeably absent from the book is a set of randomized clinical trials demonstrating the success of his teachings. Also, despite Glasser's claims that all he wants to do is educate the masses, additional Institute publications about choice theory are expensive. Although some of his theories have merit, his broad-brush characterization of all biological psychiatry as evil is an extreme disservice to the profession, which is left to deal with the individuals who can't pay to take one of his additional courses and who thus continue to be “mentally unhealthy.”