Warning: this book's warning may be hazardous to your mental health.

Glasser, W. (2003).

Warning: Psychiatry can be hazardous to your mental bealth. New York, NY: Harper-Collins Publishers. Hard cover. 244 pp. $23.95. ISBN 0-06-053865-1.

Dr. Glasser is a well-known psychiatrist who lectures widely and is the president of the William Glasser Institute in Los Angeles. He is the author of many books, including Reality Therapy (1965) and Choice Therapy (1998).

This book is the ninth written by Dr. Glasser since 1996 to explain "Choice Theory," the "new psychology" he advocates as "the road to mental health," (p. 6). Dr. Glasser describes his intended reader in the following words:

I believe you are a person who is looking for a way to find more
happiness in your life without depending on prescribed brain drugs such
as Prozac or self-prescribed ones like alcohol. You are not averse to
going to a counselor but on your tight budget your eyes are always open
to ways to find happiness by your own efforts. I see you as a thoughtful
person who enjoys finding out more about yourself and how to use this
understanding to get along better with the people near and dear to you.
(p. 7)

To better help individuals apply Choice Theory to their problems, he encourages the formation of Choice Theory Focus Groups. These groups are not intended to be therapy-oriented. Although they may require someone with a basic understanding of Choice Theory to start them, they are intended to be led by one of the participants and to be selfsustaining, much like Alcoholics Anonymous groups. The book itself describes several sessions of a Focus Theory group that began to function as this book was being written, and the author used draft chapters of the book as the beginning point of its discussion.

Choice Theory is posited on the assumption that "happiness is mental health," (p. 6). Furthermore, "The 'mental illnesses' that establishment psychiatrists diagnose, treat, and list in the DSM-IV should not be labeled illnesses ... They are the many ways unhappy people express their unhappiness," (p. 15). This unhappiness stems largely from dissatisfaction with important relationships in life. "This could be a mate, child or children, parent, friends, students (if you teach), coworkers, or boss" (p. 54).

No matter how we experience it, almost every symptom can be traced back
to its origin: relationships that lack love, respect, or both. By making
choices that help us stay connected with each other, the unhappiness can
be overcome. Caring and respecting, never controlling, are the
cornerstones of mental health. (p. 57)

The issue of control is crucial in Choice Theory:

When we have difficulty getting along with other people ... we will
almost always choose to employ what I call external control psychology,
or simply external control. It is a coercing, controlling, relationship-
destroying psychology that, essentially, everyone in the world, no
matter their culture, religion, politics, race, sex or economic class,
uses when they are having difficulty getting along with someone else.
(p. 72)

The seven deadly habits of external control are criticizing, blaming, complaining, nagging, threatening, punishing, and rewarding to control. The Choice Theory alternatives are supporting, encouraging, listening, accepting, trusting, respecting, and negotiating differences. Dr. Glasser believes that external control is learned behavior and that much of it is learned from parents and teachers. He opposes the use of external control in all relationships, including the parent-child, teacher-student, and psychiatristpatient relationships (e.g., pp. 77-78).

Furthermore, the symptoms of unhappiness are themselves choices. For example, when dealing with depression, Dr. Glasser encourages people to say "I'm depressing," or "I'm choosing to depress," (p. 52). He continues

If you're moving along down the sidewalk on your feet, you say, 'I'm
walking.' You don't say, 'I'm walked.' We're talking now, not, we are
talked. Do you see the difference? Depressed is like the way they
describe the economy. What can you do about the economy? (p. 52)

Further on he states that "... all symptoms, painful, frightening, crazy, disabling, possibly even the symptoms of a disease like arthritis, are your brain's way of warning you that the behaviors you are presently choosing are not satisfying your basic needs," (pp. 109-110). These basic needs, according to Dr. Glasser, are "survival, love and belonging, power, freedom, and fun" (pp. 94-95).

Many mental health professionals would undoubtedly agree with the basic thrust of Choice Theory. It seems to this reviewer that many people whose unhappiness is indeed related to relationship problems could be helped by the principles espoused in this book. Additionally, many of us would agree with Dr. Glasser's unhappiness with the reluctance of HMOs to pay for needed counseling. There is no doubt that many individuals who could be helped with counseling are instead treated with drugs, and no attempt is made to help them deal with social, psychological, or spiritual issues that may be contributing to their symptoms.

However, Dr. Glasser does much more than advocate for Choice Theory. He begins the preface to his book by stating that "none of the people described in the DSM-IV, the official diagnostic and statistical manual of mental illness published by the American Psychiatric Association, are mentally ill ... They do not need brain drugs and electric shocks, all of which harm their brains" (pp. xxi-xxii). Furthermore,

The real horror of this system is the harm it does to our innate desire
to try to take care of ourselves. The message that has now come through
loud and clear in the media is that when you are diagnosed with a mental
illness there is nothing you can do to help yourself. (p. 3)

He goes on to state that "The 'mental illnesses' that establishment psychiatrists diagnose, treat, and list in the DSM-IV should not be labeled illnesses, because none of them is associated with any brain pathology" (p. 3). Dr. Glasser bolsters his case in the foreword to the book, written by Terry Lynch, M.D., an Irish physician and psychotherapist who wrote Beyond Prozac: Healing Mental Health Suffering Without Drugs. He also includes a chilling first-person account by Al Siebert, Ph.D., a psychologist who, while doing his postdoctoral fellowship at the Menninger Clinic in 1965, espoused some unconventional views of mental illness. Dr. Siebert was then, presumably as a consequence of these views, hospitalized and forced to take Thorazine against his will. Finally, the author reproduces an article by Anthony Black, a freelance writer, titled "Prescription for Scandal: Biological Psychiatry's Faustian Pact," in which the writer takes aim at the widespread use of Electro-Convulsive Therapy and the even more widespread use of psychotropic drugs.

The issues raised by Dr. Glasser are much too complex to be dealt with in a brief book review. Nevertheless, this reviewer believes that there are solid grounds for disagreeing with at least some of his conclusions. Not everything described in the DSM-IV may merit the description of "mental illness" (the DSM-IV itself uses the phrase "mental disorders"). Yet to insist that none qualify as illnesses surely renders a disservice to many of those we treat. Furthermore, I, for one, am very grateful that--aside from intelligent listening, encouragement, and acceptance--I am able to offer my patients medication that relieves some of their suffering and can indeed facilitate the task of repairing damaged relationships in their lives! I would heartily endorse Dr. Glasser's rejection of those who would equate a DSM-IV diagnosis with inability to do anything to help themselves.

This book has much to offer an unhappy public and can certainly provide mental health professionals with additional tools to carry out their task. However, it may in some cases discourage those whom most of us would regard as ill from receiving adequate mental health treatment.

BOOK REVIEWERS

LEWIS, PHILIP, M.D. Recently retired from service as a senior medical officer in the U.S. Army, Dr. Lewis currently works and teaches at Biola University.

Reviewed by PHILIP LEWIS, M.D.