Health and Suffering in America: The Context and Content of Mental Health Care

Health and Suffering in America analyzes how we came to see various forms of suffering as mental illness; and argues that social and historical dynamics, not scientific discovery, gave us this notion. Robert Fancher argues that the beliefs of mental health professionals have less to do with science than with the professions' own values and ideologies. The image we have of mental health care hides vast realms of unexamined assumptions. In effect, the author maintains that mental health consists of mental health professionals' ideas about how people ought to live and act, not discoveries about human nature. The body of the book consists of detailed analyses and critiques of four influential American cultures of therapy: psychoanalysis, behaviorism, cognitive therapy, and biological therapy. Fancher emphasizes how heavily their concepts and methods are determined by their cultures rather than by empirical data. Furthermore, our notions of mental health are not scientific discoveries, but moral ideals. Yet mental health workers often fail to understand this. As a result, they misunderstand their own authority and, worse, fail to subject their moral ideals to appropriate moral and cultural criticism. The new introduction by the author explores how the rise of managed health care coalesces with insistence on parity for mental health problems, supported by continuing claims that mental health care is science-based.