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Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Friday, January 18, 2013

Book Review: Eileen Gambrill's "Propaganda in the Helping Professions"

As you might expect, people in the helping professions want to help. Physicians, nurses, social workers, psychologists, occupational therapists—although they may have other motives too, they probably won’t stay in those professions long unless one of their goals is giving help. And because they really want to help others, they may be quite vulnerable to propaganda in the form of attempts to persuade them that certain methods are safe and effective. Even if there is no good evidence to support such claims, helping professionals may accept persuasive material  enthusiastically and unsuspiciously, to the unfortunate detriment of their clients’ conditions. This situation is especially problematic if propaganda is generated by pharmaceutical companies or by proponents of alternative methods, who stand to profit if they can persuade the helping professional to use their proffered techniques.

In Propaganda in the helping professions (Oxford University Press, 2012), Eileen Gambrill, a social worker with a long history of concern about methods in her own profession, warns patients and practitioners of the potential dangers of persuasive messages about treatments, and describes at length some necessary skills for identifying and resisting propaganda. Densely informative, with 500 closely-printed pages of information and argument, Gambrill’s book presents ideas and methods which most people in the helping professions have been exposed to--  but did not necessarily catch. Like many abstractions, these ideas are easily forgotten, and most of us benefit from periodic reviews of material we recognize but don’t easily recall. Gambrill’s almost encyclopedic book will not be read straight through by many, but can be dipped into frequently with benefit to professionals and to patients who want to take some control over their treatment. Readers will find the extensive bibliography helpful, the endnotes both entertaining and informative, and the entire publication characterized by personal, opinionated, and even pejorative views (Gambrill refers to the American Psychiatric Association as “fellow travelers” of the pharmaceutical industry, for example).

An important section is one that restates a point discussed frequently over the last several years: that both practitioners and patients understand risks and benefits of events better when statements are in “natural” terms (e.g., 3 cases of breast cancer out of 1123 women) rather than in proportions or percentages. The ratios are the same, however they are stated, but the medium influences the reception of the message. Gambrill works out several problems using natural statements of numbers and shows how intuitive responses to reports of percentages may be quite different from responses when specific numbers are provided, with possible effects on our conclusions about the effects of treatments.

Several sections of the book focus on rhetorical or logical factors as they influence a message’s persuasiveness. For example, Gambrill discusses fallacies of irrelevance and the frequency with which they are used in propaganda about medical and psychological treatments. Indeed, defense of statements with comments that are ad hominem (about a speaker) rather than ad rem (about the topic) is a technique that is almost diagnostic of propaganda in the helping professions and elsewhere. For myself, I find it useful to review types of fallacies from time to time--  remembering the names helps me to identify examples that I read or hear, and assures me that others would find the statements fallacious as well. Gambrill’s book presents a thorough review, and includes a warning against the possibility of “self-propaganda”, the tendency to persuade ourselves of beliefs that in fact we cannot support.

Propaganda in the helping professions is a book full of good things, but it is not precisely a “good book”; there is more to a good book than a series of good sections. Gambrill’s book would have benefited greatly from an experienced editor who could have tightened up the text and revealed an underlying structure that is presently obscured by details. In addition, the production phase seems to have been skimped, leaving the text sprinkled with puzzling uncorrected typos of the kind that spell-check either caused or failed to fix. These include sentences where punctuation seems to have gone agley, leaving the reader to figure out what happened to the shoots and leaves.

I was left with unresolved concern about a point in Gambrill’s book. As she has done elsewhere, she refers to the Citizens Commission on Human Rights as a “watchdog group”, together with  the American Civil Liberties Union and Advocacy (sic) for Children in Therapy. Overleaf (not her fault, of course), Gambrill notes that the CCHR was established in 1969 by the Church of Scientology. It can’t be denied that the CCHR is indeed a watchdog group---  but its Scientology affiliation surely raises questions about who should be watching the watchmen. Here, where I would have expected one of the references to “fellow travelers” found elsewhere in the text, I see no comments at all. Does Gambrill presently consider the CCHR and the ACLU to be equivalent in roles and purposes?  Or is this simply a result of cutting and pasting of an unwieldy mass of material? I’d like to know, and I’d like this flaw to be corrected, so it doesn’t steal attention from the rest of Gambrill’s valuable contribution.

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