IS REALITY THERAPY IN REALITY?

     William Glasser who wrote the book, Reality Therapy, became a psychologist in 1947 and a psychiatrist in 1957 in the days when Freud was in fashion and mental illness was explained by unconscious conflicts.   Today, mental illness is considered to be a biochemical imbalance in the brain.  In an address at “The Evolution of Psychotherapy Conference”on Sunday May, 2000 Glasser commented, " ... Regardless of the cause, psychological or chemical, the belief that mental illness is real and those suffering from it have little or no control over their symptoms has yet to be seriously challenged."  He throws down the gauntlet by contending that there is no such thing as mental illness, that there are just unhappy people who have made the wrong choices.

     Glasser asserts, "I contend that when we are unable to figure out how to satisfy one or more of our five basic needs built into our genetic structure that are the source of all human motivation, we sometimes choose to behave in ways that are currently labeled mental illness.  These needs, explained in detail in Choice Theory, are: survival, love and belonging, power, freedom and fun.  What is common to these ineffective and unsatisfying choices, no matter what they may be, is unhappiness: there is no happiness in the DSM-IV... the choice to be unhappy is not mental illness."

     In his address at Anaheim, California, Glasser bolsters his opinion by citing Thomas Szaz and Peter Breggin as psychiatric experts who he has a high regard for.  Glasser cites Breggan as one of the world's leading experts on brain drugs. According to the former, "Many of them (brain drugs) actually harm the brain and render it unable to function normally.  For example, the drug makes it harder for many patients to figure out how to satisfy their needs as well as they would be able to do without the drug.  By applying Reality Therapy, Glasser claims to have helped seriously symptomatic patients to function normally without the use of drugs.

     The reason we are exploring Reality Therapy is that many of the mentally ill will meet a reality therapist during the course of their treatment.  I think that Reality Therapy has become popular as a "fix it yourself" therapy that fits into a mental health care system that has suffered cut backs and patient overloads.  Also, after a brief training period the reality therapist comes back sounding sagacious and authoritative.  Gone is empathy because if the patient is miserable he or she is promptly told to make different choices or judgmentally blamed for being the one responsible.  It's just another case of blame the victim.  When in a deep depression I certainly resented being told that I was miserable because it was all my fault.  I felt angry and assaulted.  I also will not thow my medication into the river, because it has helped me lead a more normal life.

      Many mental health consumers are sick and poor and this grossly limits the choices they can make.  Being unable to work, they cannot choose their income, and often are stuck in substandard housing.  Often they have lost out on a good social life and are struggling with unbearable pain. To the rich and healthy the number of nice choices increases.  Maybe reality therapy works best for the well to do who can move where they want to, have a great career, enjoy lots of friendships and feel vibrant health.

     Another thing about Reality Therapy that I don't buy is that it advocates a "create your own reality" kind of thing.  Life does nasty things to people and sometimes one is caught between the devil and the deep blue sea.  What if all my choices involve me in equal misery?  Am I then supposed to rejoice because I have made a different choice? Am I supposed to delude myself into feeling happy if I am broke, sick, and lonely?

      In my opinion William Glasser is going against science when he says that mental illness does not exist.  Scientists are finding that low serotonin causes certain kinds of depression and illnesses like schizophrenia have been linked to too much dopamine in the brain.  What makes Glasser think that the brain cannot get sick?  Every other part of the body is subject to illness. Genetic markers are being found for manic depression and many other mental disorders.

    On the positive side of Reality Therapy some people do need to make better choices in their life and have gotten into problems of their own making.  Probably, we all need to make better choices.  However, there is no call to insult a schizophrenic or manic depressive by telling them that all their misery is their own fault.