Propaganda in the Helping Professions This page intentionally left blank Propaganda in the Helping Professions Eileen Gambrill 1 1 Published in the United States of America by Oxford University Press, Inc., 198 Madison Avenue, New York, NY, 10016 United States of America Oxford University Press, Inc., publishes works that further Oxford University’s objective of excellence in research, scholarship, and education Oxford is a registered trademark of Oxford University Press in the UK and in certain other countries Copyright © 2012 Oxford University Press, Inc. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, Inc., or as expressly permitted by law, by licence, or under terms agreed with the appropriate reproduction rights organization. Inquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, Inc., at the address above You must not circulate this work in any other form and you must impose this same condition on any acquirer ______________________________________________________________ Library of Congress Cataloging-in-Publication Data Gambrill, Eileen D., 1934- Propaganda in the helping professions / Eileen Gambrill. p. cm. Includes bibliographical references and index. ISBN 978-0-19-532500-3 (hardcover : alk. paper) 1. Professional employees. 2. Consumer confi dence. 3. Propaganda. 4. Persuasion (Psychology) 5. Consumer education. I. Title. HD8038.A1G36 2012 650.101’4—dc23 2011033020 ______________________________________________________________ 1 3 5 7 9 10 8 6 4 2 Typeset in Minion Pro Printed in the United States of America on acid-free paper PREFACE H ow can you tell a quack or a fraudster from the real thing? We all face this chal- lenge. Indeed people have faced this challenge since the beginning of time as illus- trated by the colorful and oft en tragic history of quackery and fraud confounding people’s eff orts to fi nd happiness and to seek relief from suff ering and misery. Making this important distinction is rendered more diffi cult by the lack of success in helping us all to become critical thinkers during our education. Some have even suggested that this lack of eff ectiveness is deliberate because of the enormous benefi ts to the ruling elite of a populace that cannot detect propaganda— m aterial that encourages beliefs and actions with the least thought possible. Th e purpose of this book is to increase your awareness of how propaganda in the helping professions infl uences your decisions and to increase your skills in avoiding its unwanted eff ects. Th is book is for professionals, as well as clients. Th ey also are oft en bamboozled by false claims in professional journals and textbooks, as well as in the media, about what is helpful and what is not. Th e helping professions include medicine, dentistry, psychiatry, psy- chology, social work, nursing, counseling, and related fi elds. O nly if professionals minimize the infl uence of the propaganda they encounter can they avoid propagandizing their clients. All parties are interconnected in a dance of competing realities. Propaganda in the helping professions includes infl ated claims of knowledge and ignorance regarding: (1) the eff ectiveness of certain products, practices, and policies including assessment methods and frameworks; (2) what is a problem or risk; (3) alleged causes of concerns; (4) professional competence; and (5) what research methods can critically appraise a question. Perhaps even more oft en than greed, paternalism (“I/We know best what is good for you”) encourages propa- ganda in the helping professions. Th is book will help readers to lift the curtains of mystifi cations and confusions created by propaganda in the helping professions and the many related enterprises described. Indeed you, as was I, may be amazed to learn about all the action hidden in the wings. It is almost as if one had a house infested with mites that one did not know about — but there they are, aff ecting our lives. Professionals, as well as those they hope to help, are typically caught up in propa- ganda in the helping professions, for example, by accepting gift s and free dinners from pharmaceutical companies, attending continuing education programs funded by these companies, and by reading journal articles prepared by commercial writing fi rms hired by pharmaceutical companies. (I call these “marticles” as described in chapter 9.) It is only within the past few years that greater attention has been given to related subterfuges, mostly because they have become so “over the top,” including vi Preface creation of new maladies by pharmaceutical companies and fellow travelers such as the American Psychiatric Association. Th e framing of life’s dilemmas (how to act in the world— e .g., whether to batter one’s partner or not) as psychiatric maladies, ignoring moral and ethical aspects, provides endless opportunities for the helping profession industries to expand. But does it off er us opportunities to grow as thought- ful, responsible human beings who confront the eff ects of our behavior and experi- ence the joys possible? Do we, as some ask, want to be a nation of “Charlie Chuckles”? Certainly, many people have problems that can be alleviated by the help of informed, caring professionals, including medication; but how many, and under what umbrella — psychiatric, or moral and existential? Are all the problems-in-living now framed as psychiatric a matter of brain diseases? How many are moral-ethical dilem- mas that, if we confront, perhaps with the help of an expert guide, we can have a richer and perhaps still at times anxious life, rather than a tranquilized-zombie-like life? And who benefi ts from these diff erent decisions? In this book, propaganda is viewed as an epistemic and ethical concern — it con- cerns knowledge and ethics. Because propaganda is deceptive— i t hides, confuses, distorts and distracts, perhaps even fabricates — it is a deeply ethical issue. It deprives us of opportunities to make up our own minds about what to believe and how to act. It diminishes our humanity and our agency — our freedom to make our own deci- sions. Decisions we think we have made are orchestrated by others, including public relations fi rms hired by pharmaceutical companies. I hope that this book helps read- ers to identify unknown infl uences on their decisions and to understand how we are all deceived in many ways and how we are complicit in this process. If propaganda is essential in the technological society in which we live, as Ellul (1965) suggests, then we cannot escape its infl uence. Our only recourse is to try to understand how it works, how it infl uences our lives, and, for professionals, how it infl uences the lives of clients, and how we may mute its eff ects. Propaganda pitches oft en create an illusion of openness, while at the same time, obscuring competing views and questionable grounds for claims about what is true and what is not. Th ey are carefully tailored to appeal to our self-interests and deepest motives (to be right, to be a member of the in group) in order to discourage critical appraisal. Chapters are included designed to help readers detect diff erent forms of propaganda, for example, about bogus risks, unneeded screening tests that may do more harm than good, and unneeded interventions that may harm rather than help. Readers will learn what questions to ask about claims and recommendations made by professionals and others. And they will learn how to have fun unpacking clever persuasion tactics used in direct-to-consumer advertisements rather than being infl uenced by them in uncritical ways hoped for by the creators: “Ask your doctor for X.” Do you really have irritable bladder? Is depression really a brain disease? Should you take a statin? Should you seek the radical method of treating cancer of taking out all your insides and pouring a harsh chemotherapy into your abdomen? Is this likely to do more harm than good? Th us, it is my hope that this book will not only inform and in this way expand your ability to make informed decisions, but be fun in the process. What seems innocent, such as taking a screening test, may lead to a cascade of events that may ruin your life such as a false positive test which results in further intrusive tests with adverse side eff ects. You will have to decide whether you want to coast along with the tide directed by others or take your oars and make your own way. You may believe that you are now Preface vii in charge — that your oars are securely in the water and you are forging your own path. Th is is exactly what manipulators want you to think. But, if there is one lesson to be learned from history, including the history of public relations and advertising, as well as the history of the helping professions, it is that we oft en think we are cap- tains of our ship when we are not. Th is is the essence of manipulation — to make us believe that we are in charge when we are deck hands in ships steered by others toward goals that we may even despise if we were aware of them. When the curtain closes on a good play, the messages of the play continue. My hope is that this happens to you — that reading this book is not the end but the beginning of a new approach to propaganda, one that begins with increased recognition of propaganda and its many venues and scripts, one that expands your vision and possibilities, one that yields a reawakening of curiosity and belief in your own ability to arrive at well-reasoned decisions that you, not others, choose. I owe much to all the writers who have contributed to the rich literature on propa- ganda. I have drawn on the masterful analysis of Jacque Ellul, which so well inte- grates the psychological and sociological in understanding what propaganda is, how it works, and how it aff ects us. I wish to thank Maura Roessner, Senior Editor at Oxford, for her support and interest in this area as well as Nicholas Liu, also of Oxford for his help. I thank Bruce Th yer, Brian Sheldon, and the remaining anony- mous reviewers of earlier draft s who provided helpful feedback. I thank the Hutto Patterson Charitable Foundation for fi nancial help with this project, as well as Sharon Ikami for her word processing skills. Th anks also to Gail Bigelow for her enduring support and caring about the world. E.G. This page intentionally left blank CONTENTS PART ONE Introduction 1. Propaganda in the Helping Professions: What Is It and Why Should You Care? 5 PART TWO Context, Actors, and Scripts 2. Introduction to the Players 29 3. Interactions Among the Players 63 4. Propaganda Analysis: Diff erent Levels 90 PART THREE Consequences of Propaganda 5. A Rogue’s Gallery of Harms Related to Propaganda in the Helping Professions 123 6. Th e Medicalization of Life 159 PART FOUR How Th ey Reel Us In 7. Obscure Diff erent Views of Knowledge and How to Get It 199 8. Appeal to Popular Grand Narratives and Metaphors 235 9. Disguise Advertisements as Professional Literature 278 10. Propagandistic Use of Language and Social Psychological Persuasion Strategies 297 11. Appeal to Our Psychological Vulnerabilities 326