In "Hannah and Her Sisters," Woody Allen's character complains that his analyst became so frustrated he opened a salad bar.
If all therapists sold salads instead of peddling time on the psychiatric couch, everybody would be better off, contends Dr. Garth Wood.
A psychiatrist himself, Wood is the author of The Myth of Neurosis: Overcoming the Illness Excuse (Harper & Row, 1986, $15.95), a controversial book that has propelled him into a name-calling donnybrook with the American psychiatric establishment.
So far, the 43-year-old Brit has not minced words. He calls Freudian psychoanalysis "metapsychological claptrap" that is "irrelevant where not actually dangerous."
Wood, who studied mind-tinkering at Cambridge University's department of philosophy and philosophical psychology, and is a former senior resident in psychiatry at Priory Hospital in London, states unequivocally that, largely, his profession is "a conspiracy to extend indefinitely the boundaries of mental illness."
To fight the alleged plot, he draws the battle line at neurosis -- labeling as "absolute fallacy" what other psychiatrists define as mild to moderate mental disorders: anxiety, depression, compulsions and phobias. Wood dares "so-called neurotics" to step across that line and face life's problems themselves, forgoing the "false prophets" of psychotherapy.
"I disavow and disallow the concept of neurosis," says Wood from his Palm Beach home, soon to return to London to treat "genuine psychological illnesses" following a U.S. publicity tour of 12 cities. "Its [neurosis] bogus status as a psychological condition has led" millions of people to jump on the "mental illness bandwagon," he argues, "when their chief deficiency is an inadequate approach to life's problems and unrealistic expectations."
Dr. Paul J. Fink, a vice president of the American Psychiatric Association who sparred with Wood earlier this month on the "Donahue" show, says flatly: "I don't agree with anything Dr. Wood has to say. His book is the most insipid and overstated I've ever read . . . He blames Sigmund Freud for the 20th century, and that level of reductionism is frightening."
The chairman of psychiatry at Albert Einstein Medical Center in Philadelphia and medical director of the Philadelphia Psychiatric Center offers a second opinion: "Garth Wood really has so little understanding of the mind that I don't know how he got trained in psychiatry."
It wasn't always easy, says Wood, who confesses to clashes with professors over matters of the mind. "It was perfectly obvious to me that psychoanalysis was flawed from the beginning," he says. "It is unsound -- but it has captured the western world."
As proof, Wood quotes recent estimates that 40 million Americans have mental disorders and 10 million of them need psychiatric help. The figures, he scoffs, show how mental health gurus have propagated the lie of neurosis. The "talking cure industry," he claims, will gross up to $17 billion this year "as they milk the unhappy of a fast buck."
Wood's indictment of psychiatry doesn't stop there.
"In science, theories are guilty until proven innocent," he says, declaring that in the 80 years since Freud introduced psychoanalysis, it has never been shown to be effective by scientific method.
"My basic argument with them," says Wood, delineating the debate in a Them-Versus-Us argot, "is these people have MDs after their names. They are scientists. They would not dish out a pill which the FDA would not approve. And yet here they are dishing out therapy that there is no proof actually works . . . They're pretending to possess answers they do not have. I personally think it is immoral."
Fink defends Freud's legacy: "If you take the total body of literature on psychotherapy . . . you find there is a disparity of proof -- some things are more strongly proven than others. But I think psychiatry is as well proven as how steroids help arthritics, or as some of the chemotherapeutic agents for cancer. Nobody knows how it works."
Washington psychoanalyst Douglas La Bier cautions that while all of Wood's arguments aren't new, the psychiatric profession will attack Wood for the wrong reasons "without really understanding the truth in his arguments."
La Bier, a professor at the Washington School of Psychiatry and author of Modern Madness: The Emotional Fall-Out of Success, to be published by Addison-Wesley in September, contends "it is a pointless argument to say there is no such thing as neurosis" and disagrees with Wood that treatment has no value.
"But there is a tendency to extend the view of illness," he says. "What we really need is a more enlightening understanding of what people need."
What people need to do, according to Wood, is take personal and moral responsibility for their own actions.
"You've got to remember that what people in a mess want most is an excuse," says Wood. "They want absolution. They want somebody to tell them they aren't responsible.
"The psychiatrist is going to say, 'This is not your fault. Things happened to you in your childhood. Your family made you like this. Come to me and I will help you find out what things have formed you into the fix you're in.' "
In fact, says Wood, scientific evidence indicates that, given time, neuroses simply go away by themselves, without treatment.
He says "spontaneous remission" has been shown in many studies since 1938, citing one published in a 1975 American Journal of Psychiatry in which 77 percent of an untreated test group whose members had been diagnosed as neurotic improved or recovered within a year.
At best, Wood says, $100-an-hour psychiatrists might provide a placebo effect to distressed patients by offering a hired ear. At worst, they "prey on the weak and the gullible -- people who are at a low end, whose judgment is clouded" -- with the promise of happiness and no pain.
But no pain means no gain, argues Wood: "The fact of the matter is that life isn't all that wonderful all the time. It can be pretty bloody awful. Psychiatrists say, 'Life should be perfect, life should be pretty wonderful, and in so far as you don't find it that way, we can help you make it happy.' I think they are charlatans. They can't deliver. My view is that people in trouble need common sense."
The common sense Wood prescribes is Moral Therapy. It comes not from psychiatrists but from friends, family and our own consciences, and, he admits, is akin to the simplistic pulpit adage: There'd be no psychiatrists if everybody had one good friend.
"A psychotherapist is going to tell us we aren't guilty and it's not our fault," says Wood. "Friends and loved ones say, 'Look, frankly, you have made a mess of your life. You are drinking too much, you've had extramarital affairs, you aren't nice to your children.' Friends come up with some home truths.
"The problem we face is that we're actually not very good people. Instead of trying to be happy, we should try to be good -- be more faithful to the choice of our own conscience, obey our own moral imperative."
Again clashing with Freud, Wood says the "much maligned mechanism of guilt" is invaluable. "Use it to avoid doing those things that make us feel guilty. Use it like we use pain. If you touch something hot, the pain makes you pull your hand back. If the extramarital affair makes us feel guilty, we should give it up instead of continuing to do it and trying not to feel guilty by going to a psychoanalyst who'll absolve us.
"The answer is simple: We all know 99.9 percent of the time exactly what we should be doing."
Scientific validation of Moral Therapy? "I can't prove what I say is true," says Wood. "But I don't take money for it and I don't practice it."
"His moral therapy is a cross between Norman Vincent Peale and Ronald Reagan -- it's unbelievable," says Fink. "Let your conscience be your guide and everything will take care of itself? And then he says do the things that are most painful.
"In America, psychiatry is seen as a way to get people to be more self-reflective and find ways to change themselves . . . "
Meanwhile, public reaction to Wood's book has been mixed. Phil Donahue "took the view," says Wood, "that this is a conservative plot -- a Reaganite pull-your-fingernails-out approach to mental health."
Moral Therapy received the "roughest reception," he estimates, from radio talk show listeners in New York and Boston (65 percent against). In Los Angeles and San Francisco, Wood scores half the callers in favor and half against. But in Cleveland, St. Louis and Detroit, he says, favorable calls jumped to 95 percent.
When a St. Louis psychiatrist on a Boston talk show charged that Wood devised Moral Therapy to make money from book sales, the maverick psychiatrist shot back, "I'll tell you how much I got for writing my book, if you tell me how much you make from your patients." Wood volunteered he earned $15,000 so far from Harper & Row for a half year's work; the psychiatrist admitted earning "between $100,000 and $110,000."
Professional criticism typically has been harsher than that, says Wood. "What they all say is a stock response: 'You must have something wrong with you to write a book like this. What you need is some pschoanalysis.' "