Book Review: Outsight: Psychology,Politics,and Social Justice

Outsight: Psychology, Politics, and Social Justice (Outsight) is an unexpected critique of the psychological clinic written by five experienced and well-trained members of the Midlands Psychology Group in Britain. The various chapters apply skepticism to research, politics to the practice of skepticism, and both to the practice of psychotherapy, social services, and the question of social need. The logic is deeply sociological—social experience shaping social institutions including the practice of science itself. Bravo for insisting that psychotherapy is no more than a social contrivance—an elaboration and expression of social preferences—rather than a Divine revelation of truth and goodness. A similar practitioner voice admitting to the failure of the current field is rare, to the point of silence in the United States.

Unfortunately, their evidence and arguments are often flawed, thin, and sometimes contradictory. Outsight often nests its logic in the convenient dogmatism of postmodernism, poststructuralism, and other incarnations of Romanticism. Its affection for undisciplined subjectivities put it into a bind of aspiring for the authority of science while rejecting its logic. Yet the impossibility of knowing the world unmediated through the senses provides no warrant for inventing the world as one wishes it to be: even with eyes squeezed shut and heels clicked to turn on the magic, you cannot return to Kansas.

The authors’ major contribution is to elaborate clinical psychology within the mores of society rather than its very questionable ability to handle mental and emotional problems. Outsight offers strong evidence that clinical psychology has failed, apparently justifying an alternative social-materialist psychology. Yet a clinical solution involving any form of psychotherapy seems futile, clasping loyally to the hope that talk therapy can achieve behavioral change.

The Logic of Illogic

Outsight's earliest chapters summarize the current crisis in mental health services, providing “A Brief History of the Present” leading up to “The Current State of Psychology.” These initial chapters criticize the complicity of clinical psychology in neoliberalism's promotion of capitalism and its reliance on an exaggerated ethos of personal agency. Through the logic of extreme individualism, personal failure becomes evidence of failed character expressed as poor choices—an individual's misguided agency. In contrast, a true materialist approach explains social and individual problems not as a failure of agency but rather as the inadequacy of material conditions that sustain individuals, families, and communities through generous day care, health services, income, jobs, education, and so forth. Psychotherapy with its foundational assumption of individual agency—the human capacity for critical thought preceding behavior, that is, attitude change as the vehicle of behavioral change—elaborates a clinical role to repair failed character. To the extent to which it fails in this clinical role it may yet persist without a production function but as a ceremony endorsing embedded social preferences, in this case, capitalism and extreme individualism.

In opposition to capitalism and the individual's social isolation, “Outsight means to have a clearer understanding of how social and material circumstances are configured” (p. 21). To be consistent with their own argument, the authors might have also recognized that if an independent agency does not exist for the individual, it probably does not exist for social institutions such as clinical psychology. This supposition would seem to undercut the effort to reform the field without first reforming the culture. Be that as it may, intellectual life is barren and dull without its little contradictions.

A more modest and politically accurate presentation of the book's core assumptions concerning the relationship between clinical psychology and modern neoliberal society would acknowledge that Outsight's “clearer understanding” is not a graven truth of social life but rather an enumeration of the authors’ preferences—their ideological choices rather than scientifically demonstrated facts. Outsight does not clearly distinguish between the contingencies of political truth (the inherently subjective processes of belief) from scientific truth (what is known logically and objectively through credible methods of investigation). In fact, the book attempts to undermine the relevance of scientific methods and logic to clinical psychology except in the two chapters that handle the research of clinical effectiveness.

Chapter 4, “Does Therapy Work,” cuts against the logic of much of the book without abandoning the desirability of a more humane and effective practice of psychotherapy. Resting on the logic of scientific discovery, the chapter argues that “…clinical (as opposed to statistical) superiority is questionable, and the former declines in proportion to the quality of the study” (p. 69) and concludes that “…successes are very far from guaranteed and that, overall, therapeutic efficacy is hard to demonstrate” (p. 81).

Considerable mystery surrounds the true extent of client deterioration…Surveys suggest that between five and 10% of the recipients of therapy experience an intensification of the problems (or a set of fresh ones) as a result of psychological therapy. (p. 70)

The chapter also concludes that the failures of therapy do not mean that “established therapies never produce any successful outcomes… Considered by its own lights, research suggests that the power of therapy is modest: typically, between 15–20% more than a placebo” (p. 81).

However, a rigorous reading of the research literature that relies on the best studies of outcomes—rather than meta-analyses and the hopefulness of impaired research—would discover few if any supports for the routine success of talk therapy and little rigorous evidence that recommends psychoactive drugs (Epstein, 2006, 2019; Moloney, 2013). Meta-analyses are no more credible than their base of individual studies and their frequent low bars for inclusion simply channel the field's biases. Analysis of even the best of the research uncovers routine deception, bias, porous designs, and interpretations loyal to practice that subvert the possibility of any conclusion other than clinical failure. The last thought in this unusual chapter repeats the central theme of the book itself: Successes are “very far from guaranteed and that overall, therapeutic efficacy is hard to demonstrate” (p. 81). However, if therapy cannot be justified on the grounds that it simply works, then there must be other, more ideological reasons for its continuing preeminence.

“Does Therapy Work?,” by depriving the field of a credible objective claim on effective clinical science, offers a powerful warrant to seek alternatives. It might also have pointed out that clinical psychology has been participating in a natural experiment for more than one hundred years leading to the apparent point of skepticism that despite the popularity of psychotherapy people are not easily if ever talked out of their bad feelings and bad habits. This failure adds to the probity of trying something else; the proposition “that individuals cannot be understood separately from their circumstances” (p. 122) establishes the grounds for a social-materialist approach.

Nonetheless, the objective value of the authors’ recommended alternative of a material clinical practice—its effects on personal behavior and social problems—as well as their central assumption of environmental causation (rather than personal agency) is undercut by their recourse to subjective social and political criteria of proof. Few if any credible objective tests sustain the authority of Romantic notions of reality as well as the interventions that the heart inspires, and the ethereal mind verifies. There may be no rational basis for politics nor any compelling objective evidence that the mysticism of the implicit and ineffable offers transcendent authority. An acknowledgment of profound ignorance would strengthen the justification for liberal democracy—universal respect for the attempt at common decency and an intellectual community that rejects flimsy and improbable claims to authority, wisdom, and virtue. Indeed, the community of scholars that attends to social welfare provisions does itself no favor by reverting to subjectivity in explaining away the failure of objective tests, such as they are, to support the effectiveness of psychological clinical practice.

To explain the “continuing pre-eminence” of longstanding and presumably wrong-headed and damaging institutions, Outsight invokes manipulation and propaganda by powerful, coercive, evil, and hidden actors, along with other “distal” but ineluctable forces to excuse the general population of unwitting and coerced collaboration in harmful societal institutions. Yet again, if the masses are deprived of agency by way of excusing their victimhood, why then assume either a constituency or motivation sufficient to enact a materialist substitute for clinical practice or subtly assume the possibility of a revolution in human consciousness? Outsight fails to address the presumably false mindset of the masses or to demonstrate their rejection and displeasure with the culture as it is. The authors surely reject Marxism's justification for violent revolution and the subsequent dictatorship of the masses in order to correct false consciousness. What then is left? Acceptance of things as they are, reeducation of the masses via a consensual dictatorship, or prayer for a revolution in human consciousness?

Thus a gap remains between the desirability of change and the feasibility of doing so not least because the masses may be complacent if not actually the source of contemporary values. In this case, Outsight offers no insight into dealing with the distortions of the culture. Out of loyalty, affection, or blind commitment to the implicit virtue of the masses, it apparently rejects the likelihood that the current situation is in fact a result of the popular agency. Rather, the evil powers that wield illegitimate control have apparently duped us all. Indeed, their efforts seem bent to the task of maintaining a nationalism of popular virtue. It is worth mentioning that both former President Trump and Prime Minister Johnson—and most of the world's current set of authoritarians including Orban, Putin, and Ji—enjoyed great popularity with the very populations that presumably suffer most under their tenure. It is apparently beyond the capacity of the authors to consider the notion that by and large the masses may be ignorant, short-sighted, and mean-spirited and that leadership is simply staying loyal to democratic principles of representation.

Ideological subversion of the design and purpose of clinical interventions is hardly controversial; the goals of psychotherapy are inevitably chosen against the inescapable and pervasive backdrop of social meaning and influence. However, the nonideological facts of achieving those goals derived through applications of clinical science need not be ideological. The profound difference between what should happen and what did happen goes unappreciated in the muddling of the sublimely subjective with the objective. Kant's unsettling conclusion that it is impossible to know the world in itself because human knowing is bound by the senses, does not negate the utility of reliable experience. It is obvious that even lacking undistorted knowledge of reality, human civilization has been endlessly inventive in producing predictably effective products from bridges over water to bridges between teeth. Reliable replication has been the hallmark of scientific progress. The late sociologist Irving Horowitz may have said it well: “If objectivity is a fiction, it is a very useful fiction” (Personal comment).

Recognition of the thoroughgoing failure of objectivity in evaluations of clinical psychological practice is a major step toward intellectual modesty. However, by itself, it does not warrant the embrace of the subjective. All the belief in the world neither shrinks the tumor, provides a warrant that faith in rabbit feet or crosses can stand in for COVID vaccines, nor reduces the compulsive appetites for drugs, violence, or narcissism. The simple acknowledgment of ignorance is a refreshing beginning to take on the tasks of social progress and the scholarship of social welfare.

The core assumptions of clinical psychology—an emphasis on the individual's agency isolated from social context—are Romantic effusions variously described as self-invention, as Fichte's self-positing ego that Freud apparently borrowed without attribution, as radical autonomy, and as extreme individualism. Outsight argues, as have many before, that these assumptions sustain the political and social tenets of capitalist culture underpinning pernicious inequalities notably in the United States and Britain. But these core assumptions are not equivalent substitutes for science. Instead, they mark the social resistance to objectivity, even in clinical practice that avows objectively tested outcomes while failing to do so.

Outsight's reliance on so-called advances in philosophy by poststructuralism and “critical realism” as they define knowledge and science is a weakness of the book that subverts its own recommendation for a materialistic psychotherapy. It attributes the problems of clinical psychology in large part to its acceptance of “positive science” meaning “a world characterized by observable and measurable objects that have law-like, causal relationships with each other” and lead to “new testable hypotheses” (pp. 44, 45). In its place, Outsight touts qualitative psychological methods and turns its nose up at the objective logic of science and thus any attempt to challenge the authority of a felt reality. “Positivist” psychology is criticized as the self-serving handmaiden of capitalism and its obedient notion of personal agency while the subjective logic of Outsight is presented as the one true path—pure, independent, altruistic and noble.

Outsight might have acknowledged that science has moved past the verification principle of positivism to Popper's more modest and sophisticated concept of falsification. Verification requires infinite knowledge; falsification implies infinite skepticism and notably within a community of scholars hoping to achieve standing as a modern profession of clinical practice. In the absence of an informed skepticism applied to its own poststructuralist assumptions, Outsight's position on knowing degrades into a temper tantrum—I want it because I want it because I want it—that supplants commitment to an effective clinical practice.

Outsight appears to substitute political acceptance for a scientific clinical fact. Thus belief in material alternatives to psychotherapy is valuable and true because they are believed to be valuable and true. Still, the frequent triumph of emotion over truth does not justify the rejection of rationality in clinical science. Rather it points to the need for better, cleaner, relatively bias-free investigations of clinical practice. This is a limited function: Does clinical practice meet its treatment goals; is psychotherapy effective? Subjective “knowing”—the question of whether important constituencies feel that goals are being met—is not the same as objectively construed knowing. Scientific facts confer a distinctive authority compared with the gushing good feelings and looming dreads of those with stakes in the clinic—notably including patients but also including taxpayers, those besotted with personal agency who think that the deluded, the psychotic and the depressed are morally corrupt, as well as the commercial interests of therapists, administrators, writers, and publicists who make a living in one way or another from talk therapy. To the extent that a clinical field claims standing on the basis of objective evidence, it is stuck with clinical science rather than a vote on outcomes as proof of clinical value. The reality of political acceptance does not certify the objective fact of the outcomes, let alone their actual value to patients and the society itself.

Yet in a political sense, the fact that an ineffective psychological clinical practice has been an adored institution of many societies says much about popular values, preferences, priorities, and civic depravities. The institutionalization of clinical practice says little if anything about the actual material value of practice. Social institutions are important tools of social analysis quite apart from their objective reality; they are monuments to actual social choices. Indeed, the popularity of many institutions continues often despite their objective utility, for example, prayer and the salvation of believers as well as democracy itself. There is no scientifically credible way to test these institutional choices against alternatives. However, psychological clinical practice can in fact be credibly tested. Yet Outsight sustains the reluctance of the field and probably the culture itself to do so.

The authors’ dogmatic attachment to the mantra of postmodernism and poststructuralism is perhaps even more tyrannical than the “positivistic” ideologies they lament. The confusion between preference and belief on the one hand with object processes of testing on the other hand has served unfortunate political ends. The modern world's preeminent authoritarians, autocrats, and sadists in charge of exterminatory public policies including Stalin, Mao, Pol Pot, Hitler, Idi Amin, and others rejected science and objective evaluation in favor of one sort or another of political affirmation of cultural virtue—nationalism, genetic and cultural superiority, God's favor as well as the make-us-great-again restoration of a bygone age of power and nobility that never was. Of course, the authors of Outsight are not tyrants nor even dupes of tyrants but their logic of reforming materialism with subjectivity is reminiscent of the subversion of science and skepticism by autocrats and the totalitarian state. Whenever rationality is claimed based on subjectivity Albert Einstein's grave trembles and the Devil laughs.

Postmodernism does not provide a test of effectiveness but rather a measure of taste, preference, and compatibility. The problems of creating value-free knowledge do not provide a warrant for substituting imperfect measures of patient satisfaction, as one example, with objective and appropriately designed studies of actual outcomes. Patient satisfaction is a concession to preference, the question of what is liked and popular; it may even track with cure but it is not evidence of the cause of outcomes. That task requires clinical science rather than patient satisfaction.

It is not necessary to becloud the influence of material conditions over human behavior with the murk of postmodern thought. The book's alternative to the notion that people invent themselves—social-materialist psychology—needs objective clarity. The true materialist alternative is better defined as situational or environmental and implies providing, usually through government, the material conditions of life as comparable surrogates for failed social institutions: family, community, work, education, leisure, income, even self-expression, and others. The failure of less material efforts such as clinical psychology rather than presumed knowledge of outcomes justifies the provision of greater material equality.

The problems of testing the psychological clinic also beset any alternative including social–psychological clinical efforts unless the goals change explicitly from that of cure, prevention, and rehabilitation to those of greater material comparability, that is, from the question of efficiency and effectiveness to a bookkeeping question of parity and its social acceptance. Unfortunately, the preference for greater equality—the implicit assumptions of common decency—is not compatible with the institutionalized values that dominate the United States and perhaps many other nations including many autocracies that lack any affection for open market capitalism and associated social freedoms.

The failure of psychotherapy as science does not need the book's injudicious and unconvincing assault on science, especially after relying on the logic of science to make the major points of Chapters 4 and 5 that clinical psychology is routinely ineffective. The hypocrisy is clear: the field claims the prestige and authority of science but defies its logic at every turn. A true materialist approach is justified by the failure of psychotherapeutic clinic. Greater material equality should be tried but carefully, and cautiously with constant objective monitoring, and openly, that is, with a detailed publication of progress in search of common decency. Modest expectations are justified in the face of inevitable ignorance of consequences and not least by the hostility of large portions of society to material remedies.

The Social-Materialist Alternative

The largest portion of the book, another six chapters and one of the two appendices, elaborates the details of a social-materialist clinical practice on the assumption that “individuals cannot be understood separately from their circumstances, as mainstream psychology erroneously supposes” (p. 122). Outsight's seminal theory of material practice includes attention to feeling, language, memory, habit, interest, power, and the social unconscious (sic)—the material elements of social-materialist psychology. Yet these elements are only material in a postmodern or sociological sense. They are not the common understanding of material in an objective sense. Thus social-material psychology maintains an emphasis on the essential element of talk in therapy, diminishing the importance of the commonly understood material of inequality— food, clothing, shelter, education, work, money, etc. The authors hope to maintain common psychological practice by simply acknowledging that people are products of social conditions but adopting a language that appears to accept material conditions as somehow part of the therapeutic experience. Yet therapy under these terms never provides those conditions. In a subtle way, this marks the voyage from the traditional left that took purpose from the objective materialism of inequality to the New Left which is more linguistic and emotional, substituting talk for an agenda of material redistribution. The voyage went from a threat that failed to do much to an agenda of compliant irrelevance for poorer groups—from the politics of substance to theater.

The potential keys to behavior—feeling, language, memory, learning, etc.—are not relevant to clinical practice until they are specified as actual material exchanges. However, the book fails to detail actual practice but only a long list of considerations that are not worked out. In fact, the authors’ material practice is trivial if it only means to reject the ineffable, mystical and superstitious in acknowledging that human behavior has material precursors.

Under the assumption that similar environments produce similar outcomes, a more relevant material practice would accept an objective material logic and predicate itself on material reality rather than the emotional correlates of greater social equality. Outsight's argument is reminiscent of Wakefield's claim that a positive self-image is a distributable right (Wakefield, 1988). Both contentions float on the Dead Sea of postmodern fantasies—emotion and concurrence—unburdened by science, that is, rigorous objective evaluation of measurable physical effects.

Perhaps in anticipation of criticism, the authors state that “our social-material psychology is (the mere beginning of) a theory, emerging in dialogue with other developments” in a variety of disciplines and by “critical researchers” (pp. 123, 124). Yet, it is not enough to simply connect clinical practice to the social-material world although it would be helpful to start with a focus on material rather than emotion. An alternative clinical practice of material therapy is obliged to make a plausible claim on material ends themselves of greater equality. However, the offered examples of alternative practice are not compelling arguments for alternative social-materialist approaches to therapy. If anything, the occasional, and convenient skepticism in chapter 8—seemingly oblivious of chapters 4 and 5—provides grounds for throwing out much of talk therapy as well as trivial material interventions; it offers little if any evidence of greater effectiveness in achieving clinical outcomes. An imagined world blessed with the absence of capitalism might try to specify a way to assure material distribution and justice besides the presence of caring neighbors and good intentions. The fact seems that many nations on the brink of starvation and rampant criminality are quite willing to sacrifice self-expression and state-of-nature liberties for an authoritarian stability that feeds them.

Outsight's analysis of power promotes a common assumption that the powers of government, corporations, wealth, and others exert illegitimate, unwanted control over the population. The possible foolishness and brutal ignorance of the masses are again ignored in protecting their presumed innocence and victimhood. Are those the very same sweet, misled victims who over the years endorsed slavery, denied women the vote, perpetrated white racism, slaughtered native Americans, showed consistent contempt for education, manned the battalions of Christian Nationalism, voted for Trump, refused anti-COVID vaccines and masking, and stormed democracy on January 6 in Washington, DC, among other outrages of common decency?

Furthermore, to bring the “social unconscious” into a work on clinical practice mocks any claim on a materialistic clinical practice unless it redefines unconscious as somehow materialist. The social conscious looks like a near synonym for Jung's collective unconscious that embellished his goal to reinstate the spiritual with modern life in rejection of its soulless attachment to modernity's scientific realism. It is a tribute to the resilience of spiritualism and the Romantic tradition that they continued through the soulless decades of slaughter associated with the plague of savage nationalism, totalitarianism, libertarianism, Nazism, and communism. The tribute is sadistic, paid to an underlying savagery in society that abandoned common decency for hundreds of millions in the industrial west and billions in the rest of the world.

Outsight redefines subjectivity as material within every facet of psychological theory and practice allowing the authors to aspire to what appears to be an objective, scientific and material understanding of environmental “enabling.” The political bugaboo impeding change lies in the assumption that “neoliberal ideology has proved very useful to the rich and powerful” (p. 185) with the complicity of “the dominant majority within psychology” (p. 162). Yet, armed with the subjective as material, somehow psychotherapy can now emerge as a force of social change convincing people to overthrow their social and economic shackles that are really only threadlike binds easily snipped by an energized will.

The authors might have noted that the majority of the society applauds a largely unfettered capitalism and unregulated growth despite their complicity in global warming and doomsday. This broad social consensus of institutionalized belief stands in the way of the authors’ tepid strategy of consciousness-raising to achieve social change. Ironically, consciousness-raising builds on the very assumptions of agency and self-creation that the book argues against except, apparently, when it conveniently props up its outsights. A careful reading of the clinical literature and of their own chapters 4 and 5 strongly suggest that a well-reasoned argument and talk therapy do not change people's behavior. With popular support, American society, for one, has long resisted substantial efforts at greater material equality. With equal intensity, it cherishes linguistic fads such as social materialism that rarely say anything new or lead to meaningful change. Calling the individual “them” is not much of an agenda for revolution.

The material approach to clinical practice is justified as a default from “positivist “clinical psychological practice. A more modest alternative might justify material interventions without reliance on a speculative philosophy of the insubstantial and imagined. The justification might begin with the observation that the community of clinicians, notably its researchers, have failed to adhere to credible science. However, without an infinite knowledge of alternatives, the failure of talk therapy by itself does not sanction any alternative at all. It does, however, justify the search for an alternative.

A reasonable but so far untested alternative of greater material equality may be justifiable on ethical grounds of common decency rather than clinical outcomes although always with the hope of positive behaviors such as sobriety, meaningful work, well-taught children and adults, and binding experiences among differently situated people. It is also worth the strain to accept that the outcomes of most broad efforts to achieve greater equality through material provisions may frustrate scientific attempts to attach them to presumed outcomes. Beset by technical, theoretical, and ethical impediments, randomized clinical trials, appropriate for many clinical interventions, produce indeterminate ambiguities when applied to many nonclinical interventions. As a few examples, it is probably impossible without near jail-like conditions, to isolate a control and an experimental group from confounding experiences provided by the culture itself, to deprive a control group of necessities, to know precisely what any of the study groups actually experienced during the research period (i.e., to be confident of the fidelity of the experimental and control conditions), to control attrition, to assure subject blinding, to maintain long-term test conditions beyond demonstration periods, and to collect credible long-term follow-up data. As evidence, the income maintenance experiments in the United States have been consistently compromised—monumental and expensive efforts that produced ambiguous outcomes.

The argument over greater equality rests on political and social values and not on scientifically testable knowledge. These sorts of arguments typically rest on a balance of indeterminate and incompatible points of view shored up by belief, mood, attitude, and personal witnessing between adversaries with different goals and different values—a very unsatisfying conclusion, but nonetheless probably the natural condition of political debate in a complex open society. Data for decision-making is possible when the data is feasible and agreed on, for example, is a drug effective or not, is global warming a threat, and can it be controlled and reversed? However, a social policy debate contingent on common decency is not easily settled by empirical data.

The problem as ever lies in specifying the elements of common decency. Interpretations of common decency do not need to draw from the cave of rationality while rejecting the apparent cruelty, neglect, and punishment associated with current social and economic distributions. Nonetheless, dissatisfaction with present conditions may by itself justify moves away from them but without imposing some dream of order as a goal. More equality does not imply perfect equality nor the realization of a utopian vision. Following Huxley, “the dream of Order begets tyranny” (p. 9). The substitution of food for freedom looks like a bad deal, a desperate option for those without hope.

The principle of proximity to outcomes when a cause is ambiguous favors the intervention closest to the favored outcome. If the goal is to increase the wealth of workers, then one option is to cut taxes on business and high incomes that hopefully stimulates investment by way of increasing growth to produce a tax dividend that in turn is spent on education whose goal is to improve worker skills and thus income. In contrast, the principle of proximity argues to first directly increase worker wages perhaps while funding steps to improve worker skills to increase productivity and growth and thus repay public coffers. Both are uncertain and ambiguous. The second option is the more proximate route to the material benefit of poorer populations with presumably rapid benefits in health, nutrition, mental adjustment, childcare, socialization, and others. But the goal and the justification are increased material equality for workers; other positive outcomes are welcome but serendipitous.

So too with social-material psychological practice as a vehicle to improve the lives of poorer populations in the hope of achieving customary social benefits. The proximate alternative turns away from clinical practice toward directly providing poorer populations with greater material parity. It might secure for them a more comfortable, enriched, and productive life, perhaps even translating into broader societal benefits. Both options are ambiguous since the longer-term goals of social benefit are by and large untestable. However, the direct provision of greater material equality starts off closer to the goal.

Both science and subjectivity seem to have failed in the realm of the social clinic and more broadly perhaps in social welfare. The issue itself becomes less one of utility, efficiency, and ceremonial obedience than one of public morality, that is, common decency implying greater social and economic parity concerning access to the common institutions of society. Not quite the diehard conservative, Adam Smith made a case for reducing relative poverty presumably through public policy.

By necessaries I understand not only the commodities which are indispensably necessary for the support of life, but what ever (sic) the customs of the country renders it indecent for creditable people, even the lowest order, to be without. A linen shirt, for example, is, strictly speaking, not a necessary of life. The Greeks and Romans lived, I suppose, very comfortably, though they had no linen. But in the present times, through the greater part of Europe, a creditable day-laborer would be ashamed to appear in public without a linen shirt, the want of which would be supposed to denote that disgraceful degree of poverty which, it is presumed, nobody can well fall into, without extreme bad conduct. Custom, in the same manner, has rendered leather shoes a necessary of life in England. (Smith, 1776)

Following the interpretation of Smith as compassionate, relative poverty shifts the terms of evaluation from specific concerns with cure, prevention, and rehabilitation of deviant social behaviors to the institutionalized elements of social integration and participation—income, work, education, the range of family supports, and so forth. Yet the specific causes of social benefit, not just social satisfaction, are usually not amenable to rational testing but only presumed on more ideological grounds such as “the customs of the country,” moral conviction, tradition, or common decency. Because the vaunted, pure truth of social welfare—utility—is probably not possible to test rationally, repairing enormous inequalities looks like a virtuous default position of common decency except for one huge stumbling block. Common decency is in very short supply at least in the United States and perhaps in Britain as well. Not nice.

The United States and Britain

Over the past 100 years or so, the United States has elaborated a clinical practice of talk therapy based on Romantic effusions of self-invention and “radical autonomy” paired with “special” clinical research methods that are obedient to the field's presumably unique conditions. What has come about is a wildly popular perversion of science that endorses relatively inexpensive psychotherapy in avoiding the enormous costs of greater social and economic equality. The American research community that makes a living by creating compatible research seems to collude with an agency of government—notably, The National Institutes of Mental Health—that acquiesces to embedded social preferences and offers rewards for doing so. The resulting illusion of therapy's effectiveness or at least the ceremony of its popularity has domesticated science with unrepresentative samples, inappropriate and nonequivalent control samples, differential attrition, inadequate intention-to-treat procedures, breached blinding, unreliable instruments, unaddressed demand characteristics (subtle influences of researcher stakes), inadequate follow-up, and most importantly the absence of replication. Psychotherapy's community of scholars treats skepticism as blasphemy.

Britain has done better but not by much. Yet, in contrast with the United States, Britain has more of a tradition of skepticism within the field of psychotherapy and a preference for material responses to inequality. Barbara Wootton's quintessential work of scientific skepticism and a valuable work by Moloney (2013) are still unanswered condemnations of the field. Social Science and Social Pathology (Wooton, 1959) is an unequaled condemnation of clinical psychological practice including the efforts of presumably similar clinical occupations. An appendix reseats social work practice on a more material foundation that might provide the current field a professional standing based on measurable outcomes of actually helping rather than ceremony. Wootton's Old Left roots stand up well to the research principles of clinical science and notably to the suspicion of interventions that in seeking greater equality stray from truly material benefits. The New Left's outsights might take inspiration from the Old Left's insights.

Too much can be made of the differences. The recurrence of leadership such as Thatcher and Blair in Britain and Reagan, the two Bushes, and Trump in the United States suggest that any leftist expression of public responsibility lacks a decisive popular constituency in either nation. Passionate differences in the United States are not truly polar; the chasm is deepest between the far right and the moderate center. The Old Left in the United States is nostalgia, not history.

In both nations and probably in others as well where talking cures and extreme individualism are popular or emergent, psychotherapy as Outsight argues is profitably understood as a political expression of market values and budgetary parsimony rather than as scientific practice committed to neutral, accurate research. In this way, the long persistence of psychological clinical practice is better explained by its ceremonial endorsement of personal agency rather than by its improbable clinical value in actually creating personal agency. Indeed, clinical practice as well as other hortatory professions such as the ministry (including the various churches of mindfulness) have failed to demonstrate the sufficiency of talk therapy to change behavior without first attending to the material conditions of life.

Resistance to the public provision of greater equality insists that character deficiencies create poverty, opportunity being largely available to just about everyone who wishes to work hard. Yet the fortunate classes and the wealthy themselves offer little evidence of achieving civic rectitude, moral leadership, and social contributions proportionate to their wealth and the immense costs of their education, families, and comforts. Rather than necessary for economic growth and moral leadership, wealth both earned and inherited may have the very opposite effects, reducing the size of competitive pools of skilled workers and protecting the improvident and incompetent from market penalties. If indeed competition and a stern necessity are in fact prods to industry and necessary for continued productivity then taxes on the wealthy should be tripled, inheritance taxes elevated to confiscatory levels, and annual salaries topped off at levels that incentivize rather than diminish effort. It may be a perverse truth of political organizations that a large public sector is required to protect a libertarian society from itself.

There is little evidence to deny the universality of potential and thus ignore the value of far greater equality in social conditions; intelligence, obedience to law, affability, social skills, and good citizenship do not differ much by social class, race, gender, or ethnicity and certainly not in the early years of life. Especially since the superficial attempts of clinical interventions have failed, the belief seems reasonable if not actually a bedrock of common decency that comparable environments—greater material equality—might be more likely than neglect and indifference to engender comparable outcomes among relatively comparable groups of people. If prevailing assumptions that tie education to success are correct then rich investments in education across incomes will increase competition, individual productivity, economic growth, and the common good. Greater parity in material conditions might produce a bounty of social benefits. Greater material equality might also be justified by the principle of proximity with the goal of increasing competition by direct material investments in deprived groups. Other social benefits might be unintended consequences. Then again, maybe not.

Rather than follow Smith and much of conservative thought that assume the voluntary depravity of the poor, there is much to ponder in what appears to be the excessive, unproductive investment in wealthier classes and the corrosive effects of white-collar crime on civic values and economic growth. The possibility that habits are not formed in vacuums within a social context—that a truly free will does not and cannot exist—seems a better cultural assumption on material grounds for social policy than the embedded bigotries and stereotypes that justify enormous social inequalities. It also endorses the principle of proximity.

Whether character creates productivity and success or the reverse that the material conditions associated with success create a productive character is an open question because the proposition cannot be rationally tested. It would not be much of a surprise to learn that character, as opposed to institutional access, has little to do with social and economic contributions but much to do with preparation and investment. This sort of political and cultural reasoning sustains preferences for material redistribution but without the mystical baggage of postmodernism's Romantic fantasies. The admission of ignorance may be a more likely precondition of wisdom and common decency than the contrivance of wisdom out of introspection, vanity, and infantile belief in its own intergalactic truth.

Ignorance or at least a low level of certainty may be inevitable. Propositions that either underwrite or deny public policies of greater equality defy scientific testing. It is not possible to run randomized clinical trials on theories of social causation. It is a question of trial and error but more pertinent it is an ethical question of common decency—the social willingness to provide greater material parity. Smith himself never dealt well with the possibility that the low aspirations ascribed to the poor were more a product of their poverty than its cause—low aspirations as adaptation to conditions of hopelessness. Still, he argued that public salaries for the clergy were valuable to “bribe their indolence”—presumably so that the clergy might not be tempted to agitate political mischief (Smith, 1776, citing his friend, the philosopher David Hume). After all, the main distinction between a bribe and a reward is a question of approval or disapproval often formalized as legal and illegal. The same logic suggests that the poor could be bribed into the industry through education and the time to absorb it. The capacity for rational decision-making by individuals remains a fanciful commendation of the human condition (and a politically useful value that tends to justify inequality) rather than a fact of human life and choice. People inherit their families, communities, and societies and rarely if ever are successful in planning and implementing changes, let alone in themselves. Things happen and we boast agency.

Conclusion

Psychotherapy's clinical failure does not provide a warrant for Outsight's ambiguous social-material approach especially if evaluative subjectivities are meant to supplant science in evaluating the effects of practice. Nonetheless, rational skepticism argues for a true materialist alternative even if its effects defy scientific testing. In this case, greater equality would supplant cure, prevention, and rehabilitation as the social goal of social policy. Compared to a failed clinical practice of moral suasion, greater material equality—the right in a wealthy society to the “indispensable” conditions of citizenship—is more consistent with common decency, the value at the core of liberal democracy.

The differences in actual practice between Britain and the United States can be exaggerated since both societies for many years have been cheapening out on attention to greater equality, apparently with broad approval. Yet Britain sustains a skeptical tradition in its clinical practice that is nearly absent in the United States. Outsight could have profitably expanded itself to update Wootton with the same thoroughness while respecting this good leftist's commitment to objective coherence.

Outsight did however continue at least in a few chapters Wootton's core message—psychotherapy is ineffective—and her attempt at defining a more material replacement for psychotherapy. Unfortunately, its argument is neither consistently clear nor compelling. Indeed, the reliance on postmodern logic weakens its conclusions. Neither the current systems of governance nor the institutions of society, including the practice of talk therapy, are amenable to strategies of rational induction concerning popular values. The authors fail to consider that the stability of modern societies, such as they are, pays tribute to mass consent rather than the predations, conspiracies, usurped powers, and cunning of powerful “distal” organizations. Indeed, the book's brittle leftist vision of political power in contemporary society explains very little beyond the paranoid fantasies of intellectuals lacking experience with power itself.

Outsight should be applauded for seating the conduct and substance of psychotherapy within cultural institutions—the symmetry between psychotherapy and the embedded social belief in an extreme form of individualism. Unfortunately, it argues that those institutions are imposed on society but fails to consider that they are consensual. The apparent contradiction between the embeddedness of social institutions and the contention that they defy the will and theoretical interests of a largely innocent, victimized population begs the suspension of disbelief and nourishes conspiracies of unchecked power, satanic deviousness, hidden malefactors, irresistible propagandists, and other dominating forces of evil.

Throughout, Outsight ignores the deep consent built into current institutions and notably by the very class of people, the authors wish to benefit. The core “distal” powers they identify—“governments, multinationals, religions, the military, the police and other institutions” (p. 137)—are institutions of their culture precisely because they are elaborations—instantiations—of broadly popular values. They are not amenable to change by the compelling logic and insightful conclusions of the intellectual classes who themselves by and large are employed to service those very institutions. The most compelling intellectual elaboration of the most pointed, eloquent, and objectively true argument has little chance of moving a population beyond their comfortable realities. On the contrary, change occurs only by upsetting those comforts or by improving the lived values of a society without undercutting established institutions. As LaPiere (1965) pointed out, societal change, that is, transformative social change, as distinct from individual changes that are largely adaptive, is profoundly antagonistic to the established order. Societal change disrupts tradition by appealing initially to the micro motives and daily behaviors of the few whose use of the innovation offers an undeniable advantage, as examples, the car replacing the horse, the factory displacing the home, the city taking over for the village, the telephone and computer transforming communication, and the printing press that democratized learning without the need for priests as intermediaries with God. The small innovator class leads popular adoption that frequently fails against embedded institutional momentum. Societal change is not inevitable, bloodless, quick, or rational.

The Western world and notably Britain and the United States are not trapped by corporations, government, and the rest. Instead, their determinative and stable social institutions accrue from mass preferences that are always sensitive to but often dominated by the mean-spiritedness, cruelty, bigoted, and yes, stupidity of their populations. We are not victims of a powerful leadership class gone sour but rather proud, consenting members of a dystopian present. There is probably no way out.

Universal adult voting is the defining institution of liberal democracy. It is intended to assure that the will of the people presides over public policy. The sovereign popular will is justified by the assumption that the people choose to govern out of a sense of common decency. However, the assumption of common decency has often been contradicted by the actual and sustained choices of Americans that engender the nation's institutions. If indeed common decency justifies democracy, few nations that claim democracy are able to transcend the cruel, uninformed, and stupid passions of their masses. Yet no practical alternative to liberal democracy comes to mind—philosopher kings (and queens) are probably the next invention of Marvel Comics but unlikely political leaders.

Outsight rejects objective logic and fails to explore a credible pathway to common decency. It does offer a rosy hope, but only this, that the authors’ social-materialist clinical psychology will improve life. Yet the supply of hope and optimism to escape meanness and civic stupidity is always abundant since they are rarely depleted by use. Material inequalities have been sustained by popular consent for many decades, even centuries; the mean-spirited, bigoted, and cruel do not appear to clamor for the common decency of universal material sufficiency. Indeed, there would be little need for optimism and hope if civic stupidity and meanness were less powerful determinants of social policy. We are caught with whom we are.

It took the species a long time to appreciate its invention of scientific rationality. However, false applications of rationality distort reality and society. Whether objective reality is a dream of order is another story. However, objective truth remains a vaunted pillar of liberal democracy that is constantly subverted at least by Americans in search of the simpler, less taxing, more certain assurances of childhood and tribal identity. Cures for these delusions lie beyond psychotherapy even of the social-materialist variety.