Smile or Die: How Positive Thinking Fooled America and the World

 I was disappointed with this, having loved Ehrenreich's other books of real-world social reportage. 

I'd argue that what Ehrenreich attacks here is not, as she suggests, Positive Thinking (and by unfair association Seligman's Positive Psychology) but Pollyanna-ism and conformity. She blames positive thinking for totalitarianism and narrow-thinking in states and corporations; but dissidents aren't punished for being 'negative' -- they're punished for not conforming and for not flattering the ego of higher management. When management hear something they don't like they *call it* 'being negative' because that's how they hide their own ineptitude, short-termism and egotism. Pollyanna-ism and conformity are fair targets; but perhaps not such a good hook-line for a book? 

Here, I think, Ehrenreich's own emotional experience with some cancer internet-groups has got in the way of a thorough exploration of the subject. A brief book (200 pages), it seems to skirt around the issues and leaves many important topics unexplored, most glaringly the huge corporate interest in 'negative' psychology and in medicating social problems; the role and mechanisms of placebo; the evidence from 20 years of psycho-neuro-immunology; recent discoveries about neuro-plasticity; and the growing body of evidence on mind-body interaction unveiled by modern brain-scanning techniques. 

Even when she has an easy target (the self-indulgent nonsense of a 'Cosmic Ordering Service') she doesn't demolish it the way she could. And, by association, she ends up implying that such superstition is an integral part of Martin Seligman's Positive Psychology work, which it most definitely is not. It is true that many 'Life Coaches' have adopted the philosophy of 'wish for things and you'll get them without having to do any hard work' as a way of extracting money from the gullible, but it's unfair to beat Seligman with that stick. 

Ehrenreich has some interesting observations about the Positive Psychology 'movement', but I think she ends up throwing out the baby with the bathwater, not even discussing the important notion of shifting from thinking about problems to thinking about solutions. And, aside from ignoring the influence of the pharmaceutical companies, she also ignores the 'Negative Psychology' movement so prevalent in the US over the last 60 years or so: the evidence of the unnecessary suffering caused by poorly applied Freudian psychoanalytic methods, which by encouraging people to repeatedly relive traumatic events and emotions may in many cases actually deepen and perpetuate suffering, the only main benefit being paying of the analyst's mortgage. 

For decades the mental health industry focused on how to eliminate illness, rather than how to promote wellness. Thus the conditions that give rise to illness continue, and we simply try to medicate them away. Discomfort with this view has been around at least since the 50s and 60s, with Fromm, Maslow, Rogers and Ellis among others. So Seligman's 'Positive Psychology' doesn't mean 'Pollyannish' but means promoting wellness rather than eliminating illness. This simple definition doesn't appear in Ehrenreich's book -- and for someone so (rightly) focused on scientific principles, failing to define one's terms is a major omission. 

The author also, like many others, seems to hold to the dogma that Randomised Controlled Trials (RCTs) are the only 'valid' form of scientific evidence, as if case studies hold no value at all. The limitations of such trials are not discussed, and interpretations of the results are taken as unarguable. For instance, she cites a study showing no benefit of outcome over the control group among cancer patients who attended group psychotherapy, and so concludes there is 'no evidence' that psychotherapy (in whatever form, it seems) can be beneficial with cancer patients. 

Anyone familiar with psychotherapy knows how important details are: one therapist may get much better results than another; one type of therapy may be better indicated for certain conditions, or for certain patients, than others. So all that was shown by that particular RCT was that for those patients, receiving that particular type of group therapy, facilitated by that particular therapist, there were not very good results. As I say, the author makes no attempt to balance such evidence with the evidence from psychoneuroimmunology, neuro-plasticity experiments, or the accumulated evidence from the placebo-groups of all those RCTs she is so keen on. 

Ehrenreich rails against the 'interests' of the Positive Psychology movement; but in ignoring the body of evidence for the influence of emotional state on physical health, and instead focusing solely on drug and chemical causes and solutions to health problems, she ends up reinforcing the interests of a far bigger unaccountable lobby: the major drugs companies. A disappointing position for a left-leaning social commentator to end up in. 

So, over all, I found this to be a less than rigorous examination of the topic.