Via e-mail, Wessely acknowledges that researchers haven't pinned down the precise reasons for these results, but he's got no shortage of hypotheses. He speculates that debriefing, which is supposed to warn individuals about the emotional responses they could experience, may actually increase the occurrence of the symptoms by creating expectations, thereby implying to impressionable sorts that they need professional help when support from their network of family and friends might actually be more beneficial. Even if these conjectures prove to be inaccurate, however, he feels the scientific clues are strong enough to warrant an immediate end to compulsory debriefing, which may inoculate organizations against potential litigation but also has "the capacity to do harm as well as good."
How likely is this to happen? Not very, as Wessely understands full well. He knows that most therapists believe strongly in the worth of grief counseling and debriefing, guessing that many of them are drawn to these arenas because of what he terms "the glamour of disasters. They are exciting, and can be a lot more interesting than the often tedious routine of mental-health work." Money, he believes, isn't nearly as much of a motivator: "I think pecuniary motives are less relevant."
Tana Dineen couldn't disagree more. A licensed psychologist living in Canada, she stopped seeing patients in 1993 after more than twenty years because "I view it to be unethical to practice when so many bogus ideas are being sold to people." Since then, she's remade herself as arguably the planet's preeminent psychotherapy critic via her book Manufacturing Victims: What the Psychology Industry Is Doing to People, first published in 1996, and regular columns in the Ottawa Citizen. "I think that as a society, we've just bought into this idea that we need experts to fix anything," she says, "and grief is something that we've come to view as needing to be fixed. So we pour money into fixing it, even though these technologies don't have a basis to them.
"I saw progressively more people calling me or coming to the office who had the idea that they needed help, and they'd gotten the idea by listening to a TV show the night before where some therapist was on talking about how if you don't handle your grieving properly, you'll never get on with your life. That presents the idea that there are therapists who know the right way to do it, when we don't know the right way. But instead of admitting that, we make people helpless to help each other, and turn something that's often entirely natural into a medical-sounding problem."
That, Dineen adds, expands the market for professional grief counselors. Yet she doesn't reserve her bile for people who make a living doing grief work; she also chastises charitable organizations that support and promote it, charging that they do so in part because it's become such a reliable magnet for donations. She's especially critical of the Canadian Red Cross, which got out of the blood-collection business, previously one of its primary functions, following confirmation in 1997 that hemophiliacs had contracted HIV and hepatitis C from transfusions. In a column the following year, Dineen suggested that the organization was hyping its grief-counseling component in order to prevent its cash flow from ebbing.
"They were nearing bankruptcy," she says, "so they shifted their focus to grief counseling, which was very popular at the moment, and gave people the idea that they were doing something to help. So instead of sending something practical to disaster scenes, like blood and blankets and the things the Red Cross is known for, their priorities are now being shifted into these phony 'helping' services, which is absurd -- an incredible waste of money and resources.
"What we have now," she continues, "is a large industry that basically thrives by getting more and more customers -- and the way you get more customers is to expand the concept of who is grieving. And you can expand it seemingly endlessly. We've reached the point where you just have to have heard of somebody dying. You don't even have to have known them anymore."
In Dineen's view, the mental-health response in the aftermath of Columbine ably illustrates her point.
The outpouring of donations to a plethora of charitable sources after the shooting was staggering: The pile ultimately exceeded $9 million, topping the hauls raked in following any other tragedy, according to an April 19 Rocky Mountain News article. The Healing Fund, operated by the United Way, took in about half that total -- $4.6 million -- and when divvying it up, the organization gave the largest check, over $775,000, to the Jefferson Center for Mental Health, which used it and other monetary sources to broaden the scope of its services to an unprecedented degree.