This article advances a structured, non-ideological analysis of professional authority in medicine and psychology, grounded in halachic, legal, institutional, and moral frameworks.

First, it anchors the discussion in a precise halachic source: Aruch HaShulchan, Shulchan Aruch Yoreh De’ah סימן של״ו. The Aruch HaShulchan establishes that a physician’s actions are justified bedinei adam and fall under ונשמרתם מאד לנפשותיכם only where two conditions are met: the practitioner is government-certified, and the specific refuah employed is itself government-authorized, provided no superior physician is available. Good intentions, professional culture, or internal consensus are explicitly not the determining criteria.

Second, the article draws a sharp doctrinal distinction between authorization of a practitioner and authorization of a refuah. Modern medicine satisfies both layers: physicians are licensed, and medications and devices are independently authorized. This is why the Aruch HaShulchan’s framework applies cleanly to medicine and may apply, in principle, to psychiatry insofar as it relies on FDA-approved drugs. It cannot apply to psychology, because psychological therapies themselves are never authorized by the state.

Third, the article explains this exclusion in structural and legal terms rather than ideological ones. Governments do not certify, approve, or vouch for psychological theories or treatment modalities. They do not ascribe causal certainty, predictive reliability, or truth-value to any therapy. What the state authorizes is only the practitioner’s right to practice, leaving method selection to professional discretion and personal risk. This posture—you may choose, at your own risk—fails to meet the Aruch HaShulchan’s requirement of רשות ליתן רפואות לחולאים, because the refuah itself is never authorized.

Fourth, the article provides a structural account of authority in psychology by identifying who actually determines standards. These are not government bodies but private accreditation organizations. Their incentives are not truth-adjudication but institutional survivability, shaped by legal safety, political acceptability, and institutional consensus. Standards are selected to avoid lawsuits, controversy, and mass noncompliance rather than to identify what is most accurate or effective.

Fifth, the article exposes the circularity of the system: accreditation bodies are paid by schools; schools require accreditation to charge tuition; licensing authorities defer to accredited programs; and accreditation, in turn, formalizes existing practice. This loop reinforces itself and resists correction, even when underlying assumptions are weak.

Sixth, the article advances a moral analysis grounded in emes, drawing on the sugya in Shavuos 31. It argues that taking money, time, trust, and life-shaping decisions from people while knowing that what is being sold is institutional legitimacy rather than verified truth—and allowing that legitimacy to be mistaken for truth—constitutes a moral failure, even absent malicious intent.

Seventh, the article demonstrates through pricing analysis that licensing costs do not track instructional hours, instructor expertise, or outcome effectiveness. Instead, they track administrative overhead, legal protection, lobbying, and institutional continuity. Licenses function as tolls for permission to practice, not as valuations of knowledge or skill.

Finally, the article offers a historical proof-of-concept in the long dominance of psychoanalysis. For decades, it retained authority not because of demonstrated effectiveness but because it answered primarily to itself and faced no external veto. Only sustained external pressures eventually forced retrenchment, illustrating how a self-referential field can persist in error across generations.

Taken together, the article argues that medicine is constrained by external regulators, law, institutions, insurers, and biological reality itself, whereas psychology operates largely within a closed system of delegated trust. The difference is structural, not personal—and it has profound halachic and moral implications.

This analysis is neither conspiratorial nor anti-vaccination. It is a straightforward application of a halachic rule articulated explicitly by the Aruch HaShulchan in Shulchan Aruch Yoreh De’ah סימן של״ו. There, the Aruch HaShulchan lays down the determining criterion for whether a doctor is absolved bedinei adam for damages caused in treatment and whether his actions fall under the mitzvah of ונשמרתם מאד לנפשותיכם. The criterion is not good intentions, professional culture, or internal consensus. It is whether the doctor is certified and authorized by the government to prescribe the particular medications or treatments he uses, and provided that there is no physician superior to him in that field.

In practice, this framework applies cleanly to modern medicine where both conditions are met: the practitioner is licensed, and the specific refuah—medications or devices—is itself government-authorized. This is why the rule fits ordinary medical practice and may apply, at least in principle, to psychiatry insofar as it employs FDA-approved drugs. It cannot apply to psychology.

The reason is structural and legal, not ideological. The government does not authorize psychological therapies at all. It does not say of any therapy that it is true, that it is not false, that it predicts outcomes with accuracy, or that it has causal certainty. The state does not approve, certify, or vouch for any psychological model or method. What it authorizes is only the practitioner’s right to engage in the profession. Legally and structurally, this is nothing more than permission to practice at one’s own discretion and risk. The posture is effectively: you may choose a method, at your own risk. That is not “רשות ליתן רפואות לחולאים” in the sense meant by the Aruch HaShulchan, because the refuah itself is never authorized.

This stands in sharp contrast to medicine under the Food and Drug Administration framework, where authorization operates on two distinct and cumulative levels. The practitioner is licensed, and in addition, the medications and devices themselves are authorized through four concrete mechanisms: pre-market approval, demonstrated causal efficacy, formal risk–benefit analysis, and ongoing enforcement power including recall and prohibition. Only where both the practitioner and the specific refuah are government-authorized does the Aruch HaShulchan’s standard fully apply.

Over the past several decades, psychotherapy has expanded dramatically in cultural authority, institutional presence, and economic footprint. This expansion is usually framed as progress—more care, more science, more professionalism. What is rarely examined is the structure of accountability that sustains the field and what kind of belief is required to trust it. Who, in fact, determines what the material of therapy should be?

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Who decides?

Private accreditation boards decide. Not the government.

Standards in psychology are set by private accreditation bodies whose function is not truth-adjudication but institutional survival. They are paid by the very schools whose curricula they accredit, and they remain viable only by staying within what both paying schools and downstream licensing authorities will accept. That is the circularity.

These boards do not decide standards based on what is most true. They decide based on what is safest.

They operate on three governing constraints.

Legal safety.

They look only at what has already not gotten institutions sued. They copy existing rules, language, and practices that courts have already tolerated. They do not predict law or test truth; they avoid novelty. Courts then trust them precisely because they repeat court-accepted patterns. The loop is closed.

Political acceptability.

They avoid standards that could trigger public controversy, media scrutiny, or government pressure. They choose language that sounds neutral, inclusive, and non-provocative so that no powerful group objects. The goal is not correctness; it is backlash avoidance.

Institutional consensus.

They formalize what most schools already do. If too many schools could not comply with a standard, accreditation would fail. Therefore the average practice becomes the standard, and deviation becomes risk.

Stripped of euphemism, the rule is simple:

They copy what already exists, avoid controversy, and codify the mean. That is why the system reinforces itself and almost never corrects error.

At the top, decisions are driven by the most secure posture for income, reputation, and continuity. Everyone underneath operates almost entirely on trust.

For accreditation boards, survivability is the selection criterion. Maintaining steady revenue from fees, avoiding lawsuits, avoiding political heat, and avoiding mass school noncompliance is the governing logic. Truth is not the metric.

For everyone beneath them—schools, students, employers, licensing authorities, and the public—there is delegated trust. Each layer assumes the layer above already did the verification, so no one re-tests substance. Challenging the system creates risk; accepting it transfers responsibility upward. That is why it persists.

This raises the central question: who are we actually trusting when we pay fifty thousand dollars for a license and entrust our lives, families, and communities to the interpretive structures of therapy?

The answer is not a government entity. It is private accreditation bodies, professional boards, and academic institutions that pay those bodies to approve their curricula. These institutions know that the public interprets accreditation as truth-validation, not survivability-validation. They also know that if this distinction were made explicit, trust would collapse. Continuing under that ambiguity crosses from neutrality into deception.

Once this substitution occurs, the downstream payer—often poorer students, patients, families, and communities—becomes invisible. Their belief is instrumentalized, not respected. That is a moral failure even if no one intends harm.

People inside the system do not experience this as lying because responsibility is fragmented. Each layer tells itself: I’m not claiming truth; I’m following standards. The standards come from accreditation. Accreditation reflects consensus. Consensus equals professionalism. No one says “this is true,” yet everyone benefits from others believing that it is.

Taking hard-earned money, years of time, trust, and life-shaping decisions from people while knowing that what is being sold is institutional stability and legitimacy rather than truth—and allowing it to be mistaken for truth—is not morally neutral. What Torah classifies as emes requires alignment between what one knows, what one signals, and what others reasonably believe, as articulated in the sugya in Shavuos ל״א. Here, those elements are knowingly misaligned.

The circularity deepens further. Colleges pay accreditation bodies to approve the very curricula that allow them to charge tuition. Accreditation follows money; money follows accreditation.

If licensing programs were priced according to real value, cost would track three variables: how many hours are actually taught, how skilled the instructors are, and how much usable skill graduates reliably acquire. Under such a system, prices would vary widely. They do not.

Prices do not track instructional hours. Programs with vastly different teaching loads charge similar sums. In other professions—pilots, electricians, engineers—hours matter. In therapy licensing, accreditation status matters.

Prices do not track instructor expertise. Most courses are taught by adjuncts paid a few thousand dollars per class regardless of tuition levels. When tuition rises, instructor pay does not. The money is not going to teaching quality.

Prices do not track skill or effectiveness. Licensing exams do not measure whether graduates help clients improve. No school is rewarded for better outcomes or penalized for worse ones so long as compliance boxes are checked.

What prices do track is administrative overhead, legal protection, lobbying, and institutional continuity. As tuition has risen, administrative staff has grown far faster than teaching faculty. Accredited programs must fund compliance offices, legal teams, insurance, reporting systems, and political maintenance. These costs protect institutions, not students. Students pay for that protection.

The same core material can often be learned independently for a fraction of the cost. The difference is not knowledge. The difference is permission.

Licensing fees are tolls, not valuations of truth.

This structure does not require malice. It follows mechanically from how the system is built. Those above must be funded. Those below must pay to pass. The moral problem arises because the system depends on people believing they are paying for expertise or truth when in reality they are paying for access and institutional cover.

History provides a clear demonstration. For much of the twentieth century, psychoanalysis dominated American psychiatry and psychology. It controlled training, journals, hospitals, and prestige. Patients paid, students trained, institutions endorsed it. Decades later, leaders within the field openly conceded that it had not effectively treated many of the conditions it claimed to address. This was not acknowledged as a moral accounting. It was reframed as “evolution,” “maturation,” or “new understanding.” That is institutional self-preservation language.

A field that answers mainly to itself can sustain ineffective frameworks for generations while people pay money, lose time, and place trust under false assumptions. Medicine could not do this at scale without external veto. Psychology could—and did—not because of intent, but because there was no external authority empowered to stop it.

That is the structure.

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