Independence From the Therapeutic State

Eugene Epstein
21
113

Can you imagine a world in which there were no psychiatrists, no psychiatric hospitals, no DSM diagnoses, no psychologists, no psychotherapists, no psychiatric drugs, no psychiatric patients, no counselors, no self-help groups, no life coaches, spiritual advisors, school social workers, employee assistance counsellors, trauma experts, PTSD specialists, child guidance clinics, drug treatment centers, pastoral counselling, university mental health services, outplacement services for terminated employees, burn-out specialists etc., etc., etc.?  It would indeed be very hard to imagine, no?  That is because you and I are living within the therapeutic state and all of those persons, things, institutions and vocabularies mentioned above are a part of it.

It doesn’t matter where you might be living in the world or what you may or may not be doing; I am sure that therapeutic discourses have infiltrated your world in various ways as well.  For instance, when was the last time you thought about sadness or grief without the word depression popping up, or emotional hurt without thinking of trauma, or forgetfulness without thinking of dementia, lack of concentration with ADHD?

According to the Israeli sociologist Eva Illouz, therapeutic discourses fit in well with neoliberal policies, because within these discourses problems are individualized and persons are viewed as responsible for their own fates.  In other words, the therapeutic state perpetuates a story of blaming the victims, or the excluded if you will, of our society.  The myth of a meritocratic society is that every individual has an equal chance of making it, and if you don’t, then it is due to your own laziness, lack of motivation, lack of imagination, or some other personal individual defect.  If you happen to be homeless, then you brought this upon yourself or were somehow just not good enough to compete with others who did manage to find domiciles.

In a neoliberal turbo-capitalist society which does not acknowledge a responsibility to care for and integrate all persons within it in humane ways, it is easier to blame the victims for their fates than to admit the inequalities and bankruptcy of our social systems and forms of care.  So instead of discussing ways of making our societies more equal, or discussing systems of care that improve the quality of life for all its members, we focus on individual defects, deficits and pathologies.

Social constructionist theory, as I understand it, says that it wasn’t always like this and it doesn’t have to stay this way.  Now there are various brands of social constructionist theories and ideas out there, but the ones I tend to favor are those that have been developed over the last 40 years by the social psychologist Kenneth Gergen, along with a growing international network of academics and practitioners that constitute The Taos Institute.  According to the assumptions of social constructionism, all that we hold as real is but a set of social constructions that we continually create and recreate in language with one another.  These social constructions emerge out of the web of relationships in which we live, and from the social and cultural vocabularies available to us.  In other words, one could say that according to this theory, reality is but an ongoing series of stories, or useful fictions if you will, that we create together to help us navigate our lives.  These stories allow us to do things, they define our relationships, and they give us tools to go on living.

A social constructionist might ask what stories the medical-pharmaceutical-therapeutic-industrial complex has offered us and what the negative effects of such stories might be? What if when we thought about, say, emotional hurt, we would immediately think about resilience and solidarity instead of trauma or depression or mental illness?  What if, to repeat a phrase from the early 70’s, we should think about paranoia as a heightened state of awareness and not as a symptom of chronic illness?  How would that change the story and how might that story-change affect the range of options to think and act that we have available?  These, indeed, are the very sorts of questions that social constructionism makes available to us.

If we give up truth with a capital T, as the social constructionists do, then we accept the notion that there are no truths that are privileged over others, there are simply some stories that we prefer over others.  We no longer have to respond to mainstream psychiatry’s claims to objective knowledge about the inner workings of the brain.  Instead, we can ask about the consequences of this particular narrative and ponder whether the consequences of other narratives might be preferable.  In other words, we do not have to argue against evidence-based medicine or biologically based psychiatry with further evidence, instead we can call into question the very kinds of persons that these narratives bring forth and perhaps generate alternative narratives that evoke more aesthetically pleasing and/or more competent persons.

These are the kinds of questions that social constructionism allows us to think about.  If, let’s say science, or medicine, or psychotherapy are seen as but a collection of stories that also contain assumptions about values and ethics and especially questions about how we as a society wish to live together, then we change power relations because we no longer need experts with access to some special or secret knowledge to decode them for us.  Such stories are every person’s business and everyone has an equal stake in the values they contain.  We are well advised to increase the quantity and range of voices that contribute to these stories, because the more voices that are engaged in the storytelling, then the more complexity, richness and texture they take on and thus, the more people they speak to.  From a social constructionist viewpoint, the voices of those who have been on the receiving end of psychiatric services are just as important, if not more so, than those of the persons on the other end of the spectrum who claim to be experts.  And they certainly have a right to a place at the table.  From a constructionist point of view, a nuclear scientist may have something valuable to contribute to the story of nuclear power because his or her language enables us to do things with that power, but the many value questions about whether we should do such things and what the consequences of so choosing might be, are questions that we all need to ponder and answer together.

And if there is no better way of arbitrating these kinds of value questions via science, then we level the playing field in terms of how such questions are answered.  It may not make the search for answers any easier when we give up the myth that the experts know better than the rest of us, but it does make this search a more democratic one.  (For a more detailed exploration of how a social constructionist perspective relates to the therapeutic state, you can read this earlier blog.

Last week, from the 26th to the 28th of June, a gathering of more than 190 persons from 24 countries converged on Drammen Norway to develop visions of possible futures that go Beyond the Therapeutic State.  The conference keynote talks were given by:

Kenneth Gergen

Robert Whitaker

Olga Runciman

Sami Timimi

Carina Håkkansson

and, a closing plenary with Ken Gergen again:

In 1949, the Hollywood film “The Snake Pit”, written and directed by Anatole Litvak, opened to general audiences throughout the United States.  Exemplary of mainstream psychiatric ideas of the time, there is a scene in which a psychiatrist recommends shock treatments for a patient.  He tells the husband of the patient:

“Mr. Cunningham, I’d like to do shock treatment on your wife.  But you’ll have to sign this consent.”

“Shock treatment, isn’t it . . .  I mean do you have to?”

“The only reason I want to use it is because in many cases it helps to establish contact much faster.  When that happens we’ll be able to get to the real causes of your wife’s illness.”

The film’s title stems from an ancient practice of dealing with the mentally ill where they were thrown into a pit of snakes. The theory was that if something like that would make a normal person insane, then it must work in reverse as well.

Is the story that psychiatry has been telling us over the last three quarters of a century, that we need to treat the so-called “mentally ill” in ways that would make anyone crazy, in the hopes that the opposite will miraculously occur?  Is that the kind of story we wish to pass on to our children and grandchildren?

 

 

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21 COMMENTS

  1. Happy Forth Of July !

    Eugene, I loved that first part pointing out the use of therapeutic state words !

    Check this out, I just found it. It’s a little rough but totally cool.

    Report #TL07A: THE ANATOMY OF SLAVESPEAK

    Benefits of Understanding Slavespeak
    Once you understand political Slavespeak (the language used to establish and maintain master-slave relationships), you become very aware of how those who don’t understand Slavespeak can be dominated, subjugated, and controlled by words — essentially enslaved by words. Correspondingly, you become impervious to external control through words. In other words, you enjoy more freedom — you have more options available to you.

    If you’re active in promoting freedom, you’ll see that most current freedom-promoting activities, while they may yield short-term benefits, are unlikely to bring about any significant expansion of freedom in the long term. The reason for this is that the most basic way tyrants and terrocrats wield their power is a “control-via-words” mechanism. Most current freedom-promoting activities don’t attack this basic mechanism; in fact, they tend to reinforce and perpetuate it.

    http://www.buildfreedom.com/tl/tl07a.shtml

  2. Eugene thanks for this post, much to think about and consider. What you write about it where I’m at, although I didn’t know all the sociological and political terms for it, being a granny and late to the mental health involvement scene.

    I’m up to my neck in psychiatric survivor activism and human rights campaigning because of my sons and grandchildren. Telling stories because someone has to speak out about it from the sharp end. I am just so fed up after 3 generations in my family being targeted by psychiatry and having our reputations rubbished in their psychiatric fictional notes. “family history of” etc etc.

    I do believe that there will be a paradigm shift if we keep telling our stories and speaking out. The tipping point is near, is how I see it. Cheers, Chrys

    • I think the tipping point is not near, I think its here. I am always looking for stuff to “copy cat” link toand spread the word and I am finding more and more truth online.

      I agree we need to keep telling our stories, there is alot of material pointing out the phony science compared to the number of stories of human rights violations.

      This site is dedicated to all the people who were harmed or killed in UHS facilities. They speak for those who have no voice, to protect others from experiencing the pain they endured. http://watchinguhs.wordpress.com/about/

      I hate to admit but my story of UHS abuse is still not on here, I hate UHS.

  3. RE: ” If you happen to be homeless, then you brought this upon yourself or were somehow just not good enough to compete with others who did manage to find domiciles. ”

    Many people are just BUILDING instead of “finding” !

    What are Tiny Houses and The Tiny House Movement? It’s people who are sick of being ripped off by the government and financial institutions ! The banks don’t like it and the government, with it’s frivolous zoning laws and property taxes always on the attack, hates the Tiny House Movement it too, but for many it is all about FREEDOM. Life liberty and the pursuit of happiness.

    Tiny houses , You Tube http://www.youtube.com/results?search_query=tiny+houses+off+grid

    Tiny houses are freedom and independence. Happy July 4th !

  4. Great article Eugene.

    While on the topic of language, i note the use of the term “expert”. If we apply the Baloney test kit of Carl Sagan the term doesn’t stand up. They would be considered “authorities” in that they do not work with facts or science based evidence, merely opinions.

    With only an “argument from authority” the fraud will be exposed, and hopefully other voices will be heard.

    Regards
    Boans

  5. According to the Israeli sociologist Eva Illouz, therapeutic discourses fit in well with neoliberal policies, because within these discourses problems are individualized and persons are viewed as responsible for their own fates. In other words, the therapeutic state perpetuates a story of blaming the victims, or the excluded if you will, of our society. The myth of a meritocratic society is that every individual has an equal chance of making it, and if you don’t, then it is due to your own laziness, lack of motivation, lack of imagination, or some other personal individual defect. If you happen to be homeless, then you brought this upon yourself or were somehow just not good enough to compete with others who did manage to find domiciles.

    In a neoliberal turbo-capitalist society which does not acknowledge a responsibility to care for and integrate all persons within it in humane ways, it is easier to blame the victims for their fates than to admit the inequalities and bankruptcy of our social systems and forms of care. So instead of discussing ways of making our societies more equal, or discussing systems of care that improve the quality of life for all its members, we focus on individual defects, deficits and pathologies.

    This!

    Individuals cannot solve collective problems by themselves. To insist that they do the impossible, and then blame them when they inevitably fail, is sadistic – but very useful for profiteering and social control. Only love can smash the therapeutic state.

    Thank you for this article.

    • Yeah, I was about to cut-and-paste the same quotes in an email (are we allowed to do that?).

      The problem I’m having here is that the rest of the article is too abstract and doesn’t deal with the conditions accurately ascribed to capitalism in a concrete way, i.e. the need for organizing, resistance, etc.

    • Yeeeeeeesssss….. This is what I’ve been going on about trying to get people to see. *Collective* and *social* problems are being misconstrued as *individual* and *internal,* and thus people are being asked to solve them on their own, which is absolutely nonsensical – the very opposite of what should be done. This in and of itself is just about enough to drive me mad. For such a technologically advanced society, we are extremely socially ignorant/backwards.

  6. Nothing has meaning until we assign meaning to it with our interpretation. Different words and events mean different things to different people. Our interpretations are based on our beliefs and perspectives which we have practiced habitually, and which vary wildly. Different interpretations will create different relationship dynamics, as well as different outcomes. In my experience, thinking with heartfelt compassion (thinking with the heart), along with possessing healthy boundaries that reflect self-compassion, creates freedom.

  7. I prefer to imagine a world where choice isn’t taken away, including an individual person’s choice to see someone else for whatever kind of support they feel like they desire, or none at all. I prefer to work toward a day when the role of anyone who chooses to devote their working life providing service to others were pure advocates, with no power over others and no desire to reach for such power.

    I’m glad that I had the choice to partner with a counselor that was right for me. It was one part of a whole that was part of my path to some deep healing. But it was also completely voluntary, and my counselor prescribed no meds, and had no connecting to a system of forced treatment. I could come, or not come as I felt was best for me. That’s the kind of freedom and choice we all deserve.

    There have been people in roles of “counselors,” “guides,” any anything else you want to call them through out much of history. People who devote the bulk of their life energy to trying to serve other people and be a comfort and support to them in difficult emotional times. But in our society, that has all been distorted and contorted by power, profit and a culture of paternalism and bigotry toward persons with differing lived experiences. That’s what I care about changing. They’re can still be counselors for as long as the world lasts for all I care. Or not if no one ever wants or needs that sort of thing. But I am a defender of individual choice. If someone wants to see me, I’m not going to say no.

    • Totally agree Andrew. As I said to a friend, while I don’t know for sure, I am guessing if I saw this particular therapist before going on psych meds, they could have been avoided.

      This person truly didn’t see herself in a one up position and was actually quite embarrassed if I acted like she was. She was so good that even when I was stoned a on cocktail of 4 meds, she convinced me I had the ability to start working again which I did.

      At one point, she tried to hint that maybe being on meds wasn’t the best option for me but I just wasn’t ready to hear the message. There is no doubt in my mind that if I went back and told her I was no longer taking them, I would have her full support.

      I just think we have to be careful not to make assumptions that a group of people are all bad and prevent people from getting the necessary help they need. Without this therapist, I would have been in big time trouble.

      • Oldhead,

        We agree on many things, and that is what matters.

        Note that I am not an anarchist, however I am libertarian with respect to the role of government in society. I do not agree 100% with the libertarian agenda -mostly because I am a grown adult and thus I am aware that certain libertarian proposals would take society very close to anarchy-, but I lean libertarian instinctively, namely, what American libertarians say resonates very strongly with my inner me. I have always had very little respect for “authority” in general. By “authority” I do not mean only formal authority, but authority in a very general sense, like “experts” who tell us that we need to blindly listen to them because well, they are “experts”. And of course, I have zero respect for government or those who run it -that would be politicians- since these people are the paradigmatic example of the arrogance of pretending that they know “better” than everybody else how to organize other people’s lives. I accept government as a necessary evil, but I see it as a force of evil that needs to be contained.

        So to me, resistance against coercive psychiatry is a logical consequence of my worldview. We already have the criminal justice system to deal with people who are deemed to violate those patterns of behavior our society deems “criminal” through the democratic process, the notion of “non criminal social control” doesn’t make any sense to me.

        Now, ironically, many in the consumer/survivor movement are progressives. It always struck me as odd to hold at the same time the view that “government is good and the bigger the better” but then that when government says that “for the good of the community, it is better to commit non criminal people and force them into drugs”, these same people object. I do not want to understand why people can think this way, but I hope that we can agree that regardless of where we come from, fighting coercive psychiatry and forced drugging is a noble goal that unites people of very different ideological backgrounds.

        • Good comment cannotsay.

          The idea of “non criminal social control” is the core of the matter for me. Pre crime or preemptive strikes.

          A few years ago one of our bikers smashed a mans jaw in a nightclub. When he went to court his lawyer argued that he had done it because he knew the other guy was going to hit him. Of course the argument was not accepted by the court, and he got a prison term. Had he been a psychiatrist the court might have accepted his defence, because then he would be seen as someone who can predict the future.

          But isnt this heresy?

          • Indeed,

            “Non criminal social control” is what psychiatry is all about. This is another of the great insights produced by the great Thomas Szasz. As I have said numerous times, it is really a pity that he didn’t get to live an extra year to see the psychiatric establishment accepting his fierce critiques to psychiatry (from the Insel statement on the lack of validity of the DSM labels to more recently Ron Pies saying that the “chemical imbalance” was a marketing device used by drug companies).

            To this day, still, Szasz remains the preeminent intellectual leader in criticism of psychiatry. Nobody comes comes close in precision and clarity (except perhaps Phil Hickey 🙂 ).

            Society has always had ways to do “non criminal social control”. In the West, churches played that role in previous centuries. Psychiatry was born as an alternative method to accomplish the same job, leaving it in the hands of “medical experts”. For a long time, there was a great deal of intersection between the values of Christian churches and the values of psychiatrists, so what psychiatrists considered as “disordered” mirrored what many Christian churches considered as “sin”. In the 1970s, a split emerged, at least in the American context, when the APA decided to drop homosexuality from its own list of “sins”. 40 years later, the split has deepened so psychiatry has become effectively, the “secular alternative” to the “non criminal social control” promoted by churches. There is even an article in the peer reviewed literature that asks precisely this question http://www.ingentaconnect.com/content/routledg/cmhr/2014/00000017/00000002/art00003 “The diagnostic and statistical manual: sacred text for a secular community?”

            If you have ever had the chance to debate the issue of psychiatry with members of the so called “skeptic movement”, which is a loosely connected community of atheists who profess https://en.wikipedia.org/wiki/Scientism , they strongly defend the psychiatric model. When you confront them they would readily admit that psychiatry does not meet the scientific standards required of other disciplines but they nonetheless defend it vigorously. Once I got somebody to admit to me that he was fine with homosexuality being a “mental illness” in societies that are homophobic, since each society had a right to define what it considered to be “mental illness”! Of course, this is in direct contrast with genuine science: one doesn’t expect the HIV virus to cause AIDS only in Western bodies. Science is about truths that are universal and objectively verifiable through falsifiability.

            Nietzsche already predicted the the removal of religion from society would not result in a society free of oppression, just in a society with a different type of oppression. Now we know how that oppression looks like :).

        • I’m in total agreement with your summing up of the nature of the struggle against psychiatry as a force for uniting different seemingly diverse groups and philosophies. It’s a challenge but if we can manage to pull off forming coalitions around particular issues irregardless of our general political leanings, it would be a monumental accomplishment and would make the psychiatric establishment wet its pants. (Outright fascists must be excluded of course.)

          I don’t consider myself a “progressive,” I’m a socialist. To me, the “size” of government is as relevant to its usefulness as the size of a painting is to its artistic value. I also support libertarian cultural values regarding individual rights, so I would call myself a libertarian socialist, except that others have taken that term to be identical with anarchism. I don’t consider myself an anarchist, primarily for strategic/tactical reasons, not because I have any disagreement with the anarchist ideal.

          No truly socialist government would allow for psychiatric oppression. Like Gay people in the 60’s-70’s who had the slogan “No revolution without us!” we must make it clear to the world that NO present or future government or society should expect us to remain silent.

  8. Thank you, Eugene, for this insightful and informative blog, and the links to the conference. And I’d like to say thank you to those who ran, participated in, and attended the conference – because you are doing extremely important, albeit difficult since it’s currently societally controversial, work. I’m personally very grateful, and am sure history will view you kindly.

    And I agree, “it wasn’t always like this, and it doesn’t have to stay this way.” Thanks for enlightening me to the fact I’m a “social constructivist” now, Eugene.

  9. Thanks for the article.

    Basically: society is cruel and psychiatry’s job is to cover that up. Itthen blames the person who is suffering.

    Psychiatry is like the parent who says to the distressed child, “Stop crying or I’ll give you something to cry about.”

    • You’re right, John, some within society are evil. And the psychiatric industry has historically chosen, and still chooses today, to cover up the ugliest crimes for the most unethical and greedy, then blames the innocent victims.

      The problem with ruling in this manner is that eventually society will end up with the most ruthless and evil in control, and a completely lawless and unjust society. “It wasn’t always like this, and it doesn’t need to stay this way.”