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:
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?
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.