Rethinking Therapeutic Culture

Timothy Aubry, Trysh Travis, Timothy Aubry, Trysh Travis

• Publisher: University of Chicago Press
• Year: 2015
• Print ISBN: 9780226250137, 9780226249933
• eBook ISBN: 9780226250274
• Topic: History
• Subtopic: North American History
• Index: History

Social critics have long lamented America's descent into a "culture of narcissism," as Christopher Lasch so lastingly put it fifty years ago. From "first world problems" to political correctness, from the Oprahfication of emotional discourse to the development of Big Pharma products for every real and imagined pathology, therapeutic culture gets the blame. Ask not where the stereotype of feckless, overmedicated, half-paralyzed millennials comes from, for it comes from their parents' therapist's couches.

 

Rethinking Therapeutic Culture makes a powerful case that we've got it all wrong. Editors Timothy Aubry and Trysh Travis bring us a dazzling array of contributors and perspectives to challenge the prevailing view of therapeutic culture as a destructive force that encourages narcissism, insecurity, and social isolation. The collection encourages us to examine what legitimate needs therapeutic practices have served and what unexpected political and social functions they may have performed. Offering both an extended history and a series of critical interventions organized around keywords like pain, privacy, and narcissism, this volume offers a more nuanced, empirically grounded picture of therapeutic culture than the one popularized by critics. Rethinking Therapeutic Culture is a timely book that will change the way we've been taught to see the landscape of therapy and self-help.

Chapter 1

Damage

Joseph M. Gabriel

I live next to a three-year-old boy who generally seems like a happy child. My wife and I are friendly with his parents, and at times our children play together; my own son is five, and the two boys enjoy each other’s company. As they play ball and laugh and run about, all seems well. Yet at night when his parents put this child to bed, I hear him cry and scream through his window. He is learning to sleep on his own, so his parents put him in his room and say goodnight and shut the door and let him cry it out. He sobs and wails for what seems like a very long time. My wife has occasionally tried to bring the issue up with his parents, but they are distinctly uninterested in our opinions on the topic. I can’t really blame them. It is probably not pleasant to be sitting in their living room while their son is screaming. Yet they do it, because they love him and believe they are acting in his best interests. My wife and I sometimes sit on our porch in the evening and listen to him until we can’t take it anymore. We go inside and close our door. Later in the night he sometimes visits me in my dreams, and I wake in the dark, scared and lonely, thinking about this boy.

This anecdote captures something important about how we think about suffering. Damage is a word that appears regularly when we speak of pain, distress, and other types of trouble—damage to our bodies, our minds, our lives and relationships, damage to our souls. When used in this way, the word damage points to something in ourselves or others that is broken, something that needs to be fixed in order for us to return to how we ought to be. When I hear my neighbor crying through his window, I imagine that something is being done to him. Given that I have no reason to suspect physical abuse, I assume the harm being inflicted is primarily psychological in nature. Yet this does not mean I consider it unreal. Quite the contrary. I worry that this boy will suffer long after he learns to go to sleep without crying. I worry that he will have problems that might have been avoided, that his wounds will follow him as he becomes a man. And so, as I listen to his cries, I not only feel bad for him. I also feel bad about myself for not doing more to help.

It was not always like this. In the early years of this country’s history, suffering—both physical and psychological—was widespread and generally considered a normal part of daily life. Although people certainly tried to improve their own lives and the lives of those around them, and at times railed against the hardness of the world, they also understood pain and suffering as an inescapable part of the world in which they lived. As a result, there was no sense that emotional or mental distress might harm the individual in a lasting way; nor did it occur to people that such distress might reflect harms that had been inflicted in the past. People simply did not think of those who suffered as damaged in the way that we do today. In the years before the Civil War, however, psychological suffering was reconceptualized as anomalous and potentially threatening to the normal functioning of the self. Increasingly, it seemed to be something that happened to people and thus to be something that could disrupt and harm the most intimate parts of the self. Since then, the belief that acute psychological suffering can harm people in lasting ways has been a central assumption in the popularization of therapeutic culture. So too has the idea that such harm can be ameliorated through therapeutic intervention.

I do not have a problem with this. Unlike many critics, I do not dismiss the importance of therapeutic culture in making the world a better place. Still, this framework has a tendency to foreclose other possible responses to the troubles of the world. If we look to the past, we see that people did not always respond to the problem of suffering as we do today, and while I would never suggest that we should return to those times, I do believe that we can learn something important from those who came before us. At the end of the essay, I offer one such possibility—that of keeping company—and suggest that sometimes simply being with those who are going through difficult times may be all that we can, and should, do.

A World of Trouble: Pain and Suffering in Early America

The diary of Elizabeth Drinker (1735–1807) provides a remarkable glimpse into the extent of pain and suffering in the late eighteenth century. A devout Quaker, Drinker lived in Philadelphia; her husband Henry was a successful businessman and leader in the Quaker community. Drinker spent her days running the household, maintaining social obligations, and seeing to the needs of her family. Financially successful, the Drinkers had an active social life and by all measures should be considered among the city’s elite class. Yet despite such privileges, as Elaine Forman Crane notes, Elizabeth Drinker’s diary “offers convincing evidence that physical distress invaded daily life to a degree currently unimaginable.” Rheumatism, fevers, severe coughs, painful discharges of urine, and other ailments were common. Spoiled and undercooked food led to frequent intestinal problems; gum disease was widespread, resulting in frequent pain in the teeth, gums, and face. Broken bones and other injuries failed to heal properly. Disease was rampant, in part owing to poor sanitation, and infections were common and sometimes deadly. “Why should we expect to be exempt from pain and trouble,” Drinker noted one night. “How many of our friends have lately suffer’d sickness and death, lost near and dear relati[ons.]”1

Drinker’s comments reflect the restrained attitude toward suffering characteristic of late eighteenth-century American culture. The constant and unrelenting fact of physical pain led to a stoic attitude that today might seem callous. In part, this reflected the simple reality that medical science was relatively primitive, that disease and physical ailments were far more common than they are today, and that pain relief was simply not possible in the way that we now take for granted. Physicians and other healers had few effective analgesics at their disposal, and in any event they tended to consider pain as a warning sign of other problems rather than a problem worth addressing in its own right. Indeed, physicians often understood pain to be a natural part of the healing process and something that should be allowed to express itself, or perhaps even encouraged, in order to help the patient recover. People in the late eighteenth century simply had to accept the reality of ongoing and often severe physical pain, both in their own lives and in the lives of the people they knew and loved.

Moreover expressions of grief, worry, and other painful emotions, while common in Drinker’s diary, are surprisingly muted in tone. Drinker did not really distinguish these types of feelings from the torment she often felt in her body. Whereas today we tend to see physical pain and psychological distress as distinct, although perhaps related, types of problems, during the eighteenth century the two were frequently understood in overlapping terms. Drinker often referred to the difficulties she and her family faced simply as “trouble,” without distinguishing physical from psychological suffering. Both were part of a difficult and painful world, and as she made her way through life, watching loved ones suffer and die, feeling her body torment her, Drinker tried to face her troubles as best she could. Little wonder that her emotional response to the suffering of others was, from today’s perspective, modest. One night, when her daughter Sally lay in agonizing pain during labor, Drinker pondered her own restrained emotional response. “Is it that as we grow in years our feelings become blunted & Callous,” she asked herself, “or does pain and experience cause resignation?”2

For Drinker, suffering was an ordinary part of the world that God had created. In the late eighteenth century, discussions of pain, emotional distress, and other types of trouble were largely confined to funerals and other rituals where religious leaders explained their meaning to their flocks. Doctrinal views varied, of course, but in general religious leaders suggested that the troubles of life were God’s punishment for original sin and as such a natural part of a fallen world. These troubles might encourage ungodly behavior, such as drunkenness or cruelty, and as a result they needed to be mastered and controlled as a part of the battle against sin. From this perspective, a godly life depended upon accepting the pain and suffering of the world as an expression of God’s will, composing and regulating oneself properly in the face of it, and orienting oneself to the promise of an afterlife in which suffering would be no more. Drinker fully embraced this worldview. “This is a world of trouble,” she noted toward the end of her life, “may we so live as to find peace in the next.”3

I do not want to equate everyone’s experience in the late eighteenth century with that of Elizabeth Drinker. If anything, given the privileged life she led as a free, white woman of modest wealth, Drinker probably experienced less suffering than most. Nor do I want to collapse all responses to the troubles of the world into a narrative of godly submission. Not everyone was as resigned to the difficulties of life as was Drinker—people fled their jobs and homes, they struggled against those who oppressed them, and they worked to improve their lives in countless ways; such actions grew at least in part out of an effort to reduce the experience of physical and psychological distress. Moreover, as Amanda Porterfield has recently argued, by the 1790s religious skepticism had become commonplace in American society. Political and economic instability, social upheaval, and other destabilizing changes led to widespread doubt about the role of religion in people’s lives. Preachers and other religious enthusiasts responded by demanding that submission to God’s authority serve as both the foundation for a new national identity and as a guide to personal conduct, but their pleas did not always meet with agreement or compliance. Attitudes toward pain and suffering were a part of this contested process. While Drinker was largely resigned to a life of trouble, and she understood pain and other forms of suffering in the context of her faith, other diaries from the time reveal that people questioned the meaning both of suffering and of the doctrines that were supposed to explain it. For many, the difficult and painful nature of the world cast doubt on the presence and mercy of God.4

For the most part, such doubts were kept private. As personal matters, and topics for discussion in ritualized spaces, expressions of pain and suffering were not really a part of public or political discourse. This is not to say that physical pain, emotional distress, and other types of trouble had no effect on public affairs. Clearly, they were one of the many forces that motivated human action, then as today—the efforts of slaves, the poor, and others to improve their lives, sometimes in ways that directly impacted public affairs, make this abundantly clear. Yet despite such efforts, the experience of suffering was not, in general, a topic of public concern. For most observers, individual suffering did not point to a broader problem about how society was organized, nor was it something that could be addressed through political or social action. In general, people were not motivated by the suffering of others to change the world in which they lived. They noted the troubles of their families and neighbors and often tried to help, but they did not dwell upon such difficulties or consider them to be indicative of some type of broader problem. Suffering, whether physical or psychological, did not require much discussion. Efforts to heal were often futile, the world was hard, and for most people there was no real expectation that things might be different. As Drinker knew, in many cases there was nothing to do in the face of trouble other than to sit quietly and wait for it to pass.

Sympathy and the Project of Reform

Running through Elizabeth Drinker’s diary are small expressions of sympathy for the suffering of her family, friends, and neighbors. In an entry from 1796, for example, Drinker mentions her neighbor Molly Hensel, a young woman who had married a “drunken old man” and begun to regularly drink herself. “I look’d upon her with pity and compassion,” she notes, “one of the many beings from whom much was not required.”5 Drinker’s expressions of “pity and compassion” were modest in nature and primarily directed toward friends, neighbors, and most of all her family. Yet they also point to the intensification and proliferation of sympathy as an emotional response to the suffering of others in the coming years. Beginning in the early nineteenth century, what had once been a muted emotion became more strongly felt. Sympathy for those who suffered—even those whom one had never met—was increasingly experienced as a powerful emotion and was, at times, described as its own type of pain. It was also increasingly seen as a virtue, and to be unmoved in the face of suffering was, if not quite a sin, increasingly morally suspect. By the 1830s, the visceral experience of sympathy had become one of the ways that many people judged themselves to be ethical actors in the world.6

A complex web of causes underpinned the growth of sympathy. By the late eighteenth century, to name one important factor, physicians and other healers had begun to see physical pain as a meaningless result of illness that should be minimized, if not eliminated. Increasingly, physicians believed that people suffering acute pain deserved their sympathy and that increasing the comfort of their patients was an important part of medical care. Changes in religious sentiment were also tremendously important. As Margaret Abruzzo notes, theological changes in late eighteenth-century Protestantism “helped push benevolence to the center of Anglo-American Christianity.”7 Threatened by the erosion of biblical authority, protestant ministers began to reject the assumption that pain and suffering were a normal part of God’s world and to suggest that those who followed the path of righteousness would prosper not just in the next life but also in this one. In this new vision, undue suffering thus indicated not God’s will but rather a breach of the natural order he had so wisely ordained. Of course, despite these and many other changes, significant pain and suffering still colored daily life. The world was hard, after all, and people struggled on much as they long had. Yet increasingly, both physical pain and psychological distress were seen as unnatural, as outside the domain of how things ought to be. Increasingly, they were understood as things that happened to people. “Thou has robbed me of peace, of the blessing of rest,” wrote one anonymous poet in an ode to pain in 1814, “and has flung o’er my shoulders grief’s saddening vest.”8

In the early decades of the nineteenth century, a great wave of religious fervor linked the idea that acute pain and suffering lay outside the proper order of the world to a moral critique of changing social relations and the spread of the market. By the 1830s, this surge of religious enthusiasm had made the suffering of others the rhetorical basis for a series of broad humanitarian movements that transformed the social and political fabric of the country, including abolition, temperance, and antiprostitution reform. Reformers loudly denounced the cruelty of the world and described in endless detail the agony of tortured slaves, abused women, and other victimized innocents. As feelings of sympathy proliferated and became more intense, and as suffering was redefined as a perversion of the natural order, reformers increasingly understood their own moral status to be intertwined with the condition of the world in which they lived. To ignore the sins of others, it seemed, was to be a part of its evil; one’s own salvation seemed linked to the effort to transform the suffering world.

This was not just about physical pain. For many reformers in the antebellum period, the worst type of harm inflicted on the innocent was not to the body but to the spirit. Reformers described the terrible shame of the young girl forced into prostitution, the overpowering grief of the drunkard as he watched his family reduced to poverty, the humiliation of the man unable to support his family. Abolitionist literature depicted slavery not just as physically brutal but also as threatening the very souls of the enslaved. Frederick Douglass, for example, described the profound damage of slavery in psychological terms. “I was broken in my body, soul, and spirit,” he wrote in his autobiography. “The dark night of slavery closed in upon me; and behold a man transformed into a brute.”9 For Douglass, as for other reformers of the time, psychological harm was an unnatural part of the world. It was inflicted on a person from the outside, distorting the inner life of its victim from what it ideally should be. Acute psychological suffering was both the cause and consequence of a broken, damaged self.

Following the Civil War, the assumption that excessive psychological suffering should be prevented or ameliorated underlay the efforts of reformers who sought to create a rational and bureaucratic modern regulatory state. Tragic narratives about dangerous consumer goods, unsafe work conditions, sexual violence, and other horrors filled the newspapers and magazines of the time, prompting the passage of numerous laws intended to protect the innocent. These narratives, like the stories that reformers told in the years before the war, often focused on the emotional and psychological anguish of those who were harmed. Meanwhile, psychiatrists, social workers, and other experts sought to promote—or enforce, depending on your perspective—both psychological health and social and behavioral norms in hospitals, schools, prisons, and other institutions. Finally, a variety of new diseases were identified that had behavioral and psychological components, such as neurasthenia and hysteria. These types of ailments might be caused by a physical injury, it was believed, or result from sudden shock or some other type of “emotional disturbance.”10 Whatever the cause, however, those who suffered from such problems had clearly been harmed in some way. They had been damaged.

By the first decade of the twentieth century, the early outlines of modern therapeutic culture had thus begun to emerge. An activist state worked to protect its citizens from undue suffering, sometimes using force to pursue its goals; mental health experts sought both to promote psychological health and to enforce what they believed to be appropriate norms of behavior; a growing number of mental and emotional states were understood and described as forms of disease. These and other related changes were the work of a range of reformers who sought to reduce the burden of suffering on those they considered victims of a cruel world. Many of them brought a secular attitude to their work, but like their predecessors in the antebellum period these reformers believed that the duty to help was a moral imperative. For them, as for us, the effort to reduce suffering was part of what it meant to be an ethical actor in the world.

Compassion and Harm

We have come a long way since psychological distress was reconceptualized as something that impinges upon the self. The therapeutic culture that grew out of that reconceptualization has proliferated rapidly and is now, as Eva Illouz notes, “an essential part of the cultural and moral universe of contemporary middle-class Americans.”11 Therapeutic culture frames emotional and psychological suffering as an impairment of the self that results from some sort of previous harm. At the same time, it offers the possibility of healing through the sharing of stori...

Table of contents

• Cover
• Title Page
• Copyright Page
• Contents
• Acknowledgments
• INTRODUCTION
• CHAPTER 1 Damage
• CHAPTER 2 Gospel
• CHAPTER 3 Spirit
• CHAPTER 4 Race
• CHAPTER 5 Motherhood
• CHAPTER 6 Confessions
• CHAPTER 7 Radical
• CHAPTER 8 Narcissism
• CHAPTER 9 The Left
• CHAPTER 10 Pills
• CHAPTER 11 Testimony
• CHAPTER 12 Heart
• CHAPTER 13 Privacy
• CHAPTER 14 Pain
• CHAPTER 15 Blogging
• CHAPTER 16 Practice
• AFTERWORD
• Notes
• Contributors
• Index