Against Therapization

“The world, our world, is depleted, impoverished enough. Away with all duplicates of it, until we again experience more immediately what we have.”

Since the advent of psychoanalysis in the late 1800s, ideas about mental health have come a long way. After Sigmund Freud first defined the psychoanalytic theory of mental illness, attitudes towards these illnesses began to shift noticeably from those in earlier periods. Treatment of the mentally ill, as well as the institutions that deal with mental health, from psychiatric wards to counseling, as we know them today, are fairly new inventions, insofar as psychoanalysis is only about 200 years old. During the Renaissance, people with mental illness were looked up to for a certain kind of wisdom, even revered in some circles. With the rise of industrialism, however, this began to change. “The new meanings assigned to poverty, the importance given to the obligation to work, and all the ethical values that are linked to labor, ultimately determined the experience of madness and inflected its course.” In his book, Madness & Civilization, Michel Foucault delineates this trajectory. “Madness was thus torn from that imaginary freedom which still allowed it to flourish on the Renaissance horizon. Not so long ago, it had floundered about in broad daylight: in King Lear, in Don Quixote. But in less than a half-century, it had been sequestered and, in the fortress of confinement, bound to Reason, to the rules of morality and to their monotonous nights.”

Foucault’s account of the history of mental illness, the birth of mental institutions, and psychoanalysis sheds light on how mental health care, as we have it today, came to be, and helps in questioning some of the empiricism attributed to psychiatry in contemporary culture. At least in the West, therapy has become increasingly accessible, and normalized. In public spheres — on social media, on university campuses, and in workplace environments — there is now a marked emphasis on mental health awareness. The internet has brought large portions of its users closer to mental health resources, and therapists or “mental health content creators” now seem to be crawling on social media sites. Many universities offer free counseling to students, and companies offer mental health days and provide resources such as Employee Assistance Programs (EAPs), which offer confidential counseling services. This shift towards acknowledging the importance of mental health reflects a broader cultural acceptance of mental health, and in turn, therapy, as conducive to overall well-being. While there are many forms of therapy available, such as Cognitive Behavioral Therapy (CBT), Psychodynamic Therapy, and Exposure Therapy, conventional talk therapy remains the most popular means of accessing mental health care.

This recent phenomenon of popularization and de-stigmatization of talk therapy invites a closer look at attitudes of therapy seekers towards therapy, particularly their ideas and expectations from the experience. For some, seeing a psychologist is a regular commitment, often weekly, and almost necessarily, a long term one. Since therapy happens to be the most generalized avenue for seeking help with feelings of depression, anxiety, obsessive compulsiveness, and many other common psychological complaints, and more often than not a therapy seeker’s first contact with the mental health care system is through a therapist, it is not entirely unfounded for some therapy seekers to see it as some sort of a panacea. This is a rather naive view, informed by an intuitive but still weak parallelism with seeking treatment for a physical condition. A psychiatrist’s work is unlike that of a physician in more than one way. With physical illnesses, diagnosis and prognosis are almost entirely within the physician’s purview. An underlying condition in the patient’s blood could be revealed to the physician through a blood test, and its treatment is likely to be administered without the patient’s intervention. To the sick person, this process is as simple as outsourcing the task of solving a problem with their body; they can overcome their sickness and recover while being entirely unaware of their red blood cell count, the efficacy of their white blood cells, or the condition of their platelets. A psychologist’s work, on the other hand, rests on the patient’s active involvement, and effort, as much as that of the psychologist. Then, therapy, unlike a pill prescribed by a physician, is better seen as a tool, rather than a fix.

Drawing further upon the disjoint between mental and physical illnesses, diagnostic methods further separate these two bodies of illnesses. Physical illnesses are diagnosed with near certitude before their treatments begin. Diagnosis almost always comprises of examination of the patient by the doctor, followed by standardized diagnostic procedures. For complications that are not immediately apparent, rigorous tests and examinations are performed with even more complicated machinery: radiography, endoscopy, cell culturing, and so on. On the other hand, when seeking treatment for mental illnesses, on the patient’s part, only a suspicion about one’s own abnormalities is prerequisite. The individual feels that their mood or emotions bar them from functioning regularly, or as expected: the student feels that he is unable to perform at school because he has trouble concentrating, or the office worker feels that the monotone of his desk job exhausts him. They wish to do better at home, at school, or at work, and they book their first therapy appointment. The therapist talks to them for an hour in a closed office, and decrees what is wrong with them: either they have depression, ADHD, anorexia, or any one or sometimes several of the medical terms that the patient has very little knowledge of. Diagnosis, in the case of mental illnesses, is rarely “biological”, inasmuch the patients are not hooked up to or inserted into some contraption to reveal underlying conditions. Instead, in the therapist’s office, an obscure label to categorize the abnormalities transpires from the talk, and then more talk sessions follow, in the name of correcting whatever the label implies.

Although diagnosis of mental illnesses generally does not involve wonders of engineering or inscrutable machinery, the task is by no means easier. In contrast to a physician, a therapist feels incredibly personal, at least emotionally. The patient duly welcomes their therapist into their psyche; their past experiences, childhood memories are shared not on whim but as essential components of effective counseling. Over the course of the talk sessions, the therapist gets to know their patient almost as much as, if not better than, their loved ones, and it is not an unsurprising development, in this vulnerable space, for the patient to begin to see their therapist in the light of some degree of friendship. However, in the therapist’s office, there is one person seeking help, and the other is a trained professional being paid by the hour; the premise of therapy detracts widely from that of friendship. This lends to the understanding that the work of a therapist, albeit very personal, is far from being simple, or could possibly be done as casually by a friend. In reality, understanding and classifying mental disorders remains to be a challenging task owing to multiple causality, comorbidity, discrete categorization of disorders, and their thresholds (Clark et al. 2017). Bipolar disorder, for example, is still difficult to distinguish from borderline personality disorder through clinical diagnostic practice (Saunders et al. 2015). Appropriate diagnosis of mental disorders, then, cannot follow from naive identification with symptoms of particular disorders. This level of nuance can be hard to grasp, and it is quite often that people fall into the trap of self-diagnosing when they are casually exposed to information about mental illnesses, in conversations with friends who are in therapy, through leaflets distributed on university campuses, or most often on social media.

The issue turns grave when identification is conflated with diagnosis. There certainly is neurological evidence of mental illness, but since talk therapy rarely involves complicated clinical procedures as in the case of diagnosing many physical illnesses, it gives way to an oversimplified view of the process of diagnosis in mainstream culture. In most instances, common symptoms of a wide range of mental disorders such as fatigue, inability to concentrate, mood swings, may be traced to circumstance, such as overly demanding workload at school or work, or social dynamics, but when erroneously attributed to biology, the individual essentially self-incapacitates. Insofar as they are of the opinion that their neurochemistry begets their fatigue, inattention, or mood, they are less likely to believe in their own agency, since they deem it more difficult to change the chemical composition in their brains than their immediate circumstances. Although there are circumstances that are naturally beyond the individual’s control — social structures, socioeconomic status, the capitalist system — broadly attributing their issues to biological makeup diminishes the will to actualize possible solutions to them. This is where therapy might come in, where a trained professional guides the patient through possible means to improve their circumstances, without immediately attaching labels pertaining to psychiatry. However, therapists rarely tend to do this, as it is easier for the patient to catalogue their issues with a common denominator, i.e. a disorder. Such a preemptive label might be detrimental when the individual begins to explain their psychological issues with terms such as “ADHD brain”, “OCD habits”, or “clinical depression”. In this state, the individual is left to shoulder the weight of the label itself and is set up for over-reliance on the therapist or medication such as anti-depressants, when positive change could have been made through much more granular and individualized action. In trying to treat their assumed mental illness, the patient might be, in certain cases, putting the cart before the horse.

A patient in the depths of the mental health care system is thus prone to what is defined under misattribution theory in psychology, which explains the processes through which a person misattributes their physiological responses. As a very rudimentary example, a person might feel flushed and notice a faster heart rate and label the bodily feelings as a result of chronic anxiety, when in reality could be due to the caffeine they had before bed (Kelley and Michela 1980). Attribution bias is largely defined and studied in psychology and may be able to delineate people’s tendency to come to wrong conclusions in explaining, or even over analyzing, their behavior. A person might make a causal statement along the lines of, “I am tired because I have depression”, i.e. an abnormal neurological makeup causing them to be fatigued. However, the causality does not hold, for even if they were clinically diagnosed with depression, depression would merely be the signifier of a collection of symptoms generally exhibited by people diagnosed with the condition. It cannot, on the other hand, be the cause and at the same time the signifier of these symptoms. In making overly simple statements such as these, the person inadvertently diminishes their scope of action, because, in this case, the statement is essentially this: “I am tired because I have depression, and I have depression because I had a bad childhood.” When a psychiatric condition becomes a way of explaining something rather than being a descriptor, the person is less likely to embrace agency over their circumstances that might partly be a product of their own doing, what in this case could just be poor sleeping habits. Labels, such as those discussed, thus give way to learned helplessness (Seligman 1972), which is what social science researchers call when a person is unable to find resolutions to difficult situations, even when a solution is accessible. People that struggle with learned helplessness are prone to feeling overwhelmed and incapable of making any positive difference in their circumstances.

Beliefs about what one is and isn’t capable of strongly tied to one’s own identity. Since identity is formed largely through experience, an older, more mature person with more experience and confirmation of their abilities is less likely to be deterred by the connotations of a psychiatric label than a younger person. According to Erikson’s theory of psychosocial development, identity formation is strongest during adolescent and teenage years, and “each issue of biological heritage, expressions of self, interactions with others, and cultural setting” can influence the personality of the developing person (Herman 2011). Thus, exposing a younger person to information about mental disorders is a delicate task, and must be treated with appropriate caution, since relatability of certain vague symptoms can turn into identification with mental disorders, which is in turn a precarious process. Casual use of psychiatric terms, in print or online, is also not risk-averse, for people are prone to identifying with this or that disorder very easily, through a process that is not so different from how people believe in astrology. Mental health infographics or short videos on social media may be shared in vague language, including statements such as “symptoms of depression include sadness, lack of motivation, and fatigue.” This language is reminiscent of astrological descriptions, which is often written in a way that is broad enough to apply to many people. People may identify with these descriptions because they are indeed written in a way that allows for a wide range of interpretations, and because they tend to accept vague and general descriptions as uniquely applicable to themselves (Fichten and Sunerton 1983). Additionally, identification with mental disorders (and astrology alike), may be influenced by confirmation bias, where people tend to seek out information that confirms their existing beliefs and ignore information that contradicts them (Oswald and Grosjean 2004). Although sadness, lack of motivation, and fatigue are common and part of the general human experience, once people believe them to be rooted in disorder, they may selectively interpret their experiences to fit that belief, thus reinforcing their conviction.

This is detrimental twofold, as solutions to mental health issues found online can be harder to assimilate into one’s life than a self-diagnosis. Solutions often involve behavioral changes, therapy, medication, or a combination of these, and understanding them can be more complex than simply accepting a diagnosis. Furthermore, implementing these solutions require individuals to take active steps to change their behavior or thought patterns, which is a long-term project, and one which does not provide immediate relief. All of this requires a greater level of effort and commitment than receiving the diagnosis, which may provide immediate explanations for symptoms. Considered together with the persisting stigma surrounding mental health treatment in many cultures, people may be more averse to venture out further than the diagnosis and to take agency in relieving themselves productively. If we take freedom to be constituted not of privileges but of responsibilities, then the diagnosis, in a way, mires down the self-diagnosed person, since their assumed mental disorder now bars them from their own agency.

All of this is not to say that therapy, or mental health care, is superficial, or should be done away with, but it is rather an exposé of sorts. It goes without saying that therapy can be useful, and even necessary in certain cases, for an extreme example, in helping veterans suffering from PTSD readjust into their lives after service. However, it would do us well to reevaluate the place of therapy in our lives, and what it can do for us, and that what it can do for us is inextricably tied to how we show up to therapy and assimilate its teachings into our lives. The structure of therapy, and the mental health care system, leaves room for misdirected effort, and both the patient and the therapist are prone to human error. In the case of airline pilots, although they are required to undergo regular mental health screenings, airline staff can easily bypass medical supervision and allow their poor mental health to lead them down the wrong path, as was seen in the tragic case of Germanwings Flight 9525 (“Germanwings Flight 9525” 2024).

Perhaps, there is opportunity for change earlier in the path, in the way we show up to the world and look at our experiences. In her essay Against Interpretation, Susan Sontag writes against the mimetic theory of art, the idea that art is meant to mime something else. The art critic’s view that the content of art is always a representation of something else (the curtains are blue because the author is melancholic, Kafka’s Joseph K. in The Trial "is being judged by the inexorable and mysterious justice of God” through the bureaucratic penal system), she writes, always directs an excessive focus on the content, at the expense of attention to form, when engaging with art. This divorce between form and content is essentially what alienates the critic from the work of art altogether, and if we look at life through this lens, we are alienated from our own lived experiences. For when we experience something, and we feel a particular way about it, we make sense of the feeling by categorizing and interpreting the experience overwhelming us with psychological terms that we have learned from the experts: our therapists, or mental health infographics we saw on social media. In saying “I am feeling anxious right now”, we might describe an intense feeling of anxiety about a significant other, and further down the line of analysis, we might trace this anxiety back to some way that we were treated in childhood that led us to this psychological reaction. Or, by saying, “I am feeling sad right now”, we might be tempted to explain it with our heavy workload at work or school. We essentially dig into our past to explain our present experiences. The path of interpretation and analysis goes as far as we wish to go down the path, and although the temptation to understand our emotions is quite human and natural, Susan Sontag invites us to adapt to a more immediate experiencing of our lives. She writes, “in a culture whose already classical dilemma is the hypertrophy of the intellect at the expense of energy and sensual capability, interpretation is the revenge of the intellect upon art. Even more. It is the revenge of the intellect upon the world. To interpret is to impoverish, to deplete the world—in order to set up a shadow world of “meanings.” It is to turn the world into this world. (“This world”! As if there were any other.) The world, our world, is depleted, impoverished enough. Away with all duplicates of it, until we again experience more immediately what we have.”

This temptation to interpret and categorize our experiences to this extent is quite a modernist act, and it is domination through analysis, the “revenge of intellect” upon something as abstract as human experience. We look for patterns, discern meanings, and see how things fit together, by projecting theories out onto the world in order to understand it. When we do this, and draw conclusions from our analysis, we achieve a sense of superiority over the feeling or the experience that we did not used to understand. This is, essentially, what a therapist trains their patient to do. The therapist learns about the experiences of the patient, and then gives them the language to categorize them with psychiatric language, as in, some normative, theoretical terms, almost as if human experience could be framed within some standard, a universal catalogue that is able to describe everyone’s experiences, as if their experiences are sociologically predictable occurrences, instead of just, their life. This argument could be used against any human language, and would thus be deemed a tautology; however, to clarify, for an individual with no formal training in psychiatry, when they are given a small set of psychiatric terms and ideas, by the therapist or social media, to describe their experiences, their limited knowledge makes them prone to mistranslation. Further grounds for mistranslation lie in the plain fact that the therapist has but only one inlet into their patient’s life; they have no way of knowing whether their patient’s account is indeed accurate, or free of biases. The patient in the therapist’s office could be painting a scene of immense deprivation suffered at the hands of others, while in reality, they themselves could just as well have been the problem all along. The final effect, then, is that with their translation, the individual places themselves at a measured distance from their lived experience. At this distance, it is also easier to dismiss the experience: “I had a weird interaction with my friend, but I understand they acted this way because they were anxious, and now that I have understood and analyzed the interaction, the interaction is no longer a problem.” The moderation of our experiences through normative, standardized language, could just as well be done to positive experiences — and what could potentially be a visceral, life-altering occurrence, can be neatly dissected, and put in the back of the memory shelf. If we live our lives with the understanding that everything begs analysis, everyone we cross paths with has ulterior motives, every experience has a hidden meaning, we would have relented so much of our individual agency over to the therapist, to the assumed expert of human experience, at the expense of all of life’s richness.

“What is important now is to recover our senses. We must learn to see more, to hear more, to feel more.”

Certainly, and to reiterate, therapy is not to be done away with. However, Susan Sontag’s argument against interpreting art sheds some light on how we might go on to limit alienation and bring ourselves closer to our own experiences. What Sontag would probably say, is that first, we need to look at therapy a little differently. This could be achieved by concerting efforts into raising mental healthcare literacy, just as much as we are popularizing mental health. People would then be able to show up to therapy with not so absolute expectations, and it would cease to be the place to solve all problems. Instead of asking the therapist, say, “tell me how to feel”, we would go to therapy and ask the therapist to create a space for us where we can truly feel. For a lot of people, this space might not exist elsewhere in their lives, and it is one way therapy could be useful, and help us in not being alienated from our experiences. In art theory terms, we could try focusing more on the form of our experiences, as much as we do on their content. If we allow ourselves to feel shock, joy, or sadness in the moment, and delay trying to understand and categorize everything just by a little bit, we would have the capacity to experience more viscerally what is immediate, and more of it than we usually do. With this, we would allow our life to mold us into the person we become, and live life more fully, instead of being the one only taking stock of it. Perhaps only then we would come closer to the truth. We could feel pleasure as it is meant to be felt, to the bones, or allow our sadness to make us suffer for a little while. In Sontag’s words, “each of our truths must have a martyr” (Sontag 1963).

Bibliography

Clark, Lee Anna, Bruce Cuthbert, Roberto Lewis-Fernández, William E. Narrow, and Geoffrey M. Reed. 2017. “Three Approaches to Understanding and Classifying Mental Disorder: ICD-11, DSM-5, and the National Institute of Mental Health’s Research Domain Criteria (RDoC).” Psychological Science in the Public Interest 18 (2): 72–145. https://doi.org/10.1177/1529100617727266.

Fichten, Catherine S., and Betty Sunerton. 1983. “Popular Horoscopes and the ‘Barnum Effect.’” The Journal of Psychology 114 (1): 123–34. https://doi.org/10.1080/00223980.1983.9915405.

Foucault, Michel. 1973. Madness and Civilization: A History of Insanity in the Age of Reason. Vintage Books.

“Germanwings Flight 9525.” 2024. In Wikipedia. https://en.wikipedia.org/w/index.php?title=Germanwings_Flight_9525&oldid=1222426743.

Herman, William E. 2011. “Identity Formation.” In Encyclopedia of Child Behavior and Development, edited by Sam Goldstein and Jack A. Naglieri, 779–81. Boston, MA: Springer US. https://doi.org/10.1007/978-0-387-79061-9_1443.

Kelley, Harold H., and John L. Michela. 1980. “Attribution Theory and Research.” Annual Review of Psychology 31 (1): 457–501. https://doi.org/10.1146/annurev.ps.31.020180.002325.

Oswald, Margit E., and Stefan Grosjean. 2004. “Confirmation Bias.” Cognitive Illusions: A Handbook on Fallacies and Biases in Thinking, Judgement and Memory 79: 83.

Saunders, K. E. A., A. C. Bilderbeck, J. Price, and G. M. Goodwin. 2015. “Distinguishing Bipolar Disorder from Borderline Personality Disorder: A Study of Current Clinical Practice.” European Psychiatry 30 (8): 965–74. https://doi.org/10.1016/j.eurpsy.2015.09.007.

Seligman, M E P. 1972. “Learned Helplessness.” Annual Review of Medicine 23 (1): 407–12. https://doi.org/10.1146/annurev.me.23.020172.002203.

Sontag, Susan. 1963. Review of Simone Weil, by Simone Weil. The New York Review of Books, February 1, 1963. https://www.nybooks.com/articles/1963/02/01/simone-weil/.

Sontag, Susan. 2001. Against Interpretation: And Other Essays. Macmillan.