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What's up, friends? Michael here.
Now, at Wisecrack, we love therapy.
Getting to monologue to a captive audience
for an hour straight?
Check.
Overcoming lingering demons
from that time our mom called us an unplanned miracle?
Check.
In short, we truly believe
that therapy can change people's lives,
yours truly included.
And therapy has never been more widespread,
socially acceptable, or accessible,
which is great because a lot of people really need it.
Indeed, in 2018, one in five American adults
experienced a mental health issue.
And that was before the modern plague
had turned us all into agoraphobes.
But lately, we've seen the mega-rise of apps
promising psychological transformation
in just 5 minutes a day.
And this leaves us wondering,
"What is therapy really for?"
And, "Are we asking therapy and ourselves to do too much?"
Let's explore in this Wisecrack Edition
on "Therapy: Can It Save Us All?"
But before we really get into it,
I wanna tell you about this week's sponsor, Surfshark VPN.
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And now, back to the show.
Now, the stigma surrounding therapy
and seeking help for mental health issues
has dissolved significantly over recent years.
This is unequivocally great news.
Especially when you consider
how mental health used to be treated in the good 'ol days,
which definitely were old, but definitely were not good.
Early psychiatric treatment
typically involved confining patients to lunatic asylums
with horrible living conditions.
Often, patients were sterilized.
Women could be kept in asylums
purely on their husbands' recommendations.
- Why would your husband do that?
- He said something about me participating
in some flag burning at a local suffragette protest.
He was not happy with my decisions
and found me generally annoying.
- LGBTQ+ folks and other marginalized people
were also often considered pathological.
And typically, super-churchy people
assumed all these issues stemmed from demonic possession.
So...
(Michael sighs) It's not good.
In short, psychiatry was more about punishing folks
who failed to conform to social norms,
with a heavy dose of sexism,
homophobia, racism, and eugenics.
Then, in 1895, everybody's favorite goatee guy,
Sigmund Freud, teamed up with Josef Breuer
to publish "Studies in Hysteria,"
which championed the talking cure
to help work through psychological trauma.
You know the one: a patient lies on the couch
and talks at length to their analyst
about all their deepest thoughts and feelings.
Importantly, Freudian psychology
was less about offering practical fixes for your problems,
and more about understanding your negative thought patterns,
neuroses, and so on.
His goal was to help "make the unconscious conscious,"
which could eventually help improve people's mental health.
Psychotherapy became increasingly popular in the US
around World War II and then boomed in the 1950s,
in what scholar Daniel P. Kamienski calls
the "Age of Affluence and Anxiety."
This was due to the intersecting phenomena
of the post-war economic boom,
with the high numbers of World War II soldiers with PTSD,
then referred to as shell shock,
as well as widespread fear about nuclear weapons.
As Kamienski notes, this era of therapy
saw the origin of an emphasis on patients doing the work.
As he puts it, "Psychoanalysts advised patients
that the traditional American value of hard work
needed to be applied to therapy
as well as to their personal pursuit of happiness."
This was a big change from Freud
having you articulate traumatic memories
while half-asleep on a tiny couch.
At the same time, psychology-infused self-help books
boomed in popularity,
and they were usually about
pulling yourself up by your bootstraps
and tackling your maladaptive emotional responses.
Positive psychologists pushed the idea of self-improvement
and reaching your full potential.
If it sounds kinda like motivational speaking,
that's because it basically was.
But what was really the purpose of psychoanalysis?
According to Kamienski,
therapy functioned largely as a way
to lead people into conformity.
In particular, conformity with America's
booming consumer economy and workforce.
As he writes, "By advocating clearly defined,
traditional gender roles and normative sexuality
set in the single-family,
psychoanalysts helped legitimize
and popularize The American Dream."
Good mental health, then,
was largely defined as the ability to fit societal standards
surrounding work, gender, family, and so on.
One famous psychoanalysis institute,
The Menninger Clinic, even explicitly promised
to return its patients to the useful citizenship.
Kamienski writes that, "Psychoanalysts promised
that Americans in therapy could be made to conform,
with a high degree of efficiency,
to the values of hard work and productivity in work,
and in their personal lives.
In doing so, they reflected and reinforced industriousness
as a key value of Americans."
So, what we have here
are three important aspects of 1950s-style therapy:
One, an emphasis on the patient's hard work;
two, conformity to American values;
and three, becoming a productive member of society.
This would only grow more true in the '60s and '70s,
as cognitive behavioral therapy, or CBT,
became all the rage.
CBT focuses on recognizing
and rationalizing negative thought patterns.
For example, if your brain is telling you
that there's a creepy clown hiding in your car,
a CBT therapist would ask you to think critically
about the statistical likelihood of this being so.
They'd suggest alternative thoughts, like,
"It's very unlikely that there is a creepy clown
hiding in my car."
This can be especially useful after doing Uber pick-ups
the weekend of The Clown Convention.
Indeed, CBT encourages you
to think critically about your thought patterns
in order to change them.
It teaches logical skills
to deal with distressing situations and emotions,
with the ultimate goal of significantly mitigating
or even totally eliminating their impact on your life.
As journalist Oliver Burkeman explains,
CBT is based on the principle that,
"Your distress is caused by your irrational beliefs,
and it's within your power
to seize hold of those beliefs and change them."
Again, we see emphasis on the individual doing the work,
with the help of a therapist,
to ultimately overcome their issues.
This contrasts against the Freudian method
of understanding unconscious drives
in order to release repressed experiences and emotions.
Notably, while Freud's methods
were expected to take many years,
CBT is considered a short-term method,
at least by insurance companies,
typically consisting of five to 20 sessions.
And to be clear, it's not the individual therapist's fault
that you're only allowed
to have ten sessions a year or whatever.
They're just playing by the rules set
by private insurance companies.
And no doubt, CBT can be enormously helpful
for things like phobias and sleep disorders.
But it's been critiqued for offering cheap, fast solutions,
with some dissenting therapists arguing
that it pushes a think yourself to wellness narrative.
CBT undoubtedly has changed tons of lives,
again, yours truly.
Still, there's a growing pile of research
suggesting that it's not a one-size-fits-all solution,
particularly when it comes to depression.
So we started with a long-term commitment
based on a good relationship between therapist and patient,
centered around exploring the unconscious.
And we're trending toward therapy as a self-led,
bite-sized course.
And if you don't have the time, insurance,
or resources to afford that?
Well, now Silicon Valley has an answer:
therapy, but, like, make it an app.
You've likely already seen them:
meditation apps, breathing exercise apps,
mood trackers, and self-led therapy apps
for just about any mental health issues.
We're also offered mindfulness apps like Headspace,
which promises to reduce your stress
and improve your sleep in just 3 minutes a day.
It's kind of like therapy
for people without the time or money
to be emotionally unzipped by a professional twice a month.
(Frank screams)
- You unzipped me!
- And undoubtedly, these platforms
have made mental health care a lot more accessible,
which is great.
And online therapy has been proven to have real benefits
for people struggling with depression.
Text-based therapy also adds an element of anonymity,
which can be great for people
who struggle to talk about their mental health.
What's more, subscriptions for mental health apps
can save people tons of money
compared to conventional therapy,
which makes high-end gym memberships look cheap.
This can be a life-saver,
especially when we consider that poverty
is a major fact in anxiety, depression,
and substance-abuse issues
and that lack of access to mental health services
is the root of the mental health crisis in the US.
Importantly, though, many of these apps rely on CBT,
boasting that their use of the model
will help you stop feeling anxious, depressed, stressed,
or unable to sleep.
And the marketing of CBT on these apps
exacerbates the one-size-fits-all mentality
that people critique the method for in the first place,
turning something as multifaceted and personal
as mental health care
into Uber, but for your unconscious mind.
This raises an important question.
By pushing convenient apps
to help manage mental health issues
rather than increasing access to and funding for therapy,
are we, as a society, putting too much pressure
on people struggling with mental health issues
to understand themselves
and guide themselves through their own recovery?
With apps, we've seen the idea of doing the work
increasingly become about doing the work alone.
With apps, the onus is often entirely on the individual
to actively engage with and work through their problems.
Fittingly, the apps are also tailor-made for a gig economy,
when everybody is working multiple jobs
with no time to fully commit
to working on their mental health.
But hey, at least you can dip into five minutes of therapy
in between DoorDash deliveries, right?
This only exacerbates another existing problem
in cognitive behavioral therapy:
its historic failure to address the systemic issues
that often contribute to individual mental health issues.
You might, say, be taught how to manage the stress
of living in poverty
or anxieties about the unstable job market and economy.
But being able to manage these
doesn't change these circumstances.
You're still facing down the possibilities
of not being able to afford dinner or find a new job.
Now, you've simply learned not to be as worried about it,
and thus are able to be
a higher-functioning member of society.
Workplace counseling and support options
illustrate the tension between solving individual
versus systemic problems perfectly.
Employee Assistance Programs, or EAPs,
began in the late '30s and early '40s
to help identify workers whose struggles with alcoholism
were making them less productive.
If you're struggling at work,
whether due to depression or stress,
you might be offered counseling,
which often comes with homework and self-led regimens
to help you overcome your problems.
What appears to be an employer's genuine act of care
could cynically be seen as a situation
where interests collide:
your interest in feeling better
meets your employer's interest
in seeing you meet your productivity potential at work.
Feel the 1950's useful citizen vibes here?
Importantly, EAPs typically focus
on the few most obviously struggling workers.
As scholars J. Berridge and C. L. Cooper write,
"The concept of the troubled employee
is at the heart of the EAP."
This approach can be problematic
because it doesn't consider
where those troubled employees' troubles actually come from,
which might be the workplace itself.
This certainly seems true in cases like that of Google,
which offered counseling to victims of workplace misconduct,
allegedly without bothering to reexamine the environment
that fostered that misconduct.
As Michael P. Leiter and J. Michael Wahlan note,
"Even when effective, individually-focused interventions
may do little more than enable people
to tolerate poorly-managed situations."
And beyond the microcosm of the workplace,
there's no shortage of systemic problems
to be found these days.
Our current economic realities, like the decline of unions,
or rising wealth inequality,
have even been explicitly linked
to rising mental health issues.
Loneliness is also on the rise,
as Americans are working longer hours
with fewer support systems.
This all leaves people more reliant
on mental health professionals.
That is, when they can afford the time and cost
of seeing them.
On top of that, job insecurity due to the gig economy,
lack of long-term contracts,
and fewer opportunities for promotion
can also contribute to your risk
of developing mental health issues.
Systemic economic issues like childhood poverty
can also have the same effect.
But it's not just economic issues
that negatively impact mental health;
racism and mass incarceration
have had a staggering impact on marginalized communities.
Suicide rates among young Black people
have increased by 73% between 1991 and 2017,
while accessing treatment in these communities
remains more difficult than for their White peers.
And despite its success
in treating people with anxiety disorders
and other mental health issues,
modern CBT therapy still has flaws
when it comes to working with marginalized people.
Remember, it's a highly individualistic therapy,
which hinges on the assumption
that a patient has faulty or irrational thoughts.
This framing makes it easy
for systemic issues to go unaddressed.
For example, it's reasonable that systemic racism,
sexism, or homophobia in America
can beget anxiety or depression.
You can't be expected
to positive-think your way out of that reality.
Psychiatrists are still working
on increasing the cultural sensitivity of CBT
so that marginalized groups are validated
while they receive treatment,
rather than encouraged to view anxieties
formed around their lived experience as irrational.
And lest it sound like we're criticizing therapists,
let us quote scholar James Hillman,
"When I criticize therapy,
I'm not really out to get therapists.
I think they're doing
some of the most important work in the culture
because they are sincerely trying to pick up the pieces
that capitalism throws into the street."
Indeed, therapy is a difficult profession,
and getting it right
when you have people's mental health in your hands
can be taxing.
What's more, therapists can't necessarily help
when it comes to systemic issues;
they can only support their patients within an unjust world
and address the impact it has on them.
So, where do we go from here?
Scholar Micah Ingle argues
that as long as people consider their mental health issues
by a purely medical or cognitive behavioral model,
the responsibility will remain on each individual
to get better without inspiring systemic change.
But before you sink into despair,
know that Ingle has some thoughts
on what therapy could look like.
One interesting alternative he offers is narrative therapy,
which helps people understand
and deconstruct the way they see themselves,
and why they see themselves in that way.
Therapists and patients reauthor their lives
to retrace where their self-perception comes from,
and address the social and personal factors
that have impacted them.
This can mitigate the effects
of systemic problems on patients
by addressing the patient
in the context of the system itself.
Will this, or any other new forms of therapy
take off in our lifetimes?
It remains to be seen.
In the meantime, we're stuck with a world
that exposes us to injustice and trauma,
and healthcare providers who charge us hundreds of dollars
to even try to feel better about it,
while sometimes neglecting the broader reasons
for our mental health issues.
But hey, at least you know
there's no creepy clown in your car.
I mean, unless...
you've been the clown all along.
But what do you-all think?
Is modern therapy asking too much of its patients?
Have mental health apps
revolutionized mental health support,
or merely commodified it?
Let us know in the comments.
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Hyperfixate on that subscribe button
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And as always, thanks for watching.
Later.
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