How therapy became a multimillion dollar industry
Psychology is not only a profession, it is a mega-industry that takes us to the economic heart of modern society.
You, the reader, and I probably suffer from at least one of the following problems: lack of self-confidence; difficulty in committing to a steady relationship; sexual dysfunction; a diffuse and permanent anxiety; frequent bouts of uncontrollable anger; compulsive lying or addiction to some substance; a chronic sense of guilt; and so on. What is common to all these is that they are conventionally defined as “psychological,” and as such, the remedy is obvious: See a therapist.
Human beings have long suffered from afflictions of the soul, but how we conceived of them in the past was very different from how we define them today. Afflictions of the soul were understood in religious terms. They were viewed as the result of sin or of possession by evil spirits, as punishments or as the weakness of a particular part of the body. Among the strategies for removing or repairing them were prayer, punishment, ritual dances, self-mortification, confession and cold baths.
We now think of afflictions of the soul in psychological terms, as originating in a childhood conflict or trauma, and believe they can improve by talking about them and changing our interpretations of ourselves and others. Psychologists have redefined the psyche and their power has had important political consequences. Why? Because the way in which the psyche is defined is of supreme importance to political power. If you think, for example, that people are naturally and biologically competitive and selfish, this provides a great deal of legitimacy for the capitalist economy. Psychology is not only a healing technique; it is an entirely new cultural outlook, with political implications.
If that is the case, and given its crucial importance in modern societies, it is time for a critical examination of this outlook. What kind of soul does psychotherapy shape, and what relationship does such a soul bear to the contemporary social order?
Our deficient selves
In a premodern religious culture, the soul is understood as good or bad, sinful or pure, as being on God’s or on Satan’s path. Psychological culture views the psyche not as a moral entity, but as the result of events or drives that have, as such, no moral meaning (the “Oedipus Complex” − despite being about incest − has no moral meaning). Such emotions as anger, envy or greed, thought to be deadly sins in Christian culture, are no longer viewed as vices, but rather symptoms of an underlying mismanagement of one’s inner psychic makeup. In psychological culture, our difficulties in dealing with the world ultimately hark back to our psychic makeup, to our own “inner difficulties with ourselves.” In other words, not only must the world not be evaluated in moral categories, but its failings point first and foremost to our own deficient selves.
Imagine that you begin couple therapy and come to the psychologist with the angry view that your selfish and uncaring husband never helps with the laundry, never does dishes, never takes care of the children. You are very likely to hear that your moral condemnation is an inadequate response to your husband’s indifference to your hard domestic work, and that this condemnation in fact prevents you from taking control of the situation and from understanding that he is only reenacting childhood scenarios of dependency; or that your anger is the result of your own need to punish him. You would not hear from your psychologist anything about patriarchal control − as a form of social control − or about your husband’s moral character.
A “psyche,” then, is an entity that must be evaluated not in moral terms, but as the result of “drives,” “unconscious desires,” “repression,” “compulsion,” “obsession” − all “scientific” words that remove the moral meaning of people’s actions. (This is especially obvious in the realm of education, where it is forbidden to view children as good or bad, but simply as having specific needs.) When we look at our own psyches today, we are not looking for traces of sinful thoughts and desires, but rather for the opposite, for traces of a truth that is buried deep inside and which must be patiently discovered in order to achieve happiness, emotional well-being, etc. (For example: sadomasochistic sex feels more truthful than vanilla sex precisely because it seems as if it was dug out of the repressed psyche.)
When we look at our psyches, we are not looking for temptation to sin, but for signs of “dysfunction,” which in turn must be properly managed. Religion was about instilling taboos and a clear capacity to distinguish good from bad. Psychology is about getting rid of taboos, about painstakingly discovering a truth hidden deep inside, about overcoming the emotions and blockages that prevent us from functioning optimally and finding our inner truth. The new goal of culture is not to be good or moral, but to be healthy and true to oneself. The paradox, though, is that such ideals have turned us into “sick,” “untruthful” or “unhealthy” people who must be perpetually working on ourselves. As a result of the psychologization of the soul we have become a society of sick people. Women who love too much and men who are emotionally distant, men who marry the first woman they meet and women who have hundreds of sexual partners, all are “suffering” from a hidden problem that drives them away from the happy and healthy “middle.”
Consider this: Before Freud, psychiatry treated delusional patients or patients with severe dysfunctions. Freud enlarged the category of people who needed treatment by inventing the notion of “neurosis,” that is, inner conflicts. Although he still treated severely impaired people (with paralytic hysteria, for example), the concept of neurosis represented a considerable enlargement of the notion of psychic disease or malfunction. If a married man had no desire for his wife, or a woman felt anxious in the presence of her mother, these feelings were no longer viewed as ordinary unpleasant experiences of life, but as dysfunctions to be treated. The concept of neurosis also suggested that we could and should live a life without inner conflict, and thus justified the use of psychologists for any and all problems. For example, Margaret Mahler, one of the foremost early proponents of psychoanalysis in America, claimed: “It seems inherent in the human condition that not even the most normally endowed child, with the most optimally accessible mother, is able to weather the separation-individuation process without crises, come out unscathed by the rapprochement struggle, and enter the oedipal phase without developmental difficulty.”
If the “most normally endowed child” and the “most optimally accessible mother” still produce “difficulties” and “crises,” then this means that both normal and pathological children − all children − do not and cannot achieve mental health, and thus need the help of psychology to surmount the crises inherent in the very experience of living.
In the 1960s there occurred an additional change in psychological theory. Not only had psychologists moved from psychological disturbance to the much wider realm of neurotic misery, but they now moved from neurotic misery to the idea that health and self-realization were synonymous. The result was to define a new category of people: those who did not conform to these psychological ideals of self-fulfillment were now sick. Abraham Maslow − a popularizer of psychology − put it this way: “The people we call ‘sick’ are the people who are not themselves, the people who have built up all sorts of neurotic defenses against being human.” Or to put things differently: “...the concept of creativeness and the concept of the healthy, self-actualizing, fully human person seem to be coming closer and closer together, and may perhaps turn out to be the same thing.”
Take the analogy of the body. If I said that a body whose muscles are not fully developed is a sick body, all of us would find it absurd, and yet this is what we have come to accept about the soul. As in Zeno’s paradox, mental health and self-realization are the aim of an arrow that always moves, but never arrives. It is this perpetual movement toward self-improvement that characterizes our societies and that hide what I call the politics of psychology.
More than any other social group, psychologists have become a central nerve of contemporary society and contemporary capitalism. By definition, powerful social groups are able to impose their worldview on the rest of society. Psychologists became powerful because they entered all spheres of society: the army, the corporation, the family, sexuality, advertising, state, school. They entered all social spheres because they offered techniques for managing conflict and techniques to enable people to collaborate with others in a workplace where personality would matter as much as, or more than, competence or skill.
No social group in the 20th century has been as ubiquitous as the psychologists, as they redefined the nature of human motivation, conflict, and harmony. Why did they succeed so spectacularly? Some would say it was because they discovered the true laws of the mind. But their success cannot be explained only in this way, because: 1) the scientific validity of Freudian theory has been largely contested, suggesting that Freud is first and foremost a cultural innovator; 2) There are many conflicting paradigms in psychological practice, holding opposite and incompatible views of the psyche (dynamic, behaviorist, cognitive, neural, etc.), which in turn suggests that psychology has not been effective as a single scientific paradigm; 3) Psychology has been used in areas that are not monitored by science, such as self-help culture, spirituality or guidance, which are often conducted by people with no accreditation, yet are still effective in the sense that they help people who believe in them.
This suggests that psychology works as a cultural outlook for understanding and healing the self, that is, as a language that helps us figure out who we are in a world where clear rules and norms about identity and morality have collapsed. But there is more.
The reason why the notions of health and inner truth became increasingly powerful throughout the 20th century is that they activated a formidable economic machine. The more we look for our healthy selves; the more we can multiply and diversify psychological problems; the more we can declare any life unhealthy and in need of management and improvement − the more clients there are. Think, for example, of shyness. Until 20 years ago, shyness was in fact a virtue, a sign that a person was modest, appropriately reserved, virtuous, moral. But shyness has been relabeled as a “social anxiety,” needing a medication (Paxil) and appropriate care and cure by psychologists. Quite simply, the more a professional group labels emotions and behaviors as “dysfunctions,” the more it is able to justify what we call a psychic problem, and the more the psyche becomes a source of profit, an endless economic machine.
Psychology, then, is not only a profession. It is a mega-industry that takes us to the economic heart of modern society. Today, we use psychologists for marriage counseling, sexuality, education, workshops in corporations, to increase economic efficiency, in advertising, in political conflict, in posttrauma disorders and in self-management in general. It is difficult to think of a social problem, a conflict with another person, a dysfunction, or a collapse of trust between two people that does not get translated into a psychological problem. What psychologists, new age therapies, workshops, self-help books, coaching and psychiatric medications have in common is their use of expert knowledge (psychological, pharmaceutical, genetic) to effect emotional change, like reducing stress or anger, providing a feeling of well-being, increasing a couple’s intimacy, improving self-confidence, reducing feelings of worthlessness and powerlessness, and increasing self-esteem.
Here are a few figure. In the U.S., psychologists held about 174,000 jobs in 2010. The overall employment of psychologists was expected to grow 22 percent from 2010 to 2020, faster than the average for all occupations (where the average growth rate is 14 percent). The Mental Health Organization published a review of the cost of mental health problems (World Health Organization, 2003). This review estimated the cost of mental health problems in developed countries to be between 3 and 4 percent of GNP. For the United States, when this phenomenon was still in its infancy, in 1990, an aggregate cost of US $148 billion for all mental disorders was calculated. Spending on treatment for mental health and substance abuse in the United States was estimated at US $85.3 billion in 1997: $73.4 billion for mental illness and $11.9 billion for substance abuse (Mark et al., 2000, quoted in the review). To this we should add the gray area of workers in non-accredited and noninstitutional fields of psychology. This segment’s sales are estimated at $328 million for one year only, for the top 12 motivational speakers alone. Five thousand motivational speakers take in more than $1 billion per year.
Personal coaching, with 40,000 people working in the field in the U.S., is a $2.4 billion market and is growing by 18 percent a year. (Most charge $200-500 per month for a weekly phone call, but corporate coaches charge more.)
Privatization of the soul
Now you may say, so what? Psychologists make money, people are helped by them; what exactly is the problem? The problem is this: Psychology has transformed the way of organizing explanations, how we explain our and others’ behavior. Why is this crucial? Because how we explain our own and others’ success or failure is a crucial element of how we justify social order. If you explain your difficulty in keeping a steady job by citing your lack of self-confidence or a self-destructive tendency, you will think of your workplace and the economy very differently than if you explain them by citing labor laws that make it easy to fire workers or the ruthless competitiveness of market economies.
Here is an example of how psychologists had an impact on political culture by changing the ways in which responsibility is attributed. Around the 1920s, psychologists started entering the American corporation. They helped executives better manage the workforce to increase productivity. One of the main effects, historically, of psychologists entering the corporation was to ban the expression of anger from the workplace. A good manager and a good worker had to display at all times their capacity to understand others and act to defend their self-interest. Anger became an expression of lack of professionalism, of someone who did “not have it together.”
Of all emotions, anger is probably the most political one: without it, one can hardly think of revolutions, demonstrations and social protest. Yet, angry people are told overwhelmingly by the surrounding culture that their anger is their private problem, that it has a psychic cause, that it can and should be managed and that failure to do so only shows one’s incompetence. But is anger indeed a private problem? Think, for example, of the many ways in which the modern workplace is structurally made to produce anger: People are taught and trained to be original and creative, and yet for the most part work in entirely uncreative places; people are taught to be autonomous and self-reliant, but most often have to comply with strict bureaucratic rules and hierarchies; people are taught that their efforts and talents will be rewarded, but experience widespread cronyism and unfairness. People are taught to be cool and happy, yet the capitalist workplace can dispose of you whenever it needs to “increase efficiency.”
Modern workplaces are bound to produce chronic anger because they create chronic, structural deficits in recognition, where “recognition” is a crucial benefit sought by workers. Yet, the expression of anger has never been as illegitimate as it is now, because it supposedly points to a lack of maturity and competence. Anger is thus redirected to psychological couches, self-help books, workshops on anger management − thus defusing the enormous political power and potential of anger. When appropriated by psychologists, anger then becomes delegitimized; it becomes unhealthy; it becomes a sign that one must work out some inner conflict. It becomes the private problem of the person who feels anger, a sign that she is not well-groomed or well-bred enough.
As a result of the delegitimation of anger in culture, anger workshops have mushroomed since the 1970s. Their techniques consist, for example, of imagining the object of anger, learning techniques of deep-breathing, meditating, empathizing − in short, defusing anger.
Israeli society, like other societies, and even more than other societies, produces chronic dissatisfaction, anger and anxiety. This society has an unusually high and unhealthy reliance on New Age groups, spirituality and psychologists to channel, manage and solve conflicts and problems. Obviously some people need help, and psychology does help. But a massive amount of resources is also devoted to simply fabricating happiness, coolness, relaxation, detachment. Creating satisfied psyches ends up creating a form of quietism, passivity and inaction toward the world. When so much of our political and institutional environment needs serious questioning, such passivity − in the form of self-absorption and pursuit of the right psychological makeup − is worrisome, even dangerous.
Psychologized selves are overly preoccupied by their well-being and emotions; they are selves that think that if they work on themselves enough, they will change the outside world, or that the world outside does not matter, only the world inside, and that conflicts can always be solved by figuring out in a mature way how to communicate. That is not how social changes happen. Psychology plays an important role in the depoliticization of society, through privatization of problems and through the promise (as well as the injunction) of self-improvement. Political anger − anger caused by unfair and abusive institutions − is a political emotion, and as such it must be expressed and shared publicly.
This large industrial machine of emotions management is now part and parcel of the culture of neoliberalism. Why does neoliberalism work so well as an ideological system? Because it fits like a glove the worldview dominating so many western countries and promoted by popular psychology: that we are responsible for our failures; that if we work on ourselves enough, we can do anything we want; that reality does not exist, only our way of interpreting reality; that we can improve ourselves to death. But it must be said clearly: A just society is not one in which people take responsibility for the deficiencies and injustice of their society, institutions and workplace. A just society is not one where people improve their psyche to death to palliate the deficiencies and insufficiencies of their institutions. Neoliberalism supports not only the privatization of nationalized industries, but also of the psyche. Psychology is to the psyche what neoliberalism has been to the market: an ideology that justifies the failure of many in order to justify and celebrate the successes of others as the hard-won and well-deserved result of their inner psychic work. We must resist such a worldview and put the politics back into our souls.