Right of Reply: How Psychotherapy Fits Into a Dissolving Social Structure

A response to recent articles by Prof. Eva Illouz and three Israeli psychologists about the merits of modern psychology.

In addition to the privatization of suffering, Illouz’ second key issue with therapy culture is with its role in collapsing morality (although, interestingly, she notes that this is also its key strength since it allows individuals to question oppressive traditions). Psychology extends a secular worldview whereby anger, infidelity, impulsivity, alcoholism and the like are redefined as “symptoms” or “disorders” rather than moral problems.

She cites the example of a patient from the television series “Be Tipul” who has been involved in bombing Palestinians. There is a gap in his morality, she contends, that the therapy cannot address, given the therapeutic injunction to remain understanding and nonjudgmental.

I have not seen the Israeli version of this series but in the U.S. remake “In Treatment,” it is precisely Alex’s (Blair Underwood) inability to voice his buried guilt that constitutes the core of the therapy. Early on, his therapist, Dr. Paul Weston (Gabriel Byrne), recognizes that Alex has an exterior of bravado that conceals a sensitive and, in many respects, guilt-ridden core. He acts blase about accidentally killing Iraqi schoolchildren on one of his missions, but it becomes increasingly evident that this is not the case.

In other words, it is not the absence of guilt that is the problem; it is the transformation of guilt from an unconscious (repressed) feeling into a symptom extreme exhaustion, problems in his marriage, and so forth. Admitting his guilt and, by association, his moral culpability is the crucible on which the therapy will succeed or fail.

The point is, therapy can and does address moral lacunae. I have certainly challenged clients to think through moral or ethical deficits and, in turn, used supervision to reflect upon my own. To suggest, as Illouz does, that this is beyond the purview of therapy is incorrect and supports the assertion made by Levy, Palgi-Hecker and Rolnik that her conflation of widely disparate therapies New Age, CBT, pop-psychology, self-help, life-coaching and psychoanalysis means she can’t see the trees for the forest. While many contemporary “quick fix” treatments may, in fact, conform to Illouz’ cynical rendition, this is most definitely not the case with psychoanalytic or psychodynamic therapy.

Third, Illouz makes a critique of psychology and, by association, therapy, as both an industry linked to powerful economic interests and a worldview. She sets this against a sociological worldview founded in the recognition of a “social unconscious” that is defined by power and interests. She claims to identify the very social forces that operate outside psychologists’ awareness, drawing a strategic analogy with analytic practice.

While I am in broad agreement with her argument here, she fails to consider how psychotherapy is indeed an outcrop of the very social structure she sets up as its opposition. In this, she denies contemporary innovations in sociological theory. Let’s look at this more closely. While it is true that sociologists emphasize the social or collective meaning of individual actions, and the power that lies behind them, it is also true that there is an entire tradition concerned with individual action. As the great sociologist Max Weber observed, the “fact-greedy gullet” of structuralist sociology with its reliance on statistics and social facts often missed the meaning of social action, especially subversive social action.

Another key point here is that structures and institutions are themselves socially produced concepts as much as they are “objective things.” They are derived through sociological study, they are not as Emile Durkheim was at pains to say in his establishment of the discipline observable to the naked eye. Structures of class, gender, race, ability and so forth are discerned (and therefore also created) through systematic study; they are not simply a mirror reflection of “reality.”

This means sociology is a reflexive enterprise that constructs as much as it reflects the social order. This is precisely what is meant, in more recent sociological theory, by “reflexive modernization.” One of the most interesting and compelling directions of the “structure/agency debate” in the light of this theory is that structures are themselves dissolving.

Wherever we look the economy, the family, marriage, the nation-state, the labor market we see accelerated change and a new fluid, mobile, reflexive, globalized, “post-traditional” order. Ulrich Beck and Elisabeth Beck-Gernsheim identify a process of “individualization” running through this change such that our very collectivity is, paradoxically, defined by individualism (not to be confused with freedom).

So, the solidity of structure Illouz speaks of is itself a chimera. Structures are dissolving and reformulating in contemporary society. As a result we are required to make choices about our identity, education, religion, partner, occupation, place of residence, diet, whether to have children and so on. These are not handed to us in the form of nonnegotiable traditions that specify and constrain our place in the world. It’s not only that people want to “get a life,” then, it’s that increasingly they have to.

So, where does psychotherapy fit into this liquid social structure? Its emphasis on self-reflection, on meaning and truth, on realizing one’s potential, on honest appraisal of one’s life circumstances, and so on, is uniquely suited to and, indeed, produced by the demands of modernity. If we are increasingly required to “get a life,” and feel confused, uncertain or undermined in our ability to do so, psychotherapy not only for the sick but also for the well can be of great benefit.

However, Illouz is spot on with many of her points: the problematic nature of redefining normality as illness; the mainstream therapeutic emphasis on “happiness” rather than truth; the medicalization of suffering; the ongoing importance of public expressions of discontent; and, at the more theoretical level, her contention that the neutralization of the emotions of anger and sadness constitute a political problem.

What she doesn’t see, or perhaps realize, however, is how in agreement many, if not most, psychoanalytically oriented practitioners are with her argument. She has largely ignored a growing body of literature by those who challenge these very same problems, albeit from within a psychoanalytic paradigm (I’m thinking of Darian Leader and Robert D. Stolorow on sadness; Allen Frances on the expansion of mental illnesses in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders); Jonathan Shedler on the benefits of psychodynamic therapy as opposed to pills and quick fixes.

It is unlikely Illouz understands the full resonance of what Levy, Palgi-Hecker and Rolnik mean when they say, “Prof. Eva Illouz certainly has the right to join the chorus of those who are not interested in psychoanalytic thinking, but not to turn her blissful ignorance in the field into a tool for a hatchet job on it. This, too, is a matter of ethics.”

Psychoanalytic/dynamic clinicians are on the defensive (ironic, given that Freud invented the concept) precisely because this theory and its associated practice is beyond the infotainment, quick fix, heavily medicalized, pop-a-pill, happiness diatribe that so saturates popular psychology. To be conflated with this is rightly offensive to psychoanalysts, perhaps as much as it would be for a sociologist to be called ignorant in her chosen field of research.

Petra Bueskens lectured in sociology at the University of Melbourne and Deakin University in Australia between 2002 and 2009. She concurrently trained as a psychotherapist and has been in private practice since 2009. She is the incoming editor of the new Psychotherapy and Counselling Journal of Australia and the book “Mothering and Psychoanalysis: Clinical, Sociological and Feminist Perspectives,” forthcoming with Demeter Press in 2013 (an excerpt of Eva Illouz’ “Saving the Modern Soul” is included in the book).

Prof. Eva Illouz
Emil Salman