Below is an exchange I observed whilst a trainee lawyer at a community legal centre between a client in his early 20s who was charged with assault and an experienced lawyer:
Client: I don’t know why I did it, I keep fucking up.
Lawyer: What else is going on in your life? Are you employed?
Client: Not since last year.
Lawyer: Do you use any drugs?
Client: Just weed.
Lawyer: How often?
Client: I dunno, I use it to get to sleep.
Lawyer: Alcohol?
Client: Just parties on the weekend.
Lawyer: I think it would be good to speak to someone about your drug problems.
Client: Ok
Lawyer: If we get a report from your doctor, we could get some idea of options for treatment.
Client: Yeh, it would be good to get some help.
Notice how powerful this exchange is? It neatly frames a ‘cause’ for the client’s anti-social behaviour which the client readily adopts as a form of self-understanding.
This is the power of therapeutic discourse.
Implicit in this exchange are a number of incorrect assumptions: that most drug use is problematic, that substance use explains anti-social behaviour and that problematic drug use is best viewed as a disease to be ‘treated’.
However this therapeutic framing is socially useful because it provides options for mitigating factors in sentencing and it allows the client to construct an understanding of their behaviour where moral blame is shifted to an abstraction like ‘addiction’.
What’s particularly powerful about this kind of language is that everybody means well and the person supplying the therapeutic framing is doing so out of empathy.
Nevertheless, the end result is that the ‘target’ of therapeutic discourse develops a false sense of self.
The tyranny of therapeutic discourse isn’t just limited to people who use drugs (or criminals).
As will be seen below this practice is just as pernicious in constructing the socially marginalised and the mentally “unwell”.
Constructing Social Victims
Reflecting on the client/lawyer exchange, I recognise a similar parroting type behaviour in myself whilst I was in my late teens and early 20s.
As a gay man you are fed (usually via LGBT organisations) a particular narrative about how societies have treated differences in sexual desire and how that marginalisation persists today.
I remember a particular exchange I had whilst an undergraduate in Geelong as part of a political debate on gay marriage, where a heterosexual person said “well I think most people are pretty accepting of gay people these days”.
I was aghast, and immediately responded “How long do you think two gay men would last holding hands on the main street in Geelong before getting harassed?”.
Fear of harassment and physical assault were a huge preoccupation of mine at the time.
This fear was supported by LGBT and therapeutic organisations who would speak of the high number of gay people who had “experienced homophobia” and the “poor mental health” that resulted from such persecution.
It was only when I got older that I realised this fear was greatly exaggerated and that well meaning organisations were using fairly fuzzy statistics to make their case. I often regret the many opportunities for public (often drunken) displays of affection I missed because of an unfounded fear.
Many researchers have begun to pushback back against misery framing of LGBT lives, including noting that:
Differences between LGBT health statistics and the general population are commonly due to factors other than LGBT status.
Perceived or expected discrimination can cause just as much emotional distress as actual marginalisation.
Framing LGBT youth as ‘at risk’ of suicide simplifies the research.
We are seeing a particular proliferation of misery narratives at the moment in relation to trans people.
These include myths that the average life expectancy of a trans woman of colour is 35 years old and that trans women are at an increased risk of homicide.
What’s important to note is that, just like the client charged with assault, most LGBT people readily internalise these narratives because they directly address their fears.
However, the end result is a limited sense of self and unnecessary constraints in how sexually and gender diverse people live their lives.
Mental Illness Without Agency
At their best, categories of mental health disorders are designed to help alleviate suffering. Under the DSM-5, mental illness or “mental health disorders” are defined as:
"[A] syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.”
As many have pointed out, this is largely a social construct designed to delineate types of abnormal thinking styles or behaviour as being worthy of medical intervention.
As a construct, categories of mental illness are well justified at their extremes - in the cases of schizophrenia or bipolar disorder - as opposed to the myriad of mood and personality disorders that now exist.
We have recently experienced a cultural turn in the last few decades of decreasing stigma regarding mental health diagnoses, and a readiness to adopt categories of mental illness by the general population.
This has raised some alarm bells within the psychiatric community that negative human experiences and forms of existential suffering once designated ‘normal’ are now being construed as requiring therapeutic intervention.
As with ‘drug addiction’ or being ‘social victims’ there appears to be an eagerness by people to adopt psychiatric labels (or adjacent psychobabble) and this has an impact on the way people live their lives.
In particular concerns have been raised that ‘mental illness’ is being used to:
Avoid moral responsibility and justify poor behaviour.
Stigmatise eccentricity and transgression from social norms.
Cultivate a sense of powerlessness within Western cultures leading to the growth of a coercive ‘therapeutic state’.
Justify the overuse of pharmacological interventions.
Pathologise rational choices made within the context of poverty.
At this time, it’s incredibly important to reflect on whether current therapeutic discourse is assisting in alleviating suffering or providing limits on the diversity of human thought and expression.
The Problem With Helping
The proliferation of therapeutic discourse in modern societies is a cause for concern, precisely because it is a language generated from compassion, and by scientific and seemingly morally sound institutions.
However, as philosopher Michel Foucault put it:
The real political task in a society such as ours is to criticize the workings of institutions that appear to be both neutral and independent, to criticize and attack them in such a manner that the political violence that has always exercised itself obscurely through them will be unmasked, so that one can fight against them.
Overall, the most pernicious forms of social coercion are practices which people eagerly adopt for themselves.
You may find The Myth of Mental Illness by Szasz of interest. I read it in 1975 and it was eye opening. the 1960s book challenged all psychiatrists to review their whole foundation. “The historian Lillian Faderman called the book the most notable attack on psychiatry published in the 1960s, adding that "Szasz's insights and critiques would prove invaluable to the “homophile“ ( we now say LGBTQI) movement."