In one of his missives against organized religion, Christopher Hitchens decried the concept of original sin as declaring humanity “created sick and commanded to be well.” Has this idea mutated into its even more horrifying inverse: that we’re born well and commanded to be sick? What if nearly the entire superstructure of parenting, popular culture, media, governance and the medical community has convinced generations of Americans that they’re feeble, helpless and weak?
We’re often told that we live in the grip of a “mental health crisis.” If one casually engages with this point, along with the usual statistics, it seems like common sense. What kind of monster would deny the suffering, anguish and torment endured by young people under the weight of anxiety and depression?
But there’s another possibility: a collapse in most people’s ability to live economically stable and dignified lives buttressed by stable bonds of family and friendship. This entails a crisis of social issues, resources and distribution that roll up into a crisis of meaning, of which mental health is only a constituent piece. Aside from neurochemical and genetic cases that arise regardless of circumstances, mental health problems are often a by-product of these larger forces, not always their root cause.
This gets to a concern many Americans now have about their medical system, writ-large: so long as a doctor manages a patient’s symptoms well enough, there’s money to be made in keeping them sick. And so long as you keep Millennials and Zoomers entranced by our vacuous conception of mental illness, there’re entire industries with a stake in keeping them ignorant of larger social problems. These industries rely on therapy culture to quietly enforce the narrative of fragility, the need for credentialed professionals at every level of society, and the demand that we “spread awareness” of this or that type of illness.
The mental health crisis is not a diagnosis. It’s an injunction.
Therapy culture feigns a solution to social and political problems by reframing them as mental health problems. Through this self-perpetuating sleight of hand, it actively worsens the problem by manufacturing new ailments to justify its existence. Additionally, it overloads and asks the impossible of actual therapists, psychiatrists and social workers. It’s a poisoned band-aid on a gunshot wound. The poison may contain a numbing agent, but it only obscures and worsens the existing injury.
It needs you to look away from the collapse of meaningful work and the decline of adult social life. It needs you to think this is just the way things are, and if that upsets you, well, maybe you should go see someone about it, read this stupid book, or take these fucking pills. Therapy culture needs you to think that it’s the only option.
It isn’t.
I’m not speaking from a position of ignorance. I struggled with horrific bouts of anxiety in my late-teens, with some moments later on. These mostly revolved around relationships, fear of social humiliation, and moments of uncertainty. My symptoms were usually spurred on by a specific situation, and involved racing thoughts, intense chest pain, loss of appetite and an inability to focus. At its most extreme, this led to anorexia and suicidal thoughts.
There were a variety of factors that played into this, but my family situation was the most salient of them. True, with my regrettable childhood oversensitivity and impatience, maturation and socialization was always going to bring its challenges. But things didn’t need to get as bad as they did. My parents separated when I was in grade school, got back together, and then split again for good when I started high school. While the initial separation made me very sad, the final announcement left me almost apathetic. I knew I’d be okay. I was more sorry for them. Besides, by then I already knew who I was, what I wanted out of life, and was content not to get mixed up in my parents’ bullshit.
At the same time, however, I had this indescribable force inside me saying: “You’re not okay! You’re supposed to be destroyed by this!” I was tempted to play the part of the “kid from a broken home.” Was I looking for attention? Was I looking for some kind of meaningful emotional affirmation? Perhaps a bit of both.
And maybe I was influenced by the cultural narrative around divorce and family breakdown that developed by the early-2000s, when I was an adolescent. It went like this: the surge in divorces among the Silent Generation and the Baby Boomers in the 1970s and 80s “really messed up” Generation X. Therefore, you’re going to be “really messed up” if you go through it, too. But this story about GenXers was always a distortion. The mythos around Kurt Cobain, for example, as a tortured, sensitive artist was clearly an oversimplification and exaggeration, as was his anointment as the “voice of a generation.” Cobain’s artistic vision was always draped in layers of irony and cynicism, and turned a hostile eye to the self-obsessed pieties of the Boomers. I’d argue that this dissonance between reality and image contributed to his suicide. It’s the dissonance between seeing yourself as the star in the grand drama of “your story” for all to see, and the chorus of Nirvana’s “Serve the Servants”: “That legendary divorce is such a bore.”
My parents’ split was a huge bore as well. Or at least it should’ve been. I grew up upper-middle-class in a safe and affluent town, attended great schools, never went hungry, and had plenty of hobbies, aspirations for the future, and good friends. My friends would hear me out, but they encouraged me to be strong and matter-of-fact about what I was going through. They didn’t just hand me uncritical validation.
Through much of high school, I was still encouraged by one side of the familial partition to think of myself as “a hard case” or as someone who “had issues.” I was explicitly told several times that I’d “struggle with my issues for the rest of my life.” I was told repeatedly that I was “angry at” one or the other parent, that I had “trust and abandonment issues,” and that I’d end up “just like” one of my parents, no matter what.
There were long, drawn-out discussions in which I was interrogated about my feelings: “Just tell us why you’re angry.” I’d do my best to convince them I was fine, but nothing worked, it either was perceived as me withholding information or trying to hurt their feelings. I developed an entire mental architecture of habits and thought patterns to cope with this. Eventually, I had to start making things up, just to make it stop, so I wouldn’t be in trouble again, to satisfy people who wanted me to think of life like they did: one never-ending group therapy session.
I started to believe it was all true: that I hated one of my parents, that I had irrevocable issues that would haunt me forever, that I was doomed to face the same situations in the same way. Worst of all, I started to act it out, especially once I left for college. This phenomenon has been well-documented by Jonathan Haidt and Greg Lukianoff in their 2018 book, The Coddling of the American Mind, in which they say (emphasis my own):
“Applying labels to people can create what is called a looping effect: it can change the behavior of the person being labeled and become a self-fulfilling prophecy. This is part of why labeling is such a powerful cognitive distortion. If depression becomes part of your identity, then over time you’ll develop corresponding schemas about yourself and your prospects (I’m no good and my future is hopeless). These schemas will make it harder for you to marshal the energy and focus to take on challenges that, if you were to master them, would weaken the grip of depression.”
Through these cognitive distortions, I created real problems in friendships, romantic relationships, academic performance, and my physical health. I took things personally, overanalyzed everything, and created stupid drama for no reason. The prophecy certain people drilled into me would be fulfilled, for a time.
I entered therapy in the middle of college. My therapist was genuinely helpful and caring, and was measured about ascribing “disorders” to her patients. Her methods were a blend of cognitive behavioral therapy (CBT) and a variety of other schools of thought. She wouldn’t just affirm (or “validate,” that sickening transactional term used today) what I was feeling. She’d explain the potential reasons why. She was apprehensive when I expressed an interest in anti-depressants. Even the prescriber down the hall expressed caution.
Regardless, I started taking an SSRI. And I did feel more even-keeled. There was a sick sense of solidarity and meaning I felt in the process, a sense of kinship with others who had to “take their meds.” For a while I wouldn’t shut up about it. But eventually, a foggy malaise set in, a sort of bland carelessness. The following summer, I neglected to renew my prescription and went through withdrawal symptoms.
The gentleman I consulted informed me in a kindly manner: “Yeah, don’t do that again.” I inquired: “Am I supposed to be on these for the rest of my life?” He responded by nodding vigorously: “Listen, we can’t fix your hardware, okay? We can fix your software! We can juice you up! But no, y’all got to stay on your medication.” This man didn’t know me, my history, or any other relevant context. And yet he was willing to tell a 21-year-old in withdrawal that he was going to be dependent on meds for the rest of his life. I quake in horror at what today’s college students are told. Back into the numbing mist I went, which probably worsened the depression I entered in my last year of college.
However, in one of my last therapy sessions, I had a major epiphany: a big driver of my anxiety was the feeling that I couldn’t say what I really thought or take decisive action to resolve a situation. I’d grown too afraid of upsetting others, and cautious to the point of social paralysis, and this suppression resulted in anxiety. This revelation of learned helplessness, along with some CBT methods, left me a bit better off once I permanently got off the meds soon afterward.
Post-college life brought experience, maturity, the passage of time, a very helpful and honest spouse, and some important discussions with my other familial faction that changed my perspective. I can remember having this freeing realization, like I had woken up from a really long nightmare. At some point in my late-20s, it was as if my old, non-polluted self had returned. Some of my personality traits, long suppressed for fear of upsetting the wrong person, returned. Being an angry, overgrown adolescent just got lame. And if you convince yourself that you despise one or both of your parents, you’ll never actually grow up.
I never hated either my parents. Is the whole thing sad to think about? Sure, if I choose to dwell on it. But am I permanently and irreparably scarred by “my dark past?” No. Am I angry about “what happened to me?” No. Barely anything happened. I had it so good. So many people have had it so much worse than me and didn’t engage in the BS I did.
It’s that I was made to feel angry. Imagine what those 10 years would have been like if I had been left to just grow up without this garbage in my head. Now imagine this story scaled to the entire country.
Psychiatry is an honorable profession. Medications have significantly improved the lives of millions. I have nothing but respect for your cousin trying to develop a new drug to help ease someone’s pain. I’m not advocating for a return to just “sucking it up” or strapping on the electrodes. There’s no shame in seeking help, and we should be thankful to individuals who seek to provide it.
This isn’t personal.
The psychiatric industry, its constituent pressure groups and academic departments, and its cousin in the pharmaceutical industry comprise an economic class, with its own set of interests, incentives and motivators. How does this class reproduce itself within the prevailing set of economic relations? By treating patients through consultations, appointments and prescriptions, and teaching courses, producing books and lobbying politicians. Their existence as a profit-making industry is contingent on the accepted existence of disorders, and the presence of people who need treatment. Aside from workers who produce medicines or print the physical books, this class is mainly tasked with overseeing an institution, not the production of a tangible commodity. This places them squarely within the professional managerial class. For simplicity, we can refer to this grouping as the therapeutic industry complex (TIC).
Ashley Frawley, the Canadian researcher and lecturer, has observed a “growing class of people whose reason for existence is discovering new problems for which they claim to have the expertise to solve. It goes back to self-esteem, happiness, wellbeing, and now mental health.”
This is particularly relevant to the United States, with its mostly profit-driven industries of medicine and medical insurance, delivered as commodities rather than public services. Relevance and survival in this sense requires innovations that necessitate new ways to meet the demand for a particular good or service, thus justifying its continued production and exchange. Car companies create new models each year to meet consumer demand for transportation. Breweries come up with new iterations to foster new ways to get hammered. And so on.
There are people who stick to the same type of beer and who purchase it in consistent quantities over time. And I know a dude who made his car last for 300,000 miles. But you can only grow your margins so much with a core consumer base. Investors and shareholders will get frustrated and the pressure will be on to create disruptions in the marketplace that spur on more consumption.
Likewise, human life will always produce a certain amount of people who need lifelong care. But let’s face it: most people don’t need therapy. And most people who need it won’t require treatment on a consistent basis for their entire lives. To create a profitable therapeutic industry, you need a surplus stock of misery to cater to and perpetually redefine.
The economic and cultural shifts of the past 60 years, positive as many are, have displaced people through deindustrialization and led to social atomization. Those on the harshest receiving end of these trends understandably feel anxious, depressed and hopeless. A lot of them cope with drugs and alcohol, develop adaptive neuroses, and some even kill themselves. This is especially acute among poor and working class people, but extends to a steadily less secure professional class.
Again, the best clinicians understand this and try to steer their patients toward getting their lives in order, holding a decent job, mending relationships with their families, and reforming their own habits. But these efforts can only go so far on a collective level. It’s probably helpful to have a stoic attitude about the world coming apart. But that doesn’t stop the world from coming apart.
The wider world of pressure groups and monied institutions have innovative ways to obscure the underlying social problems that’ve produced this surplus of misery. The “crisis of self-esteem” was a particularly laughable one, which permeated many institutions from the 1980s into the 2000s until it was so widespread that it lost its potency and usefulness. In a piece for New York magazine, Jesse Singal described how:
The self-esteem craze changed how countless organizations were run, how an entire generation—millennials—was educated, and how that generation went on to perceive itself (quite favorably). As it turned out, the central claim underlying the trend, that there’s a causal relationship between self-esteem and various positive outcomes, was almost certainly inaccurate.
The idea of “believing in yourself” and having a “positive self image” being the key to success has been thoroughly discredited. But in the intervening years, a lot of consultants got paid, a lot of really bad books were sold, and a lot of vapid and hollow platitudes were pushed on kids like me. And like Romero’s legions of the undead, the mechanism of novelty keeps coming back with new innovations: “happiness” as a measurable quantity, “grit” as a way of getting ahead and the suburbs’ current mental lube of choice: “mindfulness.” In the same interview cited earlier, Ashley Frawley gives an example of how certain interest groups play a role in this phenomenon:
“Advocacy groups actually started to define mental ill health in more expansive ways. That’s what happened. The ability to claim 80% of students were suffering from mental ill health was accomplished through the inclusion of stress. Show me a student that isn’t stressed out. That used to be part of the experience. And now we’re encouraged to think about that as a mental health problem.”
This is dangerous and disempowering to young people, and has long-term consequences for the rising generations of adults. A frightened, insecure and nervous polity can very swiftly become intellectually servile and easily manipulated. Christopher Lasch, writing in 1979, saw this germinate in real time, and described it in damning terms in The Culture of Narcissism (again, emphasis my own):
“The popularization of therapeutic modes of thought discredits authority, especially in the home and the classroom, while leaving domination uncriticized. Therapeutic forms of social control, by softening or eliminating the adversary relation between subordinates and superiors, make it more and more difficult for citizens to defend themselves against the state or for workers to resist the demands of the corporation.”
Perhaps the most frustrating part is how so many people are willingly going along with it. It doesn’t have to be this way. As the writer Oliver Bateman put it recently, “I know we’re all broken people, in broken bodies, but life is about repair and reconstruction, not commiseration.”
The ultimate challenges of our time are: people need to achieve a dignified standard of living; they require a modicum of family structure to provide stability and the passing down of wisdom and traditions; and we need to strike the right balance between individualism and community for people of different persuasions.
We’ll need some real political will to rebuild an economy that generates broadly shared prosperity. It’ll take some creativity to reframe the importance of family life, and individuals’ ability to adapt to them. And it’ll take changes in our habits to rebuild community life, construct a healthier attitude to social media, and reinvigorate what Ray Oldenburg once called “the third place”— hat haven of bars, cafes, libraries, parks that provide a civic space outside of the home and workplace.
I’m not equipped with grand designs. Barring some radical restructuring of the American medical system, this faceless entity will march forward like so many others in our economy, using each crisis to further legitimate itself. In the course of these events, good practitioners will be overwhelmed with legions of patients gaslit into thinking they’re out of options, until something causes it all to collapse. And like recycling that one can of Pepsi (because it’s all you wanted, right?) won’t stop climate change, individual fronts of stoicism won’t shift the culture in a positive direction.