Are We Better Yet?
Americans have long been in love with the idea of psychotherapy. When Sigmund Freud made his first and only visit to the United States in 1909, American intelligentsia flocked to his lectures. Since then, psychotherapy has spread like kudzu, morphing from the medical treatment of specific, diagnosable mental illnesses into a sort of societal support system offered by psychiatrists, psychologists, counselors, therapists, self-help gurus and TV talk show hosts.
“Seek professional help” is our standard answer to everything from episodes of psychotic rage to dating problems, and “self-help” has become its own industry. We use terms like “manic depressive,” “obsessive compulsive” and “neurotic” to describe the most benign, everyday sort of behaviors.
And should true tragedy occur, the psychologists and counselors are there on the front lines, elbowing out the friends and clergy if not the paramedics. No other area of science or medicine so informs our national discussions or perceptions of who we are and who we should be.
But is it working? Are we getting any better? Is our mental health improving? And is our increased self-awareness benefiting society?
“It’s difficult to gauge, compared to other parts of medicine,” says Rochester, N.Y., psychiatrist John McIntyre. “There’s no question that treatment of specific mental disorders is very effective--the efficacy rate is often higher than in other medical procedures. But when you broaden it to other issues, it gets fuzzy. It’s had the overall beneficial effect of increasing knowledge of human nature, but are people better? How do you measure that?”
There is no arguing the fact that psychotherapy and psychiatry have improved the lives of millions suffering from often devastating chemical and mental imbalances. And, certainly, Freud had no personal illusions about transforming the human condition. He was content, he once said, to turn people’s “hysterical misery into ordinary human unhappiness.”
But here in America, we want to teach the world to sing, in perfect harmony. And so we look to psychology to provide us with answers and solutions to everything from a president’s mendacity (there was that abusive stepfather) to relations between the sexes (which planet am I from again?) to a baseball player’s overt racism and homophobia (don’t fire him, send him to a therapist).
According to Surgeon General David Satcher, the next decades will put the effectiveness of psychotherapy and psychiatry to the test. One out of five baby boomers can expect to suffer a variety of mental disorders, from substance abuse to late-onset schizophrenia, while almost 21% of children ages 9 to 17 suffer from diagnosable mental disorders.
But measuring a nation’s mental health is a difficult thing to undertake. One traditional method is to look at a society’s tendency toward “social deviance”--its rates of crime, divorce, suicide, drug use and out-of-wedlock births. Most of these have decreased in recent years, although the divorce rate is significantly higher than it was even half a century ago.
But how valid are these numbers as indicators of mental health?
“Crime is not a good measure because there are a lot of social and economic reasons for crime,” says Wendy Kaminer, pop psychology critic and author of “I’m Dysfunctional, You’re Dysfunctional” and more recently “Sleeping With Extraterrestrials.” “And to use divorce, well, if you have a sick norm [of troubled marriages], what is mentally healthy? To conform or rebel?”
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Even using drug use as an indicator of mental instability is dangerous, she says, because there are many possible reasons for drug abuse--many in the scientific community believe the propensity for abuse is genetic.
While Kaminer says she does not for a minute discount the importance of self-knowledge, she doesn’t think anyone gets such a thing from the pop psychology that pervades our culture.
“I begin with the belief that a lot of pop psychology is not aimed at getting people better but keeping them self-involved,” she says. “The basic message is one of happy endings--that everything happens for a good reason. And this doesn’t make people better. It makes them callous, makes them blind to tragedy and loss.”
Not that we, as a society, aren’t improving in many ways. Kaminer believes we have become a more just society, and even a more moral one.
“We have more racial justice, more sexual justice, more rights for gay people,” she says. “But this did not come from psychology. This came from political movements.”
Political movements have a complex relationship with the psychoanalytical movement. At one level, political movements by definition reject the psychological paradigm, their premise being that discontent stems not from our selves but from the System. On the other hand, Freud’s identification of the id and the unconscious had a profound effect, particularly on the youth movements of the ‘60s and ‘70s.
“The id really came out in the ‘60s,” says Peter Wolson, a Beverly Hills psychoanalyst. “Suddenly, the thing is to be happy, not to lead a good life. Have fun, have orgasms, and this leads into the ‘70s and ‘80s, which is about getting ahead, still about ‘me,’ and then you have a backlash, mainly from fundamentalists. But even the backlash is very self-centered, very much of the id.”
Wolson believes that society has simply traded one set of mental illnesses--neuroses stemming from repression--for another--compulsive disorders and narcissism. And while he sees therapy as a solution for these troubles, he cautions that the commercialization of psychology has given people false ideas about what therapy really is.
“On an absolute scale, we have become more introspective, more psychologically aware,” he says. “But good therapy is about fundamental change, and many people are still afraid to confront themselves, their demons and be objective. We want a quick fix. We want no guilt. But without guilt, we are not a civilized people. Guilt got a bad name--we need to see the consequences of our actions and do something to change. We need to help people feel guilty about greed, about hurting others.
“Freedom,” he adds, “can be psychopathic.”
The United States has a long, complicated relationship with the culture of self--with self-government, self-actualization, self-discovery, self-aggrandizement. We celebrate nonconformity in a way that absolutely defines conformity and claim to treasure individualism while mass-producing more products than any other country in the world. “I gotta be me,” we say, and if that “me” doesn’t work out, well, we’ll just try on a new one.
Psychology seems to provide both the means and the motive for the culture of self, and therein lies its greatest strength and its greatest failings.
“In a way, psychology has replaced religion,” says David Blankenhorn of the Institute for American Values, based in New York. “It is who we are, the air we breathe. And it can truly help people who suffer and can yield important insights. But the assumptions of the paradigm are so relentlessly centered on self, all other structures of meaning and authority evaporate. ‘What do I want?’ becomes the governing question.”
Much of Blankenhorn’s work centers on marriage and fatherhood, two areas greatly affected by the mass marketing of psychological theories in very different ways.
“For men, there are clearly advantages,” he says. “They are more able to express emotions. Most fathers today hug their children and say, ‘I love you.’ For our fathers and grandfathers, such emotional intimacy was not there, and there is a whole generation of men walking around wounded from that.”
But while fatherhood has benefited, he says, marriage has not.
“If talking about marriage and relationships was the basis of good marriage and relationships, we’d have the best in the history of the world,” he says. “But they are now more fragile than they have ever been. Men and women seem unhappier with each other than ever.”
Blankenhorn sees a transformation of marriage from a social institution to a private psychological relationship.
“Our parents and grandparents expected to conform to marriage,” he says. “Now we expect marriage to conform to us. But that doesn’t seem to be working either.”
His main concern, he says, is the tendency among Americans to embrace the tenets of psychotherapy as the One True Answer.
“I object to turning it into a philosophy of life. To imply that there are no moral purposes larger than the self is, I believe, empirically false,” he says. “And it doesn’t deliver the goods, it doesn’t lead us to being happier, to love and be loved, to make a contribution to society--and that’s what people want.”
Of course, Freud argued that it is pointless to try to make people happy because that’s not what they want. Yet happiness seems to be the carrot at the end of psychology’s stick--if you know yourself, you can change yourself and you can be happy. All the time. The creation of such expectations may be one of the psych-culture’s greatest drawbacks.
“It’s a mixed blessing,” says University of Washington sociologist Pepper Schwartz. “We’ve hugely increased our sensitivity to each other. We understand, for example, how much damage words can do. More people take responsibility for their actions, and if they don’t, someone makes them. But we’ve also created whole new categories of what people should worry about, hundreds of new ways in which we can fail or people can fail us.”
Our expectations from relationships have become much higher.
“Just look at the area of sex therapy,” she says. “We have a hundred new ways to create inadequacies.”
On the other hand, we have become more informed consumers, of theories as well as products.
“It used to be if Dr. So-and-So said something in the newspaper, readers would assume it was true,” Schwartz says. “Not anymore. An easy example is how we have examined and rejected corporal punishment.”
Like Blankenhorn, Schwartz believes the successes of the psychological movement are most evident in our attitudes toward parenting.
“If nothing else, I know we’ve made better fathers, although the numbers of fathers who leave is an area where we have possibly slid. But the ones who stay are much more participatory. No one’s shocked to see a man in the grocery store alone with his kids. When I was a young woman, you would have assumed the mother was dead.”
But again, are such changes the result of psychologically increased self-awareness, or the women’s movement?
“The only real answer to ‘Are we better yet?’ ” says Kaminer, “is, ‘We don’t know yet.’ ”
Mary McNamara can be reached by e-mail at mary.mcnamara@latimes.com.
