As spiked readers will be aware, the redefinition of medicine as the rather more broad concept of ‘healthcare’ and the subsequent growth of ‘psycho-politics’ - both on the radical fringes of society and within the buttoned-down institutions of the establishment - is a growing concern for many, not least within the medical profession itself. What The Quest for Mental Health brings to the table is a history of how we got where we are.
Speaking on the telephone from Canada, Dowbiggin says that what he dubs ‘therapism’ is one of the largest growth areas not only in medical practice, but in society itself. There is no longer an understanding of the boundaries between emotions and mental illness.
‘It cannot be that we are getting crazier as a society. It has to be the vast expansion of the category. What I set out to do is look at the historical — I’m a historian, not a clinician — roots of the situation we are now in, in the twenty-first century: the world is more and more dominated by everyday feelings being redefined as health issues.’
The historical scope of The Quest for Mental Health is indeed impressive. Starting with the de-institutionalisation of the mentally ill and moving through developments in psycho-pharmacology and politics, including the rise and fall of psychoanalysis, the development of new medicines like selective serotonin re-uptake inhibitors (SSRIs) and alprazolam (Xanax), the expansion of psycho-medical diagnoses and the self-help movement, Dowbiggin may have written the closest thing there is to a definitive history of the psychiatric assault on the self. The kicker is, we have been complicit in this very assault.
Dowbiggin steers well clear of conspiracy theories, noting, ‘Historically, consumers of mental health services have been far from passive.’ He does remind us, however, of the role of pharmaceutical companies, politicians, activists, psychiatrists and others in promoting the diminished view of the self that therapism simultaneously encourages and seeks to cure. In describing therapism, Dowbiggin is talking about no one single strand of psychiatric treatment but about a wider growth of the presentation of all personal problems as medical issues that invite professional intervention.
‘No doubt there is intra-professional rivalry between psychiatry and psychology’, he says. ‘They both claim they have the therapies that work, but they are united in that they have the same goal: saying “You’re better-off in the hands of a licenced professional”.’
In this, he perhaps does not go far enough. Many advocates of traditional talking therapies - such as counselling, gestalt and psychoanalysis - disparage cognitive behavioral therapy (CBT) as a ‘quick fix’. In turn, talking therapists in general tend to dislike the prescribing of medicines. He is correct, however, that psychologists, psychiatrists and counsellors share a belief that ever more people are in need of professional help.
On the matter of individuals, Dowbiggin’s complaint is not with anyone who feels the need to seek help for their problems, so much as with the policy agenda among doctors, therapists and politicians who promote increasing external intervention in people’s lives.
‘All of us knows somebody who has had some form of mental health care and, I think it’s safe to say, most of us have met someone who has been helped with it. The problem is the macrocosmic issue where we have soaring rates of mental illness’, he says. Indeed, for Dowbiggin, one of the problems with the culture of ‘therapism’ is that it undermines the help that should be available to the seriously mentally ill, saying: ‘We’re still at the frontiers of knowledge with [conditions like] schizophrenia. One of the great tragedies of therapism is the worried-well consuming resources while people with serious illness fall through the cracks. Once again, the needs of people with severe mental disabilities are being ignored.’
The question of individuation and social atomisation is central to Dowbiggin’s book. As community has contracted we have not seen the unleashing of the potential of strong and vibrant individuals so much as a growing perception of human frailty. ‘Individuals feel abused, alone and alienated, so where do you turn?’, he says. Naturally the answer is that we turn to whomever promises us help and, today, more often than not, this means professionals of some kind.
In some regards Dowbiggin appears to be a conservative thinker, but as Neil Davenport recently argued , the intellectual demise of modern conservatism is nothing for liberals to be triumphant about. Moreover, the powerful cultural actors at work here run the gamut of bogeymen of left and right, from pharmaceutical companies and the medical profession to para-medical professionals such as psychologists, government-body employees and others. What they have in common is a belief in the positivity of managerial control. ‘Officialdom in corporations, government, law and education’, writes Dowbiggin, ‘praises this shift in policy as not only a benign but a positively enlightened and overdue reform for society that above all else views personal emotions as the key cause of all social problems including poverty and crime’. If the promotion of such a preposterous idea — that social ills are a result of personal emotional problems — fails to raise liberals from their slumber, then perhaps nothing ever will.
It would be a terrible tragedy if therapism was awkwardly shoe-horned into the left-right political axis when, in fact, what it represents is nothing less than a transcendence of these categories to create what may be the worst of both worlds: individualisation of social problems married to a disregard for personal responsibility.
In conversation Dowbiggin contends that the decline of active church membership is leaving people with a diminished moral framework for understanding themselves and the world they live in, as well as weakened social networks. This is clearly true, but it comes as little succour to any of us lacking faith and who may also seek to re-establish entirely voluntary associations. A recent edition of the Irish Political Review , a small and iconoclastic left-wing newspaper, declared its ‘instinct is to defend social institutions, even conservative ones such as the Catholic Church, that mitigate the effects of the market’. This is a view I have a certain sympathy with (at least from a specifically Irish point-of-view where the Catholic Church is now routinely blamed for all of the country’s ills, many of which would be better understood as failures of the machinery of state). That said, I do think market economics alone are far from being the sole cause of contemporary individuation and alienation.
In addition, organised religion is far from being the only popular organisation in decline. In fact, it is difficult to come up with a single example of any organisation, of whatever political stripe, that isn’t in free-fall. From trade unions to youth sports teams, from the Scouts and Guides to mutual and friendly societies, the collective organisations of the past all appear to be hollowed-out shells of their former selves.
Unlike churches, however, trade unions appear to be beyond repair. Believers can freely recommit themselves to their institutions and seek to build strong bonds, but where is one to go to seek secular community? Plenty on the left noticed that, during the 1990s, trade unions offered increasingly individualised services to members, from legal mediation through to complaints about health and safety overtaking issues of pay and conditions, reaching their nadir with union-branded credit cards and loans. What many appear to have missed is that the very redefinition of industrial issues as individual ones was at the heart of this change. That this followed a period of devastating defeat for the labour movement is not surprising, but today issues like unemployment are more likely to be greeted with offers of counselling than the promise of a new job.
Additionally, communities are themselves not entirely positive in character. Along with providing a much-needed sense of belonging and stability, they can also be cloying and even crushingly conformist. There is a reason young people have often sought to leave rural and suburban homes for the bright lights and endless possibilities of big cities, even if many return when older, in search of a lower cost of living and slower pace of life.
The increasing use of the welfare state as a method of social control – surely one area that left and right alike should find alarming — also has a major role to play in the growth of therapeutic models of society. ‘The phrase “emotional welfare” is becoming increasingly popular. Governments are getting out of the business of providing material welfare and into the business of emotional welfare’, says Dowbiggin.
In relation to this, I was struck by recent debates in Britain over the role of welfare in society. Some claim that the Tories have declared war on people previously considered too sick to work, but it is worth noting that it was under the Thatcher government of the 1980s that people were first declared unfit for work — an act of economic legerdemain designed to disguise mass unemployment. That the left today seeks to defend people’s right to be declared useless is itself rather bizarre.
In effect, we have been promised liberation, but what we have actually received falls well short of it.
One of the most interesting points in Dowbiggin’s book is how certain strands of feminism responded to psychiatry, first with outright hostility, then later with acceptance and wholesale adoption of the therapeutic paradigm. ‘The late Betty Friedan was a strident critic of institutions she says medicalised women and then reaches for psychological language’, says Dowbiggin. Feminism does appear to have a case to answer for its contemporary acceptance of what amounts to the claim that women are psychologically incapable of coping with life. Were I a woman I should certainly prefer the older line of ‘stop trying to medicalise, and therefore wash away, my legitimate complaints about society’ to the modern refrain that women are traumatised by modern life — or the idea that Prozac is a ‘feminist drug’.
Dowbiggin notes how in 1971 Ms. Magazine drew attention to the ‘potential of Valium [diazepam] and other drugs to produce dependency’. This is not untrue, but fashions clearly change in medicine: today getting diazepam from many doctors is akin to getting blood from a stone, despite its proven efficacy in dealing with anxiety.
Feminism’s contradictory response to psychiatry - on the one hand declaring it to be a form of dehumanising oppression of women, while simultaneously developing its own psychoanalytic tear-downs of male power and even attempting to develop feminist group therapy - is illustrative of a broader pattern which emerges while reading Dowbiggin’s book: a definite politico-cultural process is at work, but it does not necessarily travel in a straight line – and many a strange bedfellow is to be found as it develops.
Beyond the women’s movement, it is hard to escape the sense that the entire organised left has some soul searching to do about its abandonment of traditional economic and industrial matters in favour of the conflicting and often inchoate cultural criticism and increasing claims of victimisation it makes today. When Dowbiggin writes, ‘Once states were geared primarily toward economic production, but in the twenty-first century experts hailed the reorientation of governance in favour of meeting the emotional needs of vulnerable citizens who struggle to cope with the demands of life’, he could be describing the late Blair and Brown governments , the supposedly edgy Occupy Wall Street movement or, let’s not let capitalists entirely off the hook, the financialisation of the economy .
Not every concept raised is helpful: Who says women can’t have it all, for instance? Why shouldn’t they? The notion of ‘affluenza’ also rears its head. But while dissatisfaction with shallow consumerism is perfectly reasonable, Oliver James’s conception of a ‘malaise linked to rising levels of material prosperity’ fits the concept ‘diagnostic bracket creep’ as neatly as any pseudo-illness to be found in the ever-expanding Diagnostic and Statistical Manual of Mental Disorders.
These criticisms aside, Dowbiggin’s history is an excellent one that raises questions that must be answered urgently. Outside of offering the possibility of biological and neurological treatments for serious mental illness, the book is long on admittedly much-needed criticism of creeping intervention in private life, but short on solutions. Putting this directly to him, Dowbiggin agreed but says he is a historian and the reader may choose to make their own interpretation.
In conversation, though, he does offer a prescription for our anxious ills: ‘ A solution would be for us to recover our sense of community and rediscover a new stoicism ’, he says. ‘ If we continue on this road we’re only going to become more governed by the professions and the state .’