Recently k-punk wrote a post entitled Be Positive… Or Else, in which he points out the association between the positive-thinking ethos of cognitive-behavioral therapy, or CBT, and neoliberal capitalism. In his post k-punk links to this article by Lacanian psychoanalyst Darian Leader. Since k-punk’s blog doesn’t support comments, I’m simultaneously emailing him my response and posting it here…
There’s empirical evidence supporting CBT’s effectiveness in reducing symptoms, but in most cases the results aren’t any better than for other therapeutic praxes. The same holds true for psychoanalysis: it achieves neither better nor worse symptom reduction on average than other therapies. Therapists with more training and experience don’t get any better results than novices. In fact, just having a sympathetic person to talk with on a regular basis is nearly as effective as going to a professional in achieving symptom relief. On the other hand, any treatment is better than no treatment: symptomatic individuals who are left on waiting lists typically show no improvement, whereas any treatment modality yields significant and fairly sizable symptom reduction. (See e.g. Creating Mental Illness by Horwitz for summaries of effectiveness studies.)
Darian Leader wants to listen to symptoms instead of just treating them, and that’s fine. But he expects the symptoms to tell him to look inside the self for clues about their causes and their possible resolution. In this respect psychoanalysis and CBT are allies: both modalities regard the self as the source of his or her own misery. So too does neoliberalism: if you suffer from economic symptoms like unemployment or poverty or alienation it’s your own fault. The cause may be a shallow one correctable by quality improvement techniques or coaching, or the individual may be hamstrung by deeply rooted flaws that will take a long time and a lot of money to correct through retraining or serious attitude adjustment. But make no mistake: it’s your individual problem.
That establishing a relationship with an untrained but sympathetic listener can help alleviate psychological symptoms provides evidence compatible with Leader’s observation about how therapy works:
[T]herapy is not like a plaster that can be applied to a wound, but is a property of a human relationship. Therapy is about the encounter of two people.
If establishing this sort of interpersonal relationship can be curative, might not the lack of relationship be causative? I believe it is. Individuals are the basic economic unit of neoliberal capitalism. While individuation seems to promise unfettered freedom to pursue one’s own version of the American dream (even if you’re not American), people find themselves increasingly isolated from one another. This of course offers a strategic advantage to capital: isolated workers don’t organize themselves; isolated consumers can exert no leverage in driving down costs or improving quality.
The economic threat posed by letting psychological symptoms speak is that the symptoms will direct people’s attention not deep inside themselves but outside, to socioeconomic conditions that provoke depression, anxiety, rage and alienation as natural reactions to sick situations. It turns out that the same psychotherapeutic techniques work equally for all these conditions. It also turns out that the same mood-enhancing medications are prescribed for all of them. Leader regards this convergence as evidence that diagnosis isn’t all that important, that the same underlying intrapsychic condition can manifest itself in a variety of symptoms. But couldn’t the same conclusion be drawn if you listen outside the self for causes? Workplace stress, alienation from coworkers and customers, exploitation by management and capital; the pressure to compete as worker and consumer; the nearly universal demand for presenting a facade of relentless optimism, as k-punk cogently observes; the expectation that you can buy your way into happiness; isolation from others in the community and even from one’s most intimate friends — aren’t these ongoing external sources of unhappiness at least as likely to cause symptoms as are traumata experienced long ago in infancy? If we let socioeconomic symptoms speak, if we experience a collective return of the repressed, what sorts of interventions are liable to suggest themselves?