The Therapeutic Turn

by Theodore Dalrymple

When I meet old acquaintances, we talk first about our aches and pains; second, we observe the lamentable state of the world; and last, but not least, we descant on our own good fortune not to be young these days, for to be young is far harder than it was in our time. As children of the middle class, we grew up in some kind of golden age.

Not that we appreciated it. Complaint springs eternal, and good fortune is evident only in retrospect. But our advantages were many. For example, we completed our education without an enormous burden of debt, a career path was more or less laid out for us, a lifetime of stable and reasonably well-paid employment beckoned, and we had no fear of having to work in a job that would not, in our estimation, reflect our educational level. Asset inflation had not yet turned rent into the largest item of personal expenditure by far, nor was buying a house without parental help beyond the bounds of possibility. Rising prosperity seemed almost a law of nature.

Youth, adolescence, and early adulthood would be troubled periods even in paradise, partly, no doubt, for endocrinological reasons. We had our angst, and sometimes we even wallowed in it. Not to experience it would have appeared insensitive, complacent, bourgeois (the most damning of all accusations). I recall one of our band, a few years older, who had already passed through this turmoil (if he had ever experienced it) into the manner of settled prosperity. He now smoked cigars in the way that top-hatted plutocrats do in socialist caricatures. A few years later, he did many routine but highly paid reports for employment tribunals. “You turn the handle,” he said, “and the sausage comes out.”

We didn’t have deep-seated psychological problems. Almost all of us came from two-parent households; one-parent households were infrequent and typically the result of death, not divorce. Family stability was the norm. I even remember when divorce was spoken of sotto voce, as discreditable. Stability was not the same as happiness, of course, but few people (including me) recognized its value independent of any happiness that it brought. There was much hypocrisy and deception, but it was hidden.

Unknowingly, though, we were at the onset of what one might call the therapeutic turn. The dissatisfactions of life, rather than being understood as the inherent imperfectability of sublunary existence, came to be viewed as psychological, or even psychiatric, problems—with psychological or psychiatric solutions. The therapeutic turn was a bit like the revolution in medicine that resulted from the golden age of bacteriological discovery, when the ubiquity of bacteria became apparent, and all illnesses were thought to be caused by them. With the therapeutic turn, psychological problems were found likewise to be ubiquitous, and much of the world’s evil or misery attributed to them. The main difference was in the intellectual solidity of the bacteriological science, and the concrete good that it soon did. By contrast, the therapeutic turn was more like psychoanalysis in the estimation of the Viennese satirist Karl Kraus: the disease that it pretends to cure.

A dialectical relationship held between the recognition, existence, and solution of psychological problems. Without realizing it, we witnessed the beginning of this increasingly widespread dialectic when one of our number, aged about 19, started regularly to cut her thighs with a razor blade, eventually leaving a lattice of fine white scars.

She came from a well-to-do family and probably would never have had to earn her living. She could therefore afford to study something for the sheer pleasure of it, and take up this study as a career, though it would pay little. She was attractive, without being a great beauty; nothing prevented her from having a good life.

Why, then, did she mutilate herself? It was behavior not only beyond our experience but (until it happened) beyond the scope of our imagination. Had she read somewhere that people did this kind of thing? Was she attention-seeking, or trying to make herself interesting in the absence of anything else remarkable? Or did she have some kind of quasi-neurological condition that drove her to cut herself? It seemed unprecedented; we little thought that it was a harbinger of mass self-mutilation.

No one we knew in our early childhood took an overdose or threatened to do so. Between 1957 and 1964, however, self-poisoning by intentional overdose in England increased by three times, while the suicide rate remained the same; it has risen by a further four to five times since, even as the suicide rate has declined. While suicide is more common among the elderly, overdoses occur predominantly among adolescents and young adults. Twice as many people are now admitted annually to the hospital in England for an episode of self-harm—mainly self-poisoning—as for a heart attack.

What caused the initial increase in self-poisonings? Until 1961, it was illegal in England to commit or attempt suicide. A change in attitude doubtless preceded the Suicide Act of 1961, decriminalizing suicide, so that the law was by then becoming a dead letter. But Terence Rattigan’s successful play The Deep Blue Sea, performed in 1952, opens with a scene in which the unconscious Hester Page has taken an overdose of aspirin and tried to gas herself in her lodgings. The landlady, who discovers her with two other lodgers, Ann and Philip Welch, says, “This’ll mean the police.” When Ann discovers a suicide note in an envelope, the following dialogue takes place between her and her husband:

Ann: Should we open it?

Philip: No. It may be wanted by the police.

Ann: The police? Oh dear.

Philip (unhappily): I suppose we ought to ring them up.

A little later, Ann says, “Attempted suicide is a crime, anyway, isn’t it? People get jailed for it, don’t they?” Philip answers, “Yes.”

This would not have seemed absurd or even cruel at the time, though generations have grown up since who would find it so, perhaps even unthinkable. In 1952, Rattigan was at the height of his fame as a playwright and easily the most popular serious writer for the English stage. Not much later, his reign ended, thanks to the sudden emergence of a new wave of dramatists, though as a literary craftsman he was greatly superior to most of his successors. At the same time, the law grew much more concerned with the psychological, emotional, and therapeutic considerations of those coming before it, and punishment became a kind of therapy of last resort.

Psychology continued its inexorable rise as the supposedly scientific explanation of human life, a rise of which the prestige of psychoanalysis was both a cause and a manifestation, though many other psychological theories soon entered the field. Explanation, however, held out as a corollary the possibility of a better, suffering-free life for everyone, once basic needs such as those for food and shelter were met, as they were, to an extent unprecedented in history.

What might be called the psychologization of life had two consequences. First, it encouraged people to examine their thoughts and emotions much as a hypochondriac takes his pulse or attends to the minor sensations in his abdomen, such that minor fluctuations took on major and often sinister significance; and second, that the difference between the major and the minor, the serious and the trivial, the banal and the significant in life was expunged.

The combination of banality and humorless self-importance is perfectly captured in an account of a psychoanalytical exchange published in 2014, written by an analysand who was in analysis for 13 years, sometimes five times a week:

ANALYST: What about the other dream? The second dream?

ANALYSAND: What?

ANALYST: I said, what about the other dream? No associations to that dream?

ANALYSAND: I don’t know, maybe I haven’t thought about it. What about the first dream? What about what I said about that?

ANALYST: There’s nothing there.

ANALYSAND: What? What do you mean?

ANALYST: I just told you. There’s nothing there. You’ve told me nothing.

ANALYSAND: Nothing! What do you mean, nothing?!

ANALYST: Just what I said—there is nothing!

This, it seems to me, puts the endurance of the great explorers of the Australian desert or of the Antarctic in the shade. To talk endlessly about oneself to an audience (albeit here only of one, though social media have multiplied the audience by many times), in the expectation that the buried psychological treasure will one day emerge to solve all dissatisfactions with life at a stroke, is at the heart of much “psychological-mindedness.” To say everything, remarked Voltaire, is the way to be a bore; nowadays, to say everything is the way to be healthy. Fear of being boring is a social quality, while the search for health (in this sense) is a solipsistic one.

While the psychologization of life increases the tendency of people to think about themselves, it also places a lens of theory between themselves and their experiences. They become objects to themselves rather than self-directed subjects. Not infrequently, one hears people talking of themselves as if they were neurochemicals, or at least the victims of their neurochemicals. This, as a corollary, places the onus of psychological well-being on those who supposedly know how to manipulate their neurochemicals to render life easier. Other theories offer similarly technical solutions to human problems.

Psychologization is different from the examination of the motions of a person’s own mind, as Doctor Johnson recommended. While not denying the influence of circumstance, and always allowing for the imperfections of human nature, Johnson never seeks to absolve humans from the inescapable responsibilities consequent upon the possession of free will.

From an early age, children now bathe in a sea of psychology that alienates them and undermines their sense of agency. No doubt, the availability of psychological assessment and treatment helps some children, particularly at the extreme end of any behavioral spectrum; but the overall effect of psychologization is to induct them early into the idea that their problems have a technical solution, and that they are vulnerable and may well have been the victim of something external that explains their difficulties—and thereby that either minimizes or excuses their own contribution to these difficulties. Parents are often too willing to accept this because they believe it of themselves: we are now several generations into the reign of psychology as explanatory sovereign.

Whether coincidentally or not, psychologization occurred at a time when religious belief declined and Western society lost faith in itself, to the point at which shame about, rather than pride in, the past became the default attitude, imparted to young minds by almost every possible means. This takes the form not of reasoned argument but of indoctrination about the past. Edward Gibbon’s ironical jibe that history is indeed little more than the register of the crimes, follies, and misfortunes of mankind has become as deeply imbued as the idea that the moon goes around the earth, and with much greater effect. Naturally, children lack a standard of comparison by which they may judge the truth of what they are taught. A historiography of massacre, injustice, slavery, and so forth crowds out the idea of achievement, moral and physical. Either young people take the comfort and privileges that they enjoy for granted—as natural and immemorial instead of the result of prolonged human effort—and thus believe themselves entitled to their effortless continuation; or they come to feel guilty about enjoying these blessings because they are the historical fruit of exploitation, and they feel this all the more strongly, not being able, or even willing, to give them up.

One defense against privilege that is not only unearned but also felt to be the result of injustice is to become a victim yourself: for victimhood wards off reproach, as garlic flowers warded off Dracula. The conditions of human existence are such that everyone has suffered some kind of injustice and can therefore pose as a victim of something. Nothing is easier to let stew in the mind than an injustice suffered; it grows on the recollection, and, however trivial it may seem to others, it can assume enormous proportions for the sufferer. This surely is the explanation of Greta Thunberg’s outburst—“How dare you! How dare you!”—at the United Nations. A young person, who, by the standards of all previously existing humanity, was among the most fortunate of the fortunate, managed to turn herself into a victim, and believe her own performance. And thanks to the regnant sentimentality about the idealism (and fragility) of youth, no one confronted her about her grotesque claims to victimhood. The diagnosis of autism also helped to protect her from criticism: For who dares call someone with a bona fide psychological diagnosis spoiled?

The ideology of climate crisis is calculated to turn the most safely situated people into anxiety- and guilt-ridden neurotics. Already primed by a historiography of slavery and genocide to believe themselves the heirs to a vale of tears, they now also believe that the world is about to end. Climate anxiety among the young, even among primary-school children, is well reported and appears to be rising. This is not a spontaneous phenomenon: no child of six or seven perceives or knows anything about greenhouse gases without indoctrination—but as the Jesuits once put it, give us a child for the first seven years of his life, and we will know the adult.

Thus, a child comes to believe that he or she lives during an unprecedented crisis, the failure of which to materialize in no way dents belief in its existence. One recalls the book When Prophecy Fails, published in 1956 by three social psychologists who found that the failure of the world to end on the date predicted by a prophet, Dorothy Martin, did not affect belief in her prophethood. This form of irrationality was once confined to various sects but now seems the general condition of youth.

Not since Sigmund Freud hypothesized that infant boys wanted to murder their fathers to enjoy incest with their mothers have intellectuals believed in the innocence of childhood (the famous anthropologist Bronisław Malinowski went looking for the Oedipus complex among the Trobriand Islanders). But since then, the assault on innocence has grown much stronger. With the psychologization of life, young people have ceased to become responsible for themselves; but in return, they have been made responsible for the state of the world.

When they throw a tantrum, it is not their fault, and we must seek the causes; but when they eat a banana, what a weight of responsibility falls on their shoulders! The banana has probably been cultivated by near-slave labor, and most of its sale price will go not to the workers but to the exploitative banana company or to the supermarket that displayed it. Unless the banana is organically grown, its production will also have entailed pollution. Worse, bananas do not grow where they are primarily consumed; they must be transported, at a huge environmental cost. Eating a banana is thus a guilty pleasure, unlike throwing a tantrum, which is morally neutral; and every act of consumption takes on this burden of responsibility for the imminent end of the world. Unself-conscious enjoyment, which we once might have wanted for children, is now a kind of crime.

Nearly one in ten American children is now diagnosed (and treated for) Attention Deficit Hyperactivity Disorder; the diagnosis is said, in turn, to be a risk factor for depression, along with other factors such as low self-esteem consequent upon obesity (about one in five American children); homosexuality or publicity-induced gender dysphoria; having witnessed or experienced violence; suffering from physical illness; academic difficulties; and so forth. The wonder is not that at least a fifth of children and adolescents in the U.S. and elsewhere in the Western world are believed to have suffered serious depression, but that any child or adolescent is so well-adjusted that he or she has escaped psychological or psychiatric diagnosis.

A magnificent, though unconscious, hypocrisy runs through all this. The young’s dependence on electronic screens never causes them to wonder about the environmental cost of their habit; and alas for the children, they increasingly cannot imagine a life without such screens, or even believe that life was ever possible without them. So important have the screens become that the virtual is often more real to them than the real: or rather, the virtual has become the real and the real virtual. It is not unusual to see young people (and even not-so-young people) sitting around a restaurant table, all communicating via smartphones to people not present. Real contact makes them anxious, which the screens relieve by rendering impossible—as does earsplitting noise.

The electronic means of communication not only enclose the young in an eternal present and inflate the significance of the most trivial occurrences in their lives, turning minor inconveniences or setbacks into catastrophes; they render them susceptible to the grossest manipulation, commercial and otherwise. They compare their lives not with those whose personal effort might have achieved something but with those of social-media influencers and the like, who offer a picture of existence like an extended, even eternal, Caribbean cruise on a luxury liner. Life is not like that, and even, or perhaps especially, the most entitled feel the yawning gap between what they expect and what life offers them.

The public response to the Covid pandemic not only enforced a regime of an entirely virtual social life but also conveyed the impression that any other life was fraught with peril, though this was never the case. Face-to-face contact became synonymous with danger, illness, and even death. “Coughs and sneezes spread diseases,” said the old public-health saw; now merely to breathe did so. Children were made vulnerable and responsible at the same time.

Various currents have flowed into the great river of youth unhappiness. Nothing in their lives can be taken for granted, so no security can be found. In England, a child has a greater chance of having a television in his bedroom than having a father who has lived at home throughout his or her childhood. It is said that a fifth of children do not eat with another member of their family (or household) more than once a fortnight. When I used to visit patients at home—things have probably deteriorated since—I would often find no evidence of cooking ever taking place in the house, with no place even given over to a dining table. In personal relations, as Marx put it in another context, all that is solid has melted into air. And children are now not even supposed to accept without question what sex they were born into. Life for them has become a great existential supermarket, without criteria of judgment.

The young, then, are encouraged to believe by psychologization that they are not responsible for their own conduct, but that they are inheritors of monstrous injustice, of whose advantages they cannot rid themselves. Thus, they are inescapably guilty. The world, moreover, is about to end—unless, that is, they wear enough sackcloth and ashes. They live largely in virtuality, which discourages real human contact and gives no sense of proportion or perspective. Finally, their prospects are often not brilliant. They are expensively overtrained in nonsense; many will live worse than did their parents or grandparents. The assumption of improvement had been replaced by that of deterioration. Their lives are enough to depress those who observe them, let alone those who live them.

First published in City Journal.