The Culture of Therapy: Psychocentrism
9 in Everyday Life
Heidi Rimke University of Winnipeg
Deborah Brock York University
Has life got you down? Do you have trouble getting out of bed in the
morning? Have you stopped eating? Or perhaps, you are unable to stop
eating? Do you have trouble falling asleep at night or staying asleep? Have
others expressed concern about your mental or emotional state? Have you
wondered whether your sexual desires are normal? Do you experience feelings
of helplessness, meaninglessness, worthlessness, or powerlessness? Are you
worried about having an addiction to something, such as television, video or
computer games, the Internet, sex, food, alcohol, shopping, a relationship,
texting, pornography, sports, or anything else?
You have probably encountered questionnaires with questions similar to these while reading
a magazine, watching television, or surfing the Internet. Perhaps a psychiatric association,
pharmaceutical company, or government agency has posted them. The questions act as a
set of identifiable warning signs for the reader’s self-reflection. These might then create a
crisis in the reader’s sense of “normalcy,” suggesting to the reader that s/he may be suffering
from a treatable mental or emotional disorder, requiring professional help. However, far
from referring to exceptional conditions, such lists include common feelings and prac-
tices, some of which all of us may experience at some points in our lives. Indeed, as this
chapter will discuss, virtually every form of human behaviour has been classified within
the normal/abnormal dichotomy—and there appears to be no end in sight to the growing
index of human dysfunctions, disorders, and diseases. The growth of human scientific
discourses is the most significant driving force behind what can be understood as “the
shrinking spectrum of normalcy” in contemporary Western societies.
The idea that some people are psychologically sick or disordered reflects the growth
of the pathological approach, a distinctly Western and recent historical phenomenon, in
which it is assumed that personal problems are individual and caused by biological and/or
psychological factors. Everyday terms such as “psycho,” “messed up,” “crazy,” and “nuts”
reflect the current popularity of the therapeutic ethos of our time and place. We come to
think of ourselves as not smart enough, attractive enough, rich enough, skinny enough,
fulfilled enough, sexy enough, successful enough, or healthy enough; that we must smarten
up, straighten out, grow up—so that we can “measure up.” Our cultural beliefs and prac-
tices about what it means to be a human being in the early 21st century hinge on the idea
that there is this objective thing called “normal” that we should all strive for.
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However, the notion of “normal” has a history. It has not always been a part of everyday
life. Nor are Western or North American ideas and discourses about what is normal found
in other societies, as Kleinman’s (1991, 2006) cross-cultural research on mental illness dem-
onstrates. As you have learned in previous chapters, the emergence of the idea of normal
is key in understanding the establishment of modern systems of discipline. Discourses of
normalcy and abnormality have been inserted into the very subjectivities of people through
techniques of domination and self-regulation derived in large part from the human sci-
ences. Therefore, the “psy” discourses (psychology, psychiatry, psychotherapy, etc.) wield
enormous influence in shaping our everyday lives and practices in the early 21st century.
The general popularity of psy discourses, which attempt to explain human prob-
lems by identifying their psychological or psychiatric origin, is particularly evident in the
growing consumption of self-help material and prescription drugs for mental and emo-
tional reasons. The now-pervasive presence of “psy” in our everyday lives and practices
as Westerners can be seen in the widespread acceptance of a particular psychotherapeutic
ethos that shapes social practices, which has become known as the culture of therapy. As
modern subjects, we have at our disposal an immense medicalized vocabulary for speaking
about our inner selves. Modern individuals speak with ease and confidence about their
thoughts, memories, beliefs, emotions, and the like through psy discourses. Convinced
that we should understand our selves in psychological terms of adjustment, empower-
ment, fulfillment, good relationships, personal growth, and so forth, we actively seek the
wisdom of experts and cling to their promises to assist us in the quest for self-change that
we “freely” undertake (Rose, 1998). The popularity of psy discourses reflects a deeply held
belief that psychology in one way or another can make one happy, and that at the root of
our difficulties are psy problems that can be treated with professional therapy, self-help,
and/or prescription drug use.
In this chapter, we will explore how the modern subject has been shaped through the
cultural authority of the psy complex—which itself is derived from the reigning culture of
science, as you have just explored in Chapter 8. We will employ Foucault’s conceptual and
historical approach to present the social and historical construction of psy knowledge. We
will then provide some important examples of how the development of the psy disciplines’
system of classification has had particular ramifications for the production of gender, race,
sexual orientation, and class. Later we will turn to an analysis of contemporary therapeutic
culture, and an explanation of what Heidi Rimke (2000, 2010a, 2010b) refers to as psy-
chocentrism: the outlook that all human problems are innate pathologies of the individual
mind and/or body, with the individual held responsible for health and illness, success and
failure. Through this analysis, we want to continue our task of interrogating the centre by
demonstrating how power–knowledge relations permeate our every day, taken-for-granted
world. We want you to think about how particular knowledges acquire the status of truth,
and how people or subjects are “made up” (Hacking, 1986) or constituted through the
expert knowledge of psy and medical professionals, including psychiatrists, teachers, social
hygiene reformers, psychologists, health workers, sexologists, and social workers. The rise
of these experts reflects the development of professional knowledges relying upon a scien-
tific rationality to understand, explain, and control human conduct.
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Our aim is to overthrow the “naturalness” of dominant ways of thinking about indi-
vidual pathology by studying the historical relationship between forms of knowledge, the
exercise of power, and the creation of subjects. For example, researchers have demonstrated
the multiple and shifting ways subjects have been constituted or created by expert dis-
courses seen in critical social studies on anxiety (Tone, 2008), multiple personality disorder
(Hacking, 1995a), suicide (Marsh, 2010), antisocial personality disorders (Rimke, 2003),
self-esteem (Ward, 1996), shyness (Lane, 2008), stuttering (Petrunik & Shearing, 2002),
depression (Horwitz & Wakefield, 2007), ADD/ADHD (Conrad & Schneider, 1980) and
hysteria (Didi-Huberman, 2004).
While this chapter draws primarily on the work of Foucault, we can also consider the
significance of the work of Karl Marx when studying the culture of therapy. In order to
understand the economic conditions and financial motivation which are significant factors
in the growth of the culture of therapy, we ask you to think back to your study of Karl
Marx in Chapter 6. Marx’s work is significant for our study in many ways. Therapeutic
culture has created an enormously profitable economic sector, from the dozens of self-help
books and videos released annually to the dramatic growth of pharmaceutical companies
(now referred to as “big pharma”), to the proliferation of wellness retreats and wellness
practices. Further, by asking who gains from the development and growth of a psy-oriented
industry, we can question who has the ability to define reality. While it is too simplistic to
claim that the dominant class simply controls the oppressed class, it is fair to say that his-
torically the medical explanations for mental illness shifted according to the patient’s class
position. For example, while the mental illness of the poor was often attributed to factors
as coming from “bad stock” or personal failures, the economically privileged were rarely
blamed or held accountable for a psychiatric diagnosis. Instead, it was attributed to the
climate, a fever, or a “blow to the head.” That said, the “psy effect” should not be identi-
fied with a particular “cause” or a singular powerful social group, but rather by its effects in
everyday life and how it weaves throughout our lives, connecting and dividing as well as
producing and constraining our movement. Thus while class is certainly significant in the
politics of mental health and illness, it is a Foucauldian analysis of the politics of truth and
science that most guides this chapter.
When we engage in this kind of analysis, it is not intended to deny that many people
do have, either chronically or periodically, mental or emotional issues that significantly
affect their ability to get along in the world, to meet their own emotional needs, to develop
good relationships with others, and so forth. Similarly, it is not our intent to pass a final
judgement on psy discourses by claiming that they are necessarily good or bad, or by
declaring them merely ideological. Clearly they can be enormously beneficial for many
people, just as they can be destructive for others (for example, by imposing social stigma
and discrimination). More often, our engagement with psy discourses and practices can be
mixed, with positive, negative, or ambivalent implications. The point is that they do shape
us in various ways.
The issues and debates surrounding mental illness or psychological problems are com-
plex, contradictory, and conflicting as the growing literature in the sociology of medicine and
psychiatry demonstrates. Just as we do not intend to evaluate the rightness or wrongness of
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Chapter Nine | The Culture of Therapy: Psychocentrism in Everyday Life 185
psy discourses, we do not seek to provide answers and resolutions to this broad domain of
contested expert claims and varied human experience. Our objective is a more modest one:
to discuss the social and historical development of psy discourses, institutions, and practices,
with particular attention to largely taken-for-granted popular and expert discourses about
normalcy and abnormality.
NORMALIZATION AND CLASSIFICATION
Critical scholarship about historical and contemporary psy discourses, institutions, and
practices owe much to the guidance of Michel Foucault, whose scholarship includes two
books on the history of madness and on the emergence of treatment regimes: Madness
and Civilization (1961) and The Birth of the Clinic (1963). Foucault’s governmentality
approach and his attention to practices of regulation and normalization have been par-
ticularly important for studying the culture of therapy. As you learned in Chapter 2, dis-
tinguishing between the normal and the abnormal is an expression of normalizing power
(Foucault, 1979). Specifically, normalizing power compares, differentiates mental states,
establishes a hierarchy of value between them, homogenizes by presenting a particular
notion of “normal,” and excludes those who are in some way considered abnormal. From
this explanation, we can see that normalizing power is simultaneously a dividing practice.
People, beliefs, and practices are distinguished and divided from one another. By encour-
aging certain ways of life over others, discourses of normalization offer implicit conceptions
of whom and what constitutes a good self or normal person.
For example, the hypothetical questionnaire at the beginning of this chapter is a
starting point for not only diagnosing people, but for classifying them according to “signs”
or “symptoms.” The psy disciplines, like other human sciences, have developed an ever-
expanding system of classifying people, making distinctions between and among them.
These evaluations and distinctions are not neutral. As Turner and Edgley (1983) have
demonstrated, the very core of psychiatric categories and diagnosis is based upon subjective
social and moral values. They critique the assumption that “chemical imbalances” are at
the root of “deviance” because it is not possible to distinguish, medically or chemically,
behaviours that are socially defined as acceptable or unacceptable. The seemingly “neutral”
language of psychiatry masks value judgements about good and bad, or right from wrong.
In the previous chapter, you read that no scientific test can determine morals and morality;
such determinations are always already cultural.
Another example of how systems of classification work is found through an account
of the ever-expanding Diagnostic and Statistical Manual of Mental Disorders (DSM). The
DSM was first published in 1952 by the American Psychiatric Association (APA). It was
intended to be a comprehensive account of mental illness in American society, and today
acts as the “psychiatric bible” by defining the criteria for an ever-increasing number of
mental illnesses and disorders (Kutchins & Kirk, 1998). Once an official DSM classifica-
tion of mental illness is declared, the category begins a life of its own, which can result
in unanticipated consequences. As Hacking (1995b, 1999) shows, what develops is an
interaction or looping effect between a classification and those people who are classified.
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Humans inevitably respond to being classified or classifying others, which in turn alters
their conduct, which then has an effect on the classification, and so on. As Hacking (1999)
explains, “All our acts are under descriptions, and the acts that are open to us depend …
on the descriptions available to us. Moreover, classifications do not exist only in the empty
space of language but in institutions, practices, material interactions with things and other
people.” Expert classifications thus operate at the level of the everyday culture, shaping our
views of ourselves and of others.
While we are on the topic of the DSM, it is worth noting that the original DSM, the
DSM-I (1952) was 130 pages long, listing 106 disorders. By its fourth edition, published
in 1994, the DSM-IV was 886 pages long and listed 297 disorders, thus nearly triple the
volume (Grob, 1991). The controversial DSM-V has an expected publication date of May
2012. It is expected that the new version will expand the basis for psychiatric diagnosis
and classification by including “new” disorders such as personality and relational disorders,
night eating syndrome, sensory processing disorder, cannabis withdrawal, obesity, anxious
depression, childhood disintegrative disorder, parental alienation, compulsive buying, and
Internet addiction (American Psychiatric Association, 2009; Block, 2008; Kaplan, 2009).1
A Foucauldian approach interrogates the assumptions and certainties embedded in
our cultural attitudes, beliefs, desires, and practices concerning the normal and the patho-
logical. We can thus attend to the power–knowledge relations that inform our everyday
beliefs and practices about mental health and illness, including the dominant assumptions
about whom or what forms of conduct are socially defined as normal or abnormal. Yet
scholarly critiques of beliefs and practices about mental illness by no means began with,
or are limited to, Foucault and those whom he has influenced. For example, Rosenhan’s
(1973) classic sociological study, “On Being Sane in Insane Places,” also demonstrates the
subjective nature of psychiatric medicine. Rosenhan had eight “pseudopatients” relying on
scripts present themselves as mentally ill patients in a psychiatric institution. The actors
did not display any form of symptomatic behaviour yet were nevertheless diagnosed and
treated as if they were indeed mentally ill. The study demonstrated that even psy profes-
sionals cannot always distinguish the sane from the insane because of the subjective nature
of judging human conduct.
1 Critics argue that the addition of new disorders to the DSM-V is another ploy in an endless series of
scientific rationalizations for prescribing profitable drugs for one of the fastest-growing industries in
North America. For example, in 2002, the combined profits of the ten largest pharmaceutical companies
in the Fortune 500 totalled $35.9 billion amounting to more than the combined profits ($33.7 billion)
of the remaining 490 companies together (Angell, 2004). Big pharma has become a profit-oriented
industry to advertise and sell drugs of questionable benefit. In 2007, the British Medical Journal pub-
lished a study analyzing approximately 2,500 common medical treatments and found that 13 percent
were found to be beneficial, 23 percent were likely to be beneficial, 8 percent were as likely to be harmful
as beneficial, 6 percent were unlikely to be beneficial, 4 percent were likely to be harmful or ineffective,
and 46 percent were unknown in terms of helpful or harmful effects (Clinical evidence, 2007). The
economic power of the pharmaceutical industry has resulted in the co-optation of every institution
that might get in its way, including government, health, and drug regulatory bodies, academic medical
centres, and the medical profession itself (Levi, 2006).
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THE HISTORY OF THE PRESENT
As Nikolas Rose comments, “We can question our present certainties—about what we
know, who we are, and how we should act—by confronting them with their histories”
(Rose, 1999: x). As you learned in Chapter 2, Foucault referred to his historical approach
as the history of the present. Rather than understanding historical developments as inevit-
able, or as determined by universal laws, he viewed history as contingent, because for any
event, other directions and outcomes were also possible. So while the contemporary inter-
preter of historical events might assume that the development of psychiatry and institutions
to house the insane were practical, humane, unavoidable, or even evolutionary, Foucault
provides us with a way of thinking about how this outcome was the result of power–
knowledge relations. Foucault’s methodology is a counter-history because it is written
against the taken-for-granted or dominant histories, as our examples below will show.
Foucault eventually began to refer to this critical approach as his genealogical method.
Genealogy starts with the present, not to affirm or deny it, but to ask how the present has
come to be constituted as it is. The aim is to overthrow the “naturalness” of dominant ways
of thinking by studying the historical relationship between forms of knowledge and the
exercise of power.
Foucault explored the multiple, contradictory, and shifting discourses that were
emerging from the Enlightenment onwards, particularly those with a profound effect
on how people were understood. Before the human sciences began to develop in
the 19th century, ideas about human nature and human conduct were derived from
a religious framework determined by Church authorities. Humans were understood
in religious terms of evil or virtue, rather than medically and scientifically. With the
Enlightenment, scientific theories began to claim that human nature was the result of
biological, physiological, and/or psychological factors. Thus by the end of the 18th
century, Western theories shifted toward scientific rather than theological explanations.
Positivists insisted that through systematic observation, human behaviour could be
explained in the same objective manner as the hard sciences explained the natural world.
The “discovery” that madness was not the result of demonic possession or a punishment
from God, but a disease entity that required medical attention, was a catalyst for the
formation of a medical model of mental pathology. The scientific search for endogenous
(internal) causes rooted in the person thus became a hallmark of modernity.
By the mid-to-late-19th century, the human sciences developed numerous new
branches of study, such as comparative psychology, phrenology, anthropology, neur-
ology, criminology, experimental psychology, physiognomy, craniology, necrology, and
psychological medicine. Psychiatry as a distinct specialization only expanded in the
mid-20th century. These areas of study often competed with one another, so the human
scientific project of studying the normal/abnormal divide did not develop as a single and
unified discipline (Rimke, 2008; Rimke & Hunt, 2002).
Modern society thus rested upon the new ideals of science and progress. Human dif-
ferences or problems were increasingly viewed as scientific problems that could be studied,
known, categorized, regulated, and treated or cured. The modern claim that deviance or
madness was a scientific, rather than religious, matter drastically altered how we interpret
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and perceive the self and others in the everyday. Human scientists began insisting that the
cause of deviance was rooted in the body itself and that religious ideas were outdated by
modern, scientific ideals and standards.
While the medical model’s view of the diseased individual has gradually replaced
the religious model’s view of the evil sinner as a means of understanding and explaining
human conduct, the historical effects of religious practices and discourses still exist
and affect current ideas. Rather than explain the historical shift in linear terms, where
religious authority was simply displaced by the scientific, Foucauldian research has dem-
onstrated that a hybrid discourse of Christian theology and Western science together
medicalized immorality as an objective fact (Rimke & Hunt, 2002). So, for example,
while religious discourses held that the sodomite (today, the “gay male’) was a sinner
who engaged in immoral sexual practices with other men, the invention of the category
of the homosexual by the human sciences, as Foucault has shown, relied on a notion of
“perversion” derived from this earlier notion of sin. The importance of this example is
that it demonstrates the influence wielded by two dominant discourses—religion and
science—in the making of the idea of the homosexual. We will return to this example
shortly. We will now present you with some brief historical accounts, or fragments,
concerning the history of institutionalization, diagnosis, and treatment, which disrupt
and trouble the grand narrative of medical and scientific progress. They illustrate that
so-called “progressive” historical measures carried with them certain assumptions about
class, race, gender, and sexuality. They compel us to think further about the myriad ways
knowledge and power intersect, and the impact upon populations and the daily lives of
people.
Confinement: The Emergence of the Asylum
Seventeenth-century Europe witnessed an unprecedented programme of building
institutions designed specifically for disciplining and regulating certain populations
of people, in asylums, prisons, workhouses, and so on. Foucault referred to this as the
great confinement. He was intrigued by the emergence of new strategies to administer
to and discipline the population, which included both those who found themselves
confined, and those who feared that they could one day be (the poor, and women of all
classes). These spaces of exclusion were both a cause and an effect of the growth of the
disciplinary society. People considered mad were initially confined in the same insti-
tutions as the poor, the criminal, the unemployed, and the idle. As the psy disciplines
expanded, institutions specifically designed for the diagnosis, retention, and treatment
of the mad were created. A diagnosis of madness became a dividing practice, through
which those labelled were separated from their communities, both conceptually, and
often physically. The process of diagnosing and locking up the mad in houses of con-
finement allowed for the observation of significant numbers of people under controlled
conditions, making them objects of scientific study and knowledge. Moreover, this
administration and control of the mad within public institutions came to increasingly
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Chapter Nine | The Culture of Therapy: Psychocentrism in Everyday Life 189
FIGURE 9.1 ■ The tranquilizing chair. Benjamin Rush (1745–1813), considered the father
of American psychiatry, wrote the first American psychiatric textbook and invented the
“tranquilizing chair” in 1811 to immobilize the patient using the “treatment” of restraint and
sensory deprivation.
Source: Engraved by Benjamin Tanner after John James Barralet. © Bettmann/CORBIS
depend on the classification and separation of different types of madness. Diagnostic
classifications, in turn, fostered their own forms of treatment. In addition to confine-
ment, the mad were subjected to practices that included the frontal or icepick lobotomy,
the clitorectomy, physical restraints, involuntary drugging, and electroconvulsive shock
therapy (Valentin, 1986). Some of these practices have been ended, while others con-
tinue, although not without controversy.
Drapetomania
The psy disciplines have also participated in processes of racialization where, as you
read in Chapter 5, scientific method was used to construct distinct racial types, each
with its own morphology and character. A stark historical example is the classification
of Drapetomania, introduced by a Dr. Cartwright in 1851, which was defined as the
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pathological desire of African-American slaves to escape captivity from their natural and
God-given masters (Szasz, 1971b). We find here another example of how both religious
and medical discourses have been simultaneously exercised to make claims that but-
tress social inequalities. Contemporary readers should have no difficulty identifying the
absurdity of this diagnosis. However, it should remind us to consider more closely how,
in our own time, racialized people are pathologized as an explanation for the “social
problems” of their communities. For example, the claim that there is an “epidemic”
of single mothers and absent fathers among African-Americans not only identifies the
single-parent family as non-normative, but alleges that male irresponsibility and family
instability are integral features of Black communities.
DRAPETOMANIA, OR THE DISEASE CAUSING
NEGROES TO RUN AWAY
It is unknown to our medical authorities, although its diagnostic symptom, the
absconding from service, is well known to our planters and overseers.…
In noticing a disease not heretofore classed among the long list of maladies that
man is subject to, it was necessary to have a new term to express it. The cause in the
most of cases, that induces the negro to run away from service, is as much a disease
of the mind as any other species of mental alienation, and much more curable, as
a general rule. With the advantages of proper medical advice, strictly followed, this
troublesome practice that many negroes have of running away, can be almost entirely
prevented, although the slaves be located on the borders of a free state, within a
stone’s throw of the abolitionists.
If the white man attempts to oppose the Deity’s will, by trying to make the negro
anything else than “the submissive knee-bender,” (which the Almighty declared he
should be,) by trying to raise him to a level with himself, or by putting himself on
an equality with the negro; or if he abuses the power which God has given him over
his fellow-man, by being cruel to him, or punishing him in anger, or by neglecting
to protect him from the wanton abuses of his fellow-servants and all others, or by
denying him the usual comforts and necessaries of life, the negro will run away; but
if he keeps him in the position that we learn from the Scriptures he was intended to
occupy, that is, the position of submission; and if his master or overseer be kind and
gracious in his hearing towards him, without condescension, and at the same time
ministers to his physical wants, and protects him from abuses, the negro is spell-
bound, and cannot run away.
Source: “Diseases and Peculiarities of the Negro Race,” by Dr. Cartwright (in DeBow’s Review, 1851)
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Moral Insanity and Psychopathic Disorder
Dr. James Prichard created the diagnosis of moral insanity in 1833. The invention of this
diagnosis reflected the growing medical fixation on immoral or disrespectable conduct,
particularly in response to what was perceived as increasing vices arising from industrializa-
tion and the growth of cities. Social danger increasingly came to be seen in violations of the
norms of respectable society. Moral insanity would later be codified by the psy disciplines
as “defects of character,” and eventually as “personality disorders” and other “mental and
emotional disturbances.” As psy expertise distinguished itself from the wider category
of medicine, it simultaneously generated a knowledge base about what it meant to be a
normal individual through the study of the abnormal individual. By the turn of the 20th
century, the list of psychopathic disorders grew to include: kleptomania, erotomania,
pyromania, and dipsomania, masturbation, obscene language, gender transgressions, nym-
phomania (in females) and satyriasis (in males), vagrancy, gambling, poor personal hygiene,
laziness, prostitution, general lawlessness, and the destruction or squandering of property
or money. Modern human sciences thus sought to target and regulate “bad” social sub-
jects, those who in some way resisted the normative expectations of civility and propriety
(Rimke, 2003; Rimke & Hunt, 2002).
Homosexuality
From its initial publication, it was accepted wisdom that homosexuality be included in the
DSM as a recognized form of mental illness, and that every attempt should be made by
psychiatric and medical professionals to cure the afflicted of this “sexual malady.” Foucault
describes how in the 19th century sexuality in the West became an object of scientific
analysis and regulation through the pathologizing of sexual difference. Experimental
methods for the “cure” of homosexuality included electroshock therapy and the frontal
lobotomy, although no evidence of a successful cure was ever derived from these methods.
By the early 1960s a homophile (soon to be known as “lesbian and gay’) liberation move-
ment was beginning to emerge in North America and Western Europe. Together with
sympathetic psychiatrists such as Dr. Evelyn Hooker, they produced counter-narratives and
political protest to successfully challenge the methodology and facticity of such scientific
claims (see Changing Our Minds, 1991). Homosexuality was removed from the DSM II in
1973. However, various other sexuality- and gender-related diagnoses remained in place, or
were subsequently added, such as the designation sexual orientation disturbance.
Female Depression
As you learned in Chapter 2, Foucault uses the concept of the “gaze” to highlight and
explain the process of surveillance and the growing influence of expert knowledges. The
gaze of the expert attempts to define who people are, without direct input from those under
observation. It thus reflects relations of power in which those at the centre can define and
categorize those on the margins. Feminist scholars have identified many of the ways in
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which this gaze has been deployed to inculcate “proper” standards of behaviour in women.
For example, in the late 19th and early 20th centuries, women who displayed masculine
traits such as independence, assertiveness, and sexual self-confidence might find themselves
classified as “morally insane,” because such conduct contradicted cultural conceptions of
females as essentially weak, chaste, and passive.
More recently, women subject to the psychiatric gaze have unsurprisingly also been
the target of pharmaceutical companies. For example, introduced in 1963, Valium quickly
became a widely prescribed tranquilizer, which was intended to relieve symptoms of
boredom, anxiety, and depression and to increase relaxation—and it was targeted at house-
wives (Tone, 2008). Unfortunately, it was also highly addictive, especially with long-term
use, and could produce numerous side-effects. Prescribing Valium and other sedatives to
post–World War II white middle-class women was such a widely recognized practice that
it formed the subject matter of a well-known song by the Rolling Stones, “Mother’s Little
Helper.”
The medicalization of white middle- and upper-class women’s disaffection with their
lives was soon challenged by the development of a feminist analysis. In 1963 Betty Friedan
published the landmark book The Feminine Mystique, in which she presented “the problem
with no name”:
The problem lay buried, unspoken, for many years in the minds of American
women. It was a strange stirring, a sense of dissatisfaction, a yearning that
women suffered in the middle of the twentieth century in the United States.
Each suburban wife struggled with it alone. As she made the beds, shopped
for groceries, matched slipcover material, ate peanut butter sandwiches with
her children, chauffeured Cub Scouts and Brownies, lay beside her husband
at night—she was afraid to ask even of herself the silent question—“Is this
all?” (Friedan, 1963: 13).
Feminists began to explicitly critique the role of psychiatry in pathologizing women,
claiming that women’s mental health issues would be better addressed by trying to change
women’s social, political, and economic conditions rather than attempting to change the
women themselves by coercing them to conform to traditional roles and expectations. As
Dorothy Smith and Sara David entitled their 1975 collection of papers challenging psych-
iatry, “I’m Not Mad, I’m Angry” (Smith & David, 1975). Anger in this context refers to
the collective emotional response of women and girls to the socially created limitations
they encounter throughout their lives. Women’s collective frustration surrounding unequal
wages, lack of access to birth control, abortion, and child care, lack of opportunities for
advancement in the paid labour force and limited educational opportunities was seen as
having nothing to do with women’s mental health, and everything to do with a gendered
organization of social relations that benefited males to the disadvantage of females. We
will return to the growth of the anti-psychiatry movement toward the conclusion of this
chapter.
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Chapter Nine | The Culture of Therapy: Psychocentrism in Everyday Life 193
Lest you think this is now all history, with no bearing on the lives of contemporary
Western women, we need look no further than advertisements used by pharmaceutical
giant Eli Lilly to introduce and promote the antidepressant Prozac to physicians. One par-
ticular ad, placed in The British Journal of Psychiatry, displayed images of a dirty, disordered
kitchen, inset with a picture of a clean, tidy kitchen. Such a visual representation links
women’s mental health to her attention to household chores. As we explored in Chapter
8, this is an example of how scientific and medical discourses can carry with them some
highly gendered assumptions, which are grounded in presumptuous social practices rather
than objective, scientific “fact.” The persecution of women alleged to be witches, and the
invention of hysteria, moral insanity, and now “female” personality disorders—borderline,
dependent, and histrionic—demonstrate an ongoing pattern of gendered regulation. Each
respective era has proclaimed an official category for females who in one way or another
defied socially prescribed behaviour according to gender rules (Rimke, 2003; Szasz, 1974;
Wirth-Cauchon, 2001; Ussher, 1991). Szasz asserted in 1974 that the contemporary phe-
nomenon of diagnosing women as “mentally ill” continues to define acceptable female
conduct and punish transgression, now often in the form of medical “treatment” (1974).
We want you to think about how his assertion continues to have relevance, despite the
successes of feminism.
Psychoanalysis
Finally, in the early 20th century the creation of psychoanalysis occurred through the
work of Sigmund Freud and Carl Jung. Psychoanalytic theory claims that individ-
uals are motivated by strong and dynamic unconscious drives and conflicts arising in
early childhood rather than biological functions of the brain and central nervous system.
Psychoanalysis thus provided a non-biological theory of emotional and mental life along-
side the dominating neurological, behaviourist, evolutionary, or hereditarian paradigms
(Rimke, 2008). “Talk therapy” was introduced as an alternative form of diagnosis and
treatment. While more humane than some of our earlier examples, talk therapy was also
to become a means of expanding the scope of diagnosis and treatment to well beyond
the confines of the asylum, as you will learn more about when we turn our attention to
therapeutic culture.
In summary, this section has challenged the official histories of medicine and psych-
iatry. These histories typically glorify the “great men of science” as benevolent, humani-
tarian reformers who freed the mad from brutal and inhumane institutional treatment.
However, our brief examples suggest an entirely different phenomenon: the “Age of
Reason” produced new regimes of discipline. Rather, than a new respect for humanity, the
success of the human sciences involved the establishment of more finely tuned mechanisms
of surveillance that resulted in a more effective web of power infiltrating everyday life and
practices (Foucault, 1979). The psy experts thus established their expertise on the basis
of the general argument that society required remedies for its mental ills and only certain
human experts possessed the scientific knowledge to achieve such ends.
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By the mid-20th century, the psy disciplines had accomplished a level of respectability
in the West that conferred upon them significant authority in public and political affairs.
In particular, the physician and the psychiatrist (who, unlike the psychologist, are required
to hold a medical degree to legally prescribe drugs) experienced growing social recogni-
tion and authority. Psy experts increasingly were called upon to analyze and intervene
in a growing array of social, scientific, and legal developments. This included activities
from forensic psychology and legal psychiatry (linking certain criminal acts to psychiatric
illness), to education and welfare reform, to shaping domestic and foreign policy to com-
menting on public TV watching habits. By the postwar period, psychiatric and medical
discourses were therefore shaping state policies and practices on an increasing range of
public matters. This is one example of how expert knowledges have come to exert their
influence on the contemporary state, expanding governmental power. But there is another
facet to the rise of psy knowledge, and its increasingly detailed classification and specifica-
tion of the human subject. This knowledge has now been popularized and packaged in
particular forms, so that it pervades contemporary Western popular culture, to the point
where it has indeed become what some have referred to as a culture of therapy. It is to
this popularization that we now turn.
Self-Help and Therapeutic Culture
The therapist’s office, the self-help group, and the blog are all examples of what Foucault
referred to as the modern confessional (Valverde, 1985). Foucault claims that the modern
person has become a “confessing animal.” Rather than turning to the priest to confess and
absolve our sins, modern individuals rely on psy analyses for guidance, comfort, and direc-
tion. Today people may go to their therapists’ offices or their support group to confess—
but the important point for Foucault is that it is in the process of confessing that the self is
created rather than revealed. One of the main tenets of therapeutic discourses is the assump-
tion that there is an inner core or “truth” about ourselves, which therapeutic techniques
can help us to reveal to ourselves. Foucauldians, however, invert the common or traditional
assumption that expert discourses reveal a “hidden truth,” and instead argue that the expert
discourses themselves shape the individual’s interpretation and perception of self.
The self-help genre forms an important part of the modern culture of therapy in
neoliberal societies. A massive and growing industry, self-help culture provides a dizzying
array of groups, books, experts, shows, podcasts, and so forth to guide us in our explora-
tion of our inner selves and our relations with others. Self-help literature comes in num-
erous different forms of advice: spirituality, how-to manuals, personal change, dealing
with loss, relationship advice, and more. We are incited to seek self-enlightenment by
excavating and exposing our “true” selves to the therapeutic gaze in multiple forms, such
as our MSN friends, online diagnostic questionnaires, Facebook applications, or fashion
magazine quizzes. We may search for our “inner child,” reveal our “codependency,” insist
on “tough love,” recover our “true” or “real” selves, or experiment with Eastern, aboriginal,
or otherwise “alternative” healing practices. As such, we are part of a culture of recovery.
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The culture of recovery now clearly has a very public character. Far from the privacy
of the psychiatrist’s office, self-revelation takes place through the gamut of public media.
Self-help discourses circulate and proliferate on television, the internet (websites and
webcasts), in autobiographical books, in celebrity interviews, in magazines and news-
papers, radio shows, psy-related books and texts, movies, and documentaries. Often,
now, self-help can also be considered a form of popular entertainment, seen especially
on shows like Dr. Phil, The Dr. Oz Show, or The Oprah Winfrey Show. Increasingly, this
psy network contributes more in terms of entertainment than enlightenment, and treat-
ment programs rather than cures. Moreover, “reality” TV shows such as Intervention,
Hoarders, or Celebrity Rehab centre on the pathologies of people in multiple guises, rarely
examining the relations and cultural expectations in which the suffering individual is
embedded.
In our culture of therapy, most, if not all, of us engage in activities designed to keep
ourselves emotionally healthy, regardless of whether we ever go to the therapist’s office.
We commonly use what Foucault referred to as techniques of the self to “diagnose” and
classify ourselves and others. When we employ these techniques of the self, we are being
governed, we govern ourselves, and this also leads us to govern others.
Let’s focus now on a very popular technique of the self: reading self-help books. A
trip to your local bookstore will make obvious the popularity of this genre. Shelves are
now filled with books dedicated to self-improvement; to helping us to remake ourselves
into “better people” living more “successful” lives. We can see evidence of how virtually
every human experience is reframed in psychocentric terms. Do you have difficulty with
managing your weight? Do you drink too much? Do you choose partners who are bad for
you? Do your kids rule your life? Are you a shopaholic? Could your soul benefit from some
chicken soup? Do you “sweat the small stuff ”?
Why are self-help books so popular? First, they promise to improve us not only men-
tally, but also spiritually, physically, and even financially, if this is what we seek. Second,
they make “normalcy” or mental health accessible to everyone, regardless of income or
access to a therapist, and in the privacy of our own homes, if that is our preference. Third,
they really can help. They may actually provide some useful or practical advice on how to
get along better with one another, or how to feel better about ourselves. Maybe we will
learn to be more understanding and forgiving of other people, as we learn to do the same
toward ourselves.
Perhaps we will become “better” people, but according to whose definition and
evaluation?
Much self-help advice appears to be simply “common sense,” although certain phrases
(such as the Don’t Sweat the Small Stuff reminder that soon the world will be completely
populated by new people) can have a lasting impression for many readers. Part of the
commonsense quality derives from the “homey” character of advice one might get from a
wise elder such as a grandparent. Another part also derives from the everyday popularity of
psychocentrism. The notion of “the self ” as knowable, and as a work in progress, is now as
familiar to us, and as taken for granted, as brushing our teeth.
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The first book of the popular self-help series Don’t Sweat the Small Stuff … And It’s
All Small Stuff was published in 1997. The author, Richard Carlson, was a psycho-
therapist who had already published a number of books on stress management,
one of which lead to an appearance on Oprah, guaranteeing instant success. The
first volume begins with a quote from William James (1842–1910), an American
pragmatist philosopher and psychologist, whose prolific writings contributed sig-
nificantly to the development of psy discourse. Relying on a psychocentric logic,
he argued that “the greatest discovery of my generation is that a human being can
alter his life by altering his attitude” (Carlson, 1997: 1). The first Don’t Sweat book
remained on the New York Times bestseller list for over two years. Its success led to
the publication of more Don’t Sweat books, which taught how not to sweat the small
stuff at work, in love (co-written with his wife, Kris Carlson), for women (authored
by his wife), for men, with your family, for teens, for parents, for moms, and for
graduates. The series was successful because of its simplicity; it provided short bits of
practical, commonsense advice for achieving a better life, ones that a person could
apply immediately: Focus on the things that go right, rather than the things that
go wrong. Find time for yourself every day. Write things down that you feel good
about. Be compassionate toward other people. Accept your imperfections. Pick up
litter. Don’t argue with your partner about inconsequential matters. When you die,
your in-basket will not be empty. In one hundred years, all new people will be here.
By defining human normality, and thus by extension, abnormality, self-help experts
profess to offer strategies and truths to achieve the good life, and indeed the good self.
Consequently, popular self-help projects have attempted to affect all areas of social life:
how to live, how to work, how to parent, how to love, and how to behave in various
spatial and temporal settings. In self-help books, subjects are cast as damaged and injured
commodities, as potential consumers of unique and presumably preferable selves, but also
as redeemable from within. As a result our culture has witnessed “the transformation of
ordinary behaviours of ordinary persons into the extraordinary awe-inspiring symptoms of
mental diseases” (Szasz, 1978: 194).
Some of the impetus for a focus on individual well-being emerged from the social
movements of the 1960s and 1970s, as people sought personal and social liberation through
collective social action and resistance. For example, throughout the 1970s and 1980s, a
feminist therapy movement emerged to treat and heal women who had been victimized
by physical, emotional, and sexual abuse in a patriarchal world. However, in the 1990s,
feminist and Ms. Magazine founder Gloria Steinem began emphasizing women’s need
to focus on “the revolution within” after years of feminist activism aimed at challenging
socially and historically structured gender inequality. Self-help technologies resonated in
Steinem’s book. The once-popular slogan of the 1960s women’s and civil rights movement
that declared “The personal is political” was inverted by Steinem’s advice to focus on one’s
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Chapter Nine | The Culture of Therapy: Psychocentrism in Everyday Life 197
self to achieve an “inner” revolution. Over time, the focus on self-transformation, joined
with competitive individualism, has increasingly undermined social movements’ emphasis
on collective resistance to achieve social justice and equality. As a result, prescriptions for
revolutionary action or social change are being replaced by psychocentricity, thus propping
up neoliberal ideals and practices glorifying the individual at the expense of social and pol-
itical change and analysis. Furthermore, the increasing focus on individual responsibility
and accountability has been occurring simultaneously with the dismantling of public ser-
vices, including health care, forcing individuals to absorb structural deterioration—one
partial explanation for the rise of self-help. You have already learned that neoliberalism is
predicated on the valorization of free markets (that is, the unfettered movement of capital),
on limiting state powers for the regulation of capital, and on competitive individualism.
From the 1970s onward, the rise of both neoliberalism and the culture of therapy had a
common theme: a focus on the “I” over the “we.”
Nikolas Rose commented while giving a public lecture in Toronto in the mid-1990s
that he had recently seen at a political demonstration by the unemployed, a picket sign
demanding “Jobs, not Prozac.” This slogan neatly encapsulates the sociological insistence
that the personal is also social and public. For example, the unemployed person is often not
without work because s/he lacks skills or initiative, but rather because local and national
economic arrangements have increased joblessness. While some economists claim that a
certain unemployment rate is “healthy for the economy” because it drives competition,
what of that percentage of the population that suffer the harsh realities of unemployment?
Are they to feel individually responsible or proud for contributing to the health of the
economy? Should they feel personally inadequate or otherwise psychologically inferior to
those who are in advantageous social and economic positions? The fact is there are more
people than there are jobs. Prozac may chemically help some individuals cope with the
negative personal impact of unemployment, but it is the creation of new jobs that will
resolve personal crises resulting from depression, stress, and anxiety, resulting from job loss.
From this example, you can see how Marx’s analysis of capitalism and its class struc-
ture, as well as Foucault’s approach to government, both contribute to our understanding
of how people (neoliberal subjects) are constituted through a therapeutic culture that serves
to secure relations of domination as much as it portends to liberate the self. The growth
of neoliberalism has resulted in the increasing de-responsibilization of social authorities.
Moreover, psychocentrism ensures that social and political authorities are exonerated while
individuals are held responsible and accountable for situations they did not necessarily
create.
CONCLUSION: CHALLENGING PSYCHOCENTRISM
To summarize our recent analysis, struggling with the self has become a key cultural theme
in modern life. There seems to be a persistent impulse among North Americans to worry
about whether they are what they should be, and whether they have the sort of personal
traits, skills, social manners, or inner strengths they should have. Experts translate all aspects
of human life into myriad dysfunctions, addictions, disorders, pathologies, or destructive
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behaviours that require expert attention and self-treatment. Indeed, the diversity of the psy
complex is what makes it so effective: no one is ever really good enough. We are incited,
directed, and instructed to be self- and other-critical. In the early 21st century, the psy
complex has become the most influential field in determining the best or proper way of
being human, thus wielding tremendous social influence. Consistent with the political
rationalities of neoliberalism, psychocentrism dominates a cultural landscape, masking
how broad and unequal political and social structures, discourses, and practices impact
individual lives physically, emotionally, and mentally.
The psy sciences provide a corpus of knowledge that categorizes social problems as
individual deficiencies or pathologies without seriously examining the social contexts and
conditions that define or produce those experiences and differences. While human differ-
ences certainly exist, the psy complex classifies and hierarchalizes those differences into
binary categories of good/bad, healthy/sick, normal/abnormal, moral/immoral, and so
forth. “Wellness” has become conflated or synonymous with culturally prescribed notions
and practices of “normalcy.” Productive subjects have to be healthy, upstanding, obedient,
and efficient—in one word, self-governing—in order to sustain neoliberalism in the face of
a weakening and quickly shifting global economy, as you will read more about in Chapter 11.
We live in a society in which our search for meaning has shifted away from the public
sphere toward the privatized self. Yet, whatever self the self is pursuing, we must remember
that we are always within the boundaries of cultural meanings. We learn how to appraise
and judge ourselves, and how to behave in different contexts: one must not look, act, or
talk like the marginalized or abnormal, and if one does, one is socially expected to fulfill
the obligations of the “sick role” (Parsons, 1951), which includes following doctors’ orders
and prescriptions.
The growing mental, physical, and emotional tensions, strains, and struggles of con-
temporary culture are indeed expressed in multiple forms. Loneliness, isolation, violence,
anxiety, anger, apathy, repulsion, depression, suicide, and so forth, while individually
experienced, must be placed within the context of social patterns and inequalities out-
lined in other chapters of this textbook. These include increasing economic deterioration,
social conflicts based on axes of age, sexual orientation, class, gender, physical appearance,
familial ties, educational attainment, religious status, ethnicity, and so forth. Consider also
how cultural prescriptions are contradictory, unrealistic, and naïve in the face of many
people’s daily lives and social insecurities, such as the lack of affordable housing, growing
unemployment, the erosion of pensions, rising food and energy prices, increasing environ-
mental disasters, and the credit crisis. Yet the resounding messages provided by the psy
complex imply that people’s struggles are personal and internally produced, as though our
experiences in the world were somehow separate and distinct from the social conditions
that shape, produce, and order those experiences. Psychiatric discourses have been—and
continue to be—contentious and problematic for many reasons: classifications can be
ambiguous, they often lack sufficient evidence or are based upon conflicting data, and
they are premised on highly subjective notions such as normal and abnormal. The long,
political, and controversial use of psy discourse renders the moral and intellectual status of
the psy complex scientifically and socially problematic.
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Chapter Nine | The Culture of Therapy: Psychocentrism in Everyday Life 199
As we have already seen in our examples from the early women’s and lesbian and
gay liberation movements, the rise of psychiatry has not gone unchallenged. The anti-
psychiatry movement emerged in the 1960s as part of the larger anti-establishment move-
ment, which included the collective struggles aimed at achieving women’s liberation and
civil rights. Leading anti-psychiatrists include Michel Foucault, R. D. Laing and David
Cooper, Felix Guatarri, and Thomas Szasz, all of whom received formal training in medi-
cine and psychiatry. Hostile to the fundamental assumptions and practices of the disci-
pline, anti-psychiatry arguments influenced the Western deinstitutionalization movement
of the 1970s, which resulted in the dismantling of many state-run psychiatric institutions
in favour of community-based treatment. Anti-psychiatry advocates have challenged the
modern assumption that confinement in a hospital or other institutional setting for the
majority of those diagnosed as mentally ill was necessary.
Today anti-psychiatry advocates also challenge the growth of “chemical restraints”
(drugs) for those targeted as at risk, dangerous, disorderly, disruptive, and so forth, which
has become commonplace in the West. Patients and ex-patients have challenged and
resisted traditional assumptions and labels by embracing and celebrating their differences as
strengths rather than weaknesses—as witness, the growing “psychiatric survivor” and “mad
pride” social movements (Crossley & Crossley, 2001; Curtis et al., 2000; Shaughnessy,
2001).
We can also contribute to resistance strategies through our engagement with history
and theory. The Foucauldian approach critically interrogates the psychocentricity of the
human sciences. This perspective allows something new to be thought, and as Foucault
announced, “to learn to what extent the effort to think one’s own history can free thought
from what it silently thinks, and so enable it to think differently” (1986: 9). After all, the
purpose and promise of the sociological imagination is to produce theories and research
methods, as well as new forms of knowledge, useful for understanding the link between
private troubles and public issues. Understanding the practices and discourses of thera-
peutic culture thus necessarily entails critiquing the psychiatrization of everyday life that
produces and masks the social and historical bases of human struggles.
STUDY QUESTIONS
1. What does it mean to say morality has been medicalized? What is a current example
of this that was not addressed in this chapter?
2. In what ways has the treatment of those classified as mentally ill changed over the past
100 years? How does a Foucauldian approach explain these shifts?
3. How does the distinction between normality and abnormality contribute to social
regulation? Provide examples.
4. How have counter-discourses challenged psychocentrism? What alternatives to psy-
chocentrism have been proposed? Try also to think of some examples that are not
discussed in this chapter.
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EXERCISES
1. Go to a bookstore to investigate the titles in the self-help genre. Check sections such as
health and wellness, business, travel, biography, spirituality, new age, women, lesbian
and gay, and sociology. What themes emerge from your investigation?
2. Research a criminal legal case in which a psychiatric diagnosis has been an important
component of the evidence and sentencing. How have psy discourses been deployed
in the construction of legal evidence?
3. Take note of how many times in a given day you encounter or make use of psy dis-
course. How does this exercise contribute to your comprehension of Foucault’s notion
of government?
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