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Reflections on the medicalisation of social
experience
A reply to Phillip Hodson
I am quite happy to accept criticism from any quarters even from
Phillip Hodson.
Criticism, even in the form of a polemic, can be a prelude to a
genuine dialogue,
something that all parties can benefit from. I do hope that it is
possible to debate the
many issues related to the cultural influences that provide us with
our emotional
script, definition of personhood and the relationship between individual
vulnerability
and resilience, without calling one another unpleasant names.
One of the problems I have in responding to Phillip is that he
imputes attitudes
(neo-conservative) and beliefs (upholding the virtues of the stiff
upper lip and
'unreasonable nostalgia for the 1950s') that are alien to my way
of thinking. Phillip
also generously attributes quotations to me that are directly antithetical
to my
outlook. He cites me as stating such ludicrous propositions as 'the
country is going to
the dogs', 'we must find safe and certain ground again' and 'this
therapy business is
the single cause of our problem'. He then proceeds to valiantly
counter these
invented quotes to demonstrate that I am indeed a representative
of the dark 'forces
of conservatism'.
As someone who is a radical atheist and humanist and disinclined
to conserve
anything from the 1950s, I find Phillip's description of myself
as accurate as his
account of my book. But I don't think that he sets out to deliberately
distort the
arguments. Unfortunately, Phillip is so obsessed with the standing
of his profession
that he appears to overlook the fact that the book is not about
therapists and
counsellors but about therapy culture . Nor is this an anti-therapy
book, whose
objective is to attack therapists or counsellors. As I argue in
the introduction,
'therapeutic culture should not be confused with the growing influence
that therapy
exercises over people's lives'. I explicitly note that in the book
'we are interested in
therapy as a cultural phenomenon rather than as a clinical technique'
(p. 22). So my
focus is on a way of thinking and its impact on everyday life. Throughout
the book,
the emphasis is on culture on a system of meaning that informs life.
I argue that a culture becomes therapeutic when this form of thinking
expands
from informing the relationship between the individual and therapist
to shaping
public perceptions about a variety issues. At that point it ceases
to be a clinical
technique and becomes an instrument for the management of subjectivity.
What
does that mean? You are watching a television programme that contains
disturbing
images of violence. When the programme is finished, a voice announces
that if you
were disturbed by what you saw on the television screen and would
like to talk to
someone you can call a help-line. Through this announcement a clear
signal is
communicated to the audience. You as the viewer may not be able
to cope with what
you just experienced, the experience may be so disturbing that sharing
it with friends
and family members is unlikely to help and that therefore you need
to talk to a
professional help-line. And through the provision of a help-line
the producers are
also making a cultural statement to the effect that this is a very
serious and disturbing
programme. In a sense the help-line is part of the viewing experience.
Like any other system of meaning, therapy as a cultural phenomenon
offers a
representation of life and a vocabulary through which the public
makes sense of an
individual's relationship to society. This vocabulary provides concepts
through which
we can make sense of human nature and potential. Therapeutic culture
has helped
construct a diminished sense of self that characteristically suffers
from an emotional
deficit and possesses a permanent consciousness of vulnerability.
My argument in
that the defining feature of therapy culture is its equation of
personhood with
vulnerability. Vulnerability has become a key concept of our times.
We talk about
vulnerable people, vulnerable communities, vulnerable women, vulnerable
children
. . . Indeed we use the term so frequently that we know longer have
to ask 'vulnerable
to what'? For the only possible answer to this question is 'vulnerability
to everything'.
My objection to the contemporary representation of the vulnerable
self is based
on the conviction that it disempowers people and distracts them
from gaining a
measure of control over their lives. Through cultivating a powerful
sense of
vulnerability, it undermines subjectivity and the sense of human
agency. The
continuous transmission of cultural signals that suggest that in
an ever expanding
range of circumstances people should not be expected to cope encourages
the
professionalisation of everyday life. The nub of my disagreement
with Phillip is about
this development and on whether or not the professionalisation of
people's lives is a
good or a bad thing.
Phillip claims that 'counselling has spread because organisations
have found it to
be an extremely successful and cost effective solution'. Maybe.
I argue that the
institutionalisation of therapy is bound up with the cultivation
of vulnerability and
the tendency to treat people as lacking the coping skills to deal
with life. Our culture
continually reminds us that we are 'at risk', 'vulnerable' and suffering
from an
'emotional deficit'. As a sociologist I take the view that if primary
school children are
told that they need transitional counselling when going to big school
they are actually
being trained to acquire an inflated sense of fear about their impending
move. The
institutionalisation of therapy incites people to regard themselves
as vulnerable and
places them in a relation of dependence on the professional. Therapy
Culture explores
the way in which everyday life has become subjected to the imperative
of
professionalisation.
In an exchange such as this, it is unlikely that we can resolve
the question of
whether or not the effect of therapeutic culture is good or bad.
I would merely
suggest that there was a time when enlightened mental health professionals
were
critical of the tendency to medicalise human experience. Today we
seem to believe
that the normal troubles of life*/dealing with pain, disappointment
and difficult
transitions*/require professional intervention and help. For me
questioning the
ethos of professionalisation represents an attempt to shift the
focus on the problem
solving capacity of people and not an attempt to celebrate the stiff
upper lip.
First published in the British
Journal of Guidance & Counselling, Vol. 32, No. 3, August
2004
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