• Frank Furedi
  • Frank Furedi
  • Sociologist, commentator and author

The Therapeutic University

Some months back I read a circular issued to Oxford University postgraduate students on the potentially traumatic consequences of social science research. Promoting the availability of “Vicarious (Secondary) Trauma Workshops for post-grads participating in the university’s ‘Social Sciences Research and Skills Training’ programme,” the blurb explained that:

‘It is increasingly recognised that some social science research places exceptional emotional demands on the researcher, and that managing these emotional demands can be an essential component of the work. In particular, researchers whose fieldwork entails hearing about and engaging with the traumatic experiences of others may be at risk of developing symptoms of vicarious trauma (sometimes called “secondary trauma”) which can parallel symptoms of traumatic stress.’

That social science research now comes with a health warning is testimony to the ascendancy of therapy culture in Western institutions of higher education.

Since the 1960s, universities have been in the forefront of promoting theories and practices that encourage people to interpret their anxieties, distress, and disappointment through the language of psychological deficits. Until recently, however, how students and faculty coped with their existential problems remained a personal matter. Today, the therapeutic outlook pervades campus culture so thoroughly that it influences how courses are taught, which topics are discussed, and how verbal exchanges are regulated. Teaching, some educators believe, can be trauma inducing, and so they have adopted an explicit “trauma-informed perspective.”

Outside of hospitals, the university has arguably become the most medicalized institution in Western culture. In 21st-century Anglo-American universities, public displays of emotionalism, vulnerability, and fragility serve as cultural resources through which members of the academic community express their identity or make statements about their plight. On both sides of the Atlantic, professional counselors working in universities report a steady rise in demand for mental-health services.

Among academics there is widespread agreement, too, that today’s students are more emotionally fragile and far more likely to present mental health symptoms than in the past. There is little consensus, however, about why this is so. Marvin Krislov, the president of Oberlin College, has more questions than answers on this score:

‘I don’t know if it’s related to the way we parent. I don’t know if it’s related to the media or the pervasive role of technology—I’m sure there are lot of different factors—but what I can tell you is that every campus I know is investing more resources in mental health. . . . Students are coming to campuses today with mental-health challenges that in some instances have been diagnosed and in some instances have not. Maybe, in previous eras, those students would not have been coming to college.’

Krislov’s description is familiar, but just as mystifying, to many administrators and academics. But perhaps there is no need for the confusion. Consider, if you will, that what they perceive as an expanded set of problems tracks right along with the exponential growth of the Diagnostic and Statistical Manual of Mental Disorders. What do I thus intimate?

When Peter Berger wrote in 1965 that “psychoanalysis has become part of the American scene,” he could be sure that his audience would treat his statement as a matter of fact. Berger remarked that psychoanalysis had become a cultural phenomenon that influenced the American legal system, religion, literature, and popular culture. He claimed that at least three areas of everyday life—sexuality, marriage, and child-rearing—had been “significantly” affected by it. (1) During the same year, Paul Halmos published the first systematic investigation of the impact of this phenomenon on British society and concluded that its influence is “in a process of rapid growth.” (2) A year later the American sociologist Philip Rieff announced The Triumph of the Therapeutic. Discussion of the growing impact of the therapeutic ethos was not confined to the Anglo-American world. Serge Moscovici in France and Thomas Luckmann in Germany testified to the impact of the same trend in continental Europe. (3)

These early pioneering critics of the influence of therapeutics on culture could not have imagined how much it would shape the conduct of academic affairs in the 21st century. Although Rieff gave his book the provocative title The Triumph of Therapeutic, the phenomenon he was exploring still had a relatively modest impact on society; it rather competed with traditional ideas, radical ideologies, and secular rationality, all of which still possessed a formidable capacity to give meaning to the experience of millions.

Since then, Western societies have become ever more uneasy with the values and behavioral codes of the past, and ever more open to alternative ways of giving meaning to human experience. Since the 1960s, the erosion of common webs of meaning, through which communities deal with the uncertainties of existence, has indeed created a demand for a new etiquette.

To help President Krislov answer his own question, let me suggest that perhaps the most significant development that accounts for society’s estrangement from its own traditions today has been the reluctance of its elites to uphold their own authority. It is difficult to imagine how profound cultural changes such as the wholesale rejection of tradition and the embrace of therapeutics can take place without at least the acquiescence of the elites. Among the seers of the Sixties, it turns out that Rieff is the one whose argument focused on the triumph of the therapeutic as an expression of the crisis of cultural authority.

The ruling elites, Rieff claimed, were suffering from a failure of nerve, that “the death of culture begins when its normative institutions fail to communicate ideals in ways that remain inwardly compelling, first of all to the cultural elites themselves.” A lack of self-belief, enhanced by a profound mood of disorientation, undermined the capacity of Western political elites to transmit their narrative of cultural traditions: “Many spokesmen for our established normative institutions are aware of their failure and yet remain powerless to generate in themselves the necessary unwitting part of their culture that merits the name of faith.” (4) Not only did the elites cease being supportive, they also became critical of traditional culture as a “moral demand system.” This rejection of tradition, Rieff believed, represented a cultural revolution with far reaching consequences. (5)

It was in the university that the unresolved tension provoked by cultural conflict has since acquired its most acute manifestation. As David Bromwich, a professor of English at Yale, noted, “most of the conversation about culture in America now is carried out in universities.” (6) Universities have played a central role in attempting to formulate an etiquette of behavior through questioning traditional rules of conduct and the values underpinning them. Since “traditional values” have lost their capacity to motivate a significant section of society—particularly the university-educated—opponents of traditional conventions and values have succeeded in establishing a commanding influence in institutions of culture and education, and public life more widely.

Socialization Through Validation

Socialization is the process through which children are prepared for the world ahead of them. During the past century responsibility for socialization has gradually shifted from the parent to the school. However, in recent decades it has seamlessly extended into the sphere of higher education. And with so many young people participating in higher education, universities have come to play an important role in the socialization of an ever-larger share of the young. University leaders frequently assume that they possess the moral authority to re-socialize newly arrived undergraduates by challenging their language and values. Anthony Monaco, the president of Tufts University, supports “calling people out” over their “microaggressions” as well as providing “safe spaces” and “trigger warnings” to realize this objective. He contends that comments that might have been “the norm” for students in high school or in the communities where they grew up “should not be the norm on campus with people from different countries and backgrounds.”

The objective of re-socialization through altering the norms that undergraduates grew up with is now actively pursued by universities through the imposition of language codes, rules of conduct, and workshops and campaigns oriented toward discrediting students’ values by “raising awareness” about their supposed defects. If this sounds a little like the “consciousness raising” presumptions of the Sixties, that’s because the “long march through the institutions” is not just a slogan.

The trend toward the extension of the role of socialization into the sphere of higher education was well observed by the sociologist Alvin Gouldner as early as 1979. Gouldner drew attention to the difficulties that parents faced in socializing their children: “[P]arental, particularly paternal, authority is increasingly vulnerable and is thus less able to insist that children respect societal or political authority outside the home.” (7) He claimed that teachers in higher education were increasingly involved in socializing their students into its values, describing colleges and universities as normative “finishing schools.”

Gouldner’s reflections are if anything more apposite today than they were back in the late 1970s. For some time now parents and schools have been struggling to transmit values and rules of behavior to young people. Whatever the reasons—lack of self-confidence, societal estrangement from tradition, and the rest—the hesitant and defensive manner with which the task of socialization is pursued has created a demand for new ways of influencing children. The growing remit of child protection now includes practices from behavior management among the tool kit for solving the problem of socialization. (8) These psychological techniques of expert-directed behavior management now have an important influence on childrearing. From this standpoint the role of parents is not so much to transmit values but to validate the feelings, attitudes, and accomplishment of their children. This emphasis on validation runs in tandem with a risk-averse regime of child-rearing, the (unintended) consequence of which has been to limit opportunities for the cultivation of independence and to extend the phase of dependence of young people on adult society. That, in turn, reinforces the considerable difficulties society has in providing young people with a persuasive account of what it means to be an adult.

The absence of a consensus on the narrative of adulthood enhances the difficulty for young people to adopt a “grown-up” attitude to life. Unprepared for a more independent life, many students regard universities as merely a more difficult and challenging version of a school. Many expect more of the same rather than a qualitatively different, more adult experience in which they will be tested rather than validated. Under pressure from students, parents, and the wider society to share responsibility for the socialization of young people, universities have responded enthusiastically to carrying out this new task largely because it often pays handsomely. That they have forsaken what universities are actually supposed to do is a price less rued than overlooked.

Medicalization of the University Experience

The term medicalization draws attention to the trend toward interpreting the problems people encounter in their daily lives as medical ones. When the concept of medicalization was first formulated by social scientists in the late 1960s and early 1970s, it referred to a far narrower range of phenomena than is the case today. The definition of health now pertains to areas of life that lay outside the traditional purview of medicine. (9) Health has acquired an aggressively moral connotation, and terms like “sexual health” or “reproductive health” indicate that even the most intimate part of people’s natural lives has become medicalized.

One unsettling consequence of the expanding ambit of medicalization is that the line dividing health and illness has blurred. Earlier ideas about medicalization still considered illness to be the exception; in the current era, the relationship between the two has become more ambiguous. Indeed, illness of one sort or another is frequently perceived as the normal state. Advocates of wellbeing projects assume that we all need professional support for actual or potential illnesses. Note that the phrase “to reach out,” which used to occur almost exclusively to circumstances of mental health jeopardy, has now become broadly diffused in everyday parlance both oral and written.

Anxiety about wellness is common throughout Western society, but sensitivity to emotional problems is uniquely prevalent within institutions of higher education, where new psychological syndromes and diagnosis are formulated on nearly a daily basis. Surveys and reports issue alarmist claims that the level of stress and the rate of mental health-related issues is particularly high within academia. “Stressed academics are ready to blow in pressure-cooker culture” was how a report in the Times Higher Education described life in the academy in 2012. A 2013 study published by the UK-based University and College Union (UCU) asserted that “academics experience higher stress than those in the wider population.” It is unclear from these reports what is meant by “experiencing stress.” In the 2013 survey, it was sufficient to answer in the affirmative to the statement “I find my job stressful,” as if that were something new and unusual. It seemed never to occur to the surveyors and to the interpreters thereof that university-educated people tend to be more articulate than the non-university educated, and so might be better able as well as far more willing to express anxiety to other well-educated people conducting surveys—in other words, that stress itself was less the issue than people’s willingness to talk about it.

The great sociologist Robert Merton elaborated the concept of “self-fulfilling prophecy” to describe the way that initial assumptions and beliefs about a situation can play a significant role in establishing the meaning that those assumptions had for its outcome. (10) The representation of existential problems as medical ones has an important influence on the way individuals perceive their health. The relationship between the medicalized narrative of wellbeing and its impact is a dialectical one, in that it does not simply frame the way people are supposed to feel and behave; it also constitutes an invitation to being “not well.” That is why the sensibility of being “not well” has today become part of many people’s identity.

Take the recently discovered university-focused condition of “examination syndrome.” Students who are anxious about sitting for their exams are sometimes diagnosed as suffering from “pre-exam anxiety syndrome.” That students are worried before an exam is certainly nothing new. What is new is that this age-old response is represented as a condition to be treated. “Is it possible to overcome test anxiety?” asks Dr. Daniel K. Hall Flavin on the Mayo Clinic website. His numerous common-sense suggestions end with the advice that, if all fails, get psychotherapy. Happily, most recommendations actually make sense. The Anxiety and Depression Association of America advises sufferers to maintain a positive attitude, stay focused, practice relaxation techniques, and so on. Similar good sense is provided by the University of Sheffield’s advice on “exam panic attacks.”

But that’s not the issue. The problem is not the banal exhortation to relax, or to stay focused, which could be acquired for free from any sensible parent, friend, or clergyman. It is the application of a medical label to a very normal condition, and the consequent artificial professionalization of the advice. The unstated corollary of this labeling is the assumption that sitting and preparing for an examination may be harmful to your wellbeing, whatever that term has come to mean. “Pre-exam anxiety leads to stress syndrome” is the title of an article on the plight of students in, of all places, the People’s Daily of China. (At least it’s not just the United States.)

The Cultural Script of Student Vulnerability

Terms like examination syndrome illustrate a growing tendency to medicalize the language through which personal problems are communicated. In universities, terms like “trauma” are now used promiscuously to signify upset and distress. As the political scientist Mark Neocleous observed, “‘That was really traumatic!’” is now an appropriate response to any event that would once have been described as “rather unpleasant” or “quite difficult.” (11) The transformation of distress into a condition of emotional injury has as its premise the belief that people are likely to be seriously damaged by unpleasant encounters and the setbacks thrown up by everyday life. As the current discussion on trigger warnings in universities indicates, the term “trauma” can be applied to experiences as banal as being disturbed by reading about distressing events. (12)

One of the clearest manifestations of the trend toward the medicalization of human existence is the widespread and unquestioned use of the term “vulnerable.” The term is habitually used as if it is a permanent feature of a person’s biography. It is presented and experienced as a natural state of being that shapes human responses, and is now a label frequently used to describe entire groups in society.

The perception of vulnerability is so deeply immersed in our cultural imagination that it is easy to overlook the fact that it is a recently invented concept. (13) The term “vulnerable group” did not exist in the 1970s. One study notes that the tendency to frame children’s problems through the metaphor of vulnerability became visible in the late 1980s but took off in 1990s. (14) And when these children turned into young adults and arrived at the university gate, they continued to possess this newly pasted-on identity.

The emergence of the term “vulnerable student” ran in parallel with wider cultural trends. A search of the LexisNexis database of English-language newspapers failed to find any reference to “vulnerable students” during the 1960s and the 1970s. There were 13 references during the 1980s, of which seven referred to pupils in schools. The first reference to vulnerable university students appeared in The Times (London) in 1986, the New York Times in 1991, and the Guardian in 1995. But there was a significant increase in references to vulnerable students during the 1990s, and a veritable explosion of the term in the first decade of the Millennium.

During the year 2015–16 there were 1,407 references to our search term. Even taking into account the likelihood that LexisNexis has expanded the sources cited in its database, the remarkable increase in allusions to the vulnerability of students provides a striking illustration of an important transformation in the way university students are represented and perceived.

This stands as evidence for a more general proposition: That the 21st-century version of personhood communicates a narrative that continually raises doubts about people’s emotional capacity to deal with physical and emotional harms. The transformation of distress into a condition of emotional injury has as its premise the belief that people are extremely fragile in the face of the vicissitudes of everyday life. How has that come to be?

Today in the West we live with an unprecedentedly pessimistic account of the workings of human subjectivity and personhood. The downsizing of expectations regarding human agency, along with the normalization of the sensibility of powerlessness, is intimately linked to the wider mood of cultural pessimism afflicting Western societies. (15) Numerous studies and surveys noted that in the 1970s, trust and respect for the institutions of Western societies fell dramatically. From this point on the estrangement of people from politics and public life was closely paralleled by a mood of fatalism and cultural pessimism. What followed was a perceptible loss of conviction in the capacity of people to shape or alter their circumstances. It was this sense of loss of human agency that created fertile conditions for ideas about fragile identity and vulnerability. And it was from the general milieu that such notions percolated into and became concentrated in Western institutions of higher learning.

A Cultural Problem Masquerading as a Medical One

In an insightful essay on the therapeutic turn of campus life, Greg Lukianoff and Jonathan Haidt called attention to rising cases of mental illness in young people, both on and off campuses:

‘Nearly all of the campus mental-health directors surveyed in 2013 by the American College Counseling Association reported that the number of students with severe psychological problems was rising at their schools. The rate of emotional distress reported by students themselves is also high, and rising. In a 2014 survey by the American College Health Association, 54 percent of college students surveyed said that they had ‘felt overwhelming anxiety’ in the past 12 months, up from 49 percent in the same survey just five years earlier. Students seem to be reporting more emotional crises; many seem fragile, and this has surely changed the way university faculty and administrators interact with them.’

How are we to make sense of this epidemic of mental health problems on campus? Lukianoff and Haidt argue that “some portion of the increase is surely due to better diagnosis and greater willingness to seek help, but most experts seem to agree that some portion of the trend is real.” However, the issue is not whether this trend is “real” or not: It is likely that the vast majority of people seeking help from counseling services are experiencing some sort or degree of psychological distress. Once everyday life is interpreted through a medicalized idiom, the meaning of pressure and stress often acquires a pathological dimension. Feelings and emotions that were once considered unexceptional can acquire a more threatening dimension in a medicalized culture. What Lukianoff and Haidt describe as a “greater willingness to seek help” is itself actively promoted as a virtue in a medicalized setting.

Advocacy of the virtue of help-seeking is paralleled by a cultural disposition to endow human experience with mental health diagnoses. That is why advocates of the medicalization of student life invariably come up with alarming statistics to convey the impression that academic study is a highly toxic vocation. In Britain, the National Union of Students (NUS) regularly produces reports that highlight an epidemic of mental health issues in universities. Its 2015 survey stated that 78 percent of students indicated that they experienced mental health problems, and that one-third of the respondents claimed to have had suicidal thoughts. Reading this survey, one can readily draw the conclusion that the real deviants were the 22 percent who are likely to be suffering from some disorder that makes them impervious to stress.

Of course, some students do have mental health problems and require pastoral and medical support. But the representation of psychological distress as the normal condition of university life encourages young people to interpret their troubles using a medicalized language. This then becomes a self-fulfilling prophecy. If young people are constantly told that life on a campus is very stressful, they will worry about that and become…stressed out. It is not surprising in the slightest that many will experience life through the prism of psychological distress because, social life being what it is, this sort of thing is contagious. It is likely that, given the reproduction of the current cultural setting and the current disposition to promote therapeutic interventions, the reporting of emotional distress and mental health problems among young people will continue expand.

There is considerable evidence that, in the current climate, the normal challenges and discomforts of academic life can provoke outbursts of tears and cries for help. Irina Popescu, a teacher of comparative literature at Berkeley University reports encountering traumatic displays of fragility in response to relatively routine discomforts facing students. Writing of her “students’ fragility,” she explained: “I mean the fragility I witness when a students misses an assignment because he simply forgot to check the syllabus, or when a students speaking aloud in class for the first time starts shaking, or when a student who is handed back an incomplete paper with a C on it immediately tears up.”16 Popescu’s analysis of the difficulty that undergraduates have in engaging with what she calls “the educational power of discomfort” is rightly focused on the disempowering consequences of their previous phase of socialization. Unfortunately, higher education has become complicit in continuing to treat students as if they are children.

Why Is This Generation Different?

Those concerned with the emotional fragility of university students frequently assert that the reason for their reaction is linked to the unprecedented economic insecurity that they face, or to the threat of mass-casualty terrorism, or to something or other out there in the big bad world. University students are often portrayed as confronted with a wide range of unparalleled problems and as struggling to make ends meet.

There is little doubt that many students face serious financial pressure and that they are often forced to juggle the conflicting demands of coursework and economic survival. However, it is far from evident that there is a link between their economic status and their emotional fragility. After all, none of this is new. Many students of past generations suffered financial difficulties without feeling that they needed psychological support. Besides, students from well-to-do backgrounds are no less likely than their poorer peers to speak in the language of trauma and psychological distress. Indeed, some of the most privileged campuses—Oxford, Cambridge, Yale, Berkeley, Oberlin—have been in the forefront of campaigns drawing attention to the emotional harms suffered by activists and other students.

The most influential explanation used to account for the emotional fragility of students in higher education is to link it to the growing number of first-generation university students who lack the parental, financial, and cultural support that was once enjoyed by nearly all undergraduates. Some advocates of widening participation argue that first-generation students—that is, undergraduates whose parents did not attend university—face unique problems fitting in to what is an alien and difficult environment. This argument is widely used in the United States, where almost half of all college students are the first in their family to go to university. It is also asserted that, since significant numbers of first-generation students come from minority and socially deprived backgrounds, they face particular problems fitting in to a traditional white middle-class environment.

That the first-generation university students may well be at a disadvantage in comparison to their peers who have parents with a degree is not in doubt. The socially mobile often face obstacles, as was the case with the large number of first-generation students who entered higher education in the 1960s, 1970s, and 1980s. The principal problem faced by first-generation students is that their parents had little cultural capital to hand on to them and were therefore less prepared for university life then their more comfortably-off peers. Unlike today, however, the problems they faced were not portrayed in psychological terms but in the language of culture and socio-economic deprivation. That being a first-generation students serves today as a risk factor for emotional distress is the outcome of wider cultural influences.

Unfortunately, when first-generation students arrive on campus they are often treated as if they are likely to possess some emotional deficits. It is now common for universities to organize special programs for integrating first-generation students. Diversity officers dealing with the first generation often operate under the theory that this group faces a unique problem of being torn between family and university. They frequently contend that first-generation students suffer from pangs of guilt for leaving their family behind. Most of this is sheer nonsense.

The upshot of these theories, however, is the belief that first-generation students need special dedicated psychological support. As one expert on the subject advised: “The challenge of higher education is to recognize the psychological impact that first-generation status has on students and to provide help.”

But of course, this condescending attitude does not ameliorate problems so much as cause them. The focus on psychology distracts attention from more constructive ways of preparing students from disadvantaged backgrounds to deal with the pressures of academic learning. The provision of academic support to help students gain intellectual confidence is probably the most useful way of helping students to make their way in the university. Perversely, the provision of psychological support as the default solution for helping first-generation students is likely to intensify their quest for validation. Instead of developing their power of resilience, it may well heighten their sense of vulnerability. What universities need to do is not to cultivate the identity of first-generation students but to provide them with the intellectual resources that will help them to gain confidence in their ability to achieve.

Let us close with a pop cultural observation. In certain corners of youth culture, it has for a few decades now been the case that the adjective “sick” means what used to be called “cool.” To say that an outfit or a song or a behavior is “sick” means it is out of the ordinary, outstanding, captivating, even creative, and original. Think this is a coincidence?

1) Berger, “Towards a Sociological Understanding of Psychoanalysis,” Social Research (Spring 1965).

2) Halmos, The Faith of the Counsellors (Constable, 1965).

3) See Moscovici, La Psychoanalyse—Son Image et Son Public (Presses Universitaires de France, 1961), and Luckmann, The Invisible Religion: The Problem of Religion in Modern Society (Macmillan, 1967).

4) Rieff, The Triumph of the Therapeutic: Uses of Faith After Freud (Chatto and Windus, 1966), pp. 18–9.

5) Rieff, The Triumph of the Therapeutic, p.15.

6) Bromrwich, Politics By Other Means: Higher Education and Group Thinking (Yale University Press, 1992), p.103.

7) Gouldner, The Future of Intellectuals and the Rise of the New Class (Macmillan Press, 1979), p.44.

8) These problems are discussed in chapter four of Furedi, Wasted: Why Education Isn’t Educating (Continuum Press, 2009).

9) My ideas on medicalization are developed in Furedi, “Medicalisation in a Therapy Culture,” in D. Wainwright, ed., A Sociology of Health (Sage, 2009).

10) Merton, “The Self-Fulfilling Prophecy,” Antioch Review (Summer 1948).

11) Neocleous, “‘Don’t Be Scared, Be Prepared’: Trauma-Anxiety-Resilience,” Alternatives: Global, Local, Political (August 2012), pp.188–9.

12) For a skeptical statement on the desirability of trigger warnings, see Richard McNally, “Hazards Ahead: the Problem with Trigger Warnings, According to the Research,” Pacific Standard, May 20, 2014.

13) On the history of this concept see Furedi, “From the Narrative of the Blitz to the Rhetoric of Vulnerability,” Cultural Sociology (July 2007).

14) Ronald Frankenberg, Ian Robinson, and Amber Delahooke ‘Countering Essentialism in Behavioural Social Science: The Example of the “Vulnerable Child” Ethnographically Examined’, Sociological Review (November 2000), pp. 588–9.

15) See Furedi, Politics of Fear (Continuum, 2005).

16) Irina Popescu, “The Educational Power of Discomfort,” Chronicle of Higher Education, April 17, 2016.

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