"Message: I care."
George H. W. Bush
The mad have always been with us--convincing descriptions of severe mood disorders in particular exist from antiquity. But neuroses and "problems of living," or at least the recognition thereof, are largely inventions of modernity, as set forth by Ronald Dworkin in his account of what he calls "the caring industry." His article is not brief but presents some fascinating arguments and warrants careful reading. I have time for only a short summary and response here.
As Dworkin describes, since the 1950's a massive population of therapists of every stripe and, now, "life coaches," has sprung up to manage emotional issues that until then had been the domain of traditional peer groups, lines of authority, and cultural connectedness. The rise of mobility and suburbanization and the decay of natural communities began this trend, which was reinforced and hastened by the social turmoil of the 1960's and onward. Therapists do the work (or try to) that used to be done (if it was done at all) by families, neighbors, and the clergy.
So far this is pretty familiar territory--Dworkin documents the increasing ubiquity of the caring industry in the military, the schools, and everyday life. He points out that while the 1950's are often recalled as a calm before the storm of contemporary upheaval, the decade was, beyond its infamous conformity, actually marked by a deep malaise, reflected in its moniker as "the Age of Anxiety." It was as if the plunge into collective and rapid social and technological change, still a few years off, could nonetheless be glimpsed and feared.
But Dworkin's more creative and radical claim is that, presumably in response to the civilization-wide catastrophes of the two world wars, people in the West at mid-century underwent a profound change in their emotional engagement, one that we still haven't recovered from. He suggests that for the better part of a millenium, love had grown as an ideal in personal, religious, and national life. But the extent and depravity of the world wars showed that love stops at the nation-state and cannot be extended to humanity as a whole; the implication is that love is not only insufficient for global security, it is positively dangerous, and an unaffordable luxury, inasmuch as it fosters tribalistic nationalism in a nuclear age.
The consequence was that people have tended to grow more detached and cynical in their attachments. Much of the residual lure of love, intensified by the entertainment industry, has come to reside in individual erotic connection, upon which more and more seems to ride even as it becomes more fragile. Dworkin argues that people have largely given up on the organic, intense, but volatile attachments to natural peer groups in favor of cooler, more easily manageable relationships obtainable from therapists in finely titrated 50-minute increments. It is an elaborate theoretical version of the therapist-as-friend-substitute claim.
There is much that could be said in response to this fascinating version of history. First, while he does not come out and say so, Dworkin's elegaic tone certainly evokes some Golden Age when people were happier--is that really the case? While he suggests that the masses are lonely and miserable, most surveys of Americans at any rate show that the majority consider themselves basically happy (I am aware of the myriad nuances surrounding a fraught construct such as happiness). To be sure, attachments are not so simple, so monolithic, or so geographically given as they long were, but are they worse? Perhaps they are more dynamic, more flexible.
For some reason Dworkin refers primarily to the traumas of the war-ridden early 20th century, but it seems to me that the nuclear age contributed more directly to civilization-wide angst. For 65 years now the possibility of nuclear holocaust has been a gun held to the head of humanity, and it has not gone away, even if we don't so much envision a Soviet premier with his finger on the button. For those so inclined, the environmental threats of recent decades have added to the perceived risk of the earth being ruined beyond repair. These things, it seems to me, could sap social trust and confidence more than the legacy of the trenches and the Holocaust, horrible though they were.
Dworkin maintains that people utilize "the caring industry" on a massive scale because they have grown more sad and alienated. However, by this argument, one could argue that people use air conditioning because they have grown hotter than people of previous centuries. The latter would of course be wrong, but one can make a case that psychotherapy is not so much a response to cultural calamity as it is just another modern innovation that people find useful and reassuring. The comparison to air conditioning may sound trivializing, but it isn't entirely far-fetched; after all, in heat waves such as we are having now in my part of the world, AC does save lives, even if for most it "merely" adds to quality of life.
It is true that air conditioning has made people less tolerant of the heat, just as automobiles make people on average less tolerant of exercise. But these are side-effects and trade-offs that the majority seem willing to make. And the relative softness and sensitivity of modern populations are arguably consequences of unheralded prosperity--there is a bit of a princess-and-the-pea phenomenon whereby the better off on is, the less tolerant one becomes of imperfection. Most people in history had no need of therapy because they were too busy trying to stave off starvation and disease.
Modern psychotherapy arose in Europe in the 19th century, which on that continent on average was a time of great prosperity; suddenly there was a larger middle class with the time and disposable income to worry about the kinds of "problems of living" that traditionally could be "suffered" only by the rich. It is significant then that psychotherapy really took off in the U. S. in the 1950's, which, while it was a time of war weariness and nuclear anxiety, was also in economic terms the start of a globally novel degree of economic well-being.
Despite its inequalities (more stark in recent years), over the past half-century the U. S. has been, in sum, the most prosperous nation in the history of the world, so arguably its vices--the breakdown of the family, the hypertrophic media and entertainment industries, the rise of obesity, and yes the "triumph of the therapeutic"--are largely ailments of prosperity. But these ailments are very real, and attended by real suffering--just ask the morbidly obese. The caring industry may be an inevitable result of liberal capitalism. As a culture, it may be that we have become less trusting, and perhaps even less loving, than our great-grandparents, but arguably we are also more knowing and less naive.