I will not get into why I started therapy. Let us just say that I was young and things were out of sorts, and this was proving inconvenient. In any case, I went; and so on and off for several years, I sat down and spoke to a stranger about how I was. To start with, something — sheer Englishness, perhaps — stopped me from “opening up”. But in time I resolved that if I was going to go at all, I might as well be forthcoming. So I did my best to sketch what was going on in my life, and we spoke out about how we might bring things back into order.
And — it was helpful. Plainly many people do find therapy helpful. Even if we set aside the small fact that we are hardly reliable narrators of our lives, there is no doubt that there are many good therapists out there. Indeed, I know some of them. But I have to say it: after more years spent talking to therapists than quite frankly I care to admit, and after speaking to others about their experiences, I have some doubts about how helpful therapy is. In fact, I wonder if there is not a case to be made that it can do more harm than good.
What has muddied the water, I think, is this term mental health. To say we have “poor mental health” is, usually, to say we have unpleasant feelings more than is appropriate. Were I to burst into tears when someone cut in front of me in a queue, something would be off. Well all right, then. The problem is that we hear the term so often we forget it is a metaphor. And like all good metaphors, it is useful till taken too literally. Unless that thorny mind-body problem has been solved, it treats the mental like the physical. But where I can recover from a sprained ankle, I cannot get over worry or sadness in any lasting way. These latter are ordinary responses to life. To feel nervous before you give a eulogy is not a sign you have generalised anxiety disorder. It is more likely a sign that you want to do a good job. And quite right, too. Thank heavens you weren’t asked to sing. There is no end to therapy if the goal is to get a clean bill of mental health. It doesn’t exist.
There is some evidence that those who suppress fearful thoughts feel better than those who don’t
“Was mich nicht umbringt, macht mich stärker”, as Nietzsche put it in Twilight of the Idols (it sounds much better in German): “What doesn’t kill me makes me stronger.” Perhaps we have forgotten this. In the attempt to deal with our feelings by talking, we may just avoid doing what would weaken their grip. We all know a person who will do absolutely everything except grasp the nettle. But can we be surprised? For we have been led to think that if we could only find some inner strength, then we could face down that ghastly neighbour, or open the letter from HMRC. The truth is that more often than not self-belief follows action, not the other way around. If you want to be the kind of person who does hard things, then go and do them, and if a glass of wine helps you pluck up the courage — well, I won’t judge. You may just find you are still standing in the aftermath.
This is to say: we are what we do. It is an old idea, but perhaps Slavoj Žižek said it best:
Pretend that you are good and act accordingly and maybe there is a chance you will become good. But don’t look deep into yourself. You will discover only shit.
There are subtler ways to put it, but you can see what the man is driving at.
There is a more pernicious, insidious aspect of therapy. In Beyond the Self, the Buddhist monk and former scientist Matthieu Ricard questions the wisdom of an approach to wellbeing that is “me, me, me”. For him, trying to find peace “within the ego bubble” resembles a kind of Stockholm syndrome. Breaking free of our various entanglements and focusing on what is outside of ourselves might be better. We tend to make too much of things simply because we’re involved. One risks getting trapped in a hall of mirrors and losing one’s sense of proportion. To paraphrase the priest and writer Pablo d’Ors, we “martyr [ourselves] with diminutive problems or imaginary pains”. If we had a friend in the same situation, we would see things differently.
More: what Carl Rogers called “unconditional positive regard” can feel to the patient like endorsement. The patient suggests his friend or parent is “toxic”. The therapist does not disagree. Emboldened, the patient grows more certain. But his view may be highly subjective. Ask ten people for theirs and, on balance, they might find he has more to answer for. He is unlikely to hear that in therapy. Worse: his therapist has only his version of events, and is duty-bound principally to him. Yet our patient lives among others and must answer to them, too. This can lead to an absurd state of affairs in which someone grows ever more sure of his rightness, and ever less able to mix with those around him. He may even turn away from those precious few who would drop everything to get him out of a bind — or at least bring him tea and sandwiches — because their idea of affection doesn’t quite match his.
Abigail Shrier, who has a knack for walking straight into the hornet’s nest, charts this drift in Bad Therapy, which paints a vaguely dystopian picture of the therapeutic landscape. She shows that therapy can teach helplessness and induce distress; that its very definition (The American Psychological Association defines therapy as “Any psychological service provided by a trained professional.”) is circular; and that the idea behind the bestseller The Body Keeps the Score is reheated “repressed memory”, a discredited theory that led to the wrongful incarceration of people in the 80s. (The book’s author, Bessel van der Kolk, was a witness in their trials and “crucial to putting innocent people in prison”, according to journalist Mark Prendergast). Shrier’s book ruffled some feathers, as you can imagine; but it also drew approving nods from many in the therapy world. The writer and psychotherapist Joseph Burgo admitted that the profession “has come to be dominated by bad ideas”.
One begins to suspect something larger is going on. Patrick Deneen and the other post-liberal types are fond of saying “liberalism has failed because it has succeeded”. The claim is that it leads to a rampant individualism that erodes social bonds and causes misery. If they are right, then therapy starts to look less like a cure than a coping mechanism. The therapist becomes a kind of secular priest, charged with the hopeless job of helping us get by in a culture ill-suited to our flourishing. Perhaps this is true, perhaps not; but that therapy has not reversed, stopped or even slowed the tide of rising gloom is suggestive at least of its limits. It has long been known that strong social ties, a closeness to nature and — that thoroughly unfashionable idea — a sense of the sacred are key to our wellbeing. Tea and a cat or two also helps.
Ricard may well have been onto something when he said that trying to find peace through the filter of self-centeredness might not be all that wise. It is, after all, striking that some of the more well-grounded ways to lift our spirits involve, in effect, getting out of our own way. Many are ancient. Cognitive Behavioural Therapy owes much to the Stoics; meditation turns up in nearly every faith; and yoga came about over 2,000 years ago. Amusingly, there is now some evidence that those who suppress fearful thoughts feel better than those who don’t. It had been roundly accepted that it is terribly unhealthy to bury our feelings. But it seems the stiff upper lip might in fact have its uses.
If Deneen et al. are right, it seems somewhat curious to treat the effects of individualism with more of it. And yet, as I read that Britain has become one of the least “flourishing” countries in the developed world, that more and more children have mental health disorders, that millions of adults feel lonely, that mental ill health is behind soaring benefits. It seems therapy is becoming the answer we look to. There were 1.44 million referrals in 2017, 1.76 million in 2023, and a record 1.83 million last year. Around Christmas, the NHS said it had given 671,644 courses of talking therapy over the past 12 months — 10 per cent more than before Covid. And all the while, nearly half of all therapists say they are over capacity. If I am right, or even half-right, then all of this talking is unlikely to make much difference.
