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In Therapy We TrustReview - In Therapy We Trust
America's Obsession with Self-Fulfillment
by Eva S. Moskowitz
Johns Hopkins University Press, 2001
Review by Brian J. McVeigh, Ph.D.
Feb 10th 2009 (Volume 13, Issue 7)

Have many times have we heard a relative complain that their children's schools have enacted Alice-in-Wonderland policies designed to enhance "self-esteem": teachers are not allowed to correct with red pens because of the negative associations of their color; sports teams are not allowed to win because the defeated experience disappointment; everyone is awarded for excellence so no one feels dejected, etc.). 

How widespread such practices are is debatable, though certainly the perception exists that "feelings are sacred and salvation lies in self-esteem."  This sentiment is fueled by the "therapeutic gospel," but than God, Americans now turn to "psychological idolatry."  Even how "people feel about how they feel" is a great concern (pp. 2–3).  And consider this: in the fifteen years that the Diagnostic and Statistical Manual of Mental Disorders has been available, the number of mental disorders listed has grown from one hundred to more than three hundred (p. 4).  Between 1945 and 1970, the number of psychiatrists increased from 3,600 to 18,400 (p. 217), and between 1957 and 1976, those seeking psychological help increased from 14% to 24%. 

How did we reach an "age consumed by worship of the psyche" (p. 2)?  "In Therapy We Trust" attempts to answer this question by illustrating how faith in psychological happiness has been intimately bound up with major socio-historical developments.  The chapters are arranged chronologically, thereby making the arguments persuasive since the historical transition from a less-therapeutic mind-set to the highly psychologized society of today becomes clear.  The therapeutic gospel has three tenets: (1) happiness should be our supreme goal.  Wealth, public recognition, or high moral character are only valuable if they make us happy; (2) our problems stem from psychological causes; and (3) psychological problems underlying our unhappiness are treatable (p. 3). 

Eva S. Moskowitz begins her tale of the birth of psychological society by introducing Phineas Pankhurst Quimby (1802–1866) in Chapter 1 ("Illness: A New Cure, A New Faith, 1850–1900").  In 1859 Quimby began to advocate "Spiritual Science" which, for the time, was based on novel notions, e.g., "investigations in psychology," "mental therapeutics," and "mind cure."  It may be difficult for us to appreciate, but before 1850, medicine had a somatic or a spiritual orientation, so that treatment was not conceived psychologically (p. 280).  For Quimby, however, one gained power over disease by understanding the mind.  Conventional medicine neglected the role of the mind while religion contributed to sickness.  Prayer was secularized, and the pursuit of personal happiness became a commandment.  Not sin, but pessimism and negative thoughts, were to be avoided.  Religion and science were fused. 

Quimby's ideas constituted an important precursor to the postmodern therapeutic ethos of happiness.  In particular, a movement of "religious medicine" loosely based on his teachings, called New Thought, would emerge (p. 19).  Mental suggestion, psycho-gymnastics, and "mental photography" were aspects of this new worldview.  The latter was developed by Henry Wood in his Ideal Suggestions through Mental Photography (1893).  Pictures of a placard would be taken on which one would write down positive thoughts, and then an individual would stare at it for ten to twenty minutes.  This practice was a "key aspect of the modern therapeutic agenda" in which one's mental processes and deep-seated emotions were made visible (p. 23).  Organizations such as the League for the Larger Life, National New Thought Alliance, and the International Divine Science Association formed, and eventually over one hundred New Thought magazines would sprout up. 

Chapter 2 ("Poverty: Reformers Offer Treatment, 1890–1930") deals with the intersection of social problems (e.g., poverty), the state, and social reformers who, imbued with the therapeutic gospel, encouraged welfare's psychologization.  Some reformers traced the roots of poverty to character flaws, and saw asthenontology (study of human weakness) as the answer.  Others sought to banish punishment from the criminal-justice system by injecting a "clinical atmosphere into the courtroom" (p. 45) and by replacing sentencing with diagnosis. 

In the 1920s and 1930s, marriage began to be judged by a new psychological valuation that placed a premium on happiness, as explained in Chapter 3 ("Marriage: A Science of Personal Relations, 1920–1940").  An increasing divorce rate caught the attention of commentators, such as Ernest R. Groves, who authored the first textbook on matrimonial relations (Marriage, 1933) and the first book on social psychiatry (Mental Hygiene, 1930).  Other works, such as Psychological Factors in Marital Happiness, appeared, as did new journals, with names like Marriage Hygiene.  In 1942 the American Association of Marriage Counselors was established. 

Military psychology emerged due to large number of psychiatric casualties caused by the massive killings of twentieth-century warfare.  This is the subject of Chapter 4 ("War: The Soldiers Psyche, 1941–1945").  While a limited program was provided in World War One, during the Second World War millions of American men for the first time were exposed to the tenets of the psychological gospel.  Theodore Adorno attempted to understand the mental underpinnings of fascism in his The Authoritarian Personality (1950), and eventually, the need for "psychological warfare" in order to predict and understand the psyche of our enemies would be recognized. 

After the war the American home became the next target of the therapeutic gospel.  In Chapter 5 ("Home: The Unhappy Housewife, 1945–1965") it is explained how attempts, driven by the consumption engine of postwar prosperity, were made to push products by appealing to women's apprehensions and aspirations.  The virtues of self-fulfillment, linked to domesticity, were put on display in women's magazines, which introduced a new idiom, e.g., unconscious, psychosomatic, defensive reaction.  Other terms that we now take for granted--ego, inferiority complex, self-esteem--became household words.  Meanwhile, concerned with the "happiness" of average Americans, the federal government stepped in with the National Mental Health (1946) and National Mental Health Study (1955) Acts.  In 1949, the National Institute of Mental Health was established, as was the Joint Commission on Mental Illness and Health in 1955. 

The counterculture, feminist movement, and "personal politics" can be understood within the context of the dramatic growth of psychology as a discipline after 1945.  The humanistic psychology of Carl Rogers and Abraham Maslow would play its part in stressing the "liberation of the self."  These issues are treated in Chapter 6 ("Social Protest: Liberating the Psyche, 1960–1975").  This was also the period when the psychological harm of racism was recognized, e.g., Abram Kardiner and Lionel Ovesey's The Mark of Oppression: A Psychological Study of the American Negro (1951). 

Chapters 7 and 8 ("Feelings: Expressing the Self, 1970–1980" and "Personal Problems and Public Debate," respectively) both deal with how modern society idolizes the individual's inner life.  Encounter meetings, support groups, and self-help books of the "me" generation advise us to articulate a more authentic self and display our true feelings.  Personal problems are made public via technologies such as "TV talking cures" and the Internet that were inconceivable to earlier generations.  Identity politics, a product of the 1960s and 70s, became linked to the therapeutic gospel, as did the identity of being an addict (now we can be addicted to anything: sex, love, substances, shopping).  Addiction has spawned other types of identity, e.g., codependents and survivors.  By the 1980s a change in therapeutic thinking was discernable.  "Rather than focusing on human potential, promoters of the therapeutic gospel focused on psychological vulnerabilities" (p. 282). 

Moskowitz's most important point concerns how the "gospel of psychological happiness" distorts our appreciation of the production of self-disaffection by "underlying economic and political realities," the "realities of class," and "flaws in the market economy" (p. 7).  Rather than "emotional retooling," "remedial emotional education," or "emotional illiteracy," we should acknowledge the social conditions that generate alienation.  For example, the discourse on what makes for a happy marriage in fact represented "deep-seated gender and class interests" (p. 99), and despite well-intentioned efforts of reformers, such attempts ended up ignoring larger economic conditions and "psychologized difficulties that were structural and social" (p. 69). 

In the Epilogue Moskowitz writes that "No other nation in the world puts so much faith in emotional well-being and self-help techniques" (p. 278).  She suggests optimistic individualism, generated by prosperity, account for such dedicated "soul-doctoring."  This very optimism, however, "seems continually undermined by consumerism," which "markets psychological ill-being."  Products, and even the "act of purchasing itself are the cure" (p. 279).  Other reasons for this "national investment in feelings" include the: (1) decline of religion; our loss of faith in salvation has been replaced by self-glorification; (2) institutional experimentation that has led to the growth of psychologized welfare-ism; (3) "dynamic nature of America's cultural economy"; and (4) demands of corporate culture, which include not just production, but reproduction, i.e., how to bring up one's children as workers while avoiding dysfunctional families (p. 280). 

All these explanations have merit, but they strike this reviewer as somewhat tautological.  Moskowitz claims that the therapeutic turn began in the 1850s, but arguably its roots are further back.  Moreover, therapeutic thinking is not just an American story, as Moskowitz suggests; it is a global phenomenon (though arguably more evident in the United States because of its vast wealth).  Her book's themes resonate with those of two other works I have reviewed for Metapsychology, --Micki McGee's Self Help, Inc. and Eva Illouz's Saving the Modern Soul: Therapy, Emotions, and the Culture of Self-Help.  All three address the psychological revolution, but revolutions have deep historical roots requiring elucidation.  The longue durée of mental transformations happens to be a particular interest of the reviewer, and this comment does not detract from a thoughtfully organized, jargon-free, and thoroughly researched book (a useful and annotated bibliography is appended).  Moskowitz has made a solid contribution to the debate about the psychologization of society. 

© 2009 Brian J. McVeigh

Brian J. McVeigh teaches in the East Asian Studies Department at the University of Arizona.  An anthropologist and Japan specialist, his latest book is The State Bearing Gifts: Deception and Disaffection in Japanese Higher Education.  He is currently writing a book entitled The Propertied Self: Politics, Psychology, and Ownership in Global Perspective


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