Can we have too much mental health?

I am on a break from social media right now, so I’m doing old fashioned things like reading newspapers on Sunday morning over a breakfast of sesame croissants with brie. I’m glad I’m not on social media, because frankly, the photos of this would be insufferable.

This morning I had the Times Literary Supplement and Die Zeit. I was tempted to buy the latter paper because its front page advertised a long article on the growing trend of… therapy by Stefanie Kara and Rudi Novotny. Yes, friends, 127 years after the publication of Sigmund Freud’s Studies in Hysteria in Leipzig and Vienna, therapy culture has reached Germany at last.

If I were on Twitter right now I’d post a few angry things about the article I read as my coffee grew cold this morning, but lacking that particular outlet for easy relief, it looks like I’m going to have to write a few thousand words about it.

The article begins with a group therapy retreat in a eco-hotel “in the middle of nowhere” in Bavaria. The participants’ portraits are sketched with a light hand: a businessman who never managed to have a girlfriend, an inhibited mother whose husband is cheating on her, a bit of trauma here, a bit of overwork there. The implication is clear: these are middle class problems, and they have more to do with a perception of unhappiness than with measurable circumstances.

Then, we are introduced to the trend: Germans are starting to go to therapy, and don’t even have the decency to hide it, the way they used to. They are buying books about their inner child. Three times as many university students are studying psychology as they were twenty years ago. A literary agent in Hamburg is quoted complaining that “characters in novels now often have nothing better to do than to fret about the tiniest cracks in their psychic condition.” (Please, nobody tell Cervantes or the Brontë sisters or Flaubert or Tolstoy about this new development…)

Fear not, before the page break we are told who and what is at fault. Psychology has become popular because it believes in the individual, and we can blame individualistic hippies in 1960s California for making it as big as it is. So it’s, you know, an American import.

Phew. This is where we need to step back for a moment. It might be useful, for context, to know that Germany is a country where talking about therapy is completely taboo. (I read news reports about how it’s becoming less of a taboo, which really just confirms how much of a taboo it still is.) The general idea, as far as I can tell, is that people are supposed to ignore their psychic issues until they develop into a full-blown crisis, and then, if they know the system and how to use their health insurance, they might get a “Kur” — a lengthy resort treatment.

Do you want to know how taboo getting therapy is? When I went for the mandatory civil servant physical for my current job, I was asked if I had ever been in therapy. Please note the wording: I was not asked if I had ever needed therapy, just if I had ever gotten it. I made some kind of face at this question, and the doctor examining me became embarrassed. "I hate that we have to ask. It’s just that,” she explained, “most of the civil servants who go on permanent disability do so for mental health reasons.”

Friends, I held my tongue. I did not say, “Maybe the problem is with their jobs.” God, I wanted to. But I needed to pay the bills. I answered, truthfully, that I had never been in therapy. Had I been, I would have had trouble becoming a civil servant, and I would also have had trouble getting the private health insurance civil servants are nonsensically forced to get.

You see, in Germany it’s fine to be sick, but trying to become healthy is punished.

So now a bunch of Germans have figured out that maybe they would not like to see how bad things get before getting help. More of them than ever, due to the pandemic. And the system is completely unprepared for them, as the Frankfurter Allgemeine reported in January of this year, with waiting lists of up to eight months. One therapist is described as not even answering her voicemail anymore. None of this is particularly new. I have heard story after story from my North American friends (the only ones who talk about this topic openly) about the difficulty of getting treatment, even just to get prescriptions updated.

I give you this as context for a long reported feature that claims to examine the therapy “trend,” and in fact tries to find every way it can to firm up the fading taboo. A small crew of scholars are interviewed. One claims that we are dealing with a “perfidious” capitalist movement to force workers to optimize themselves. Another makes the one really fair point of the article, namely that socioeconomic factors have a substantial effect on mental health, and can’t simply be talked away. A military psychologist in Zurich worries that soldiers who spend too much time cultivating mindfulness might no longer be capable of following orders.

I did not make that last bit up. It’s a pretty close translation of the quote.

The article’s concerns? Too much individualism. “Resilience” is a capitalist lie. People are getting help who aren’t truly sick, whatever that means. Oh, and we won’t be able to fight Putin if we’re weak, which is apparently what therapy makes us?

It’s interesting reporting, overall. Bring in a few patients like animals in a petting zoo, and then spend most of your time getting hot takes from experts. One more look at the patients, trying to work on their sad - but not really sick — lives for a single weekend. No interviews with the patients themselves about what brought them there. No interviews with longer-term therapy patients about their experiences. No sense of what the results of therapy are, how they are determined, what effects it might have on patients’ work lives, families, and physical health.

We are offered one striking statistic in favour of the rise therapy, though with no solid information about context or causality: half as many people die of suicide in Germany now than they did in 1980.

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I am writing so much about this one article because of what it means in its local context: it’s an uncurious, often smarmy take-down of therapy in a country that badly needs more of it to be available and easy to access. But it also strikes me that, at its core, there are some fallacies of thought here that occur in other cultures too, and that might be worth spelling out.

Fallacy 1, as I hinted earlier, is to assume that if a problem is not being acknowledged or treated, it does not exist.

Fallacy 2 is the quiet assumption that mental health is somehow separable from physical health. We could have a whole conversation about people who think they can “deal with their problems themselves,” but who suffer from chronic health conditions that are classically stress-related and that a series of specialists can’t solve.

Fallacy 3: If socioeconomic factors play a significant role in a disease, individual treatment is not legitimate, or distracts from the real problem. But socioeconomic status affects life expectancy overall in Germany, not just mental health. Women with low levels of education have higher levels of coronary heart disease than women with more education, for example. That doesn’t mean a woman suffering heart failure shouldn’t be treated by doctors. The problem can be systematic but individuals still need treatment when they are ill.

Fallacy 4 holds that care for an individual is necessarily individualistic, perhaps even narcissistic. It is a waste of resources. And when individuals try to care for themselves — by trying to understand themselves better, for example — they are taking something away from others. An alternative way of seeing things might be that people who take care of themselves are better able to care for others too, or at least not to make the lives of those around them miserable.

Fallacy 5: A robust society is one in which as many people as possible are ready to thoughtlessly follow orders, without too much introspection. Because that is working out so great for Putin, after all. Because that’s worked out so well in the past.

Fallacy 6 is the “argumentum ad capitalismum.” That’s a Latin term I just made up for arguments that go like this: “X might seem like a good thing to do, but corporations seem to be pushing it, so it is vaguely suspect and probably actually bad.” I, too, am allergic to corporations brandishing superficial “wellness” programs while demanding their employees work extra hours for little pay. But if your employer tells you to ride a bike or do yoga, that does not mean biking or yoga are necessarily bad things to do. It just means your employer should stay out of your private life.

Fallacy 7: The attempt to know oneself is a new “American trend,” rather than a pursuit that’s been around in a range of times and cultures, in some cases for thousands of years. There’s a reason why Zen Buddhism and the Stoics are part of this “trend.” It’s not all that new, and certainly not invented in 1960s California.

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In case I didn’t make it clear, I do not think we can have too much in the way of mental health resources — especially not now, years into a pandemic that has left many suffering and without options for treatment. But I’d be interested to hear your thoughts. How is this question treated in your culture? Is there such a thing a too much therapy, or too much of a culture of therapy — and if so, what does that mean? And what, after all, are we to do with the trauma plot?

Thank you for reading this far. If you have found this or any other of my posts interesting, I’d be grateful if you would share them.

Irina

Some updates

• In this week’s Times Literary Supplement, I review three recent books of writing advice. One of these is Melissa Febos’ Body Work, a powerful argument for the value of writing memoir. (The bias against memoir is related to the bias against therapy.) Here is a quote by Febos I loved so much I can’t help but repeating it from the piece: “Refusing to write your story can make you a monster… or perhaps … we are already monsters. And to deny the monstrous is to deny its beauty, its meaning, its necessary devastation.”

• My episode of CBC Ideas on medieval and modern perfectionism is now online: listen to it here.