Ashley Frawley, James Mumford, Mark Vernon: After Therapy

The comedian Johnny Carson quipped that in Hollywood, if you didn’t have a shrink, everyone thought you were crazy. The joke has spread beyond Tinseltown. ‘Mental health’ content proliferates, ads for online therapy platforms are ubiquitous, and language once confined to the consulting room appears in corporate strategy documents. Welcome to the age of Big Mental Health. The origins of the therapeutic turn lie in the anti-psychiatry and psychiatric survivor movements of the 1960s. These allied forces sought liberation: from stigma, pathologization, and the coercive practices of institutional psychiatry, whose high priests wield power through the complex nomenclature of the Diagnostic and Statistical Manual of Mental Disorders (DSM). In the rapidly innovating healthcare systems, anti-psychiatry was a dead end, its critique overtaken by developments in psychopharmacology, which reduced the use of some more obviously injurious applications of physical restraint and entrenched the bio-medical model of the mind. The DSM’s empire has waxed ever larger. But the activism of the ’60s did give rise to new ways of conceptualizing mental distress. The efforts to ‘normalize’ its manifestations have replaced the old discourse of madness with a new discourse centred around the amoeba idea of ‘mental health’ and shaped by the forces of managerialism and identitarianism. One paradoxical effect of this is that swathes of commonplace emotional experience are now pathologized. Another that the experience of severe mental distress has again become marginalized. A third is that the diagnostic labels, that previous generations of activists rejected are now prized, yet evacuated of meaning. Is there space for genuine illness in ‘mental health’ discourse? Can we still rely on Freud’s distinction between “neurotic despair” and ordinary human misery? Do we need more or less therapy, and to what private, social, or political end?