Ok, I hate the word therapy. Or, more to the point, I hate the word therapy as a word to describe what I do.
How come?
I hadn’t looked up therapy until just this moment, but it’s always smelled of illness to me. When I hear “therapy” I think less about the coming together of two or more people than I do of sickness and disorder. I think of words like chemotherapy and phrases like intensive reparative therapy.
Looking up the etymology brings this sense of therapy into focus: From 1846, we see the word therapy defined simply as “the medical treatment of disease.”
How about psychotherapy?
That’s even worse! Psycho historically means simply the “whole of the human mind” (thus its root in the discipline psychology, meaning the study of the mind). Sure. But for the last 50 years or so “psycho” has come to be a stand in for crazy–and not “ha, ha, my sunglasses have been on my head the whole time” crazy, but rather “that guy’s looking at me like he wants to eat my liver” crazy.
Kidding aside, the pairing of the prefix psycho with the word therapy, whatever their historical origins, seems to suggest “getting your crazy self fixed.”
Two histories of therapy
A clinical history:
Psychotherapy has its origins in the treatment of psychopathology. Traditionally the subjects of this treatment were “the mentally ill.” If this evokes images of ice baths, leather restraints and Victorian-era insane asylums, you’re not far off. Critically, this work was done entirely under the guidance of doctors. Mental illness wasn’t differentiated all that much from other sorts of illness. The disruptions these patients suffered were extreme and assumed to be the products of the same sorts of physical dysfunctions that cause other sorts of illnesses.
Medicine invented all sorts of responses to these disorders. Many of them were barbaric and altogether unhelpful (I wasn’t joking about the ice baths; lobotomies did considerably more damage) while others provided some relief, even with the expense of serious side-effects (anti-psychotics have evolved considerably, but all of them still cause distressing side-effects for most users).
Talk therapy (as it’s referred to to contrast it with medical therapy for “mental illness”) began with Freud, its most famous practitioner. Freud’s breakthrough was the discovery that there were ways of easing emotional suffering other than the medical (i.e. drug) interventions employed thus far by doctors. Thus Freud invented an entirely new sort of therapy–psychotherapy–differentiated from medical or physical therapy. (Freud’s particular approach to therapy is called psychoanalysis, but in employing talk as the method of treatment he invented the entire category of psychotherapy, which includes modalities that aren’t necessarily psychoanalytic, i.e. “Freudian.” In this sense even therapists who aren’t Freudian owe a great debt to Freud.)
A socio-cultural history
From the vantage point of medicine, that Freud’s “talk therapy” worked (and it most certainly did) was a profound revelation that changed the way we think about our mental/ emotional lives (in domains far beyond the field of psychology).
But from the vantage point of human history, the idea that we could engage in a particular sort of talk that could make our lives better and help us feel better is pretty ordinary. From the dawn of history (it seems pretty clear) human beings have helped improve one anothers’ lives through verbal discourse.
Freud was hardly the first professional to formalize this tradition. Variably through history and across cultures we have called such professionals priests, mentors, mothers, fathers, friends, cousins, psychics, teachers, spiritual advisers, soothsayers, medicine men (so named by Westerners) and (yes) doctors (who have always provided help of the verbal variety).
The fundamental activity employed by Freud (using talk to improve the lives of people who came to him for help) wasn’t at all new. The revolution Freud started was the legitimizing of talk as an acceptably scientific approach to be considered good medical practice.
Talk therapy needed this formalizing. It allowed a profession to form (initially psychiatry, but later clinical psychology and psychotherapy), which created a financial incentive in its practice. It also legitimized the suffering of those historically thought of as weak-willed or even possessed by evil spirits. The groundwork was laid for mental anguish to be validated as legitimate suffering alongside physical anguish. It became worthy of formal study. Much later this foundation lead to mental health parity laws which require insurers to cover mental health treatment on a level equal to that of other kinds of health care.
The consequences
Validating and formalizing the practice of talk therapy, and bringing it into the domain of medicine was a double-edged sword. On the one hand, stigma was reduced, the work was taken seriously and money flowed in ways that helped bring innovation and services to those who were suffering.
On the other hand, in the process of gaining legitimacy, talk therapy gave up an awful lot. Everything under its ever-expanding domain (the DSM, the psychiatric manual that defines all mental disorders, has increased in size dramatically with every addition, with more recent inclusions such as “adjustment disorder”) is seen in light of the language of medicine.
This necessarily means that all emotional suffering, in order to be granted the status of medical legitimacy, must be understood within the conception of the disease model, which has been the formulation of medicine since it became a formal discipline. Put simply, the disease model insists that at the root of all suffering is some sort of disease or disorder. (For e.g., chronic headaches can have a number of causes, but there is a cause, and that cause is a malfunction in the body.) The practice of medicine employs diagnostics (identifying the source of the disease or disorder) and the execution of a treatment (also known as therapy–ah, hem!) according to the prevailing medical standard.
As mental suffering moved under the domain of medicine, this disease-model understanding of it became heavily privileged, not just by professionals but in the eyes of most everyone; when we experience mental suffering, when we find ourselves in emotional pain, we assume that there is a “root cause”–some sort of dysfunction at the root of it–that needs treatment (i.e. therapy).
Or, in other words, something’s broken that needs fixing.
And gone are…
…all sorts of other ways of conceptualizing what’s happening when we’re in emotional pain. Sure, the wisdom of your grandfather or your priest is valid, but what’s “really going on” can only be “legitimately” understood within the framework of what’s included in the latest edition of the DSM.
The pain is real, my friend
Oh, yes. Very real. Emotional suffering is all too real. And, it must be stated clearly: Many, many people get all kinds of help from therapy grounded in a conception of disease.
It would even be wrong to say that we don’t employ this conception of therapy in our work at TriBeCa Therapy. Sometimes it is of great help to investigate suffering through the cause-and-effect lens of disease and cure. But often (quite often) that framework falls short.
One of the guiding principles of creativity is that of keeping as many options open as possible. When people come to us for therapy who’ve been suffering for some time, they’ve generally tried all kids of things to get help. They’re stuck! And when you’re stuck, you need to get creative, which is supported best by keeping LOTS of options open.
This means exploring non-disease oriented ways of seeing what’s wrong. Can we understand what’s happening through a cultural or even spiritual lens? Is there a learning issue that can be addressed to create the sort of growth we’re looking for (learning how to build relationships, learning how to get a better job)? Does this suffering necessarily reside in you (is it perhaps in the world, or better understood as grounded in your relationships?)? Is the search for a “cause” of this suffering the only way to fix it?
Yes, emotional pain is real. There’s much to much of it. The invention of psychotherapy has done a tremendous amount towards curing this problem. Freud and those who’ve come after him were pioneers in bringing legitimacy to the age-old practice of talk-as-cure. In the bargain, however, we’ve closed off creative possibilities. We’ve insisted that those who are suffering first buy into the notion that there is something wrong with them that needs to be fixed. It’s time we move beyond “therapy.”
So, what are you going to call it?
I’m going to keep calling it therapy. Why? Because whether I like it or not, therapy is what we’ve come to call the activity of employing a professional to sit with us and use the medium of talk to make our lives better.
What I’m going to DO however is far more to the point. I’m going to work to challenge conceptions of what emotional help can look like. I’m going to help my therapy clients be as creative as they can be in tackling their emotional pain. I’m going to continue to write about the importance of valuing culturally-grounded approaches to therapy.
It doesn’t really matter whether I like the word therapy or not. What matters is creating new ways of helping people grow.
