As a nation we seem headed for the couch

Who am I? Who are you? Who are we? We are a nation for whom psychotherapy and self-help has become part and parcel of answering just those questions.

By MARY McNAMARA, Los Angeles Times

published February 9, 2000

Americans have long been in love with the idea of psychotherapy. When Sigmund Freud made his only visit to the United States in 1909, American intelligentsia flocked to his lectures. Since then, psychotherapy has spread like kudzu, morphing from the medical treatment of specific, diagnosable mental illnesses into a sort of societal support system offered by psychiatrists, psychologists, counselors, therapists, self-help gurus and TV talk show hosts.

"Seek professional help" is our standard answer to everything from episodes of psychotic rage to dating problems, and "self-help" has become its own industry. We use terms like "manic-depressive," "obsessive-compulsive" and "neurotic" to describe the most benign, everyday sort of behaviors.

And should true tragedy occur, the psychologists and counselors are there on the front lines, elbowing out the friends and clergy if not the paramedics. No other area of science or medicine so informs our national discussions or perceptions of who we are and who we should be.

But is it working? Are we getting any better? Is our mental health improving? And is our increased self-awareness benefiting society?

"It's difficult to gauge, compared to other parts of medicine," says Rochester, N.Y., psychiatrist John McIntyre. "There's no question that treatment of specific mental disorders is very effective -- the efficacy rate is often higher than in other medical procedures. But when you broaden it to other issues, it gets fuzzy. It's had the overall beneficial effect of increasing knowledge of human nature, but are people better? How do you measure that?"

There is no arguing the fact that psychotherapy and psychiatry have improved the lives of millions suffering from often devastating chemical and mental imbalances. And, certainly, Freud had no personal illusions about transforming the human condition. He was content, he once said, to turn people's "hysterical misery into ordinary human unhappiness."

But here in America, we want to teach the world to sing, in perfect harmony. And so we look to psychology to provide us with answers and solutions to everything from a president's mendacity (there was that abusive stepfather) to relations between the sexes (which planet am I from again?) to a baseball player's overt racism and homophobia (don't fire him, send him to a therapist).

According to Surgeon General David Satcher, the next decades will put the effectiveness of psychotherapy and psychiatry to the test. One out of five baby boomers can expect to suffer a variety of mental disorders, from substance abuse to late-onset schizophrenia, while almost 21 percent of children ages 9 to 17 suffer from diagnosable mental disorders.

But measuring a nation's mental health is a difficult thing to undertake. One traditional method is to look at a society's tendency toward "social deviance" -- its rates of crime, divorce, suicide, drug use and out-of-wedlock births. Most of these have decreased in recent years, although the divorce rate is significantly higher than it was even half a century ago.

But how valid are these numbers as indicators of mental health?

"Crime is not a good measure because there are a lot of social and economic reasons for crime," says Wendy Kaminer, pop psychology critic and author of I'm Dysfunctional, You're Dysfunctional and more recently Sleeping With Extraterrestrials. "And to use divorce, well, if you have a sick norm (of troubled marriages), what is mentally healthy? To conform or rebel?"

Even making drug use an indicator of mental instability is dangerous, she says, because there are many possible reasons for drug abuse -- many in the scientific community believe the propensity for abuse is genetic.

Political movements have a complex relationship with the psychoanalytical movement. At one level, political movements by definition reject the psychological paradigm, their premise being that discontent stems not from our selves but from the System. On the other hand, Freud's identification of the id and the unconscious had a profound effect, particularly on the youth movements of the '60s and '70s.

"The id really came out in the '60s," says Peter Wolson, a Beverly Hills, Calif., psychoanalyst. "Suddenly, the thing is to be happy, not to lead a good life. Have fun, have orgasms, and this leads into the '70s and '80s, which is about getting ahead, still about "me,' and then you have a backlash, mainly from fundamentalists. But even the backlash is very self-centered, very much of the id."

The United States has a long, complicated relationship with the culture of self -- with self-government, self-actualization, self-discovery, self-aggrandizement. We celebrate nonconformity in a way that absolutely defines conformity and claim to treasure individualism while mass-producing more products than any other country in the world. "I gotta be me," we say, and if that "me" doesn't work out, well, we'll just try on a new one.

Psychology seems to provide both the means and the motive for the culture of self, and therein lies its greatest strength and its greatest failings.

"In a way, psychology has replaced religion," says David Blankenhorn of the Institute for American Values, based in New York. "It is who we are, the air we breathe. And it can truly help people who suffer and can yield important insights. But the assumptions of the paradigm are so relentlessly centered on self, all other structures of meaning and authority evaporate. "What do I want?' becomes the governing question."

Freud argued that it is pointless to try to make people happy because that's not what they want. Yet happiness seems to be the carrot at the end of psychology's stick -- if you know yourself, you can change yourself and you can be happy. All the time. The creation of such expectations may be one of the psych-culture's greatest drawbacks.

"It's a mixed blessing," says University of Washington sociologist Pepper Schwartz. "We've hugely increased our sensitivity to each other. We understand, for example, how much damage words can do. More people take responsibility for their actions, and if they don't, someone makes them. But we've also created whole new categories of what people should worry about, hundreds of new ways in which we can fail or people can fail us."

Our expectations from relationships have become much higher.

"Just look at the area of sex therapy," she says. "We have a hundred new ways to create inadequacies."

On the other hand, we have become more informed consumers, of theories as well as products.

"It used to be if Dr. So-and-So said something in the newspaper, readers would assume it was true," Schwartz says. "Not anymore. An easy example is how we have examined and rejected corporal punishment."

Like Blankenhorn, Schwartz believes the successes of the psychological movement are most evident in our attitudes toward parenting.

"If nothing else, I know we've made better fathers, although the numbers of fathers who leave is an area where we have possibly slid. But the ones who stay are much more participatory. No one's shocked to see a man in the grocery store alone with his kids. When I was a young woman, you would have assumed the mother was dead."

But again, are such changes the result of psychologically increased self-awareness, or the women's movement?

"The only real answer to "Are we better yet?' " says Kaminer, "is, "We don't know yet.' "

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