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Artillery Row

False hope and online therapy

What the cloying advertorials conceal

Therapy is in an imperial mood. Everywhere one looks, from sponsored posts to adverts on public transit, it is impossible to escape the message that everyone deserves help, that everyone can get better, that everyone can find her condition ameliorated by the simple and cheap application of some online Rogerian change. There is a play of transcendence and immanence at work here — all people can benefit from the bounty of therapy, and this means you. Podcast interstitials now feature the host directly using the second person towards the listener — you deserve help, and it’s here for you now. If the host has a history of mental health problems, he may (as Alistair Campbell does in adverts on The Rest is Politics) invoke his own suffering and deliverance via therapy as part of the promise — you, too, can be saved as I was. 

Freudianism was seen as the new confessional in an increasingly materialist world

The problem with saying “everyone deserves help” is that it logically means that those people who cannot use online therapy — indeed, who will be eagerly and enthusiastically rejected by every single online therapy provider — are not entitled to be members of this community of human sympathy. I refer here to those people with severe mental illness, who are medicated, suicidal or self-harming enough that the virtual door is slammed abruptly in their faces when they try to sign up for such services. For these people, false hope engendered by adverts gives way to hurt at the rejection. Then the relentless advertising asserting that help is available for “everyone” mixes in some melancholy notes of anomie. As I am such a person, I admit I take this all rather personally. 

It wasn’t always like this. True, therapy as a panacea is not a particularly new idea. One of the benefits of Freud’s and Jung’s unscientific approach to their art, was that virtually any ill could be ascribed to some hidden neurosis which could be discerned by a course of analysis. As Civilisation and its Discontents makes clear, Freud was prepared to take this logic to its natural conclusion: societal ills, too, were amenable to psychoanalysis. Freudianism was seen as the new confessional — a replacement in an increasingly materialist world for the comfort of religion. It did not, however, despite the visions of Golden Age science fiction, become a truly universal phenomenon. 

In part, this was a matter of money; spending discretionary income on talking therapy was the mark of a certain type of bourgeoisie, the kind of thing to be written up in The New Yorker rather than sold to any punter off the street. The corporate world preferred quicker “personality tests” like Meyers Briggs (which are, impressively, actually more pseudoscientific than Freudianism) to building complex psych profiles of every hire. The language of therapy pervaded the culture, since borrowing clinical speak is free — whilst pop-psych books have been a never-ending cocktail of profits and nonsense. Yet, therapy didn’t quite break through until our current moment.

The use of virtual therapy means office overhead is out. Qualifications (insofar as they exist) can be obtained easily enough that many people have them, and they are thus worth so little that the “therapist” of an app cannot demand a very high fee. Price, however, accounts only for some of the upswing in demand. The anomie of lockdown deprived many of the social experiences which give us our sense of “normalcy”. It also reminded people of how little agency we have in the world. The great seductive myth of therapy is that the problem is within ourselves rather than with the world. This paradoxically egotistical view is comforting, because it promises that, with proper guidance, one has the agency to fix oneself simply by talking it all through. The adverts for online therapy always talk about taking control of one’s life, and that is a very seductive promise.

In a more naïve state, it was enough to seduce me once. On hearing that people feeling depressed, feeling down, feeling sad, could simply deal with this by means of therapy, I looked up the provider. I still do so in response to adverts. The bare scientific plausibility of the matter — the fact that in some instances there is some evidence for talking therapy — tempts my ostensibly rational mind in a way that, say, Scientology (which makes the same promises) doesn’t. Every time, though, there comes the cruel twist: no self-harmers or severe depressives allowed. It genuinely hurts.

Character and therapy are melded together: good people are open about their issues

Perhaps I shouldn’t be so sensitive, but one of the vanishingly few privileges appertaining to the status of major depressive disorder is some leeway to feel sad about a state of affairs. This sadness is a feeling so familiar that it does not hurt, so much as merely weigh one down. False hope, on the other hand, does hurt. I can distinctly recall when I first tried to sign up for an online therapy provider. My initial twinge of excitement was dispatched efficiently and without fuss when I admitted self-harm on the intake form, but even a humane killing still leaves something dead. There was no need to give such false hope. It would cost these companies nothing to say, “Help is here for the mildly depressed, those who perhaps feel sad in winter, and those who might occasionally have bad days, but we cannot help people with severe mental illness.” Instead, their advertising promises help for depression, anxiety, mood issues, taking full advantage of our pathologised age to elide the distinction between depression qua emotion and depression qua disorder that causes people to kill themselves.

The bigger harm is societal. Mental health is pitched as the sort of thing the erudite listener to Oh God What Now can sort out by putting aside traditional British reserve and just being an open, caring, expansive person. Character and therapy are melded together: good people are open about their issues and go to therapy. This has seeped far enough into society — or at least my sordid, metropolitan élite corner of society — to such an extent that when I tell people about having severe depression, the response is often, “Aren’t you going to therapy for that?” It is as if I had failed to do my duty by confessing my depression and receiving absolution, as if I had turned my back on the wonders of science and progress by not taking this miraculous gift of therapy.

The problem with this positivist outlook is that it is unscientific. Therapy is not a treatment for severe depression — hence why I’m not prescribed it on the NHS. I once was sent to an NHS psychological services appointment, only to leave five minutes after they looked at the case history on my intake paperwork. The best treatment we have for severe depression is to take some chemicals whose precise operation remains a bit of a puzzle, throw them in someone, and in the meantime revoke any shotgun certificates the patient might hold and don’t let him join the army. This treatment (the pill bit anyway) has kept me alive, and so I feel mostly grateful, depending on my mood. 

I am sure that the online therapy does its job, in our increasingly anomie-ridden society, of providing some level of human connection and comfort. All I would ask is that it have the simple honesty to admit that it cannot, and does not, help everyone. 

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