- This video is brought
to you by Surfshark VPN. (bright music) What's up, friends? Michael here. Now, at Wisecrack, we love therapy. Getting to monologue to a captive audience for an hour straight? Check. Overcoming lingering demons from that time our mom called
us an unplanned miracle? Check. In short, we truly believe that therapy can change people's lives, yours truly included. And therapy has never
been more widespread, socially acceptable, or accessible, which is great because a lot
of people really need it. Indeed, in 2018, one
in five American adults experienced a mental health issue. And that was before the modern plague had turned us all into agoraphobes. But lately, we've seen
the mega-rise of apps promising psychological transformation in just 5 minutes a day. And this leaves us wondering, "What is therapy really for?" And, "Are we asking therapy
and ourselves to do too much?" Let's explore in this Wisecrack Edition on "Therapy: Can It Save Us All?" But before we really get into it, I wanna tell you about this
week's sponsor, Surfshark VPN. Surfshark VPN keeps your data secure everywhere you go on the internet, thanks to their secure protocols
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download Surfshark VPN today. And now, back to the show. Now, the stigma surrounding therapy and seeking help for mental health issues has dissolved significantly
over recent years. This is unequivocally great news. Especially when you consider how mental health used to be
treated in the good 'ol days, which definitely were old,
but definitely were not good. Early psychiatric treatment typically involved confining
patients to lunatic asylums with horrible living conditions. Often, patients were sterilized. Women could be kept in asylums purely on their husbands' recommendations. - Why would your husband do that? - He said something about me participating in some flag burning at a
local suffragette protest. He was not happy with my decisions and found me generally annoying. - LGBTQ+ folks and other
marginalized people were also often considered pathological. And typically, super-churchy people assumed all these issues
stemmed from demonic possession. So... (Michael sighs) It's not good. In short, psychiatry was
more about punishing folks who failed to conform to social norms, with a heavy dose of sexism, homophobia, racism, and eugenics. Then, in 1895, everybody's
favorite goatee guy, Sigmund Freud, teamed up with Josef Breuer to publish "Studies in Hysteria," which championed the talking cure to help work through psychological trauma. You know the one: a
patient lies on the couch and talks at length to their analyst about all their deepest
thoughts and feelings. Importantly, Freudian psychology was less about offering practical
fixes for your problems, and more about understanding
your negative thought patterns, neuroses, and so on. His goal was to help "make
the unconscious conscious," which could eventually help
improve people's mental health. Psychotherapy became
increasingly popular in the US around World War II and
then boomed in the 1950s, in what scholar Daniel P. Kamienski calls the "Age of Affluence and Anxiety." This was due to the intersecting phenomena of the post-war economic boom, with the high numbers of World
War II soldiers with PTSD, then referred to as shell shock, as well as widespread fear
about nuclear weapons. As Kamienski notes, this era of therapy saw the origin of an emphasis
on patients doing the work. As he puts it, "Psychoanalysts
advised patients that the traditional
American value of hard work needed to be applied to therapy as well as to their personal
pursuit of happiness." This was a big change from Freud having you articulate traumatic memories while half-asleep on a tiny couch. At the same time,
psychology-infused self-help books boomed in popularity, and they were usually about pulling yourself up by your bootstraps and tackling your maladaptive
emotional responses. Positive psychologists pushed
the idea of self-improvement and reaching your full potential. If it sounds kinda like
motivational speaking, that's because it basically was. But what was really the
purpose of psychoanalysis? According to Kamienski, therapy functioned largely as a way to lead people into conformity. In particular, conformity with America's booming consumer economy and workforce. As he writes, "By
advocating clearly defined, traditional gender roles
and normative sexuality set in the single-family, psychoanalysts helped legitimize and popularize The American Dream." Good mental health, then, was largely defined as the
ability to fit societal standards surrounding work, gender,
family, and so on. One famous psychoanalysis institute, The Menninger Clinic,
even explicitly promised to return its patients to
the useful citizenship. Kamienski writes that,
"Psychoanalysts promised that Americans in therapy
could be made to conform, with a high degree of efficiency, to the values of hard work
and productivity in work, and in their personal lives. In doing so, they reflected
and reinforced industriousness as a key value of Americans." So, what we have here are three important aspects
of 1950s-style therapy: One, an emphasis on the
patient's hard work; two, conformity to American values; and three, becoming a
productive member of society. This would only grow more
true in the '60s and '70s, as cognitive behavioral therapy, or CBT, became all the rage. CBT focuses on recognizing and rationalizing
negative thought patterns. For example, if your brain is telling you that there's a creepy
clown hiding in your car, a CBT therapist would ask
you to think critically about the statistical
likelihood of this being so. They'd suggest alternative thoughts, like, "It's very unlikely that
there is a creepy clown hiding in my car." This can be especially useful
after doing Uber pick-ups the weekend of The Clown Convention. Indeed, CBT encourages you to think critically about
your thought patterns in order to change them. It teaches logical skills to deal with distressing
situations and emotions, with the ultimate goal of
significantly mitigating or even totally eliminating
their impact on your life. As journalist Oliver Burkeman explains, CBT is based on the principle that, "Your distress is caused
by your irrational beliefs, and it's within your power to seize hold of those
beliefs and change them." Again, we see emphasis on the
individual doing the work, with the help of a therapist, to ultimately overcome their issues. This contrasts against the Freudian method of understanding unconscious drives in order to release repressed
experiences and emotions. Notably, while Freud's methods were expected to take many years, CBT is considered a short-term method, at least by insurance companies, typically consisting
of five to 20 sessions. And to be clear, it's not the
individual therapist's fault that you're only allowed to have ten sessions a year or whatever. They're just playing by the rules set by private insurance companies. And no doubt, CBT can
be enormously helpful for things like phobias
and sleep disorders. But it's been critiqued for
offering cheap, fast solutions, with some dissenting therapists arguing that it pushes a think
yourself to wellness narrative. CBT undoubtedly has changed tons of lives, again, yours truly. Still, there's a growing pile of research suggesting that it's not a
one-size-fits-all solution, particularly when it comes to depression. So we started with a long-term commitment based on a good relationship
between therapist and patient, centered around exploring the unconscious. And we're trending toward
therapy as a self-led, bite-sized course. And if you don't have the time, insurance, or resources to afford that? Well, now Silicon Valley has an answer: therapy, but, like, make it an app. You've likely already seen them: meditation apps, breathing exercise apps, mood trackers, and self-led therapy apps for just about any mental health issues. We're also offered mindfulness
apps like Headspace, which promises to reduce your stress and improve your sleep
in just 3 minutes a day. It's kind of like therapy for people without the time or money to be emotionally unzipped by
a professional twice a month. (Frank screams) - You unzipped me! - And undoubtedly, these platforms have made mental health
care a lot more accessible, which is great. And online therapy has been
proven to have real benefits for people struggling with depression. Text-based therapy also adds
an element of anonymity, which can be great for people who struggle to talk
about their mental health. What's more, subscriptions
for mental health apps can save people tons of money compared to conventional therapy, which makes high-end gym
memberships look cheap. This can be a life-saver, especially when we consider that poverty is a major fact in anxiety, depression, and substance-abuse issues and that lack of access
to mental health services is the root of the mental
health crisis in the US. Importantly, though, many
of these apps rely on CBT, boasting that their use of the model will help you stop feeling
anxious, depressed, stressed, or unable to sleep. And the marketing of CBT on these apps exacerbates the
one-size-fits-all mentality that people critique the
method for in the first place, turning something as
multifaceted and personal as mental health care into Uber, but for your unconscious mind. This raises an important question. By pushing convenient apps to help manage mental health issues rather than increasing access
to and funding for therapy, are we, as a society,
putting too much pressure on people struggling
with mental health issues to understand themselves and guide themselves
through their own recovery? With apps, we've seen the
idea of doing the work increasingly become about
doing the work alone. With apps, the onus is often
entirely on the individual to actively engage with and
work through their problems. Fittingly, the apps are also
tailor-made for a gig economy, when everybody is working multiple jobs with no time to fully commit to working on their mental health. But hey, at least you can dip
into five minutes of therapy in between DoorDash deliveries, right? This only exacerbates
another existing problem in cognitive behavioral therapy: its historic failure to
address the systemic issues that often contribute to
individual mental health issues. You might, say, be taught
how to manage the stress of living in poverty or anxieties about the unstable
job market and economy. But being able to manage these doesn't change these circumstances. You're still facing down the possibilities of not being able to afford
dinner or find a new job. Now, you've simply learned
not to be as worried about it, and thus are able to be a higher-functioning member of society. Workplace counseling and support options illustrate the tension
between solving individual versus systemic problems perfectly. Employee Assistance Programs, or EAPs, began in the late '30s and early '40s to help identify workers whose
struggles with alcoholism were making them less productive. If you're struggling at work, whether due to depression or stress, you might be offered counseling, which often comes with
homework and self-led regimens to help you overcome your problems. What appears to be an
employer's genuine act of care could cynically be seen as a situation where interests collide: your interest in feeling better meets your employer's interest in seeing you meet your
productivity potential at work. Feel the 1950's useful citizen vibes here? Importantly, EAPs typically focus on the few most obviously
struggling workers. As scholars J. Berridge
and C. L. Cooper write, "The concept of the troubled employee is at the heart of the EAP." This approach can be problematic because it doesn't consider where those troubled employees'
troubles actually come from, which might be the workplace itself. This certainly seems true in
cases like that of Google, which offered counseling to
victims of workplace misconduct, allegedly without bothering
to reexamine the environment that fostered that misconduct. As Michael P. Leiter and
J. Michael Wahlan note, "Even when effective,
individually-focused interventions may do little more than enable people to tolerate poorly-managed situations." And beyond the microcosm of the workplace, there's no shortage of systemic problems to be found these days. Our current economic realities,
like the decline of unions, or rising wealth inequality, have even been explicitly linked to rising mental health issues. Loneliness is also on the rise, as Americans are working longer hours with fewer support systems. This all leaves people more reliant on mental health professionals. That is, when they can
afford the time and cost of seeing them. On top of that, job insecurity
due to the gig economy, lack of long-term contracts, and fewer opportunities for promotion can also contribute to your risk of developing mental health issues. Systemic economic issues
like childhood poverty can also have the same effect. But it's not just economic issues that negatively impact mental health; racism and mass incarceration have had a staggering impact
on marginalized communities. Suicide rates among young Black people have increased by 73%
between 1991 and 2017, while accessing treatment
in these communities remains more difficult
than for their White peers. And despite its success in treating people with anxiety disorders and other mental health issues, modern CBT therapy still has flaws when it comes to working
with marginalized people. Remember, it's a highly
individualistic therapy, which hinges on the assumption that a patient has faulty
or irrational thoughts. This framing makes it easy for systemic issues to go unaddressed. For example, it's reasonable
that systemic racism, sexism, or homophobia in America can beget anxiety or depression. You can't be expected to positive-think your
way out of that reality. Psychiatrists are still working on increasing the cultural
sensitivity of CBT so that marginalized groups are validated while they receive treatment, rather than encouraged to view anxieties formed around their lived
experience as irrational. And lest it sound like we're
criticizing therapists, let us quote scholar James Hillman, "When I criticize therapy, I'm not really out to get therapists. I think they're doing some of the most important
work in the culture because they are sincerely
trying to pick up the pieces that capitalism throws into the street." Indeed, therapy is a difficult profession, and getting it right when you have people's
mental health in your hands can be taxing. What's more, therapists
can't necessarily help when it comes to systemic issues; they can only support their
patients within an unjust world and address the impact it has on them. So, where do we go from here? Scholar Micah Ingle argues that as long as people consider
their mental health issues by a purely medical or
cognitive behavioral model, the responsibility will
remain on each individual to get better without
inspiring systemic change. But before you sink into despair, know that Ingle has some thoughts on what therapy could look like. One interesting alternative he
offers is narrative therapy, which helps people understand and deconstruct the way
they see themselves, and why they see themselves in that way. Therapists and patients
reauthor their lives to retrace where their
self-perception comes from, and address the social
and personal factors that have impacted them. This can mitigate the effects of systemic problems on patients by addressing the patient in the context of the system itself. Will this, or any other
new forms of therapy take off in our lifetimes? It remains to be seen. In the meantime, we're stuck with a world that exposes us to injustice and trauma, and healthcare providers who
charge us hundreds of dollars to even try to feel better about it, while sometimes neglecting
the broader reasons for our mental health issues. But hey, at least you know there's no creepy clown in your car. I mean, unless... you've been the clown all along. But what do you-all think? Is modern therapy asking
too much of its patients? Have mental health apps revolutionized mental health support, or merely commodified it? Let us know in the comments. Big thanks to our patrons
for all your support, and don't forget to
listen to our podcasts. Hyperfixate on that subscribe button like it's your childhood
abandonment issues and don't forget to ring that bell. And as always, thanks for watching. Later. (upbeat electronic music)
