Simone Beauvoir On Psychotherapeutic Healing As Mutilation

In Simone de Beauvoir‘s The Mandarins (WW Norton, New York, 1954; 1999, pp. 64), Anne Dubreuilh, a practicing psychoanalyst wonders:

Why does healing so often mean mutilating? What value does personal adjustment have in an unjust society?….My objective isn’t to give my patients a false feeling of inner peace; if I seek to deliver them from their personal nightmares, it’s only to make them better able to face the real problems in life.

It is a matter of some interest that Beauvoir does not place scare quotes around “real” in the passage above; given the worries about her practice that Anne has just expressed, such a distancing might well be considered appropriate.  The doubt that Anne directs at her apparent ‘healing’ of her patients is an acute one: Is the patient being ‘cured’ or merely subjected to a form of psychotherapeutic cosmetic surgery to make them fit better into the contours and constraints of an entirely unreasonable world? Their nightmares are not only of their own making; a nightmarish world should induce such visions even in our sleep. Perhaps it is the world that is out of joint, not the sufferer on the couch; but we cannot cure the world, so we cure our patients instead.

In his Listening to Prozac: A Psychiatrist Explores Antidepressant Drugs and the Remaking of the Self (Viking Press, New York, 1994), Peter Kramer had expressed a similar worry: perhaps anti-depressants were a form of chemical cosmetic surgery–“cosmetic pharmacology”–deployed to round off and smoothen the rough edges of depressed and neurotic patients, the ones that did not allow them to fit into, to conform with, the world around them. We cannot respect and cherish the oddity, the idiosyncrasy, the ‘depressed’ or ‘neurotic’ person brings with them; they do not sit comfortably with this world’s required characteristics, the attributes it has granted preeminence in its table of values. (Kramer balances these claims with a sensitive appreciation of the suffering of the depressed thus addressing the perfectly reasonable claim that some kinds of mental health situations cry out for chemical intervention if only to prevent severe harms from being visited on the patient or those around them.)

The language of ‘cosmetic pharmacology’ and ‘mutilation’ suggests then, uncomfortable resonances with the oldest feminist critique of psychiatric healing directed at women: their supposed ‘mental illness,’ their ‘hysteria,’ was an entirely appropriate response to a sexist and patriarchal world. (These critiques would find particularly pointed form in Phyllis Chesler‘s 1972 Women and Madness.) If they were mad, they had been driven so; but that madness was a divine one, for it was touched with visions that the society around them was blind to. An ‘adjustment’ to this society was to take on its madness instead; it was to participate in its ‘unjust’ structures and arrangements.

This then, was the ‘unjust society’s’ final addition of injury to insult for those who could not, would not, conform: a labeling as ‘defective,’ and a prescription for modification. Come back when you’re different and are ready to play; we’ll still be here.

Of Therapy And Personal And Academic Anxieties

Reading some of the discussion sparked by Peter Railton’s Dewey Lecture has prompted me to write this post.

In the fall of 1996, I began studying for my Ph.D qualifier exams. I had worked full-time at a non-academic job for the previous year, saving up some money so that I could take a month or two off and study for my exams. I had notes, I had copies of the previous years’ exams. I was set. I began reading my way through an unofficial reading list.

As I worked, my mood swung between extreme anxiety and over-confidence. There were times I felt I would breeze through my pair of inquisitions; on other occasions, I would fight a rising tide of panic at the thought of sitting in a classroom, an empty blue-book in front of me. Sometimes, I would rise early, drink two cups of coffee, smoke a few cigarettes, look through my notes, and decide I could not read any more, just because the reading was making me anxious. Sometimes, I would check out, smoking pot all day before returning to work again the next day. Sometimes I wondered what the point of a long, endless pursuit of  a degree which would only guarantee unemployment at the end of it all was. I was lonely and isolated in my apartment; my girlfriend returned home late at night from her corporate job.

One day, I worked out in the morning, returned to my apartment, stared long and hard at the papers in front of me and burst into tears, sobbing on and off for about thirty minutes. The next day, I called a friend to ask for help.

Three years previously, shortly after I had begun graduate school, I had met my friend at a student party. Over a beer, she had told me she was in ‘therapy.’ I was surprised to hear her talk about it openly, as something she ‘needed’, which ‘kept her from going nuts.’ Then, in the fall of 1993, it had not been even six months since my mother had passed away after a long struggle with breast cancer, and I knew I was still mourning. I had often felt in the months that had passed, a melancholia that was not easily dispelled by the immersion in school and off-campus work and the long hours of drinking in bars that were my primary modalities for treating it. I had flirted with the idea of seeking help for a mood that was stubbornly resistant to being lightened, sensing that I was not in the grip of a garden variety change in mental disposition.

But therapy seemed like a cop-out. Many of my male friends spoke disparagingly of it, of the culture of whining it seemingly created, the endless childish blaming of parents for adult pathologies. Therapy seemed wimpy, not manly enough; it seemed like a solution for those not strong enough to deal with life’s adversities, who wanted to wallow instead in self-indulgent pity parties on therapists’ couches.

So I had held back, hoping I would just ‘deal with it’ and get better. But I noticed little change; I easily descended into gloom and doom; I struggled with sleep, with drinking too much, with staying in romantic relationships; I found anxiety and panic to be constant companions. I never used the d-word to describe myself, but I often suspected I was depressed.

In the fall of 1996, with my qualifier exams creating many new opportunities for questioning my self-worth, and thus further compromising my fragile sense of being held together, I had finally broken down. I went looking for help.

My friend directed me to the Institute for Contemporary Psychotherapy in Manhattan where, after intake interviews, I began therapy twice a week. A year later, I considered taking anti-depressant medication, and consulted a psychiatrist for an evaluation. The good doctor told me he could prescribe one of the most popular medications at the time–Prozac or Serzone. I agreed, but then, panicked, and said I didn’t want to start. I continued with my talk therapy. But it was a secret; I told no one, and continued to feel like I had ‘copped out.’ Sometimes this secrecy would require elaborate subterfuge; I would tell friends I had to leave them to ‘run an errand’, sometimes walking in the wrong direction, away from my intended train station.

A year later, I changed therapists. I had felt like I was going in circles. Much had changed; I had passed my qualifiers, passed my oral exam with distinction, and also ended my older relationship and begun a new one. It was time for a new therapist too.

I found a therapist and resumed therapy twice a week. I continued to keep my therapy a secret (from everyone except my girlfriend and my friend.) I finished my dissertation, and for the semester that I was in the US after completion, stayed with the same therapist. My move to Australia meant my therapy would be interrupted. I took this break in stride, telling myself that perhaps I could move on now, a new person in a new land.

But a few months after I had moved to Sydney, I was looking for help again. I found a therapist–a Kleinian interestingly enough–and began visiting him twice a week. I was struggling with the usual anxieties academics suffer from; these seeming ephemera jostled with my struggles with a long-distance relationship, with subterranean feelings of fear and non-belonging, and an anxiety that never vacated the basement. I crossed an important barrier when I told some good friends–including a particularly near and dear male friend–that I was in therapy; that openness felt liberating.

After I returned to New York to take up my current position, my therapy was interrupted again. Two years later, I called up my old therapist to find out if he would take me back as patient; he was agreeable, but he had moved. I gave up looking for therapists, unwilling to go through the process of finding a compatible one. Over the years, on several occasions, I would go searching for therapists, look through web pages, and even make a few phone calls. But I never went all the way. I stayed hesitant; finding a good therapist had been hard work, and I seemed unwilling to do it all over again. I wondered if a cognitive behavioral therapist might not work better for me, compared to the analytical types I had previously worked with. Some good friends of mine urged me to resume therapy, sensing from some of my pronouncements that I might need it. (My career moved along; I was tenured and became full professor, but I never stopped doubting that I belonged in this profession, never stopped suspecting that I was simply not smart enough, hard-working enough. And I never stopped missing my long-departed parents.)

I haven’t started therapy again. Perhaps I dread its ‘ramping up’ phase too much; perhaps I have convinced myself my ‘workarounds’ are adequate; perhaps I’m ‘cured.’ I’m not sure but whatever the answer, I’m glad my graduate school friend helped me out when she did, that she urged me to overcome my hesitancy and discomfort about seeking professional help, that I was able to speak openly and frankly with my friends that I had done so. I am now a father and my anxieties have not diminished; if anything, they have increased. Perhaps I will seek help again. I won’t be shy about telling my friends I’ve done so.