(SCL4) Therapeutic societies and cultures

"Therapy-speak” and its various underlying assumptions increasingly inform how we think about ourselves and our relationships, while also shaping various institutional practices. These developments attest to the power and influence of the “psy” professions and the self-help and happiness industries; they also suggest that happiness and wellbeing elude us much of the time. This session addresses what has been variously described as therapeutic culture, the “emotionalisation” of culture, or the therapeutic society. The papers in this session explore various aspects of therapeutic culture and society, from the way medico-therapeutic vocabularies are used in the construction of social problems, including childhood trauma, to the medicalization (and commodification) of social support, emotional regulation, meditation, and psychedelic practices for therapeutic purposes, to the limits of therapeutic directives about “healthy” relationships that are made evident when people choose to maintain difficult friendships. Tags: Culture, Health and Care

Organizers: Fiona Martin, Dalhousie, Peter Mallory, St. Francis Xavier University; Chairs: Fiona Martin, Dalhousie, Peter Mallory, St. Francis Xavier University

Presentations

Sydney Chapados, Carleton University

Problematics of Childhood Harm: Discursive Transformations in Child Protection Practice

Childhood harm has long been a focus of governmental intervention, but approaches to the problem have shifted drastically over time (Hacking, 1991). The complex nexus of actors and institutions that address harm toward children generally conceptualize harm as observable and preventable with the proper application of the correct knowledge and tools (Cradock, 2014). Harm is heavily contested despite this conceptualization, and several knowledge domains assert their criteria for good childhoods. This paper examines a relatively new construction of harm associated with the concept of "Adverse Childhood Experiences" and childhood trauma, more broadly. Within the discourse of ACE, harm is understood as compounding events in childhood that contribute to leading causes of death in adulthood through neurobiological deterioration (Felitti et al., 1998). A compelling body of research has emerged that argues that ACEs will drastically influence children’s physiology and their ability to make healthy choices for themselves and their future offspring. For these researchers, the long-term and severe nature of ACEs makes detection, prevention, and early intervention even more urgent. Introducing neurobiology into the governance of childhood harm, ACE is a significant development. Yet, there is a marked lack of critical scholarly attention toward understanding harm through ACEs. How harm is conceptualized is profoundly political, drastically impacting children’s material worlds and how they relate to themselves and others. Interventions described as addressing childhood harm have long been criticized for their colonial and carceral surveillance tactics that systematically criminalize and dismantle families (Dhillon, 2017; Sinclair, 2004; Swift, 2018). Without examining the frameworks that inform child protection, children can continue to be harmed by tactics that are marketed as being in their best interest. My research explores the implications of orienting child protection around neurobiological deterioration, unsettling the categories this framework leverages and considering tensions between people and policy. Informed by Foucault’s writings on governmentality and genealogy, this project argues that neurobiological discourses are not objective, scientific truths about the harm that children experience and continue to be deeply moral. Drawing on interviews with service providers, archival data, and media to locate these discourses in a complex historical and political context, I argue that thinking about childhood harm and related responses in terms of "toxic stress," "trauma," "hormonal responses," "brain architecture," "fight or flight," “bodily regulation,” "intergenerational transmission," amongst others, are a recent development and contingent on social, historical, and political events and technologies. Many of the categories and constructs used to describe childrens experiences are presented as evidence-based and scientific even while they are contested, leading to increasingly ambiguous therapeutic interventions that depoliticize childrens experiences.

Sarah Badr, McGill University

The Psychological Imagination and the Ascent of the Contemplative Practice Industrial Complex

My paper aims to better understand the rise of contemplative practices within the scientific industrial complex. Using a comparative approach to examine mindfulness meditation and psychedelic-assisted psychotherapy, it will frame these practices as cases which reflect the growing prominence of what Daniel Nehring and Ashley Frawley call "the psychological imagination." Meditation, with its Buddhist origins, and psychedelic use, with its long history in traditional societies around the world, first arose to prominence as practices in Western culture through the American counterculture of the post-war period and were associated with groups such as the hippies and anti-war activists. In recent decades, these practices have undergone secularization and commodification, transforming from esoteric, niche practices for the purpose of expanding ones consciousness, to mainstream practices that are promoted as tools of self-care and healing within a growing cultural focus on "wellness". This can be illustrated by the rise of what Ron McPurser calls McMindfulness, his term for the popularization and commodification of meditation practices as tools for stress reduction, as well as the Psychedelic Renaissance and the increasing popularity of practices such as microdosing. Critics of both the mindfulness industrial complex and the nascent psychedelic medical industrial xomplex argue that rather than being liberatory tools, these practices as currently promoted place the onus of wellness on the individual while neglecting the social causes of stress and mental illness. Building on previous research related to the growth of wellness cultures and the growing popularity of self-care practices, this paper contributes to critical interventions which explore how conceptions of wellness and productivity have become intertwined using the framework of the psychological imagination. Drawing from the sociology of knowledge, science and technology studies and social theory, my research hopes to deepen our understanding of therapeutic cultures through an investigation into the ascent of the mindfulness industrial complex and of psychedelic medicine. Using a comparative approach, this paper will use political economy and discourse analysis to trace the rise of contemplative practices in the scientific industrial complex, in the greater xontext of the rise of the psy-sciences, illustrating how these shifts have occured alongside neoliberal economic approaches to health and a growing mental health crisis. It will draw special attention to the implications of the psychedelic renaissance, and the ways that psychedelic knowledge is being integrated and shaped within larger processes of medicalization and commercialization. The significance of this investigation is greater insight into the political, social, cultural and economic processes which shape scientific production generally, and approaches to mental health specifically. In the context of a growing mental health problem, the crisis of psychiatry and the growth of the wellness industry, examining the processes of medicalization and commodification in the case of meditative and psychedelic practices offers a chance to explore questions that challenge societal understandings of health, healing and wellness in a time of increasing social and environmental crisis. By investigating these cases from a sociological perspective, this paper hopes to contribute to a growing literature which frames these issues as an opportunity to emphasize community-based understandings of health and wellness.

Laura Eramian, Dalhousie University; Peter Mallory, St. Francis Xavier University

Why do difficult friendships persist? Justifying the 'good enough' friend

Scholars have shown how therapeutic culture gives rise to a series of idioms that encourage people to reflect on, monitor, break-off, or even ‘curate’ their personal relationships in the service of optimal ‘wellbeing’ (Eramian, Mallory, and Herbert 2023). Popular media brims with content about discerning ‘healthy’ from ‘toxic’ relationships, including friendship (Lahad and van Hooff 2022) or the necessity of extricating oneself from ‘emotionally draining’ or ‘one-sided’ friendships. Alongside these therapeutic cultural imperatives, however, exist the intricacies and commitments of everyday friendships as lived and practiced. Despite the messages from various commentators and experts on relationships and wellbeing, imperfect friendship is a common, relatable experience that people easily recognize. How then might we make sense of the intersections of ubiquitous therapeutic directives to cut out friends who can disappoint, and the commonplace experience of maintaining less-than-ideal or difficult yet ongoing friendships? In this paper we draw on interviews from a series of recent interview and participant-observation-based studies we have conducted on modern friendship in an Atlantic Canadian city. These studies produced rich data on difficult yet ongoing friendships and the reasons that people saw them persisting in spite of their imperfections. Those reasons and justifications include the following: people may not like what it says about them if they break off the friendship, stubbornness and hard work, long histories together, inertia, people ‘settle’ for the friends they have because they have no time to make new ones, and some people even saw difficult friendships as valuable because they can make them better persons. To analyze our findings, we take an interpretive (Geetz 1973) and cultural sociological (Illouz 2008; Swidler 2001) approach to friendship that begins from the idea that it has the inherent, unpredictable potential to oscillate from feeling easy and pleasurable to difficult and fraught. We argue that the justifications our research participants offered for how and why their difficult friendships persist raise a series of competing moral imperatives that people struggle to navigate, some of which align with the therapeutic directives to prioritize the self and wellbeing, while some awkwardly conflict with the therapeutic.

Dennis Soron, Brock University

Therapeutic Claims-Making and the Construction of Contemporary Social Problems

Drawing upon well-established strands of social problems theory, in addition to more recent work by Frank Furedi, Ashley Frawley and others, this paper offers a fresh take on longstanding and contentious debates over the political valence of therapeutic culture. Within constructionist social problems theory, claims-making is understood to be the fundamental process through which specific social conditions acquire recognition as “problems,” providing a particular vocabulary and set of conceptual resources that furnish them with meaning, connect them dynamically to existing values, interests and concerns, and offer guidance for ameliorative action. As Furedi and Frawley, among others, have argued, a growing proportion of contemporary claims-making activity surrounding the problems that deserve public concern and sympathy has been infused with a medico-therapeutic vocabulary. In this respect, developing a critical understanding of what Furedi calls “therapeutic claims-making” is essential to analyzing the ongoing construction and reconstruction of a wide range of social problems purportedly warranting an urgent public response. It also offers a useful means of theoretically reconsidering the political dynamics, possibilities and limits of therapeutic culture itself.  

Michael Slinger, University of Ottawa

Medicalization Through the Re-Definition of Problems and Solutions

In this paper, I analyze how the practice of psychotherapy medicalizes previously non-medical topics through both the re-definition of problems and the re-definition of solutions. I do not seek to ascertain whether a given problem or practice is “truly” medical and should be managed by health care professionals. Instead, through this paper, I analyze the process by which “problems” become understood as mental illnesses and “solutions” as psychotherapeutic interventions. Understanding how psychotherapy proliferates medical understandings and the jurisdiction of the “psy” professions is key given the increasing popularity of this treatment modality, with recent U.S. data estimating that roughly 10% of the population received psychotherapy within the past year. Using a grounded theory approach, I conducted 15 semi-structured interviews with two groups of practitioners in Ontario: clinical psychologists—who have completed an accredited graduate program culminating in a PhD dissertation and year-long clinical internship—and MD psychotherapists—who have complete medical school, residency, and a year-long fellowship in medical psychotherapy. I examined the various interventions and therapeutic techniques these practitioners employ to produce changes in the patient’s condition, exploring the medio-professional language and framings practitioners use to structure their everyday clinical activities. I argue that practitioners facilitate medicalization through an ambivalent attitude towards the Diagnostic and Statistical Manual’s (DSM-5-TR) understanding of mental illness. Despite consistently using DSM diagnostic labels, practitioners prefer to view mental illness as a biopsychosocial feedback loop—an active, multifaceted, self-maintaining process that incorporates the patient’s brain-body as well as their current and past social environments. Here, definitions of “illness” remain loosely coupled to the official language of the mental health professions, allowing practitioners to medicalize problems outside of the supposed scope of the DSM. I further argue that practitioners spread medical understandings through an often-overlooked form of medicalization: medicalization via the re-definition of solutions. Through this process, an intervention that previously was not seen as medical in nature is transformed into a “medical intervention”—i.e., a treatment or therapy. I develop medicalization through the re-definition of solutions by contrasting it against existing approaches that have predominately focused on the re-definition of problems, e.g., how deviance, badness, and “problems in living” come to be understood through the label of “illness”. I argue that just as pharmaceuticalization and traditional medicalization theory question how “medical diseases” are socially constructed, we can also examine how the “medical nature” of interventions is constructed by health care professionals. Applying this lens to the practice of psychotherapy, I propose that practitioners ascribe a medical, healing function to social support and emotion management techniques, bringing these previously non-medical emotional interventions under the purview of mental health professionals. I detail the parallels between lay and professional emotion management, connecting psychotherapy’s medicalization of emotion management to the broader medicalization of emotions. In sum, focusing on the re-definition of problems limits the applicability of medicalization theory by overlooking how medicalization can shape our understanding of both illnesses and healing practices. Medicalization through the re-definition of solutions must be examined alongside medicalization through the re-definition of problems to fully gauge the nature and extent of this process.