The erosion of the boundary that separates the public from the private is one of the chief accomplishments of therapy culture. We are all used to seeing TV celebrities telling the world about their illnesses, addictions, sex lives and personal hurts. A key theme promoted through confessional television is that in order to heal, emotionally injured individuals need to let go of "private wounds by sharing them with others". The act of "sharing" - turning private troubles into public stories - is now deeply embedded in popular culture.
"Popular therapies have demonised silence and stoicism, promoting the belief that healthy people talk about themselves," says Wendy Kaminer, an American social critic. Individuals who have lost a loved one through tragic circumstances have found the invitation to share it through the media difficult to resist, in the belief that talking to the public about their pain is an effective form of therapy. Jayne Zito, whose husband was killed by a mentally-ill assailant, recalled that she had a "huge need to go on talking". The idea of therapeutic campaigning to work through personal problems is also widely endorsed. Colin Parry, whose young son Timothy was killed by an IRA bomb blast in Warrington, became a public figure often consulted about the political situation in Northern Ireland. "Colin needed the media as his therapy," noted his wife, Wendy.
The rise of self-disclosure television - Oprah Winfrey, Geraldo, Ricki Lake - exemplifies the mass transmission of streams of emotion. Yet, thrash TV, along with its more elevated literary cousin, the new genre of self-revelatory biography, mirrors new cultural norms about notions of intimacy and private space. It seems that everybody wants to talk or write about themselves. In the 1990s, confessional auto-biographies and semi-fictional accounts expanded beyond the usual "I was an addict" stories and adopted themes that were far more private than before. What the American critic Laura Miller has characterised as the "illness memoir" became one of the most distinct literary genres of the late 1990s. Books such as Elizabeth Wurtzel's Prozac Nation and Ben Watt's Patient have fulfilled cultural critic Andrew Calcutt's prediction that memoirs of addictions, cancer, post-natal depression and a variety of other afflictions were likely to turn into a growth area in British publishing.
In a larger context, disclosure represents the point of departure in the act of seeking help - an act of virtue in therapeutic culture. Help-seeking also constitutes the precondition for the management of people's emotions. That is why there are such strong cultural pressures on the individual to "acknowledge pain"and "share". Confession, preferably through therapy, relieves the burden of responsibility and offers a route to public acceptance - even acclaim.
When footballer Paul Gascoigne was exposed in a newspaper as a binge drinker and smoker, he faced the full wrath of the media. He was treated as a public outcast until he acknowledged he had a "problem" and checked into a clinic. By acknowledging his problem, Gascoigne performed a mandatory ritual which was necessary for his re-entry into the moral community. Tony Adams, former England football captain, only earned the respect ofthe media after his public admission of an alcohol problem. Following his autobiography, Addicted, which provides vivid details of his drunken debauchery, some wags suggested that he is now more respected for his addiction than he ever was for his football: Adams has become the paradigmatic victim-hero of British sport.
Because the public exposure of inner pain can count on the affirmation and support of today's culture, more and more people identify themselves through their addiction, syndrome or physical illness. As Miller remarks, "In a world where unadulterated heroism is harder and harder to define, let alone accomplish, the syndrome memoir turns simple survival into a triumph." Illness as a fashion statement is emblematic of this new cultural outlook that attaches so much significance to emotional survival.
And this culture is a self-reinforcing circuit: by upholding the act of seeking help, society continually demands the exposure of pain and public contrition. By treating emotions and feelings as the defining feature of individual identity, the private sphere has become a legitimate area for public scrutiny. So any claim for privacy represents a refusal to accept the new etiquette of emotional correctness.
A powerful parallel development to this is the acceptance of an ever-widening definition of what constitutes psychological distress. Recent decades have seen the discovery of an unprecedented number of new types of illnesses. The diagnoses of post traumatic stress disorder (PTSD), depression, addiction, chronic fatigue syndrome, attention deficit hyperactivity disorder (ADHD), and multiple personality disorder (MPD), are being applied to an astonishingly wide section of the population. In the early 1970s, MPD was a rare diagnosis - less than a dozen cases in the previous years; by the 1990s, thousands of people were diagnosed as multiples. Depression, once primarily associated with women, is now represented as an infirmity that also afflicts children, students and men. Until recently, the diagnosis of ADHD was confined to children. It has now been reinvented as a condition that also afflicts adults. This elaboration of the impact of mental disorders is matched by the growth in the number of routine experiences that are said to cause psychological damage.
But this new narrative of illness does not simply frame the way people are expected to feel and experience problems - it is also an invitation to infirmity. Take the growing phenomenon of stressed-out children. A recent survey discovered that children as young as eight described themselves as "stressed by relationships and school". Professor Stephen Palmer of City University, who led the study, was "surprised by the extent of the problem". "If you had asked eight-year-olds about stress 20 years ago, they would have looked blank," he adds, whereas "now they understand the concept and a significant number report experiencing it." So it is precisely through concepts such as stress that children are educated to make sense of the problems they experience. By the medicalisation of emotional upheaval, young people are trained to regard troublesome experiences as the source of illness for which help needs to be found.
Adults, like children, are continually invited to make sense of their troubles through the medium of therapeutics. Take the experience of crime. The belief that the impact of crime has a major influence on people's emotional life is a relatively recent one. Concern with trauma suffered by a victim has been gradually extended beyond the immediate victim to family members, friends and eyewitnesses. The concept of the indirect victim allows for a tremendous inflation of the numbers who are entitled to claim such support.
But the truth in all this is that people have no inner desire to perceive themselves as ill (or traumatised). Instead, powerful cultural signals provide them with a ready-made therapeutic explanation of their troubles. And once the diagnosis of illness is systematically offered as an interpretive guide for making sense of distress, people are far more likely to perceive themselves as ill. Distress is thus not something to be lived, but a condition that requires treatment. According to this version of personhood, the individual lacks the power to deal with the trials of life. This profoundly disabling view sees the individual as existing in an almost permanent state of vulnerability. As American cultural critic Christopher Lasch notes, "The dominant conception of personality sees the self as a helpless victim of external circumstances." From the standpoint of therapeutic culture, the integrity of the person is threatened through any exposure to adversity.
On the face of it, the tendency to inflate the problem of emotional vulnerability and to minimise the ability of the person to cope with distressful episodes runs counter to the therapeutic ideal of the self-determining individual. In reality, though, the rhetoric of therapeutic self-determination never granted individuals the right to determine their lives: self-discovery through a professional intermediary is justified by the assumption that individuals are helpless to confront problems on their own.
Mirroring this sense of "self-as-victim" is the contemporary obsession with self-esteem. At an individual level, low self-esteem is presented as an invisible disease that undermines the ability of people to control their lives. When, in her celebrated TV interview with Martin Bashir, the late Princess Diana informed us of her secret disease, bulimia, she said: "You inflict it upon yourself because your self-esteem is at a low ebb, and you don't think you're worthy or valuable." Diana's confession resonated with the new common sense that perceives low self-esteem as the principal cause of not only of individual unhappiness, but also of much larger social problems.
The point was echoed by Oprah Winfrey when she informed her audience that "what we are trying to change in this one hour is what I think is the root of all the problems in the world - lack of self-esteem." Low self-esteem is now associated with virtually every social ill. Policy-makers, media commentators and experts regularly demand that action should be taken to raise the self-esteem of schoolchildren, teenagers, parents, the elderly, the homeless, the mentally ill, delinquents, the unemployed, those suffering racism, lone parents, to name but a few.
Even anti-poverty campaigners have shifted their focus. One recent study, Hardship Britain: Being Poor in the 1990s, is promoted on the ground that it examines the "experience of poverty and exclusion, and its impact on self-esteem and personal dignity". In this brave new world, the problem is no longer poverty per se, but its invidious consequence: impaired self-esteem. Government agencies, too, continually point to a self-esteem deficit as the source of social problems. "Whilst there is no single route through which children become involved in prostitution, we know that the most common factors are vulnerability and low self-esteem," according to a briefing document by the Department of Health for Wales. Thus major social problems are atomistically recast as individual woes.
"But why should anyone imagine that such diverse social issues and such complex types of human behaviour could be caused by just one factor: how good or bad one feels about oneself," asks Jennifer Cunningham, a community paediatrician from Glasgow. It is a timely question: its ability to jump from one problem to the next suggests that the self-esteem deficit has taken on the character of a folk myth. An attractive feature of this folk myth is the claim that raising self-esteem works as a magic bullet, able to solve almost any problem facing the individual and society.
British psychologist Terri Apter, a proponent of the miraculous effects of raising self-esteem, enthuses: "New research confirms what has repeatedly been found to be true: self-esteem is a key to successful development and has a far greater impact on future success (and happiness) than intelligence or talent." Along with Oprah, Senator John Vasconcellos of California, a leading voice of the self-esteem movement, regards self-esteem as the "social vaccine safeguarding us all".
The passive narrative of the self-promoted today acquires its apogee with the celebration of self-esteem. Its advocates continually remind people of the virtue of the unconditional acceptance of the self. This static, conservative view of the self represents a rejection of previous, more ambitious calls for "changing yourself", "improving yourself" or for "transcending the self". Instead, the call for self-acceptance is a round-about way of avoiding change. Such a conservative orientation towards the future is clearly reflected within the role of therapy itself.
The paradox of therapy culture is that the more universal it becomes, the less ambitious it seems. Although individual therapists sometimes make extravagant claims about the effectiveness of their product, therapeutic culture is distinctly modest about its efficacy. Therapies tend to be promoted on the grounds that they help people "cope" and "come to terms" with their condition. Such minimal claims stand in distinct contrast to the way that therapy was promoted in the past.
Throughout most of the 20th century, therapy was advertised as both a cure and as an instrument for the construction of a happy society. It was promoted as a positive way of exploring and expanding the individual's personality. From the perspective of today's therapeutic ethos, therapy is much more a means of survival than an instrument through which enlightenment can be gained. Individuals are not so much cured as placed in a state of recovery. They are far more likely to be instructed to acknowledge their problems than to conquer them.
Therapy today, like the wider culture of which it is a part, teaches people to know their place. All that it offers in return are the dubious blessings of affirmation and recognition.
· Therapy Culture, by Frank Furedi, published by Routledge (£14.99)
