Jack Trotter reviews One Nation Under Therapy

On September 14, as horrifying images broadcast from New Orleans dominated the nation’s headlines, USA Today, citing as its source Charles Currie, head of Substance Abuse and Mental Health Services, reported that as many as a quarter of the Hurricane Katrina “evacuees” would fall victim to Post Traumatic-Stress Disorder (PTSD) and require long-term professional care. Thus, as many as 250,000 of the approximately one million people displaced by Katrina are walking disasters waiting to happen all over again. At some point in the coming months, according to the current wisdom of the mental-health establishment, these people will begin to reexperience the frightening events that led to their displacement: recurring nightmares, crippling phobias, and anxiety more intense than the feelings generated by the original experience. In short, they will add their numbers to the ranks of the millions of Americans who, since 1980, have been diagnosed with PTSD, a mental disease whose taxonomic history is suspect, to say the least.

According to Christina Hoff Sommers and Sally Satel, authors of One Nation Under Therapy, PTSD’s inclusion as a taxonomic category in the 1980 edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (APA) was, in large part, the result of a long campaign on the part of Vietnam veterans and their advocates. At the forefront of the campaign in the early 1970’s were psychiatrists and antiwar activists Robert Jay Lifton and Chaim Shatan, who were convinced that prolonged trauma of a pathological nature should be understood as the normal response of veterans—not only of those who had experienced combat duty but of those who had served in Vietnam in virtually any capacity. They argued that hundreds of thousands of homecoming veterans—alienated, self-destructive, and angry at having been used as pawns in an unjust war—were victims of something they called the “Post-Vietnam Syndrome.” Lifton and Shatan tirelessly trumpeted this message at every available opportunity: at political rallies, at war-crimes hearings, in the media, and, above all, within the psychiatric profession.

The APA began revising its diagnostic manual in 1974 but eventually rejected the Lifton-Shatan notion of a “Post-Vietnam Syndrome” in favor of a broader classification. The diagnostic scope of the PTSD taxonomy established in 1980 included not just the casualties of war, but a variety of victims or survivors of “natural disasters, severe accidents, and . . . concentration camps.” Critics of the new classification argued that many of the symptoms listed—“recurrent images, avoidance, guilt, jumpiness, irritability”—were not at all distinctive and “could be subsumed under variants of existing disorders such as depression or anxiety.”

These early warnings proved to be all too germane. Soon, all kinds of advocacy groups saw the political and social benefits that might be reaped from the new taxonomy. Feminists, for example, recognized that PTSD “created a diagnostic niche for victims of rape, domestic violence, child abuse, and sexual assault.” Moreover, the APA exacerbated the problem when, in 1994, it redefined PTSD, modifying the “range of events that could count as ‘traumatic’ . . . to include hearing about the unexpected death of a loved one” or being diagnosed with a fatal disease. Indeed, so flexible was the revised definition that one no longer need be the actual victim of a disaster or severe accident; merely witnessing such occurrences might in some cases qualify one for a PTSD diagnosis. More recently, a group of Boston therapists has been lobbying for the recognition of something they call, in all seriousness, “Post Traumatic Slavery Disorder,” a diagnostic atrocity that would explain the disfunctionality of underclass black families as a legacy of slavery. Clearly, as Sommers and Satel imply, the trivializing of “trauma” in the name of therapeutic progress is tending toward a reductio ad absurdam, and they are surely not far off the mark when they claim that PTSD has become an almost archetypal “cultural narrative for suffering” in America today.

The problem with defining trauma as the normal response to life’s adversities, and thus medicalizing that response, is that it is morally debilitating. As trauma victims, we are no longer responsible; we become patients rather than the agents of our own healing; we are no longer self-reliant but, increasingly, self-obsessed. Early in One Nation Under Therapy, Sommers and Satel define “therapism”—an ugly but useful term—as an attitude typified by “openness, emotional self-absorption, and the sharing of feelings.” Additionally, therapism assumes that “vulnerability, rather than strength, characterizes the American psyche,” and, as a result, we require an army of “therapists, self-esteem educators, grief counselors, healers and traumatologists” to guide us toward genuine mental health. That the authors do not countenance such assumptions is evident on nearly every page of their book. In six lucid and thoroughly documented chapters, they call into question the myth of the fragile child, the self-esteem movement, the secularizing of sin and guilt as “syndrome,” the cancerous spread of “emotional correctness,” and more. In every case, they chart the disturbing rise, since the 1970’s, of a massive and intrusive therapeutic culture in a society that until recently prided itself on its deep reservoirs of self-reliance.

Problems arise, however, in the authors’ failure to explain how it is that a nation of rugged individualists could so rapidly be transformed into a nation of whiners and dependents. At one point, they draw upon the analysis of Boston College political-science professor Alan Wolfe, who notes that Americans have always lacked a “tragic sense of life” and that their historically easy optimism has rendered them helpless against the morally dubious claims of the “nonjudgmentalism” that is a cornerstone of therapism. Considering that the one section of the country that does preserve a tragic sense of life, the South, has also been at least marginally more resistant to the therapeutic culture, there may be something to Wolfe’s reflections. Sommers and Satel imply that the growth of secularism may also be a factor in explaining why Americans from every socioeconomic background have embraced therapism, especially as secularism erodes the capacity for moral judgment and responsibility and undermines the traditional understanding that the endurance of suffering and pain can lead to spiritual and moral maturity. This explanation is no doubt true enough as far as it goes. However, it fails to answer some questions.

Perhaps it is no coincidence that the authors are resident scholars at the American Enterprise Institute, for, in typically neoconservative fashion, they studiously overlook some important political and economic factors in explaining this unfortunate transformation of the American character. If the moral resistance of Americans to the blandishments of the therapeutic society has been dangerously eroded, it may be in large part because Americans are increasingly atomized, uprooted from traditional communities based on networks of kinship and economic interdependence. Americans may once have been a nation of rugged individualists, but they were individualists whose self-reliance grew out of self-reliant and self-sustaining communities. The destruction of those communities began as early as the Civil War but proceeded apace with the creation of the vast state-sponsored bureaucracies of the Roosevelt era. By the 1970’s, the collusion of an ever-expanding central state and a corporate capitalism intent upon reducing us all to the status of passive consumers had produced a nation of individuals ripe for therapeutic “intervention.” The rise of therapism is simply the latest phase in the evolution of the consumerist society—i.e., a quasitotalitarian society of vacuous “selves” incapable of self-government and, therefore, no longer any threat to the Moloch state that has devoured them. As the late Robert Nisbet notes in his much-neglected book The Quest for Community, “Totalitarianism is . . . made possible only through the obliteration of all the intermediate layers of value and association that commonly nourish personality and serve to protect it from external power.” It is unfortunate, but not surprising, that, while the authors of One Nation Under Therapy brilliantly trace the growth of therapism in the psychiatric profession and in the culture at large, they are virtually silent about the role played in that development by agencies of the “compassionate” state such as Substance Abuse and Mental Health Services (handmaid of the Department of Health and Human Services), whose motto is “a life in the community for everyone.”

Jack Trotter writes from Charleston, South Carolina.