A Culture of Care

Dateline:  June 20, 2018

By Jeff Heller

In the past, religion provided individuals the psychological care needed for the sustenance of human existence. But, with the onset of modernity – and especially 20th century modernism – this role fell increasingly to culture and, in particular, the helping professions. And yet, as the 20th century English psychologist, David Smail, understood (better than anyone), psychotherapy may in fact be powerless to reverse the harm done to us by the world we now live in.  In fact, despite the dissemination of armies of helping professionals, it may be that we live (and have lived for at least a half century) in a culture bereft of care.

To get a clearer sense of this sad state of affairs, how it came about and what might be done to reverse it, I highly recommend you consult Smail’s books – as I did, time and again, throughout our eight-year correspondence. To that end, I hope the following brief overview, much of it familiar perhaps, will prepare and encourage you.

Professional help begins of course with Freud, who referred to psychoanalysis as an education to reality. As with Plato and his improvement of the soul, Freud pointed to the need for a strengthening of the reasoning faculty by way of a reigning in of the appetites, in favor of an identification with cultural ideals. Yet, for Freud, this process was justified as much, I think, by a fundamental belief in the social and economic benefits of the bourgeois social system, as it was by the development of mind or sexuality, as he purported.

Indeed, through the medium of psychoanalysis, Freud sought to occupy the cultural space vacated by religion, based on the presumed capacity of Mind – as overseen by a trained priest class – acknowledge, interpret, and regulate reality. In a sense, too, Freud’s ‘science’ echoed the idealist phenomenology of the philosopher Hegel – who had been for 19th century romanticism what Freud was for 20th modernism  – in that both advocated a dialectical integration of the rational and the real. Though, unlike Hegel, Freud did not believe in the possibility that individuals or groups could do all that much to alter reality itself.

For all that, the staunchly anti-religious Freud was on the same page as the Hegelian historian, Karl Marx, insofar as it was now up to empirical science to actualize the human potential philosophy had merely articulated for the previous two millennia. But, for Marx, such a goal could only be achieved within the political and economic spheres; not within the mind, as purported by religion and philosophy. What’s more, Marx believed that capitalism was so utterly and incorrigibly cruel that it needed to be superseded, lest it take down the global economic system along with its exploited producer class.

Like Marx, the late 19th century, self-proclaimed psychologist, Friedrich Nietzsche, was an anti-idealist who saw  psychology as a science not of thinking but of doing. Both of their critiques, indeed, oppose the abuses of authority – political and economic, in the case of Marx, cultural and religious, for Nietzsche. Whereas, Freud, by contrast, saw a need for a rapprochement between statist demands on the individual and the satisfaction of her instincts, arguing that this was no less than the hallmark of psychological maturity, just as a child must curb his rebellious proclivities vis-a-vis his parents.

However, as evidenced by Freud’s trinity of disciple-dissenters – Alfred Adler, C.G. Jung and Otto Rank – the critiques of Marx and Nietzsche were very much on the minds of the early psychoanalysts, both in terms of their respective theoretical orientations and emancipations from founder Freud. For the socialist Adler, in particular, this divergence contained references, explicit and implicit, to Marxian economics; notably, Adler’s notion of social interest, the lack of which, with its obvious allusion to capitalist alienation, he saw as the basis of all neuroses.

The socio-economic-minded psychology that Adler advocated at the outset of the psychoanalytic movement (and maintained throughout his career) would become prominent by the middle third of the century – with the ‘culture school’ of Karen Horney, Erich Fromm and Erik Erikson – even as Freud’s hard-line Oedipal interpretation (which William James deemed a ‘fixed idea’) was forced to retreat from a previously uncontested vanguard. Erich Fromm, a scion of the Frankfurt School and a practicing analyst in his own right, was particularly taken with synthesizing the theories of Marx and Freud.

Nevertheless, beginning in the 1960s, the French philosopher, Michel Foucault, working in the post-structural school that owed everything to Nietzsche, showed that therapeutic psychology was, in fact, nothing other than a capitulation to materialist Power. That is, as with other modes of institutional control, the ‘psycho’ professions were in the business, essentially, of advancing the interests of the elite; though not through force, as in epochs past, but via bureaucratic propaganda and procedures, designed to get people to discipline themselves.

In this way, then, was western society returned to the therapy-as-religion model that was Freudian psychoanalysis, with its self-appointed mandate to modify the individual in accordance with cultural norms. The difference being that during the first third of the 20th century, Freud could still point to religion as the chief ideological culprit. Whereas by the last third of the century, after the descent into neo-liberal post-modernism, with which we are still contending, critical thought had reset its focus upon culture itself as the means by which Power asserts and retains hegemonic control.

And no one, in my view, has done a better or more hopeful job of explicating this postmodern condition, especially as it relates to myth-promoting psychotherapy, than David Smail. In his four penetrating yet elegantly argued books – Illusion and Reality (1984), Taking Care (1987), The Origins of Unhappiness (1993), and How to Survive Without Psychotherapy (1996) – Smail cuts through the myth of therapeutic cure and calls instead for a culture of care. What’s more, he envisions the role of psychologist as a non-profit enterprise, dedicated to providing comfort to patients, not least by correctly locating the cause and cure of anxiety and depression not in ourselves but in our dehumanized, pathology-breeding bourgeois culture.


Jeff Heller, M.A. has been a college counselor, social-service manager, and businessperson. An avid songwriter and scribbler, with doctoral training in Counseling and Sociology, he is available to consult groups and individuals on How to Be Your Own Psychologist.



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