currently reading: Females by Andrea Long Chu
books bought
The Book of Daniel by Aaron Smith
Females by Andrea Long Chu
books received
Excellent Women, Less Than Angels, The Sweet Dove Died, and A Very Private Eye by Barbara Pym
Nobody’s Child: A Tragedy, a Trial, and a History of the Insanity Defense by Susan Nordin Vincour (e-galley, out 3/24)
books from the library, which i’m finally fucking using
Pastoral, The Hidden Keys, and Days by Moonlight by André Alexis
Against Joie de Vivre by Phillip Lopate
books finished
Super Pumped: The Battle for Uber by Mike Issac
The Big Book of the Dead by Marion Winik
Pastoral by André Alexis
Excellent Women by Barbara Pym
The Book of Daniel by Aaron Smith
Hey you,
I can’t remember how I first came across the work of the late psychologist David Smail, which is frustrating because it was only a few months ago. I think it was while looking for an article I thought I read in the Stanford Law Review years ago about involuntary inpatient commitment. (I couldn’t find it!) So. We’re off to a good start.
The fundamental thesis in all of Smail’s books that I’ve read is that
psychological distress occurs for reasons which make it incurable by therapy, but which are certainly not beyond the powers of human beings to influence. We suffer pain because we do damage to each other, and we shall continue to suffer pain as long as we continue to do the damage. The way to alleviate and mitigate distress is for us to take care of the world and the other people in it, not to treat them. (Taking Care)
One of the most important points he makes, in my view, is how thoroughly therapy atomizes people, how it removes them from the larger social context. In so doing, it places one’s responsibility for one’s mental health solely in their own hands, which is, frankly, fucking bonkers. Or, a little more eloquently:
The consulting-room model of human psychology… has had a profound effect on our idea of ourselves, reinforcing an emphasis within our culture on personal responsibility and autonomy in relation to psychological suffering. The effect of this has been to lift us out of the social environment and attribute to us not only a distinctly moral role in the acquisition of our own troubles but also the power to better our lot principally through our own devices (though perhaps needing a therapist to act as a kind of midwife to our efforts)… What the consulting-room model does above all is inflate enormously, and grossly misleadingly, the power of individuals to take charge of their own fate. (How to Survive without Psychotherapy)
And if that sounds grim, well, maybe it is. Smail argues that there is a certain relief in knowing what is happening to you and what you are feeling are neither your fault nor within your power to change; I find I agree, but I imagine many people will not. Looked at in a certain light, it’s positively cruel—if you tell someone in distress it’s not within their power to make their life better, is that different from condemning them to a life of suffering or unhappiness? Still, I think it is unarguably the case that much distress could be alleviated if people had access to steady paychecks, or affordable housing, or healthcare, and you can’t achieve any of those things in therapy by yourself.
To be clear, I don’t mean to imply that if you’re in therapy, that’s bad or wrong or somehow misguided. I certainly don’t think you should stop going if it’s helpful to you. I just want to look at the larger picture.
The last few months I’ve been looking, with increasing despondence, for a new psychiatrist, and for a while I was thinking of looking for a therapist, too. I’ve had a few appointments with a few different providers in the last few months. When I tell these mental health professionals that what is ailing me is that there is so much suffering in the world, all of it so needless, or that the world’s climate is changing for the worse, forever, with effects I can’t even wrap my head around—they answer this very uniformly. They tell me to limit my news consumption—as if not thinking about something is the same thing as it not being real. Or if I say I am worried that people making what I make or less will not be able to afford to live in Boston in the future because we’ll be priced out because homeowners believe their property is worth displacing thousands of people—the answer is always something like, “Just get roommates,” as if the housing crisis is made up of me and only me. Smail writes:
the language of therapy and the principal concepts it concerns itself with are extraordinarily unlike the main preoccupations of your everyday life. Whereas almost before you wake in the morning you are likely to be worrying about the rent or the mortgage, whether you’ll keep your job or pass your exam, therapeutic language seems to have a lofty—at times contemptuous—disregard for such matters, as if they were merely distractions from the important issues of your unconscious desires and fantasies and the ways in which, through them, you are supposedly creating your problems. (Taking Care)
I think we understand on some level the hugeness of the problem of distress, how it has its tentacles in everything, but we must start somewhere, and the impulse is to start with the individual and the individual’s pathology. In her essay “Time Heals All Wounds” from her excellent book Axiomatic, Maria Tumarkin writes about suicide among high schoolers. She interviews a woman named Erminia Colucci, who’s studied youth suicide in Italy, Australia, and India:
Erminia’s view of suicide is existential. You cannot begin to grapple with the somethingness of a suicide without talking about the crisis of meaning people experience, the what’s-the-point-of-it-all questions that get asked and stay painfully unanswered.
It is not like anglo ways do not recognise soul… It’s just that when talking about suicide takes in culture, chemistry, disease, meaning, soul—“Conversation about suicide becomes almost unmanageable,” Erminia says.
Mental health is people’s way of holding the conversation down like an animal.
Why wouldn’t you want to hold it down, make it easier, if you could? If it felt like you could.
All of this is further complicated by the fact that depression, to paraphrase Andrew Solomon in The Noonday Demon, is an illness of how you feel:
It is my absolute belief that in the field of depression, there is no such thing as a placebo. If you have cancer and you try an exotic treatment and then you think you are better, you may well be wrong. If you have depression and you try an exotic treatment and think you are better, then you are better… If you really truly believe that you can relieve your depression by standing on your head and spitting nickels for an hour every afternoon, it is likely that this incommodious activity will do you tremendous good.
This is an idea that comes up against a lot of pushback, at least in my circles, because of a belief that it delegitimizes both depression and the medically accepted treatments for depression. And yet I think it’s part of why therapy works. (Not the entire reason, of course—therapy is also helpful for the same reason having loving friends and family is helpful. Smail: “Of course, in one’s battles with the world, it helps to find an intelligent, experienced, wise and loving ally… But allies of this caliber are, in the present-day world, in desperately short supply, and if you need one badly enough the chances are you will have to pay for one.”)
But it does mean it is possible to feel relief from distress without the structure of society changing, without one’s situation changing. I’m just not sure how long lasting such relief tends to be.
Reading Smail’s work, I was reminded of an essay Solomon wrote about experiencing an exorcism in Senegal. At the end of the essay he describes visiting Rwanda and discussing with a man the similarities and differences between Senegalese and Rwandan treatments for distress. Then the man mentioned the western mental health workers who came to Rwanda after the genocide; the man says they had a lot of trouble with them.
I said, “What was the problem?”
And he said, “Their practice did not involve being outside in the sun, like you’re describing, which is, after all, where you begin to feel better. There was no music or drumming to get your blood flowing again when you’re depressed, and you’re low, and you need to have your blood flowing. There was no sense that everyone had taken the day off so that the entire community could come together to try to lift you up and bring you back to joy. There was no acknowledgement that the depression is something invasive and external that could actually be cast out of you again.
“Instead, they would take people one at a time into these dingy little rooms and have them sit around for an hour or so and talk about bad things that had happened to them. We had to get them to leave the country.”
In other news: my dear and beloved friend Spencer has moved to Idaho, the days are light at the wrong times, and I am, as usual, in love with someone who is certainly not in love with me. Any books you’d recommend for me? Something that feels like a warm bath? I’ve been getting very into Barbara Pym lately…
Your friend,
Smalls