Wednesday, July 16, 2008

Psychobabble for $600 a Session, Part 3

According to the NY Times today's top therapists are complaining that their patient population has changed. In the good old days they were working with out-of-work heirs and heiresses; now they have to deal with people who have earned their fortunes themselves.

They appear to have been more comfortable with the trust-fund crowd than with the strivers and achievers. The former were more depressed; the latter more narcissistic. More importantly, the former made for more obedient, compliant, and dedicated patients.

But are there other reasons why people who are depressed are no longer signing up for four-times-a-week therapy? After all, everyone knows that insight-laden therapy is no longer the treatment of choice for depression. Better ones would include SSRIs, cognitive-behavioral therapy, and aerobic exercise. And to this we must add the advice of Harvard's Dr. Richard Mollica: "the best anti-depressant is a job."

The message seems to have gotten through. Today's tycoons seem to be less willing to indulge their scions. Some of the wealthiest, like Warren Buffett and Bill Gates, strictly limit how much their children can inherit. They see excessive unearned wealth as a curse, encouraging sloth, decadence, and interminable psychotherapy.

So, people who lived off of inherited wealth were wonderful patients; they worked the program; they excavated their past history; they got in touch with their feelings. They enjoyed introspecting; they came to all of their sessions; and were happy to be relieved of the obligation to get involved in the real world.

The new tycoons are nowhere near as compliant. They miss sessions with impunity, refuse to introspect, do not want to get in touch with their feelings, and stop treatment abruptly, apparently because their lives are going too well.

Is this a function of their narcissism? I think not. Try it from a different angle. Successful people usually want to see results. If they do not see progress that is commensurate with the time and expense, they will cut their losses.

In the old days psychoanalysts used to warn people against ending treatment prematurely. Unless you held out to the bitter end you would be consigned to an eternity of neurotic torment. Nowadays, for people who have achieved a large measure of worldly success, this ploy no longer seems to work.

Heirs and heiresses had the kinds of problems that fell well within their therapists' comfort zones. They had been neglected and unloved by their parents; they were afraid that they would not measure up to their parents' success; they felt depressed because they did not have a real place in the world.

They may have had all the money in the world, but that does not give you a meaningful role in society. When someone asks what you do for a living you cannot say that you are passing your time spending your father's fortune.

But what was therapy offering to these people. Was it teaching them how to blame their parents for their indolence? Was it telling them that their successful fathers had done them a disservice by doing so well? Was it providing them with rationalizations for their inability to hold jobs? Was it making them think that inherited wealth was not a great opportunity, but an insurmountable problem. If so, it is no wonder they stayed depressed.

And how are you going to encourage someone to go out into the world when you are telling him that his happiness and well-being were sacrificed on the altar of his father's success.

Many trust-fund children face a simple, but difficult problem. Why should they work when they do not have to? Doesn't Freudian theory tell them that hard work involves repressing their creative potential and their libidinous urges.

Therapists pay lip service to "work," but their ethos suggests that a life of creative expression is a better way to go. Why should these young people follow in their parents' footsteps when that entailed pain, travail, high blood pressure, ulcers, and emotionally crippled children?

When therapy tells the scions of great wealth that hard work is repressive and exploitative, how can it expect that they will want to try to measure up.

Isn't life about pursuing pleasure by acting on your desires? Doesn't hard work diminish your capacity for same? But why does the therapy culture so blithely assume that work and pleasure are mutually exclusive, that you must repress your true desires in order to succeed at business?

I do not know how many therapists today would still cop to believing such a thing? Nonetheless it is built into the method. As most people should know by now, depression in and of itself will seriously limit your capacity for pleasure, and it will also diminish your appetite and your libido.

So, it makes a certain amount of sense that the therapy culture would promote different ways to overcome these symptoms. The culture has glorified the pursuit of pleasure, as though it were a fundamental right, to be obtained by any and all means. And it has encouraged people manufacture desires out of societal taboos and indulge any and all appetites.

If you have to work at pleasure, there is something wrong. And if you have to manufacture desires, you are never going to be satisfied with what you find.

The problem is not limited to therapists' offices. As a culture we are acting like we are heirs to limitless wealth, unwilling to do what our forebears did to accumulate it, because the therapy culture has taught far too many people that whatever they did was bad for their souls. So we happily live off its bounty and deal with our despair by making life into a permanent party.

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