How a language got off the couch and into the world
First, let’s survey the situation. It’s as though the haze of our inner lives were being filtered through a screen of therapy work sheets. If we are especially online, or roaming the worlds of friendship, wellness, activism, or romance, we must consider when we are centering ourselves or setting boundaries, sitting with our discomfort or being present. We “just want to name” a dynamic. We joke about our coping mechanisms, codependent relationships, and avoidant attachment styles. We practice self-care and shun “toxic” acquaintances. We project and decathect; we are triggered, we say wryly, adding that we dislike the word; we catastrophize, ruminate, press on the wound, process. We feel seen and we feel heard, or we feel unseen and we feel unheard, or we feel heard but not listened to, not actively. We diagnose and receive diagnoses: O.C.D., A.D.H.D., generalized anxiety disorder, depression. We’re enmeshed, fragile. Our emotional labor is grinding us down. We’re doing the work. We need to do the work.
Around every corner, trauma, like the unwanted prize at the bottom of a cereal box. The trauma of puberty, of difference, of academia, of women’s clothing. When I asked Twitter whether the word’s mainstreaming was productive, I was struck by two replies. First, overapplying the term might dilute its meaning, robbing “people who have experienced legitimate trauma of language that is already oftentimes too thin.” And, second, invoking “trauma” where “harm” might suffice could play into the hands of “people who despise and fear vulnerability.” During this exchange, Twitter served me an advertisement that urged me to “understand my trauma” by purchasing a yoga membership. Ridiculous, I thought. I’m not a sexual-assault survivor. I’ve never been to a war zone. But, countered my brain, after four years of Trump and four seasons of covid, are you not hurting? The earth is dying. Your mother issues! Your daddy issues! A clammy wave engulfed me. My cursor hovered over the banner.
Perhaps the language of mental health is burgeoning because actual mental health is declining. According to one report, nineteen per cent of adults experienced a mental illness between 2017 and 2018, an increase of 1.5 million people from the previous year. covid-19 has correlated with soaring rates of depression and anxiety, especially among young people. (In one study, conducted last September, more than half of eleven-to-seventeen-year-olds in a screening of 1.5 million said that they’d thought about suicide or self-harm “nearly every day” for the past two weeks.) A growing awareness of mental illness may be prodding these numbers even higher, although our everyday lexicon still lags behind the science. “We live in a lonely country,” Darby Saxbe, an associate professor of psychology at the University of Southern California, told me. “There’s a lot of genuine distress.”
Yet that may not be the full story. As Saxbe pointed out, the language of the therapist’s office has long flooded popular culture: terms like “hysteria,” “shell shock,” and one’s “inner child” all reflected the psychoanalytic approaches of their day. Freud, in particular, showered Western letters with now common phrases: repression, death wish, slip of the tongue, denial, transference. And the new stuff, too, is still pretty Freudian. It conjures not so much behavioral or cognitive modes of counselling—which might, for instance, inspire influencers to post about the interplay of their thoughts, feelings, environments, and actions—as it does a “kind of modern confessional,” Saxbe said. This language, with its sensitivity to trauma and abuse, seems aimed at “revealing the truth of a difficult experience.” It refreshes Freud’s emphasis on self-disclosure—itself a refreshment of an older religious impulse, a hunger for connection and absolution.
But if the make of the therapeutic chassis hasn’t changed, the past few years have driven it somewhere new. Therapy-speak’s expressive and confessional qualities implicate Freud, and yet its aim, its attention to grounding behavior in care and respect, suggests a rival influence: the psychoanalyst D. W. Winnicott, who was known for his gentle portraits of early childhood. Consider “holding space,” a standout in the new vernacular. The words often appear as a verb phrase, which the Gender and Sexuality Therapy Center defines as “putting your focus on someone to support them as they feel their feelings.” (This, in turn, can be tweaked to “holding” or “holding feelings.”) But the concept of the holding space, or the holding “environment,” grew out of Winnicott’s writings in the nineteen-fifties and sixties, when he broke from his peers at the British Psychoanalytical Society. While his colleagues were bent on studying the fallout of repressed yearning, Winnicott cast back to his patients’ pre-Oedipal beginnings, training his eye on the elemental processes that buttress the self.
In the holding space, the “good enough mother” interacts with her baby, mirroring and sheltering its tender sense of identity. Revealingly, contemporary therapy-speak imagines this dynamic everywhere. Winnicott argued that our ego is shaped in a web of met and unmet needs. The infant discovers that he is a self, an I, when his ordinary devoted mother, over the course of responding to his cries, cannot satisfy every yearning. The ensuing frustration drives home for the child that he and his parent are two, not one—and yet, in a healthy environment, the child figures out how to “go on being.” Therapy-speak, with its first-person narratives of pain, assumes a similar link between vulnerability and identity. Its confessional aspect doubles as an affirmation of humanness, which is always both empowered and frail.
But confession can also become a class performance. (Think of Woody Allen’s Manhattanites, talking endlessly about their shrinks.) In the United States, basic mental-health care remains a luxury item; there’s a reason that the most fluent speakers of the trending argot tend to be wealthy and white. This may explain some of the irritation that therapy-speak occasionally provokes: the words suggest a sort of woke posturing, a theatrical deference to norms of kindness, and they also show how the language of suffering often finds its way into the mouths of those who suffer least. In 2019, for instance, a much-mocked Twitter thread offered a template for turning down a friend’s request for help. “Hey! I’m so glad you reached out,” it read. “I’m actually at capacity/helping someone else who’s in crisis/dealing with some personal stuff right now, and I don’t think I can hold appropriate space for you. Could we connect [later date or time] instead/Do you have someone else you could reach out to?” The technical vocabulary, the holding (or not) of appropriate space, did read as slightly unfeeling, but people seemed more annoyed at such a strenuous attempt to avoid a sad pal.
Illustration by Lan Truong
For Lori Gottlieb, the author of the book “Maybe You Should Talk to Someone,” the downsides of casual therapy-speak are more straightforward. “I want to be clear that there’s no reason why people who are not professional psychologists should be expected to use these terms correctly,” she told me. “But there’s a lot of inaccuracy.” Error can be introduced via colloquialism—“O.C.D.” for “organized”—or the actual misconstrual of a word’s meaning. (Someone mistaking “conflict” for “abuse” or labelling you a “gaslighter” because you’ve expressed an opinion that they don’t agree with.) As philosophers from Michel Foucault to Peter Conrad have observed, medical vocabulary lifts up the speaker—claiming that your intrusive neighbor has “borderline personality disorder” cloaks you in authority while pathologizing him. Using these words as bludgeons strips them of complexity; the problem with armchair therapy, or what we now might call “Instagram therapy,” is that it can transform a “deeply relational, nuanced, contextual process,” Gottlieb said, into something “ego-directed, as if the point were always, ‘I’m the most important person and I need to take care of myself.’ ”
Consider boundaries. (Seriously, always do this.) Online and in the letters sent to many a relationship-advice column or podcast, boundary drawing is often invoked to mean cutting people off. “But when we talk about boundaries in therapy,” Gottlieb explained, “it’s something that is really reflected upon and not extreme, and it’s all about interrelationality.” That crude/subtle contrast, Gottlieb said, plays out more broadly between the “idiot compassion” of social media—blind agreement with whatever your friend does—and the “wise compassion” of the psychologist’s office, the effort to help a patient see herself anew. Unquestioning validation “can feel wonderful in the moment,” Gottlieb added, “but it’s not useful to you in the long term.”
Saxbe voiced a similar concern about the appropriation of “triggers,” a concept that is intertwined with the clinical treatment for P.T.S.D., and “spoons,” which arises from the disability-advocacy community. (A spoon is like a unit of energy that you can spend on routine tasks; once you’ve used up your daily allotment, it’s hard to function.) “The most empirically validated approaches would have the patient slowly gaining mastery over her discomfort through exposure, whereas the popular understanding is much more about avoidance,” Saxbe said. In a clinical setting, in other words, the focus falls on interacting with the world—on “developing approach behaviors,” or building routines that pair challenging activities with rewards. But, online, protesting that you’re out of spoons can give you permission to hide from the world, and a trigger warning can seem less an opportunity than a hazard sign: keep away.
One concern that I expected to hear was that the mass adoption of psychological speech might disserve people with severe mental illness. Wasn’t it disrespectful to toss around terms—trauma, depression—that can imply so much suffering? Where was the line between unravelling a taboo and draining a word of its value? The psychologists I spoke to surprised me: steeped in a counter-history of silence about and vilification of mental illness, they could not bring themselves, it seemed, to worry about this particular aspect of therapy-speak’s rise. Gottlieb, pointing to a cottage industry of drinking memes on social media, noted that most of us are still more likely to minimize mental-health challenges (including addiction) than to exaggerate them. And although Saxbe allowed that “there’s a danger of pathologizing and over-treating,” she found both modes preferable to fear and shame. Nor is the seam between “real” conditions and invented ones as conspicuous as some might believe. For more than a century, American culture has embraced a biomedical model of misery; we source bad feelings to chemical imbalances in the brain. But that emphasis “hasn’t actually been well supported by the data,” Saxbe told me. “There’s a lot of evidence that mental health is also related to social connection and having a sense of purpose.”
It only makes sense, then, that the language of psychology has seeped into the rest of our lives; psychology itself is entwined with the rest of our lives. Our emotions are social as well as neural phenomena—their expression can be gendered, racialized—and how we talk about them prefigures both what we want for ourselves and for others. (Hurt people hurt people, as a cohort of psychoanalysts would have it.) If I was once suspicious of the language budding across my social-media feeds, lamenting its expansion now feels like making a claim about who, exactly, “mental health” is for and what we’d like it to do. We could say that it’s for individuals who struggle with its opposite—but, in that case, the language of healing will always be a language of difference. And if we say that it’s for those who have traditionally spoken of such things, we restrict well-being to a milieu that can afford it.
Such border patrolling may be obsolete, anyway. Therapy seems to have absorbed not just our language but our idea of the good life; its framework of fulfillment and reciprocity, compassion and care, increasingly drives our vision for society. Writing this piece, I thought especially of the Greek concept of eudaimonia, or human flourishing. Some might call it blessedness. In any case, it seems worth talking about.