We think, therefore we diagnose

America is in the grips of sudden syndrome proliferation syndrome.


Carina Chocano
May 30, 2001 11:35PM (UTC)

Has your sharply diminished net worth resulted in decreased self-esteem, self-confidence and motivation? Have your worthless stock options triggered feelings of depression, anxiety and disillusionment? If so, you may not merely be broke and bitter but be suffering from sudden poverty syndrome.

The good news is this means you're probably in recovery from sudden wealth syndrome -- which is also characterized by depression, anxiety and disillusionment accompanied by decreased self-esteem, self-confidence and motivation, but comes served with a large inheritance or Wall Street windfall.

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Whether you have been diagnosed with one or both of these syndromes, or have had feelings of any kind relating to money or its absence -- including an inability to delay gratification, an inability to tolerate frustration, a false sense of entitlement and, of course, depression, anxiety and disillusionment accompanied by decreased self-esteem, self-confidence and motivation -- you are probably a victim of "affluenza." In fact, alarmingly few of us are immune to affluenza -- it's a cultural epidemic stemming from "the myth of the American dream." Gesundheit.

It is tempting to wonder whether sudden poverty syndrome is real or just a trumped-up name for an understandable human response to a major disappointment. Whatever it is, it is but one of hundreds of examples of how problems once considered political, economic or educational are today considered psychological. America appears to be suffering from sudden syndrome proliferation syndrome.

Advertisements for financial services appeal to the vague dissatisfaction of the wealthy. ("Money is not the end of worry. It is the beginning," reads one ad for U.S. Trust. "You worked all your life to feel comfortable and here you are feeling decidedly otherwise.") Reality show contestants, like a platoon of photogenic Oprahs with one-tenth the body fat, prattle on endlessly about "being who they are" and "needing to win" and being "special and unique." These are the kids who were spoon-fed self-esteem curricula in school and came home to drawers full of nongendered, nontoxic, ego-boosting toys; who spend their lives pursuing a fuzzy, golden vision of happiness; who could sooner name the seven habits of highly effective people than the seven dwarfs.

Before the 1980s, the term "addiction" referred specifically to a dependence on addictive substances: drugs, alcohol, cigarettes. Now, disorders, addictions and syndromes can involve any activity -- shopping, eating, collecting, driving, sports, sex, talk shows and religion. We talk blithely about our "addictions" to things like chocolate and yoga. We visit transactional analysts, Jungian analysts, occupational counselors, multicultural counselors, pastoral counselors, milieu therapists, reality therapists, existential therapists, gestalt therapists, behavioral therapists, cognitive therapists, phototherapists, poetry therapists, bibliotherapists, activity therapists, pharmacotherapists, flotation therapists, remotivational therapists, rational-emotive therapists, phone therapists, van therapists and Internet counselors. Four in 10 Americans frequent support groups.

Looking at the numbers, it's hard not to conclude that we've taken a wrong turn somewhere. This is not to say that clinical depression is not real or that important advances have not been made in the field of mental health. But today the therapeutic industry is a $69 billion business, increasing at a rate of 7 percent every year. Each year more than 15 percent of adults and 21 percent of children visit mental health professionals. In the U.S. today there are more than 40,000 psychiatrists, 65,000 family therapists, 125,000 psychologists, 10,000 psychoanalysts and 150,000 social workers. Twenty-five million Americans now take Prozac. In the past 10 years, sales of antidepressants have reached $11 billion.

Psychology has ceased to be a perspective, a way of looking at the world as a possible means of understanding it; it has acquired a quasi-religious status. The lust for total emotion management has led to a grand-scale, unquestioning embrace of cures. There is no human activity, emotion or behavior exempt from possible diagnosis; and buying something has become the principal cure for all that stands in the way of our uninterrupted happiness.

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That happiness should be our supreme goal is the central tenet of what author Eva Moskowitz calls "therapeutic gospel" in her new book, "In Therapy We Trust." Moskowitz, who has taught American history at Vanderbilt University, the University of Virginia and the City University of New York, believes that the history of therapeutic excess is the shadow history of modern America, a movement that began with a fringe mid-19th century health craze and became a national obsession with compulsions and an addiction to self-help.

With the help of progressive reformers, government agencies, women's magazines, social activists and television talk show hosts, the cult of therapy, says Moskowitz, came to dominate both political discourse and the popular culture, turning us into a nation of sick people and healers whose self-awareness has overwhelmed our rational and objective view of human nature. Our self-regard tends to crowd out other social, economic or educational factors, she says, blinding us to social ills and rendering us incapable of making moral judgments. Not surprisingly, with the rise in psychiatric activity, says Moskowitz, there has been a concurrent decline in civic activity.

With an acute attention to Dickensian detail, Moskowitz traces the beginnings of our national therapy jones to an obscure clockmaker and one-time mesmerist named Phineas Quimby, who, in the 1850s, theorized that a person could cure disease by "sitting down beside the patient and putting himself en rapport with him." Quimby believed that he could cure people of their illnesses by curing them of their false beliefs, a method he believed to have been pioneered by none other than Jesus Christ himself.

Rather than praying with the infirm, Quimby "would put them in possession of a knowledge of themselves." His "mind cure" movement, which later came to be known as "new thought," soon became the rage in the 1890s. Organizations formed in large and small towns and reached a broad audience through magazines with titles like Fulfillment, Success, Realization, Mind and Mental Science.

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Quimby died in 1866, just as a science-crazed America was entering a period of active social reform. Influenced by Quimby's theories and the newly founded Christian Science Church, progressive social workers embraced consciousness-raising as a poverty-fighting tool. In the early 1900s, reformers began to advocate the implementation of psychological programs in prisons, courts, hospitals and schools that would focus on therapy, intervention and cathartic exercises.

The psychiatric establishment remained skeptical of these therapeutic movements until after World War I (some doctors going so far as to diagnose followers of new thought as insane), but by the 1920s, it began to champion therapeutic rhetoric and -- along with social workers, criminologists and social workers -- started to weave it into the institutional fabric of the courts, schools, prisons and welfare agencies.

According to Moskowitz, few people have appreciated how crucial psychological notions were to the reform movement of the early 20th century, and the subsequent growth of the welfare state. The "discovery" of maladjustment as a national social problem, she says, played a key role in the government's expansion. The therapeutic establishment and the federal government first linked hands to help fight poverty: Between 1900 and 1930, welfare and social workers began to look at self-worth and its role in poverty, asking whether providing food and shelter to those who couldn't provide it for themselves was essentially self-canceling. Later, therapeutic doctrine was crucial in the government's extension of help to returning soldiers as they struggled to readjust to civilian life after World War II.

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Meanwhile, psychiatric professionals were lobbying for further government expansion of therapeutic services. The Group for the Advancement of Psychiatry was formed to further the application of psychiatric principles to family welfare, child rearing, education and civil rights.

By the 1950s, therapeutic gospel was thoroughly ingrained in America's social institutions, and poised become a popular pastime. In the two decades following the war, women's magazines were at the height of their power, reaching two to three times as many women as they do today; housewives, meanwhile, were so numerous and affluent that they became "the only market that mattered." Women's magazines discovered that stories about unhappy women sold magazines, and publishers soon hit on a magic formula for success: Put out the message that women have the right to be happy, quantify their mass unhappiness with studies (one found that only one in 20 housewives was happy) and offer therapeutic help.

Magazines ran countless miniquizzes under headings such as "Are You an Everyday Neurotic?" and "Ask Yourself: Is Your Life Satisfying?" They introduced the radical idea that having problems was not bad, but ignoring them was. If a reader scored poorly on a miniquiz, she was advised to seek treatment. Readers were also educated about where to seek therapy and what to expect from it and received a whole new emotional vocabulary -- words like unconscious, ego and self-esteem -- and the confidence to use it.

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In the 1970s, the women's movement picked up the mantle of fulfillment and made it political, arguing that the institutions that defined women's lives failed to measure up to the standards of happiness and personal identity many women had come to see as the only authentic experience. By 1977, President Carter was eager to study the nation's "state of mind," setting up a committee that discovered that a quarter of all Americans were suffering from "bad feelings." Bookstores began to feature self-help sections and self-help books began to dominate the bestseller lists. In that decade alone, 6 million Americans joined encounter groups.

It's easy to see how the sheer novelty of this therapeutic approach to life would have yielded boundless optimism. In the 1970s, Americans had no evidence to contradict the belief that if they could get to their real, raw feelings and learn to communicate them, they could change the world. Unfortunately, getting to these feelings required ever more burrowing into the psyche and, often, other private places. By the end of the 1970s, unprecedented numbers of people across the country were participating in primal therapy, rebirthing therapy and nude marathons. The world stayed pretty much the same as thousands of Americans stood around naked, shouting, "Look, it's me!"

Needless to say, the encounter movement soon lost its charm. Consider, for example, the "primal scream" therapies of Daniel Casriel, in which nude group members eyeballed one another intently while snapping, "Fuck you, I'm me!" and "I'm entitled!" Werner Erhard's EST workshops featured mass group exercises in which trainers restricted participants' eating, smoking and bathroom breaks and then hurled invectives at them for hours at a time.

Moskowitz describes one EST seminar in a San Francisco hotel at which Erhard "lectured the audience for hours in a mostly incomprehensible way," frequently calling those assembled "assholes," and finally shouting, "You turkeys! Everything I've said is lies!"

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In the 1980s, psychologists and educators fanatically embraced the idea that self-esteem was the key to happiness and success, and talk show hosts like Phil Donahue and Oprah Winfrey took the idea mainstream. Self-esteem enhancement replaced achievement as a personal goal, and this notion remains entrenched in the culture. A recent New Yorker cartoon sums it up: "It's okay to be guilty," says one prisoner to another, "but not to feel guilty."

Though recent studies suggest that self-esteem does not determine success (studies of gang members, for example, have shown that they regard themselves very highly, while many high achievers often feel worthless), the idea dies hard. From school curricula to bookstore layouts to television programming, every area of life that could be shaped by the culture of therapy has been.

Most of us born after 1960 are familiar with at least one therapy casualty. I know someone, for example, who has built her entire adult life around a place known to us only as "the center," where, after two decades of study, she now ekes out a meager living. Another acquaintance, probably the most professionally successful person I know, lives on a diet of Zoloft and Clonopin while smoking pot every day because his $300-an-hour therapist has told him it's OK. A former roommate cut off all contact with her parents after she realized in therapy that they had been emotionally distant. Her subsequent devotion to self-expression and fulfillment resulted in frequent bongo drum sessions at 3 a.m. None of them seem any closer to happiness for their efforts; none of them question the efforts themselves.

Fifty years ago, none of these people would have been considered ill. Today, they are the victims of various "identity disorders," which are defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) -- a huge compendium of sometimes bizarre syndromes considered the bible of the psychiatric industry -- as "severe subjective distress regarding inability to integrate aspects of the self into a relatively coherent and acceptable sense of self." People suffering from identity disorders -- of which my obsessive-compulsive (circular thoughts, apparently) Clonopin-popping friend is one -- experience "uncertainty about a variety of issues relating to identity, including long-term goals, career choice, friendship patterns, sexual orientation, religious identification, moral value systems and group loyalties."

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The inclusion of identity disorders in the DSM has had important economic importance for the therapeutic industry. Without them, millions of Americans engaged in therapeutic treatment would not receive reimbursement from their insurance companies. Today, an insurance company will not reimburse a mental health claimant without a diagnostic reference to the DSM.

Meanwhile, no strict criteria are required for getting a disorder listed, and the inclusion of a new category has been known to engender fierce personal and political battles among psychiatrists, whose profession is increasingly fragmented. Some have suggested that the manual itself is "creating madness." The first edition of the DSM, published in 1952, was 100 pages long; the latest edition, from 1994, totals 900 pages. Between 1980 and 1990 alone, the number of disorders recognized in the DSM grew by 300 percent.

Sudden wealth syndrome and sudden poverty syndrome aren't listed in the manual, but they represent the apex of therapeutic gospel. The terms were coined by Jessie O'Neill, M.A., a certified experiential therapist trained in psychodrama and emotional release, author of "The Golden Ghetto: The Psychology of Affluence" and founder of "The Affluenza Project." O'Neill also happens to be an heir to the kind of fortune that could bring on an acute case of the malady -- which, in her case, it did -- and the purveyor of a variety of therapeutic products, as well as keynote addresses, corporate and therapeutic seminars, corporate and individual consultations, phone therapy, in-person therapy and workshops, all designed to help clients learn to cope with emotions surrounding their sudden riches, sudden loss of riches, gradual riches, gradual loss of riches and/or terminal lack of funds.

Had O'Neill inherited her fortune in the '50s or '60s, then "gone into a tailspin" that included a drug and alcohol addiction, she might have been unsympathetically called a "poor little rich girl." But because her experience -- like everyone else's -- is personal, emotional, relative and highly subjective, and because we now seem to value these experiences above all others, suggesting that she or any suddenly rich person might be anything other than a victim of fortune would be "wealthist." ("Wealthism," O'Neill tells me, is a legitimate term denoting "a reverse snobbery or discounting, dislike, hatred or prejudice by the nonwealthy against the wealthy.")

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And why exactly do the suddenly rich need their own syndrome? "Poor people in general get more sympathy than rich people," O'Neill says. "But it's the emotional roller coaster, it's the inner roller coaster, that is affecting these people so drastically." Asked if there have been any studies done on sudden wealth and/or poverty syndrome, O'Neill says, "Not really, it's pretty a new term, a fairly new experience. I don't think that we've ever had, in the history of this country, this sort of roller coaster ride so many people have gone on." (Of course, there was that blip known as the Depression, but that was long before we all became ill.)

Perhaps the greatest irony in all of this is that the scientific charity workers of the 1890s, high-minded do-gooders who helped popularize the therapeutic approach to life, believed that it was through sustained contact with the rich that the poor could be taught to better their condition in life. As Moskowitz writes, "Scientific charity leaders maintained that the poor needed 'to be in the possession of a real friend'" -- specifically, a wealthy woman or her daughter -- "whose education, experience, influence and whose special knowledge of domestic economy are placed at the service of those who have neither the intelligence, the tact nor the opportunity to extract the maximum good from their slender earnings."

Dedicated as they were to psychological principles (mainly emphasizing cheerfulness), the goal of scientific charity workers was to "strengthen the poor's resolve to resist poverty" by stressing "the harsh, even painful methods that need to be adopted to achieve moral and healthful results."

I wonder what they would make of O'Neill's next "Grace of Money" workshop, which will be held at the Esalen Institute in Big Sur, Calif. (home of the 1970s encounter movement and, according to an early brochure, the place to go to discover "what it is to be human"). The weeklong workshop will include such healing exercises as "The Money Chair," a game in which people have an opportunity to express their feelings about money; "The Family Money Journal," in which each member of a family is given the opportunity to "write about their feelings about the family money, and how it's being handled and felt about, in a family journal"; and "Risky Money," a "dyad" between two people "where you take them deeper and deeper into their thoughts, feelings and beliefs about money."

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I wonder what Quimby would think of all these newly impoverished rich families, after the day's exercises are done, discussing their feelings about money while soaking in the Esalen Hotsprings, a personal sanctuary where swimsuits are optional but respect for the human body is encouraged.


Carina Chocano

Carina Chocano writes about TV for Salon. She is the author of "Do You Love Me or Am I Just Paranoid?" (Villard).

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