“Personal Responsibility Inc.”: Self and mental health within the neoliberal culture of psychotherapy
Julie Tilsen is a practicing psychotherapist and the author of Queering Your Therapy Practice (Routledge, 2021), Narrative Approaches to Youth Work (Routledge, 2018), and Therapeutic Conversations with Queer Youth (Rowman & Littlefield, 2013) as well as a variety of professional articles and book chapters. We’ve had the pleasure of talking with her about Personal Responsibility Inc.: How Psychotherapy Turns Society’s Problems into Yours, published by OR Books this June. Personal Responsibility, Inc. offers a one-of-a-kind investigation into psychotherapy’s complicity with the insidious and harmful effects of neoliberalism on individuals, relationships, and society: it is, in that sense, not only a must-read for those interested in psychotherapy – or undergoing it – but for anyone wishing to gain a deeper insight into questions of mental health and the ways it is shaped by the market and technology.
Timofei Gerber: Personal Responsibility, Inc. is a powerful critical analysis of today’s culture of psychotherapy. You address, as the title suggests, the ways in which neoliberalism has turned responsibility into a slogan of unending betterment and a tool of separation and control. It thereby replaced the traditional model, where ‘responsibility’ implied becoming a well-adjusted ‘normal’ adult. What changed between the two? And what kind of responsibility lies beyond them both – beyond control and integration?
Julie Tilsen: I can’t answer that question without addressing the assumptions embedded within it. I think that the assumption that, and framing of, “traditional” personal responsibility as a mark of “adulthood and adjustment” is a construction from a particular cultural and historical context: It’s very modernist and euro-centric. There is not one version of adulthood, it’s not universal across time and place.
Even in a time and place that does hold those ideals of adulthood, we can ask, just because something has always been done, should we continue to uncritically embrace it? The idea of “personal responsibility” is culturally contingent – we have to ask: responsible to whom and/or to what? Responsible for who or what? It’s not a binary – we can have personal responsibility for others, for something other than ourselves, for example, because we understand ourselves not as independent and separate, but as connected.
Today’s project of personal responsibility, as I think and write about it in the book, certainly does, as you point out, function to control us and separate us as we’re tangled up in the unending, unachievable project of self-optimization. We’re consuming multiple messages from multiple sources, from social media to our physician to our therapists, that we need to regulate, be our “best self” – which is an Oprah concept, by the way – and otherwise keep our shit together.
Gerber: In the book, you connect this unending mission of becoming our “best self” to the ways in which neoliberalism has deteriorated the public sphere, so that everyone is nowadays involved in their own private little problems, permanently self-improving – and self-monitoring. To the point that we don’t even need an all-powerful public opinion that keeps us in place by keeping us ‘normal’. Do you see, on the utopian horizon of liberatory psychotherapy, the reconstitution of something like a public sphere?
Tilsen: What I’m not interested in are notions of so-called “normalcy.” When we traffic in that, we always have to ask, normal compared to what? Who has the authority to determine this? Who’s included, excluded, and what are the effects of inclusion and exclusion?
What we have now is, one, the increasing medicalization of the human condition and, two, the obfuscation of material contextual realities that affect people. It’s a more constricted range of so-called “normal.”
We pathologize and then turn to treat the distress that comes with being a person in world. A loved one died? Oh, you’re still grieving after 3 months? Pathology. Got a kid who hates worksheets and can’t sit at a desk for 6 hours a day? Pathology. But it’s not only a diagnosis – people embrace these as identities.
Similarly, we privatize the social and political harms that governments, systems, and monied interests, for example, inflict on people. Then we impose the burden of individualism that pathologizes people’s responses to these harms and we send them to therapy, too. It’s nearly impossible to qualify as normal, so off to therapy we go!
I’m concerned that being human, as in the human condition of imperfection, pain and pleasure, and mundanity, are pathologized rather than met with compassion, understanding, and a sense of solidarity. Therapy has become routinized like drinking water and taking a multi-vitamin. We’re not good at being uncomfortable, whether that means being with our own or with others’ discomfort or distress.
While I’m not interested in normalcy, I’m interested in liberation and possibilities of futures that allow people to live into their values and ethics. There is no real future in having people tied up in personal performance and self-improvement, diagnosis-based identities, and the dis-belonging and dis-connection that current conventional therapy practices often promote. So, to answer your question about “the public sphere,” I like to imagine a public space that allows people to show up across differences and different ways of knowing and being… I get tastes of this in some organizing communities and places of collective care and mutual aid where people connect across differences while connecting around a shared vision or purpose.
Gerber: Indeed, between this impossibility to qualify as normal and the impossibility to optimise our selves, it is unsurprising that we’d identify with the only thing that gives us something to hold on to: our diagnoses. What would it mean to leave our diagnosis-based identities behind? What other forms of identity can we imagine, beyond efficacy and presumed self-perfection?
Tilsen: Again, I don’t aspire to tie anything to so-called “normalcy” as that is not something I privilege. My academic background, beyond my training in applied fields of counselling psychology and family therapy, is in social construction with a queer studies focus – I am very much about interrogating notions of so-called “normality” and questioning the power relations inherent in them. Normalcy demands fitting in; it’s alienating. I’m interested in fostering ways that promote belonging and solidarity across differences.
Psychotherapy has always been, to varying degrees, and depending on a number of factors, an agent of social control. And, as a product of culture, therapy always reflects the cultural norms that it comes from, and it is always bounded or constrained by the boundaries or limits of the culture it emerges from. Psychiatric diagnoses have always been ways to impose notions of normal, what is and isn’t acceptable, and they are very reductive and totalizing accounts of people.
Ten years or so ago, people (and especially any self-respecting teenager!) were not seeking a diagnosis, let alone organizing their sense of who they are around one. Sanni Paljakka and Tom Stone Carlson, two other narrative therapists, call diagnoses “unstories” – it’s not only that they’re experience-distant and thin stories, as cultural anthropologist Clifford Geertz would say, they are pre-packaged, off-the-shelf designations…brands, even. They are not the stuff of stories – there is no future to author in them, they are conversation stoppers, dead-ends.
So, I’m concerned, as I noted in the previous question, that people are taking on diagnoses, or diagnosis-adjacent descriptions, as identities, because of this foreclosure on possible new identities and futures to live into.
But to answer your question, my perspective is, following Bakhtin, our identities are multiple, fluid, and flexible, and that they are relational accomplishments. This is a bit more about the how of coming into or constructing identities, but I think it does provide part of my answer to your question: our identities are relational.
And, as you mentioned, I think our identities are about values, ethics, politics (not the party kind, the kind about power, discursive and material). Instead of organizing “who I am” around what I produce or achieve, it’s around what I contribute to others and something bigger than myself. It’s not an essentialist structure inside of me; it’s how I move in the world, how I show up and the effects it has on the world. What I do and how I do it speaks to who I am.
Gerber: I feel like one of the great strengths of Personal Responsibility Inc. is to show the consequences of this deterioration of our relational being: anxiety, hopelessness, nihilism, all those symptoms that contemporary psychotherapy pathologizes and promises to resolve. But rather than being the marks of our illness, you call them “reasonable responses” to deteriorations within the social sphere. The actual causes, you argue, are not in our faulty brain chemistry, but in the “damaging system” that produces an atmosphere of hopelessness and powerlessness in the first place. But why are we unable to intuitively make this connection? What is missing for us to turn these responses, which, more often than not, make us complacent, into a catalyst of change?
Tilsen: Perhaps we don’t make that connection because we dial into and respond to what is present and explicit – fear, anger, sadness, for example – while attending to what the expression is in response to is what we call in narrative therapy practice the absent but implicit. We’re not often supported to “listen” for what matters to people, to the value expressed on the other side of what’s apparent.
We also don’t make those connections because – say hello to personal responsibility, neoliberalism, and the degradation of societal connections – it requires a critical look at and dismantling of structural and systemic harms that produce and maintain the very stuff we’re struggling with and having responses to. Individualism doesn’t teach us to look at that; it teaches us to look at ourselves.
One example I gave in the book is the conventional practice in therapy of “anger management.” I am not interested in managing, which is a kind of correction, anyone’s anger. We also have to take a critical look at whose expressions of anger get policed, pathologized, criminalized, and/or minimized compared to those in society who are allowed their expressions of anger, even respected for them. I like to say that I do anger acknowledgement therapy, not anger management therapy. Anger is a response often to injustices – MLK famously said “a riot is the language of the unheard.”
Therapy has historically played an implicit, and at times disturbingly explicit, role in correcting people – especially people who occupy certain social locations such as BIPOC, women, trans and queer folks, poor people, youth, neurodivergent, and disabled folks for example. As subjects under neoliberalism, it’s like we’re trapped in an Escher print of self-correction, and many practices of therapy have uncritically joined that trap rather than collaborating with people to find escape routes away from constant self-correction and isolation. And there’s big money to be made in the trap, selling self-help, self-monitoring, so-called “self-care,” and of course, psychotherapy.
Correction is in service of fitting in. Fitting in is not the same as belonging, or, as I like to say, because I think it’s more relational: being belonged. So much of what I witness people struggling with is feeling dis-belonged. It’s alienation. I think the embrace of diagnoses as identity is one elaboration of this struggle.
Gerber: How can we nourish this feeling – or way of being? – of being belonged, in psychotherapy and our everyday life?
Tilsen: This is a very reasonable follow-up… but as I say in the book, I’m not trying to offer a “how-to” or another therapy book… it’s really about trying to ask new questions that may help us, as therapists and/or consumers of therapy, to reconsider the institution of therapy and how we approach it. I’m interested in asking and inviting all of us to grapple with this very question you ask.
Gerber: Another important transformation you trace in your book regarding psychotherapy is that from the psyche, as it was the object of psychoanalysis, to the brain and its chemistry. It is this change that has reduced the range of solutions to mere medicalization. The German government is currently planning on radically reducing the funding of psychotherapy, possibly leading to its dissolution. Is this the radical last step in the elimination of the psyche? Can the psyche be saved, or do we need to reconsider it completely?
Tilsen: I’m not interested in “saving” the psyche as a construct. If it’s a concept that someone who’s consulting me has a relationship with, I’d certainly respect that and be curious about what it means to them. But, as an essentialist construction on its own, it’s not what I am by default interested in.
I am interested in the human condition, what it means to be in relationship with others and within the contexts we exist. I am interested in what we make together in the material world, in possible new futures that are dignifying and belonging of others. I am very interested in asking, how can what we call therapy stop being an agent of social control and instead be a place of imagination, liberation, and practices of futuring together?
Gerber: In many ways I feel that your book is targeted at those of us who have “reasonable responses” to the despair of today’s world, with hopelessness and nihilism as means of self-preservation. But what about those who vote for fascists not out of a false consciousness, but as conviction? What about those who consciously take pleasure in making the world burn?
Tilsen: Yes, this is a book for those of us who need to connect and organize with others to stand against the world burning and stand for a sustainable and meaningful world.
But it’s also for people who don’t want the world to burn, but who have been taken by the neoliberal imperative to be personally responsible for structural and political harms and want an escape route from that Escher print of self-improvement.
And it’s for the people who believe in boot-straps, compliance, and personal responsibility, who think they’re doing all the right things…until the leopard eats their face.
As for people who truly take pleasure in making the world burn, that’s the 1%. The jackboots on the streets, the thugs deputized by the federal government to snatch my neighbors…they want the world to burn because they think that puts them close to power. But they are not oligarchs, they are alienated, and they will suffer social murder because they’re expendable to the world burners. This book is, as Aussie therapist Alan Jenkins wrote many years ago, “an invitation to responsibility.”
Gerber: As anxious as we might be, what characterizes our time, as you show, is complacency: ultimately, we are not desperate enough, trying to numb our despair with pills and by “focusing on what we can control”. Beyond that, you open up the perspective of psychotherapy as a liberation of imagination, the creation of possibilities, the cultivation of hope. What can we do in the face of genocide, the militarization of police, and a burning world?
Tilsen: One of my foundational tenets is that, to refuse neoliberalism, we need to stop only measuring, valuing, or as my late colleague Bill Madsen would say, mattering, what we do in terms of outcomes or big, material change. We need to center and organize around our values, what is precious to us, and avoid all-or-nothing renderings of the actions we take. I see people – myself included – held hostage, frozen and unable to do anything, because we let ourselves be convinced that it doesn’t matter. It’s important to do things because they reflect what we stand for, even if it doesn’t lead to change.
When I get caught up in, why bother, Julie, it won’t do anything? I ask myself, what will it say about me if I don’t speak up, or attend this organizing meeting, or somehow support this effort? It goes back to asking what matters to us and how can we live into that, embody it?
In our isolation, we don’t always see what others may be up to, what they are creating, what small but significant acts of refusal or gestures of grace they may engage in. Or, we get caught up in comparison to grand displays of resistance and then tap out because we can’t do that…but we don’t know the many, many little bits that went into that grand act because we’re so taken by the outcome.
For example, most of the world saw how people in Minneapolis were in the streets monitoring and following ICE thugs. They saw the crowds of people surrounding and videoing these masked cowards in military kits, chasing them away, or bravely standing against them in the face of their brutal and lethal violence. But for every body that was in the streets, there were so many more bodies behind the scenes, providing communication, cleaning people’s houses and cooking their food while they were on watch, coordinating more patrols, organizing and distributing money to pay people’s rent, escorting kids to school, buying and delivering groceries to people in hiding…on and on. And this didn’t pop up out of nowhere – Minneapolis has been organizing for years.
It all comes back to coming together, not staying isolated, being connected. Paradoxically, in the early days of the covid pandemic, we got really creative – I’d open my front door, and neighbors would have left a bag of puzzles, books, and cookies; we’d gather in the street or in back yards…we’d make bonfires in the winter.
Under neoliberalism, we go it alone. To fellow therapists, my challenge is, how can you use your skills of hosting conversations to bring people together, in ways that foster connections that they can lean into and take care of? If you refuse the construction of therapist/client and the urge to fix or resolve, what offerings might you be able to show up to the neighborhood gathering with?
Gerber: Absolutely! And I guess that this challenge is not limited to the therapists’ self-reflection; it is all of us who should reconsider our work as something that goes far beyond our individual ambitions or the mere means to provide a salary, but that is itself profoundly relational: a creative human activity.
Tilsen: I love that! And when you mention going beyond the provision of a salary, I think about what Dean Spade says about organizing, and in particular, mutual aid: it’s the work but it’s not your job… it can’t be done for money.
Gerber: It definitely can’t. Thank you for your time, Julie!