“Human beings, as a rule, adapt to fit social norms, and patients adapt to medical standards… diseases do not exist outside of diagnoses…and science does not exist outside of culture… every culture holds bodies; bodies adapt and respond with the appropriate symptoms”
The targeting of physical, bodily, affective and psychic wellbeing has become a key strategy of governance within a therpeutic culture permeated by the orthodoxy of neoliberalism. Alternative and complimentary therapies, self help strategies (including the proliferation of self-help books and illness memoirs) and avenues for self-actualization through the practice of ‘wellness’ which works to uncover the ‘true self’ are proliferating as the current wellness and health industries get on board.
These modalities (everything from yoga and pilates to psychotherapy and personal training to creative self-expression in five rhythms and the mainstreaming of positive psychology etc) take ‘techniques of the self’ to a whole new level: these new spiritual and emotional ‘holistic’ approaches to wellness are headed by emotional and creative guides, advisors and mentors to help you attain the best version of yourself.
But in favouring this narrative arc, these also create particular categories and norms of behaviours and ways of being which, as Foucault uncovered, also operate as dividing and exclusionary practices between what is normal/abnormal, healthy/unhealthy etc and constructs and projects and ‘ideal’ self which is shaped by a rationality that tells us we can all be the person we aspire to be. In his book Powers of Freedom, Nikolas Rose draws attention to this exclusionary practice through what he calls a “therapeutic version of subjectivity” in which:
“… health depends upon the discovery, acceptance and assertion by oneself of who one really is, upon bonding with those who are really the same, upon the claim that one has the natural right to be recognized individually and collectively in the name of one’s truth”. (p196)
While it is true that through this practice, communities emerge, they do so around particular biosocialities that are often contingent upon a whole range of practices and forces which define waht the terms of those communities are. At the same time, this orthodoxy ignores the complex social and structural constraints that lie outside and external to individual control. It also disregards the consequences when it turns out that actually, we can’t be the person we aspire to be. But these ‘positive’ practices operate on the neoliberal logic of self-governance (through individual responsibility and management of risk) and encourage instead individuals to adapt to their environment and cultivate a self equipped to thrive within the current system, rather than turning the gaze outwards to the social practices which constitute and construct much of these existential dilemmas and doubts.
This ‘emotional governance’ is also seen in the talking (or ‘psy’) therapies of psychology, psychotherapy, psychiatry and, to a lesser extent, counselling, but the way into these emotions are increasingly through neuroscience-based paradigms of the biophysiology of the brain and correlated affective states. And while the body, brain and emotions are intricately enmeshed and intertwined, we still do not fully understand the complexity of how this actually is. Or indeed whether there is such a thing as the body, brain and mind: perhaps they are merely artefacts of language and our own limits in fully comprehending the nature and mystery of consciousness?
Emotional governance can be thought of in another way: through the “political engineering of affect”. Human geographer Nigel Thrift cites an extreme example of this form of emotional governance in soldiers who are trained to modulate and dampen their affective responses (fear etc) so as to produce better (more efficient) killers on the battlefield. As in Thrift’s example, the recipients of this emotional governance (the soldiers) are positioned as allies with their governors (the military machine). This contingent relationship is no less true of the ‘psy’ and ‘wellness’ professions, albeit perhaps a crude comparison. My point here is that these ‘doctors of the psyche’ or ‘healers of the soul’ occupy positions of authority and awe (they possess the aura of the healer as Taussig would say). As such, they can shape and influence, through careful therapeutic discourse and practice with the client, the terms of the relationship and the relevant emotions and affects to be brought under control. It is the professionals who drive the question: what levels and in what ways the Self is best (and most productively) able to ‘function’ (even though it may feel like these questions are driven by the client). As such, they contribute to a political economy of the ‘therapeutic self’; a self very much at home in this post-secular culture which has shifted from a culture of confession to a culture of expression. Here therapy comes in all sorts of guises and there are a proliferation of therapeutic experts here to help.
A Foucauldian approach to this subject of inquiry pays particular attention to the assumptions and values which are embedded within normative frameworks and practices as well as what constitutes our contemporary beliefs and attitudes about what is normal and what is pathological etc. It also orients us toward the relations between forms of power, bodies of knowledge and the shaping of subjectivities.
Here, I must declare my deep and passionate ambivalence.
I myself am implicated and participate in this political economy, yet at the same time struggle against the impossibility of critiquing the system using the tools and language of the system: am I just creating another ‘alternative’ narrative to choose from? In other words: is de-institutionalisation possible? I also have friends and family who I hold close and dear who have gained benefit, meaning and solace from engaging with this system (to differing extents and in different ways).
For while people are no more passive receivers of the knowledge and wisdom of others or unthinkingly inhabit systems of oppression or constraint , my concern is whether this culture of therapy perpetuates the myth that there is some kind of psychological, if not moral, essence of the self at stake here (and associated negative judgement towards perceived moral or social deficits): an essence that is increasingly coming under the expanded terrain of the alternative, holistic and wellness industries. These spread beyond the ‘psy’ professions to include all sorts of therapists and health practitioners. As new and more expanded understandings of mental and emotional ‘illnesses’, ‘disorders’, ‘syndromes’ are discovered (that is, socially created) by the ‘psy’ establishment, a whole new species of experts emerge, and other experts (experts in mindfulness, yoga, relaxation and other therapeutic endeavours etc) rise like phoenixes to the challenge; equipped to address the exact and specific imbalance, disruption, mis-alignment that you have – whether its assumed location is in ‘spirit’ or ‘matter’.
Cultures have always sought out the moral meaning and significance of illness, disease and dis-ease within their populations, and in the past (amongst traditional cultures studied by anthropologists, for example) the signs and symptoms of such things were not separate from an understanding of the human relations and social organization which they embodied. But the moral question is a big one, and it often gets lost in the muddle. Moral disorder does not the political hierarchy like.
Perhaps one of the distinctions between these contemporary healers and those of the past is that advanced liberalism combined with post-secularism has shifted the moral questions of society and culture onto individuals. The questions once answered by religion and then by medicine and science, have become privatized, individualized and resuscitated by what Sontag might call a “sublimated spiritualism”. And this is where the therapeutic self and the aura of the healer come in. By this secular but quasi-spiritual mythology, the individual holds deep within herself the answer to the mysteries and confusions that life throws her; and, if she can gain mastery over these, she will have some of the tools needed to support her own growth and journey into wellness. To re-balance and re-align. My concern, exacerbated by the orthodoxy of neoliberal forms of social organisation, particularly late-modern individualism, is that rather than look at the genealogy of our values and norms within our communities, we follow the neoliberal path which devolves responsibility for public health onto individuated selves who become experts in their own self-craft.
As with western biomedicine, holistic and alternative approaches have their limits, particularly when transplanted into a social and cultural context that places individuals over society. But of course it is not a one-way street and these relationships are dynamic. The therapeutic self and its therapeutic allies all participate in a complex system of power and labour relations which determine and legitimate the limits and excesses of therapeutic (self) governance. ‘Holistic’ approaches and emotional therapists have done great things in bringing in the ‘spirit’ and ‘soul’ from the biomedical cold, as it were, but in order for them to gain a foothold, have had to lean back on neuroscience and discuss their craft in terms of the ‘biological mind’ which, as the ghost of Descartes hovers above, is ‘located’ (conceptually at least) in the brain. The mythology and discourse of ‘mind-over-matter’ remains a common mantra.
Be it talking it out or dancing it out, creative expression has also been pulled into the therapeutic vortex. Never mind the revolution and revolt on the other side of the world, at least you can bring yourself into some sort of order. The irony here is that it has been argued that it is precisely the values and priorities of neoliberalism (including excessive individualism and market competition which has spread to all aspects of social life) that has led to both a decline in happiness and wellbeing and in an increased inequality between the haves and the have notes. No wonder we’re in a state of shock and confuscion.
LET THEM EAT CAKE! Wake the f*** up!
 Asti Hustvedt, Medical muses: Hysteria in nineteenth-century Paris (Bloomsbury UK, 2012), 140.
 I use the term ‘industry’ to suggest a certain dynamic (or political economy) of production, consumption and exchange that occurs in the enterprise of self-expression and self-discovery, for I’m pretty convinced that the forces shaping the enterprise of wellness (psychological, spiritual, emotional, social etc) are no less present in the fields of alternative, integrated and holistic self-craft than they are in traditional biomedical models of care.
 Nigel Thrift, Non-representational theory: space, politics, affect (Routledge, 2007).
 In the 1960s and 70s, the anti-psychiatry movement (exemplified in medicine by the contentious work of psychiatrist Thomas Szasz; and within critical theory by Michel Foucault, among others) repudiated what they saw as an ideology of the Theraputic State. Other scholars have written around ideas of the ‘therapeutic self’ and the ‘therapeutic state’.
 I will not go into the intricacies of debates over power-freedom, structure-agency here, for there are whole disciplines within the social sciences that do this and I am not versed in the ins and outs. What I will concede though is that individuals actively navigate these tensions and are not entirely without agency. But agency is constrained by and contingent upon a whole range of forces external to and beyond the individual’s control.
 These discursive dualisms of (im)balance, (dis)order, (mis)alignment etc must not be unthinkingly taken in the literal sense, for they are also figurative, standing in as metaphors for the way we conceptualise and make sense of a certain natural order of things.
 Susan Sontag, Illness as metaphor and AIDS and its metaphors (Picador, 2001), 56.
 …and legitimated by fancy fMRI scans and studies (which for example might show how the same areas of the brain light up when playing the piano and thinking about playing the piano) which seem to illustrate simple causation but really only show cool correlations, the full extent of which are not fully understood.