Therapy? Are You Mad?

By Kevin Murphy
Psychoanalytic Psychotherapist,
Dublin, Ireland.*

If you need therapy you must be mad. So runs the old fashioned attitude. But it is not so old that, despite our modern attitudes and enlightened approach, it still doesn't linger in many people’s minds. The word ‘mad’ is long since gone from medical and therapeutic usage. But it lives on in the popular imagination.
I mention this because the predominant unspoken, and sometimes spoken, fear that people have about coming to therapy is that they are mad. Either they are mad to need therapy or else they will be diagnosed as mad once they are in therapy or if anybody they know finds out about them they will be labelled as mad. There is a recognisable degree of paranoia here but the greater part of this fear is reasonable and is due to the product of social stigma which is a very powerful tool.
The word itself is short-hand for not being normal. Normal people don’t need therapy. Normal people have happy lives. Normal people fall in love with the perfect person and have perfect relationships. Normal people don’t need to go to someone to ‘talk’ about their problems. It’s all pretty attractive stuff, this normal world occupied by normal people.
I was reminded of this listening to a seminar last weekend by London based psychoanalyst Gerry Sullivan. He was in Dublin speaking on the topic ‘The Role of the Father; Decline or Displacement?’ for the Association for Psychoanalysis and Psychotherapy in Ireland. He pointed out that for Freud the three broad structures that operated within society were psychosis (clinical madness), perversion (of the sexual kind) and neurosis.
The last of these is the largest category by far and the one into which all our obsessions, hysterias, phobias, compulsions, addictions, depressions and anxiety-related conditions are grouped. This, for Freud, was the category that underpinned society, this was normal. To be normal, for Freud, is to be neurotic.
One can only wonder, therefore, where this message has disappeared to in the past one hundred years or so? How have people suffering from sadness, fear, inadequacy, inability, hidden prohibitions, and all the other afflictions that make dealing with reality difficult, come to consider themselves as abnormal? It is a hard question to answer without taking into account the societal changes in the past century. But we can safely assume that somewhere along the way we have forgotten how flawed human beings actually are. Or maybe not forgotten but chosen not to recognise it. And so we now find ourselves in the 21st century believing that any flaw is not just unacceptable but is a sign of some inherent abnormality.
Advances in science, while undoubtedly welcome, have also had the unpleasant side-effect of creating a body of thought in which there is no place for ordinary flawed humanity. The popular social discourse, too, requires our young people to be word-perfect and looks-perfect pretty much from the start of their lives. There is very little room now for difference or anything that falls short of the imaginary norm of perfection. Anyone unlucky to find themselves in this position, and there are very, very many, is then left dealing with a potentially uncomfortable relationship with themselves, to whatever degree it manifests.
Why? Because we have come to believe too much in ideals. An ideal way to live, an ideal way to look, an ideal way to interact with others, an ideal way to think. And while that might serve us reasonable well in our relations to the outside world, what one often finds is that the very place it breaks down is when the person is left to their own devices, isolated to whatever extent, in their own company and with their own thoughts. The reason is because this pursuit of ideals is often one that is devoid of meaning, in the sense that it does not satisfy us or answer our questions at a core level. This is not to say that having achievable goals and setting out in a defined way to reach them is not a good thing. No I am talking about demanding of ourselves that we become flawless and display no weaknesses or deficiencies in the living out of our lives. One is a reasonable ask. The other is not.
* The next blog will appear on Tuesday April 13th, 2010.