Rose - Power in Therapy: Techne and Ethos
Power in Therapy: Techne and Ethos
by Nikolas Rose
What does it mean to talk of power in psychotherapy? I approach this question with a certain trepidation. My trepidation is not because of what I am going to say is going to be so critical of the ills of the therapies, but the reverse. It may appear too mild, too benign. But I think the value of the radical gesture is exhausted. To understand how the therapies operate and how they have achieved such a wide influence, on those who go to them and on those who practice them, we need to abstain from denunciation. Of course, we may need to come to judgements about what therapies do to their subjects, or about the role they play in society. But in order to reach such judgements, it is helpful first to be descriptive and diagnostic.
The French philosopher and historian of science, George Canguilhem gave a lecture about 40 years ago at the Sorbonne entitled ‘What is Psychology?’ (Canguilhem, 1980). In this lecture, he examined the peculiar nature of those types of knowledge that call themselves psychology or psychotherapy, knowledges that the French tend to call simply ‘psy’. After a provocative dissection of these disciplines, showing the hybrid elements from which they were put together, he ended his talk with a little metaphor. When psychologists take the exit from the Sorbonne on the Rue Saint Jacques, he said, they can either go up the hill or down the hill. If they go up the hill they end up at the Pantheon, where, as everybody knows, the philosophers rest along with the great and the good. If they go down the hill, which ever route they take, they are bound to end up at the Prefecture of Police.
Now this is a rather nice metaphor. Unfortunately, however, it is a little misleading. It suggests that we can think about the psy knowledges in terms of a kind of opposition between a benign philosophical sort of knowledge and a malign controlling sort of knowledge. Clearly what Canguilhem wants to do is to urge those who are involved in the psy business to take the path up the hill rather than the path down the hill. Something similar seemed to underpin many criticisms of psychoanalysis and the psychotherapies in the 1970s and 1980s. Critics argued that, of course, in contemporary, racist, capitalist, patriarchal societies, the therapies were clearly instruments of normalisation and control. But in accepting such a normalising role, or failing to challenge it, what had happened was that the radical potential of therapeutic theory – psychoanalysis in particular - had been ‘recuperated’. In this kind of criticism, it appeared that there was, or there could be, a ‘pure’ psychotherapy, a ‘pure’ psychoanalysis that would be culturally critical and indeed, which had radical and liberatory potentialities. Radical critics had to free this pure potentiality from all the deformations that it had undergone through being taken up in normalising practices designed to produce docile and obedient individuals.
I take a different view. I do not think the theories of therapy and the practices of therapy are distinct and external to one another. In fact, I think it is better to begin the other way round. Rather than seeing actual practices of psychotherapy as in some way or other an ‘application’ or ‘misapplication’ of therapeutic theory, I would start from the reality of actually existing therapeutic practices as they function today. The question would then be how the concepts, theories and explanations of the various therapeutic schools make these practices possible and operate within them. Of course, in talking about actually existing therapeutic practices, one is talking about a motley assortment, ranging from five days a week, 50 minutes a day, potentially interminable psychoanalysis, through brief psychotherapy, cognitive therapy, behavioural therapy, rational emotive therapy, and whole variety of other therapeutic practices and sites from radio phone-ins to the use of therapeutic techniques in hospitals, in prisons, in schools, and so forth. It would be foolish to pretend that the power relations in all these practices are the same. But for the purposes of my argument here, I am going to use the word psychotherapy rather indifferently to refer to all these psycho-dynamically or psychologically informed practices for what I shall call - for reasons that I think will become obvious later on - the cure of souls.
Therapists don’t really need a sociologist to come along and point out the power relations in these practices, because in many ways they are obvious - which doesn’t mean to say they are not important. Let me just list some of these obvious kinds of power in psychotherapy in no particular order.
First, psychotherapy is a relations of clienthood. What is clienthood? The dictionary gives a number of senses. In the early seventeenth century, the term could refer to one who uses the services of a professional, a customer; by the nineteenth century it was also used for a person assisted by a social worker. But there is an older meaning, going back late middle English, to around the fourteenth century, in which a client is one who is under the protection and patronage of another, a dependent. In the psychotherapies, it seems, all three senses are combined: the client uses services of a professional, and is the subject of a kind of assistance, but is also in a relation of subordination and dependence. This is so, however much the individual relation may strive to be egalitarian. For example, in order to enact this activity called therapy, one person characteristically travels to another persons place of work. One person controls the time, the frequency, the physical location, the layout of the room in which the activity occurs. These features of the situation already establish certain vectors of power. Of course, there are some case when the psychotherapist travels to the patient, but that is usually when the patient is in confinement in a mental hospital or in a prison.
Second, money usually changes hands. Therapy is not freely given as the help of one person for another who is suffering. Care is contractualized. There is a lot that could be said, and indeed has been said, about the role that money and the financial exchange plays within the psychotherapeutic relationship. There is a whole literature which argues, in different ways that the exchange of money has a value in the therapy. And there is another whole literature that argues that the financial relation disguises a relation of inequality and power, if not exploitation. I only want to make one point here. In our current climate, the exchange of money is often seen as a liberating phenomenon, one that liberates the individual doing the paying from dependency, giving him or her power over the other who provides a service in return for the payment, and establishing legitimate expectations of as to the nature and quality of that which is provided, the time scale, and so forth. The contract, especially over the period of the l980s in Britain and the United States was seen as a mechanism that established equivalence between two parties. The classical legal notion of a contract is of a exchange freely and mutually entered into by equals, which is binding on both parties, and specifies that certain goods or services should be provided by one party in exchange for a specified price or other consideration. A moments thought I think is sufficient to indicate that the contract in therapy is not of that sort. It is a pseudo-contract. Certainly there is a financial exchange involved, but it would be difficult to regard the patient or the client as a customer in the way in which the passenger on the railways is now supposed to be a customer able to chose between Virgin Express and Great Western and entitled to a certain level of service, with legal redress if this is not delivered. Actually, the relation is more tutelary than contractual: the therapist is more like a tutor than a plumber and the recipient of therapy more like a ward than a purchaser. This shapes the whole structure of the encounter. One person is in charge, one person isn’t. One person establishes the pace, the direction, the structure, the sequence, the etiquette, the language of the encounter. The other has only limited capacity to influence any of these things. Of course, I am not saying that it is a simple one way relationship. No doubt, no relationship between master and disciple or teacher and pupil is entirely one way. But it would be foolish to deny that, in therapy, tutelage infuses and underpins the contract.
Some have argued, powerfully, that the contract is indeed a liberating device and that the movement to contractualisation in the social services and the helping professions is a move away from relationships of dependency and a means of empowering the user, the client. I think that psychotherapies don’t actually fit in to that pattern very clearer. And indeed, although therapies are mostly thought to be voluntary and contractual, sometimes they are not voluntary and contractual even in the sort of pseudo-voluntary and pseudo-contractual sense that I have mentioned. For example there is an increasing use of therapeutic techniques as a condition of probation or in the prison service or in psychiatric hospitals. And in some jurisdictions, more in the United States than in the United Kingdom, I suspect, entry in to a therapeutic relationship is the condition for having some more severe punishment suspended, for example a mother may be required to go into some form of therapy if her child is not to be taken into care.
Third, therapy involves a kind of power that might be termed priestly. One person confesses and is known. The other does not, remains secret, mysterious, merely hears the confession. This kind of relation involves what Pierre Bourdieu terms ‘symbolic violence’. One person is a person of knowledge, and the other person isn’t. One person has the capacity to reshape the meanings through which the other makes sense of their life and their actions. I’m going to have more to say about this later.
Last, in this rough and ready catalogue of dimensions of power in therapy, is the aspect that has been the basis of a long standing critique. This is the argument that psychotherapies turn public and social ills in to private woes. This type of criticism was very powerful in the 60s and 70s, where it centred in particular on the depoliticizing effect of psychoanalysis. Therapies take problems that are the consequence of the damage wrought by social and political disadvantage, by familial and sexual pathologies, by cultural or ethnic discrimination or oppression, and construe them, intentionally or unintentionally, as private, individual difficulties amenable to solutions by working upon the damaged individual rather than the things doing the damage. In so doing, they are condemned to be apologists for these wider ills, or to admit their impotence to change them, or to actually support and legitimate those ills by treating adaptation to the existing state of affairs as if it were progress. I am less sure about this line of criticism. Many would argue that it is entirely possible to have therapy that does not normalise – for example ending in female clients getting married and having a baby. Others would say that the therapist, in his or her professional practice, has no option but to work with the individual in front of them, whatever they may do in other parts of their life to act politically on the wider ills of our society.
Of course, even if one terms these dimensions of power, that is not necessarily to be normative and critical. Power certainly can involve relations of coercion, repression, exclusion and denial. Power can also involved relations of tutelage, mastery and subservience. But power can also create things. Power, as Michel Foucault suggested, is best seen as action on the action of others (see Foucault, 1986: 331ff). Power relations are ways of shaping the conduct of others, the action of others, their intention and their decisions, which nonetheless leave the other party free, free to act. Power works most powerfully, works most effectively if it works by shaping the way in which individuals enact their freedom. And what I want to suggest, is that that the most interesting way of looking at this question of power and influence in psychotherapy, is to examine the ways in which the therapists shapes the way in which human beings enact their freedom.
This is not to deny that there are some forms of power in psychotherapy which we can adjudge bad without requiring fancy sociological analysis or ethical expertise to advise us. For example it is easy enough to condemn therapies where they involve impropriety, charlatanism, exploitation, sexual abuse, or even, perhaps, where they involve disbelief or the discrediting of certain versions of events. But these ways of being bad aren’t particularly exclusive to psychotherapy. Garage mechanics can take money under false pretences, builders can be charlatans, child care workers can sexually exploit the children in their care, police can and do disbelieve and discredit. In the psychotherapies, it is usual to use the term ‘ethics’ to talk about the way in which the professional conduct of the therapists is regulated so as to ensure that these malign effects are reduced if not excluded altogether. I don’t want to deny the importance of this sense of ethics in the internal governance of the therapeutic professions. But I think we can take ethics in a different and in a more interesting sense. Ethics, in this different sense, has to do with the ways in which human beings lead their lives, the ways in which they make decisions as to how to live, what to avoid and what to strive for, the relative weight accorded to different values, the criteria of judgement of what are good or bad, wise or foolish, vicious or virtuous ways to proceed. I think that we can link ethics, in this different sense, to the idea that I proposed earlier of power as action upon action, the shaping and enactment of individual freedom. This is what I want to try to do in the rest of this paper.
Experts of living?
Max Weber gave a famous lecture in 1918 called ‘Science as a Vocation’ (Weber, 1948). In that lecture he made reference to a remark made by Tolstoy, or rather a judgement made by Tolstoy. ‘Science is meaningless’ said Tolstoy, ‘because it gives us no answer to the only question that is important for us, what shall we do and how shall we live?’ Well of course, whether or not you agree with Tolstoy and Weber depends on what you are prepared to call science, and if you are willing to put the therapies in this category. Weber himself has harsh words for the psychologists and the psychotherapists. In fact, he agrees with Friedrich Nietzsche. Nietzsche was witheringly critical of the psychologists and the therapists (Nietzsche, 1956). He called them ‘those last men who invented happiness’. He has contempt for a way of life and a type of person that thinks that happiness can be achieved by scientific or rational techniques for the mastery of life. Indeed, Nietzsche and, I think, Weber have a profound contempt for happiness, ore even contentment, as an ethic of existence. They regard it as a kind of slave morality, the nature of the human being is to suffer and to overcome, not to be content.
Well, we may well agree with their normativity here. Some would argue that Freud himself shared this view, and his well-known therapeutic pessimism was linked to a pessimism about the prospects or the attractions of happiness and contentment. Nonetheless, I think it is useful to defer our judgement for a while about the ethical worth of the life offered by the psychotherapies and to see that they do, on some non-trivial fashion, relate to Tolstoy’s question, and do claim a certain kind of ‘expertise’ in this regard. With the rise of psychological knowledges and therapeutic theories and techniques over the course of our own century, there is a certain sense in which science has tried to address Tolstoy’s question: ‘What shall we do and how shall we live?’ The psy knowledges have addressed the questions of ‘how shall we live?’, ‘what shall we do?’, ‘what kind of people are we?’, ‘how shall we conduct our existence?’. Even if these sorts of questions cannot be resolved by science, they are addressed and understood on a dimension of positive knowledge. By positive knowledge I do not mean anything evaluative. I do not mean that positive knowledge is either good or true. But I do mean that it is truthful. Georges Canguilhem, whom I quoted earlier, argued that scientific knowledges may not be true, but they were truthful, veridical, that is to say they were internally organised around a norm of truth and error, and through a constant attention to the issue of error, they subjected themselves to critical correction (for an introduction to Canguilhem’s work see Canguilhem 1994 and Osborne and Rose, 1998). They were to that extent open. Now, we know that may writers, Karl Popper being the most notable, denied this status to psychoanalysis. Popper argued that psychoanalysis was a closed knowledge, not correcting itself through its errors but constantly reassuring itself of its truth. Reading the actual history of the therapies, however, I think it is possible to see something different. The therapies have embraced, perhaps disingenuously, the apparatus of the positive knowledges, including learned journals, conferences, presentation of results, research, evaluation and so forth, together with a whole apparatus of training and credentialing of practitioners.
So the claim of the therapies is that, in this sense at least, it is possible to have expert knowledge, it is possible to have expert technique, it is possible to have experts who can address this fundamental ethical question of who we are and how should we live, or at least who can provide the spaces and the tools through which this question can be addressed. The line of division between the ethical and the scientific is not so clear as Weber thought. And I want to suggest that with the emergence of these therapeutic knowledges and techniques over the course of this century, this question of how to lead a life has entered the domain of positive knowledge and it has entered the domain of expertise. New forms of authority, therapeutic authority, have emerged over how to lead a life. And there has been a kind of therapeutic transformation of whole range of other types of authority. A whole range of governors of conduct in our own culture - social workers, nurses, even prison officers - give their authority legitimacy because it has undergone a kind of therapeutic mutation. They exercise a therapeutic authority, and this gives it a new ethical basis, a way of legitimating itself at a time, and in a climate, in which all authority has to justify the authority which it wields.
The rise of therapeutic authority did not take place in a vacuum. It was intertwined with some significant transformations in the nature of the life that is led and the kinds of people humans think themselves to be in the 20th century. If these conditions transform again, it is likely that therapies will loose their cultural and ethical significance.
There is a well known journalistic argument that the psychotherapies have undermined and replaced religion and theology in our moral codes in our ethical practices: therapies have taken the place of religion; the visit to the therapist has taken the place of confession; the therapist has assumed the role of the priest. That is a simplistic argument, I think. But it does point us in the direction of some interesting features of the relationships between the therapies and power.
The first is the actual organisation of psychotherapy itself. The therapies have moved from what one might describe as a sect-like structure, based on the charismatic leadership of a few great men and women, to a Church-like structure, regulated bureaucratically, with career structures, attempts to regulate professional status via training and initiation rituals of various sorts, hierarchies granting licences to practice, inter-school rivalries, strategies to expend social influence and so on. To that extent the analogy between ‘the therapeutic complex’ and ‘the religious complex’, if I can use those two phrases, is not entirely far fetched.
But I want to focus on a different sense. This is the relation of therapies to practices of ‘spiritual guidance’. I have suggested that we can think of ‘ethics’ in terms of the practical systems, types of judgement, languages, and exercises which people use in order to shape and direct their own conduct under the guidance of others. Now since the Greeks there have been more or less systematic ethical doctrines and ethical practices designed to shape conduct, systems which have guided people in their choices as to what to do and what not to do, how they should do what they do, why they should not do what they should not do, how they should avoid vice, how they should become virtuous and so forth (Hadot, 1995; Leites, 1988). Each of these ethical practices has depended in some way or other on a certain understanding of the person whose conduct is to be shaped, the person who is to be subject of ethics. That is to say, they have been based on some understanding of who the person is who is being instructed, what kind of person is the bearer of these ethical codes, as a man, as a woman, as a master, as a slave, as a child, as a freeman, as a serf and so on.
From this perspective, I think we can trace a line between psychotherapeutic practices of the self and these ancient spiritual exercises. For example, Benjamin Nelson has argued that Freud was also central to the invention of a whole novel scheme for the direction of souls (Nelson, 1965). Therapy here has to be seen then in terms of the invention of an array of new ways in which human beings can take themselves as the object of their own thought and their practice, act upon themselves in the name of their mental health. To that extent, therapies are continuous with, and not a radical break from a whole series of other techniques of spiritual guidance. Indeed, before Freud there were a range of other quasi-psychological techniques of spiritual guidance, such as those of Mesmer, and many of the practices that Freud adopted, such as his early use of hypnosis, had a longer history in the practices of the nerve doctors of the nineteenth century.
Why then in our own culture have the therapies come to replace or at least to displace these older religious techniques of spiritual guidance? Well, I suggest that the psychotherapies like the psychological knowledges are bound up with the transformation of the very kinds of people that human beings are considered to be. The modern self is considered - in a rather historically unusual way - to be autonomous, to be free, to be an agent. This modern form of human being is thought to become a self most fully when he or she is able to chose, is able to make a life for themselves in their everyday existence, to become the actor in their own narrative. This notion of the self that is free to chose is not simply an abstract cultural notion, it is embodied in a whole series of practices throughout our society. Most notable are the practices of consumption, where us human beings define the kind of self that we are through the choices that we make, through the books that we buy, the clothes that we wear, the car that we drive around in. Each of these goods both realises or materializes our personality in the choice we make, and casts a kind of glow back on the kind of person that you are. Thus the self in our society is not merely free to chose. The self is obliged to chose, obliged to make his or her life meaningful, as if it were the outcome of a series of choices. Marriage or not marriage, children or not children, how many children, to work or not to work if you are a mother, what to wear, how to lead your life, what football team to support, whatever. Each decision is seen to realise a certain aspect of the personality and you make it intelligible to yourself and to others as if it was an expression of some underlying feature of your personhood. You are to take responsibility for the happiness or the sadness of your own existence. You are to be the actor in the drama of your own existence.
Now at the most general level, I suggest that the rise of the psychotherapies as techniques of spiritual guidance is intrinsically bound to this injunction that the self must become the subject of choice in its everyday life, in order to realise its potential and become what it truly is. Therapies are sought out by individuals when they feel unable to bear the obligations of choice. Or individuals are directed to therapy where others consider them to be unable to exist as responsible choosing selves. Even those therapeutic systems that claim not to be normative give a particular value to this notion of the autonomous, choosing self. Their watchwords are self control, self direction, autonomy, self worth, be self aware, become yourself, realise the sort of person that you are. So I want to suggest that, at the very least, the ethics of personhood espoused by the therapies are entirely consonant with the new regimes of the self that have come into existence over this century. A stronger claim, which I would actually want to make, but cannot justify here, is that the therapies, their languages, techniques and types of authority, have actually played a significant role in making us up as certain kinds of self. The kind of persons that we now take ourselves to be are tied to a kind of project of our own identities: we are to live, and to discover our identity as a matter of our own freedom.
Thus far, this probably seems a rather airy cultural critique, of the type that pleases sociologists but is less relevant to practitioners. But I would like to suggest that this argument can be followed through at a rather micro- level. So let me try and change the scale, as it were, of the investigation.
Bruno Bettleheim contributed the Afterword to a moving autobiography by Marie Cardinal (Cardinal, 1984). This book was called The Words to Say It, and was a narrative of her experience of schizophrenia and psychoanalysis. In his afterword, Bettleheim writes this:
once the inner freedom to be truly herself was added to the outer freedom of running her own life as she saw fit, which she gained during her years of analysis, she no longer needed the help of an analyst… she has become a stranger to her analyst, but not a stranger to psychoanalysis. Psychoanalysis will remain with her all her life.
What does he mean by this? And what is meant by the title of Cardinal’s book: The Words to Say It ? Well, actually, for Cardinal, ‘It’ is bound up with a complex set of beliefs, which I don’t want to go into. But at a fairly obvious level, the title suggests that the place to start might be with words. And as we all know, therapies are, in large part, a matter of the exchange of words. So what of the words of therapy?
It is a commonplace to say that therapy is our response to an age-old injunction: know thyself. In late antiquity, St. Augustine urged his contemporaries "return to yourself, it is the inner man that truth dwells" (Hadot, 1995: 65). But this inner man that Augustine and his contemporaries sought was a very different character from the psychological self we are urged to discover as our truth today. And at least in part that different character of the inner person who we are urged to discover, if we are to ‘know ourselves’, has to do with language. The birth of psychological languages of description of persons and their conduct hollows out certain kinds of self, locates certain zones or fields within that self which are significant, requires us to speak about ourselves in particular vocabularies, to evaluate ourselves in relation to certain norms, to narrate our experience to one another, and to ourselves in a psychological language: traumas, emotional deprivation, depression, repression, projection, motivation, desire, extroverts and introverts. We now have a whole psychological vocabulary to describe ourselves - or rather a family of divergent vocabularies - and what ever the origins of these languages of the self they are indispensable to the ways in which we can make ourselves the objects of our own reflection. They are indispensable, that it is to say to the ways in which we ‘know ourselves’.
In equipping human beings with a new language of the self we make it possible for us to experience ourselves and to act as particular kinds of human beings. Ian Hacking argues that we can experience ourselves as certain types of creatures only because we do so under a certain description (Hacking, 1995). It is only because we can describe ourselves in certain ways that we are able to reflect upon ourselves and act. When new languages of description are brought into existence for human beings, Hacking suggests that we actually bring in to existence what he calls new ‘human kinds’. He calls this ‘the looping effect of human kinds’. Let me give you one example, the word trauma. This is an example that Hacking himself uses. Trauma, he points out was originally a surgeons word, a word for a wound of the body. Over about 100 years it has become fully psychologized. It was extended first to the idea that head injuries could cause loss of memory and other psychological symptoms without manifest neurological damage, then, by Janet, to the notion that horrifying experiences alone were sufficient to produce hysterical symptoms without any physical assault on the body which could be treated by hypnosis, and then, by Freud, to the idea that repressed memories of past events were enough to generate hysterical symptoms. Once it has psychologized in this way, we can think of any number of events and experiences as traumatic – in terms of the damage that they do not to our flesh, to our bones, to our limbs, to our head, or even our brain, but the damage that they do to some inner personality, to development, to self esteem. In early life traumatic events, such as bereavement now appear to cause irreversible psychological damage. In the case of adults, involvement in road traffic accidents, or witnessing a fire or a riot are sufficient to cause ‘post traumatic stress disorder’. According to the most recent version of the Diagnostic and Statistical Manual of the American Psychiatric Association, post traumatic stress disorder has life time prevalence rates of up to 14%, and up to 58% amongst combat veterans and others at risk (1994: 426). So not only is there now a whole specialist literature on the aetiology, diagnosis, treatment, prognosis of different kinds of trauma, but we can all have our own experience of trauma. No wonder we are ‘depressed’ after splitting up with our partners, having a job interview, taking an exam, because these, naturally, are all incredibly traumatic events.
Applying new languages to ourselves as human beings makes it possible for us to experience things in new ways, to form new intentions, and to do new kinds of things – for example, to go in to counselling, have different relations with our lovers. It also makes it possible for new kinds of person to come into existence, and for us to become such types of person. For instance, there was once cruelty to children and there were people, sometimes cruel, sometimes evil, sometimes merely callous or misguided, who beat or injured children. But we now have a different way of speaking about this: not people who are cruel, which anyone can be, but ‘child abusers’ who are specific human types, with particular personalities, psychic formation and so forth. Anyone can be cruel to children, but the child abuser is what Hacking would term a certain ‘human kind’.
Language, then, is important in this matter of power and influence in psychotherapies. But psychotherapies are more than just language. They are, if I can use this term, technologies. They are ways of working on ourselves in a rather practical kind of way. Michel Foucault took confession, the confession as it operated within the apparatus of priestly power in the Catholic Church, as a rough model of the type of technology in the therapies (Foucault, 1979). Confession, Foucault argued, was a practice of subjectification. In confessing one was subjectified by another, because one confessed in the actual or in the imagined presence of a figure who prescribed the form of confession, who appreciated, who consoled, who understood. Confession was also subjectifying because in the process of confession one constituted oneself. He had in mind the reflexive nature of the speech one brings forth in the confessional context: the ‘I’ that speaks identifies itself with the I’ that is the subject of that speech, of the acts confessed. This is an act of identification. One identifies oneself with the ‘I’ of which one speaks, one identifies oneself with and through the language which one brings forth in this confessional situation. Through the obligation to produce words that are in some way true to an inner reality, through the self examination that precedes and accompanies the speech, one is made a subject for oneself.
For Foucault, confession was a diagram of a certain kind of power. It was a diagram of a kind of power that binds us to others, to those to whom we confess and to those who originate the language within which we confess, at the very moment as it binds us to our own identity. So when I use these words, trauma, stress, neurosis, self esteem, it is not simply a matter of words and meanings. It is not just that I am telling myself stories in a certain vocabulary about my experience and in so doing coding it and classifying it in particular ways and giving aspects various kinds of positive and negative valuations. I am also activating a whole ‘regime of truth’, an array of authorities who stand behind this language and guarantee it, a complex of practices and procedures.
If we turn again to the question of spiritual exercises for a moment, we can see that this diagram of power, is not, in essence, particularly novel. I have already referred to Pierre Hadot’s research on the history of these spiritual practices (Hadot, 1995). He has suggested that the whole ethics of self government can best be understood within this field of spiritual exercises, the instruction and practice of particular techniques for the therapeutics of the passions, of the mind, of the body and of the will. For Hadot, the meaning of philosophy in antiquity was bound up with these kinds of practices. The philosopher was not one who pursued a particular academic discipline, but one who pursued a practical ethical discipline in their everyday life. The Stoics were exemplary in this regard for Hadot, but many of the principles and practices were common to the Epicureans and others. One who would lead a philosophical life must practice self examination, a constant vigilance and presence of mind, must cultivate attention to the present moment, devote oneself to duties, cultivate indifference to indifferent things, keep certain things before ones eyes, practice exercises to curb anger, gossip, curiosity, meditate first thing in the morning, to write down things last thing a night, to utilise rhetoric and imaginary, to mobilise the imagination. All these kinds of things were spiritual exercises which the philosopher undertook to craft themselves as a certain kind of person with a certain kind of ethical relation to themselves.
Now of course, the spiritual exercises amongst the Greeks were exercise for an elite. They sought to reshape the soul of a very small group of individuals who were concerned with a kind asceticism, a cultivated practice of the art of living. But these practices of spiritual exercise and spiritual guidance did not die with the ancient world. They were the organising principles of early Christian communities. From the 12th Century onwards, a new practice of Christian administration of ‘the cure of souls’ made advances across Europe: "After 1215, when annual confession became the obligation of all Christians, these treatises became the guides to Christian souls everywhere" (Nelson, 1965: 64; c.f. Leites, 1988). It is a well known and familiar sociological argument that with the rise of Christianity, these practices for the cure of souls spread themselves to all Christian persons. Max Weber, who I have already mentioned, famously pointed to the way in which Protestantism universalised Christian asceticism and then enjoined it on each pious individual in the mundane world (Weber, 1976). And by the nineteenth century in Europe and the United States, elements of religious exercises for the formation and administration of an inner and personal conscience were incorporated within a whole range of secular practices - notably those of schooling - for the inculcation and administration of habits of life and modes of self-scrutiny and vigilance (Hunter, 1988).
So this is another sense, it seems to me, in which that tired old analogy between the therapies and religion can be given a bit of a new life. The techniques of psy, and the therapies that have been promulgated by rival schools from psychoanalysis to behaviour therapy and from humanistic counselling to family therapy, can be understood, I suggest, as the contemporary successors to these spiritual and Christian exercises for the care of souls. And they have disseminated a whole variety of procedures by means of which individuals, on their own or in groups, can use techniques, elaborated by psychological experts to act on their bodies, their emotions, their beliefs and their forms of conduct, in order to transform themselves. Such technologies set up a certain kind of relationship that the self has with itself and give us certain procedures for deciphering ourselves, for examining ourselves, for judging ourselves, and for rectifying ourselves.
Let me now turn to look more directly at some of the ways in which these kinds of reflections on ethics might help us understand the psychotherapies. I want to look at these along four dimensions: ethical scenarios; ethical materials; ethical techniques; and ethical goals. The terms should not be taken too seriously – they are rather pretentious names for things that are really quite mundane.
By ethical scenarios I mean the way in which a whole range of problem spaces have been transformed through the application of therapeutic knowledges in to kind of therapeutic issues. I have discussed a number of these in more detail elsewhere. The first is the subjectification of labour. Issues such as where one works, how one works, one’s satisfaction in one’s work, one’s choice of work are all now understood in subjective terms: as having subjective determinations affecting the choice, having subjective characteristics that can be assessed to ensure that one is best matched to one’s work, as having subjective consequences for one’s life outside work. We have come to believe that work is crucial, as much for its psychological as for its financial benefits: we realise our potential and discover ourselves, at least in part, through work. Thus issues of labour and the whole complex of relations around it have become saturated with therapeutic languages and have become profoundly psychological affairs.
Secondly there has been a psychologization of the mundane. A whole range of everyday matters have been made in to psychological affairs, that is to say, matters which are discussed and understood in a therapeutic language. It is not just the rise of counselling in general, or even marriage guidance counselling, or sex counselling. There is counselling for debt, for diet, around reproduction, childbirth and a whole array of matters which are to do with the minutia of how one leads a life. These have become rephrased in therapeutic languages and judgements, which have permeated way beyond the consulting room, onto television, radio, into the newspapers and magazines: into the everyday discourse of everyone (more women than men, perhaps, more the have’s than the ‘have nots’ – the epidemiology needs further study).
Third, there is a new therapeutics of finitude, by which I mean a therapeutic engagement with all the implacable limits of human existence: illness, bereavement and death. These aspects of human finitude have become very fertile grounds for the generation of psychological knowledges and techniques. This is not simply because of the rise of specialists psychological and psychotherapeutic sub-professions like bereavement counselling, but also because of the ways in which these issues of our limits, of our loss, of our ending have become infused with a therapeutic language outside the therapeutic situation and a psycho-dynamic significance within the therapeutic situation.
So this is what I mean by the proliferation of ethical scenarios which are framed in a therapeutic way: the kinds of issues in our society that have become rendered problematic in a therapeutic vocabulary, have therefore, entered the domain of therapy, both because they move into the routine practice of therapy and because they become the object of therapeutic problematization by other experts and by lay people themselves
The second dimension of ethics is what I have called the ethical material. By this I mean simply the aspects of the self that are given ethical significance, that are valued, that are problematized, that have to be worked upon. When one casts one gaze upon oneself, what is it in oneself that one takes to be of significance? For many, the rise of psychoanalysis in its Freudian form was exemplary. Psychoanalysis seemed to show that, for all the therapies, what one took to be of significance ones ethical substance was desire - sexual desire. It appeared that sexuality was the truth that had been hidden within us in order to be discovered in therapy, in order to be made the principle according to which one lived ones life. And, of course, psychoanalysis was criticised for giving that sexuality a particular form and for valorising in its theory one particular type of domestic arrangement: Daddy, Mummy and baby.
But I think that this focus on sexuality, the assumption that sexuality and desire is the only kind of material that the therapies work upon, is misleading. More significant, I suggest, is the way in which autonomy and identity, the autonomy of the self and the self-possession of our own identity, of who we really are, have become the central terms in the organization of therapeutic discourses. Our identity, the discovery of our identity, the release of our identity, the capacity to be who we truly are has been fabricated as the truth that we must discover, that we must proclaim, that we must have recognised by others. We must find the person within, we must release our potential, we must become who we are.
Of course, the therapeutic valorisation of the autonomy and identity of the individual is only one part of a much wider cultural celebration of autonomy, individuality and identity in our own society and perhaps even more in the United States, where the politics of recognition of identity has become so absolutely powerful and producing both good and rather problematic consequences. The critiques of therapeutics in the 1970s focussed upon this aspect of their cultural significance (Lash, 1980). But perhaps the most interesting thing that has occurred over the last 20 years or so, has been the emergence of an understanding of the self as a kind of complex of acquired competencies and habits. This is the ethical material presupposed by behavioural therapies: the emergence of the self as a composite of skills of life conduct that can be taught and can be learnt. One of the things that has been least recognised in the literature on therapeutics is the way that, in the proliferating practices of clinical psychologists, of social workers, of health visitors and others, the psychotherapeutic and psycho-dynamic languages that used to be so dominant have been displaced (Baistow, 1997). There are a whole series of reasons for this, which I cannot discuss here, But the consequence is the prominence of forms of analysis that have a much more direct concern with the conduct of the individual. These behavioural and cognitive therapies take the superficial conduct of the individual as that which is problematic and as that which is to be reformed. In the simplest of these kinds of therapeutic techniques, conduct is broken down in to a series of problematic areas, in each of those areas targets are identified, homework is set for the individual to practice, the goal is to achieve those targets. The individual goes away, and practices the little habits necessary to achieve those targets on their own – particular ways of dealing with provoking situations, for example, or of calming a distressed child. These techniques, which are not all that dissimilar from the spiritual exercises I discussed earlier: the person seeks to learn techniques and to internalise them within themselves as habits, in order to achieve a better life. The ethical material here is behaviour itself, in the form of social skills and capacities to cope: therapy here is a matter of the cultivation of competencies.
There is a whole story to be told about why competencies have come to supplant other kinds of objectives in so much of the therapeutic work of social workers, doctors, clinical psychologists, health visitors and nurses. It is partly because competencies can be specified and measured, and thus converted into targets, outputs, throughputs and the like. It is partly because competencies promise to be achieved in a short period of time, thus becoming amenable to audits, monitoring and evaluation. It is partly because the therapists themselves can feel some satisfaction in producing a noticeable change. It is partly because the therapists can feel that their clients are being given something to take away when they leave the consulting room, which is important within contemporary client-centred and customer-centred professional ethics.
It seems to me that we have here an example of something which is rather difficult to evaluate in terms of power. In fact, those who practice these forms of cognitive and behavioural therapy frequently use the language of power themselves. What they say is that these techniques are empowering. They are giving people the power and the skills to live their own lives, unlike the forms of psychotherapy which they believe set up an endless, an interminable relationship of tutelage, between a disciple – the client or patient - who will never know enough and a powerful person – the therapist - who will know more, control more, be more. Now it is easy to be cynical, and to say that the belief that these forms of therapy are empowering are self-serving, self-aggrandising and self-deluding. But perhaps cynicism would be misplaced, in part at least. These techniques of living, of actively and consciously sculpting a self, of deliberately fabricating the competencies, capacities and presentations of the self one wants to be and the life one wants to lead are not themselves new. They have been the prerogative of the privileged, of aristocrats, bohemians, and dandies through the ages. We may query the values embodied in these contemporary therapeutic programmes of self-shaping, We may query the means employed. We may query the problems around which these kinds of concerns are developed. We may ask questions about the extent to which these new forms of self are actively chosen by their recipients, or imposed coercively. Nonetheless, the thought that one can shape the kind of person one is by practical exercises, and the generalization of this beyond an elite, doesn’t seem to me something that should simply be mocked.
Thirdly, let me say a bit about ethical techniques. The technique side of things which I have alluded to in relation to these behavioural therapies seems to me to be extremely significant. Therapies do not merely equip people with a certain language. They do not merely equip people with a certain way of disclosing and accounting for their inner world and confessing it or making it hearable in certain ways. They do not merely provide people with a certain way of understanding their sorrows. They also equip them with certain techniques for acting upon themselves in order to reform themselves. Now, of course, some therapies, psychoanalysis in particular, deny that they do provide such techniques. Psychoanalysts refuse to see themselves as merely technicians of the soul, giving people a few little techniques which might help them lead their lives in a more contented manner. But even psychoanalysis, by providing people with certain ways of reflecting upon themselves, enjoining people to reflect upon themselves, to interpret their actions, their conduct and their words in particular ways and to bring them forth in particular situations, is giving people a ‘mental technology’ for acting on their life in thought, and so perhaps in action.
I have suggested elsewhere that we could make a four-fold inventory of these ethical techniques.
Techniques of engaging with the self: an epistemological mode, for example, which searches for past determinants of present states, an interpretative mode, in which the word or act is understood in terms of its significance in relation to other parties to the interaction, a descriptive mode which seeks to fix attention on conduct dissected into micro-competencies such as grooming, bathing, eating, eye-contact which can be recorded, normalised and made the subject of pedagogies of social skills.
Techniques of disclosing the self: ways of speaking not only in the consulting room, but to children, bosses, employees, friends and lovers. We do not merely have ‘confessional’ styles, but a whole range of other ways of putting the truth of the self into discourse, making it hearable, seeable, inscribable, hence manageable, manipulable. And we have a proliferation of sites within which human beings are required to reflect upon themselves in psychological terms and render this into speech, from the doctor’s surgery to the radio interview.
Techniques of evaluating the self, diagnosing its ills, calibrating its failings and its advances in terms of the norms of the intellect or the personality propagated by psychology, the repertoires of feelings and emotions disseminated by the therapies, the forms or normality certified by the proponents of cognitive and behavioural systems.
Techniques of reforming the self : the purgative effects of speaking out, the liberating effect of understanding, the restructuring effect of interpretation, the little practices for the re-training of thoughts and emotions, the techniques one should adopt to raise self-confidence and to maximise self-esteem. As I have already said, of particular importance here has been the invention of new methods for the therapeutics of behaviour and cognition, versatile micro-procedures which can be taught by a variety of professionals and utilised by individuals in order to reshape their psychological self to ‘take control of their lives’ within an ethics of ‘empowerment’.
Now, it would be nice to say that these rather abstract remarks could be confirmed by empirical evidence on the actual practice of psychotherapy. But unfortunately we lack detailed ethnographies of the way in which the psychotherapies work. If one could observe in practice the ways in which the psychotherapies work it would be possible to support or even to deny the kinds of approach that I have tried to outline about the way in which certain kinds of things are brought in to existence in the therapeutic situation.
Sociologists, over the last 10 or 15 years, have carried out a whole series of studies of other kinds of enterprises, in particular, scientific enterprises. We have a number of very detailed ethnographic studies of what goes on in scientific laboratories (Latour and Woolgar, 1986). These ethnographic studies of what goes on, have shown the way in which scientific laboratories bring certain phenomena into existence that did not exist before. The facts that science theorises are actually forced into existence through the experimental apparatus and procedures of science. Ethnographic studies of even the most apparently ‘hard nosed’ sciences, such as astro-physics, have shown the labour involved in making up scientific facts, and the theory laden nature of even the apparently most objective or real fact. It is not so much that these scientific facts – the measurements, observations, inscriptions on graphs and the like, which are produced through complex manipulation of scientific apparatus, measuring devices and inscription mechanisms, are true or false. What they produce is a kind of ‘irreal’ world, the world of scientific reality. Scientists seek to conjure up in reality - through their observations, measurements, inscriptions and so forth, the things they have already made conjured up in thought- in their concepts, theories and explanatory forms.
I think that one can regard psychotherapeutic situations in somewhat similar ways. If we look, for instance, at Bion’s descriptions in Experience in Groups, you can see the way in which, in the forced ‘hothouse’ atmosphere of the groups that he deliberately produces, certain phenomena pertaining to the relations between individuals which are invisible in other situations are forced in to existence (Bion, 1961; c.f. Miller and Rose, 1994). They are rendered visible, thorough a kind of intensification of effects that is entirely analogous to that intensification that is deliberately produced in a scientific laboratory to make the invisible visible. This is why I think that therapeutic situations are like laboratories, they force certain things in to existence. And, in the same way as scientific experiments, they force those things into reality which have already been dreamed up in the minds of the therapists.
Now, of course, like the scientist, the therapist can’t force anything into existence. Despite what is sometimes said by critics of ‘recovered memories’ it is seldom a case of simple suggestion or implantation of ideas or beliefs from the therapist to the patient or client. But the way in which an entity is brought in to existence is made visible, is made hearable, is then described, is then made to operate, to do certain things, seems to me a characteristic of those kinds of therapeutic situations and one of the ways in which they realise their effects. This is the way in which the ‘irreal’ reality of the therapeutic encounter is produced.
If one did have detailed ethnographies of what went on in therapeutic situations, I think one would begin to observe the way in which, in a complex and subtle way, through the joint labour of the therapist and the patient or client, the problem is shaped up according to certain grammars, repertoires or frameworks. For example, Ian Hodges has been looking at a rather particular kind of therapeutic situation: radio phone-in therapy (Hodges, forthcoming: I am grateful for permission to draw on this unpublished work). This is very interesting because it is a very, very intense two or three minute condensation of something which goes on at a slower pace and in a manner that is more difficult to discern, in other therapeutic contexts. In these radio phone-ins, within a matter of two or three exchanges between the caller and the counsellor, the person doing the counselling has transformed the problem that has been brought to them by the caller. It has been made amenable to therapy, has been transformed into therapeutic terms. For example, the caller may have phoned in with a problem with a recalcitrant husband, and this is transformed into a problem of the difficulty that the caller has with authority or with showing love. This is a process of shaping up the problem: the caller, or more generally the client, needs to become ‘good subject of therapy’ by representing their problem in a particular psychotherapeutic form, as a matter of the relation between inner world and outer conduct, or inner world and felt emotion or will.
Thus, through a series of conversation encounters - because all there is, is words - the problem gets shaped up through the use of a small number of discursive techniques. Further, one can describe the ways in which an individual is identified as a certain kind of person from a particular therapeutic repertoire of persons: this is a diagnostic moment even in the least explicitly diagnostic therapies. And one can see the way in which the caller is given instruction in certain ways of conducting self, or, at the very least, a valuation of certain norms of conduct and speech and a classification of others as suitable for treatment, requiring work, working on oneself.
Now, of course, sophisticated therapists have long known this, although they tend to ascribe this to others rather than themselves. In The Basic Fault, Michael Balint has some unkind things to say about what he calls ‘the Klein school’ (Balint, 1968). Balint says that the Kleinian’s have developed "a very characteristic, though somewhat peculiar, ‘mad’ language, but nevertheless the patients learn to adopt this language if it is consistently applied". "As a result of the interaction between a consistent analyst and his conforming patient, " Balint says, "an atmosphere is created in which certain events will inevitably happen". He goes on to say that the interpretations that are made of these events "create the impression of originating from a confident, knowledgeable and perhaps even overwhelming analyst, an impression apparently shared by their patients. If this is true," suggests Balint, "this attitude of the analyst might be one of the reasons why on the one hand so much aggressiveness, envy and hatred emerges in their patients’ association-material and, on the other hand, why they seemed to be concerned so much with introjection and idealisation. These are the two most frequently used defence mechanisms in any partnership in which an oppressed weak partner has to cope with an overwhelmingly powerful one." (Balint, 1968: 106-7)
And as those who know Balint’s work will know, he also suggests that general practitioners shape up the problem that is brought to them, transform it. He thinks that general practitioners have an irresistible urge to organise their patients complaints in to an illness and that this produces, in the patients, a compulsion to organise their own condition into a "clinical illness" which may have little to do with their original dis-ease. So the lines of approach I have been suggesting do not really say anything that would not be quite familiar to the many therapists who attentive to the microstructure of the analytical situation.
Many people might say that this all very well, but what has it got to do with power? Well, as I said at the very beginning, I felt rather hesitant about my presentation here. It is not a grand denunciation of the evils, abuses, manipulations, patriarchal powers, exploitation that some claim characterises the therapies. It is a rather mild attempt to describe some of the things that go on within the situations of therapy and a culture in which therapeutic situations abound. Nonetheless, if construes power in terms of ‘action upon action’, one can see the ways in which through the kinds of mechanisms I have sketched out, therapeutic language, therapeutic techniques, therapeutic scenarios, the proliferation of the therapeutic through our culture, has a role in fabricating us as certain kinds of persons: certain human kinds who attend to ourselves in certain ways, value particular aspects of ourselves, take certain things as our truths, whether these be our desire or our identity or our skills, and act on those things in order to lead our own lives.
The therapeutic situation, even in Britain is a relatively rare experience. But unlike many other professionals, psychologists in general and psychotherapists in particular, are incredibly generous. They give their knowledge away, they give their language away, they give their techniques away. Through this ‘generosity’ of the therapists, many other authorities of human conduct, engineers of the human soul, have had their ways of working, their styles of practice, transformed. This generosity of psy is on one condition only: that these other technicians of the psyche adopt a therapeutic language, therapeutic techniques, therapeutic norms, values and objectives. This therapeutic transformation can give their authority a kind of ethical cast. Whether it be it as a social worker, as a nurse, as a probation officer, as a prison guard, these authorities can understand their authority as a matter of doing good for others. And part of the significance of the therapeutic, for these authorities, is that, in giving them a kind of ethical basis for their work, it actually ‘authorizes’ authority, it gives authority a basis which is more than simply brute power or dominion – it is democratic and therapeutic, it is in the interests of those over whom it is exercised, and hence it is a virtuous vocation for those who will exercise it. I think part of the attraction of the therapeutic is indeed this ethical characteristic. Hence if one was looking at the powers of therapy in more detail, one would want to look not merely at ethics in terms of the transformation of the client or patient, but the kind of ethical transformations of the therapists themselves. A certain ethical work on yourself is not just a characteristic of what the therapist gives to the client, but also a characteristic of what the therapists get for themselves. Perhaps this accounts for some of the seductiveness and the proliferation of psychotherapies in our culture.
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Nikolas Rose is Professor of Sociology at Goldsmiths College, University of London . He is managing editor of Economy and Society, and is a co-ordinator of the History of the Present Research Network, an international network of researchers whose work has been influenced by the writings of Michel Foucault. He was originally trained as a biologist and psychologist, and taught in a school for 'maladjusted' children and directed research for a major child protection charity before becoming an academic. He has published widely on the social and political history of the human sciences, on the formation and nature of empirical social thought, and on changing rationalities and techniques of political power. His works on the human sciences and subjectification include The Psychological Complex (Routledge, 1985), Governing the Soul (Routledge, 1989, Second edition with new Preface and Afterword, Free Associations Books, 1999) and Inventing Our Selves (Cambridge University Press, 1996) and a number of papers on the history of the Tavistock Clinic and Tavistock Institute of Human Relations - institutions which pioneered 'applied psychoanalysis' in the UK and abroad. His most recent book on power and governmentality is Powers of Freedom: Reframing Political Thought (Cambridge University Press, 1999). His current work is on the social, ethical, cultural and legal implications of biological psychiatry, molecular genetics and the neurosciences.