Ashley Frawley, James Mumford, Mark Vernon: After Therapy

Johnny Carson quipped that in Hollywood, if you didn’t have a shrink, everyone thought you were crazy. The joke has spread: ‘mental health’ content proliferates, therapy ads are ubiquitous, and consulting-room language appears in corporate strategy. Welcome to the age of Big Mental Health.

The therapeutic turn’s origins lie in the anti-psychiatry and psychiatric survivor movements of the 1960s. These sought liberation from stigma, pathologization, and coercive institutional psychiatry, whose high priests wield power through the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Anti-psychiatry’s critique was overtaken by psychopharmacology, which reduced physical restraint and entrenched the bio-medical model. The DSM’s empire has grown. But ’60s activism gave rise to new ways of conceptualizing mental distress: efforts to ‘normalize’ it replaced madness with the amoeba idea of ‘mental health’, shaped by managerialism and identitarianism.

Paradoxically, commonplace emotional experience is now pathologized, while severe mental distress is again marginalized. Diagnostic labels that previous activists rejected are now prized, yet evacuated of meaning.

Is there space for genuine illness in ‘mental health’ discourse? Can we still rely on Freud’s distinction between “neurotic despair” and ordinary human misery? Do we need more or less therapy, and to what private, social, or political end?