Resisting Therapy Culture, with Matthew Loftus

By any measure, we are living in an unusual paradox. Americans are investing more and talking more a great deal more about mental health care. There’s some studies that indicate that nearly 1 in 5 adults will either be on psychiatric medication or in therapy at some point this year. And if you spent any time online, you’ve likely noticed both the ideas and the language of therapy and mental health applied to more and more aspects of both private life and public life. Yet at the same time, reported rates of psychological distress have only increased. And while undoubtedly better tools of diagnosis as well as thankfully reduced stigma help explain part of those trends. Our guest today has suggested that the extension of the concepts, frameworks, obligations, and language of therapy to our broader public life, including the church has also contributed to this frustrating paradox. And even more importantly, it’s distracted from the church’s mission and purpose. It’s a provocative and important argument, and I’m so looking forward to discussing it with our guest today, Matthew Loftus. Matthew, after growing up in the Baltimore area as the eldest of 15 children, is now a medical missionary who practices family medicine in East Africa, which he has done for well over a decade. He is also a writer who has contributed to such outlets as The New York Times, The New Atlantis, Plow, Comment, and Mere Orthodoxy. And I am very proud to say those of you who have followed the Trinity Forum know that last year we launched a new effort for us, the Michael Gerson Memorial Prize for Excellence in Writing and Faith in Public Life. And Matthew was our inaugural winner. And what we’ll discuss today is actually his first book, Resisting Therapy Culture. I’m so excited to get to talk with you today. Welcome.

Thanks, Cherie. It’s an honor to be here.

Great. So let’s start off your title of this book, Resisting Therapy Culture, I imagine, will almost immediately raise some eyebrows because there’s many of us who believe and just assume that therapy is an unqualified good. And I know that you yourself have benefited from therapy and have often helped others struggling with mental health issues. So what is it that you mean by therapy culture and how is it different from therapy itself?

Yeah. Thanks Cherie. So therapy is a practice, right? It is a way of helping people find, figure out what’s going wrong in their life and what they can do to make it better within their own mind. And so as a practice, it can be very life giving. It can save people’s lives when they’re really depressed or having some other kind of really difficult struggle. But as a culture, it is pernicious, divisive and really works against what the goals of therapy are. So as a practice, it’s good, as a culture, what happens is that medicalizing our normal experiences, turning grief into symptom of depression, turning our normal day to day stress, calling it trauma. Those kinds of things turn people towards thinking of themselves as sick and unable to change, which is the opposite of therapy, right? Therapy is designed to help people change in ways that make their lives better. And therapy culture leads people to kind of collapse in on themselves.

Yeah. You know, I want to ask you quite a bit about kind of therapy culture in the church, but one of the areas of potential overlap, it seems, is that, in many ways, both our faith and therapy and therapy culture encourages us to reflect. Therapy encourages us to look inward and therapy culture perhaps really encourages us to look inward, to kind of focus on who we are and our authentic selves. And of course, Christian spirituality very much values, even commands, reflection, contemplation. These are all part of the spiritual disciplines. Although I think it’s probably fair to say the gaze is directed in slightly different directions. And we’d love to hear your thoughts on essentially how these two visions of reflection differ.

Yeah. Good question. So, I think I want to start with the positive, the Christian, inward vision because I think when we do have that inward turn and we examine ourselves, I think what’s happening there is we are allowing the light of Scripture, the illumination of the Holy Spirit to uncover things about ourselves that God created us for or things that are sinful nature has allowed to proliferate in the dark, you know, sinful habits, ways of dishonoring God and not loving others and then doing something about that. And then kind of through the love of God, through the work of the Holy Spirit, again, embracing, a transformation from the old self to the new self. And that’s obviously something we all have to do as part of our Christian lives. Therapy as a practice, I think is sort of like that, except I think the instead of the all powerful light of God illuminating, it’s more like a flashlight that’s pointed in one particular direction and trying to find, okay, where exactly is the problem here? And what’s 1 or 2 specific changes that we can make? Therapy culture is much more about accepting the status quo and even an inward turn that assumes number one, I can’t change to make things better. Like I am powerless to help. I am sick and I can’t get better, but also a sense that other people need to change to cater to me, they’re the ones who are being toxic. I’m always growing. They’re the ones who are narcissistic or whatever. And it’s a sense of self examination that’s not really interested in looking to get better. Therapy culture really drains people of their agency and their ability to make positive changes for themselves.

You know, I’d love to hear you unpack that a little bit more because it almost makes it sound, what you just said, that the assumptions of therapy culture are almost at odds with the goals of therapy, which is presumably increased mental health, well-being, and sense of agency. Is that fair to say? Or am I missing something?

No, I think that’s a really good way of putting it, because I think a lot of therapists, a lot of psychiatrists and psychologists are concerned about therapy culture in some way. I think it was Jonathan Alpert who just wrote a book called Therapy Nation, that kind of touches on some similar themes, and several different psychologists and therapists that I’ve talked to about the book or who have read it, say, yeah, this is a problem. This is something I’m seeing in my office of people coming in either self-diagnosing from something they saw on social media or people who have absorbed this sense of, well I need to start cutting people off in my life because they’re burdening me too much. And there’s this sense on like I myself am an immovable object. And that really drains people of their ability to enjoy a good life. Right? Because when people wallow in their own suffering or they think of themselves as not capable of making changes in their life to make their life better, that is just such a research proven detriment to mental health.

Yeah. There’s so much there that I want to ask about, but let’s start with, you know, you mentioned social media and just the tendency towards self-diagnosis that we see and, I certainly get, and one of the things I noticed the other day, I tend to procrastinate. I’ve had a lot of stuff on my social media feed encouraging me to think that, it’s not that I’m procrastinating, it’s a trauma response. And there’s something that feels good about that, I’m not putting off my work. I am a brave heroine soldiering on in the midst of all the trauma. And there’s much to ask about there. But let me start with the language. Not a couple of books ago, David Brooks did something I thought was very clever. He basically did a Google in word analysis of language usage over the decades. And so in preparation for this, I did a little bit of that myself and just sort of found that like, oh, it’s really remarkable how language use has changed. Like the language of the virtues, courage, bravery, sacrifice, kindness, virtue itself has really fallen. The language of therapy, words like toxic, triggered, narcissists and the like has really accelerated. And of course our language doesn’t just reflect our reality. The language that we use helps shape the way we perceive and understand reality. So, what do you believe is lost or gained by the shift from a language that is more morality and virtue based. And of course, that language has been in decline for many decades. It’s not just in the last two decades or so, but that kind of language in decline and the rise of the therapeutic language. What does it mean for how we even see ourselves in our world?

Yeah. I mean, I think the paradigm of medicalization is helpful here because shifting away from the virtues takes us from a place where we recognize that we all have deficiencies and flaws and things that we’re struggling with and maybe have struggled with for a long time, but that we are overcoming them, that we are growing in them. And I think you guys just did a conversation with Alan Noble that was really great about the virtues and I definitely recommend people check out his work on that and his new book, the, again, shifting from being able to think of character as like a muscle that we grow, something that we work out, that we work on, that we strengthen over time through practice, as opposed to therapy and psychiatry, think of especially, I think the move away from psychoanalysis and the rise of the more scientifically bent DSM, the paradigm of illness and disorder, right? Instead of us being active participants in our own well-being, we are now passive recipients of therapeutic interventions. I mean drugs, especially, right? It’s very passive sense of like, okay, well, you have this problem now take this pill. And, as a doctor, I will say we are, we are so guilty, especially primary care doctors like me of just kind of handing people pills instead of trying to work more holistically with them.

And so that shift from an active one to a passive one is really at the heart of therapy culture. And so we lose that sense of being able to be active participants. Now for people who are impaired in their ability to make positive changes for their life, when they accept that they have an illness, then they are able to receive the treatment that allows them to reactivate their agency, which again, is what therapy and psychiatry are all about. When I’m prescribing psychiatric medications for patients, I’m trying to give them something that lets them have more control over their life and not less. What’s gained is for the people who are sick, who are suffering, then they can have the tools that they need to rebuild their life, but obviously, just like with any other medicine, with any other therapy, if you’re not sick and I give you an antibiotic, I’m not making you any better. I’m risking a side effect for you, and I’m risking antibiotic resistance for the whole community.

Yeah. That’s actually an interesting point. In the ways that I guess the wise use of therapy is very life giving and, you know, indiscriminate is the wrong word, but like sort of just the too bountiful kind of dabbling can actually do some harm. I’d be interested in you saying a little bit more about just the tendency to sort of practice therapy culture when it’s not needed. I mean, you wouldn’t think that there would be part of us that would almost lean into the idea that we are victims or lean into our own vulnerability. Obviously vulnerability is certainly not a sin, but nor is it necessarily an asset. You would think that the normal orientation would be towards maximizing agency rather than feeling rewarded by vulnerability. And so yeah, we would be interested in hearing more from you about the ways that you think therapy culture is actually increasing, perhaps positively reinforcing, vulnerability or illness.

Yeah. So I think some of these conversations are difficult because especially when I’ve talked to people who are older, they remember a time when, mental health was really stigmatized. And Christians especially could not talk openly or honestly about their, their vulnerabilities. I think I’m probably just about old enough to like have caught the very tail end of that sense, but was right there when it.

Still lives on in places.

Sure. Yeah, certainly here in rural Kenya, I see it all the time. But I feel like I was right there to see vulnerability become the buzzword. And then to see other people who were maybe a little too vulnerable or people who misused vulnerability to kind of build their own brand or whatever. And you can see, I think within social media today, there is this real tendency to overshare and to valorize suffering, and there’s some interesting research too about this, that especially among young people who, I was one of them too, who thought that the more profound my suffering um appeared, the better it made, you know, I think that’s a natural tendency for a lot of us, but I think our culture has magnified it. And now there’s even the sense of social cachet and people almost competing in certain spaces to be the most oppressed, the most vulnerable, the most mentally ill, even. And that is really bad because it encourages people to think of themselves as sick. And a good sense of vulnerability allows you to connect with another person, and maybe a small community, in a way that helps you to unburden yourself of whatever it is that is you’re struggling with or whatever and allows them to connect. But when that vulnerability is misused and you’re amplifying it with this social media megaphone or whatever, then it’s misusing the purpose of vulnerability, I think.

Yeah. You know, as I was reading your book, one of the things I thought I’d love to hear your comments on it, like it’s not only in the realm of therapy culture where something valuable, maybe even vital, became distorted and stretched, distorted into an all encompassing worldview. I mean, in some ways, one could argue that something somewhat similar has happened with politics. Politics is necessary and has its place. It’s also kind of been pulled and stretched to where it is a primary source of identity for far too many people and political culture, and the combat and contestation now seems to increasingly kind of define public discourse. And it also occurred to me, and I’m curious what you think about that. And in some ways, both therapy culture and runaway political culture both of them offer a very compelling and enticing story, which is one personal absolution and a scapegoat to kind of blame one’s problems on. And I’m curious about your thoughts on that. Am I distorting the metaphor too much, or is there is there a harm simply in taking, wherever it might be, a very useful tool, a very vital function and just distorting it to try to cosmologies it into a worldview that should not be speaking to the places it purports to speak.

Yeah, absolutely. I think you’re definitely on to something there. I think as our national and cultural stories kind of get demythologized and certainly our religious stories as well, get excised from public life or demythologized or privatized, people are still looking for something really powerful to give their life meaning. And I think that absolutely both politics and therapy do give you a really compelling story about who you are, where all your problems came from. That scapegoat thing, is very real, right? Whether it’s, the Republicans, the Democrats, your parents, your ex-boyfriend, that if there’s a villain in the story and you are the protagonist, then that feels good. And that gives your life a sense of meaning that I think a lot of people, especially young people, are looking for. The problem is that these things were never designed to give people that sense of meaning. And so it spirals out in very destructive and unhelpful ways.

Yeah. I’m also curious how much you think the basic problem is the medium through which therapeutic culture is primarily spread. And part of what I mean by that is social media itself encourages pop psychology, dumbing down, pushing to the extremes along with monetization. And you can go online and you can see on one hand, online therapy culture everywhere, but also juxtaposed with the manosphere where they very much dismiss the same categories like toxicity and narcissism that they seem to be exhibit A’s of, and I guess you could probably spread therapeutic culture through books, but it would be a little bit more difficult to do so. To what problem is the medium through which it spread?

I mean, I think in general, yes, social media is both an accelerant of preexisting weaknesses in human rationality, let’s say, just getting to our lizard brain and our uncontrolled passions. It’s even saying something like lizard brain. That’s therapy culture right there. It’s hard to escape. So certainly I think there are some specific things about the medium. But therapeutic culture has been building for a very long time. Philip Rieff wrote Triumph of the Therapeutic in 1968. I think my book is a spiritual successor to that. I think that’s what the kids call it these days. And so I think we’re at the end, the process has been going on for a long time, but certainly social media has accelerated it in a way that’s unhealthy. So, for example, The Body Keeps the Score, is a book that came out 12 years ago, I think has been very, very influential on certain aspects of therapy culture and there is enough misinformation in it that I really don’t feel comfortable recommending it anymore. There’s a good book called Myths of trauma by Joel Paris, who’s a psychiatrist, that covers some of the same ground, but not enough to necessarily be a replacement, at least not in the same way. So certainly there’s full length books that also kind of push this, but I think you are right that there are ways in which the medium of social media makes the whole problem worse for sure, but not exclusively.

Yeah. I definitely want to ask you about therapy culture and relationships in that one of the huge challenges right now is loneliness and isolation. Therapy cultures, you’ve defined it, largely encourages essentially curating your relationships, to those that you believe increase your well-being.

My Mom calls it Marie Kondo for relationships.

(laughs) Yes. And establishing boundaries around those relationships that you believe don’t. And that has been taken in some ways to really counterproductive lengths. I mean, there’s been a bunch of articles recently about people who have cut off contact with family members and then later really regretted it. At the same time, also want to acknowledge that there are times that the church or churches have really encouraged or pushed reconciliation and forgiveness in the cases of like abuse and the like, where it was premature and harmful. So you, as a Christian, as a doctor, as someone who has been in therapy, as well as been a critique of the culture, how do you argue we should think about the fact that there’s no point in being unnecessarily vulnerable to bad treatment. And at the same time, we as Christians are called to love our neighbor and even call to love our enemy, which literally means that there is risk and possibly even danger involved. How do you think about that paradox?

Yeah, I think a lot of it comes down to how we look at the question of suffering and also what is the point of having relationships with other people if relationships are only meant to serve me in some way? If my relationships has to be some return on the relationship in a sense, then of course that means cutting off people that I don’t feel like are bringing that return in some way. And so that is a really poisonous way to look at relationships, a really unhealthy way, a way that’s not consonant with a good life and certainly society as a whole, right? Like there’s a lot of vulnerable people who are vulnerable because they’re not very likable, or because they are hard to love. And so those people need love, and God loves those people. And in many cases, God has called us to love them. I think cutting off a relationship, it’s sort of like a fire alarm and a sprinkler system.

If your building is on fire, you should pull the fire alarm and get out of the burning building and turn on the sprinklers to get the fire out. If you totally cut off a relationship just because like your computer is overheating or whatever, then it’s premature. You’re doing this really extreme measure for something that is bad, dangerous, right? And it’s difficult because each person will have to discern for themselves what is the best way to handle a relationship, especially a relationship with a family member who has been abusive, who has been unloving, who has taken advantage of your vulnerability in some way. But I do think that it does proclaim the goodness and the love of God when we love people who don’t deserve it. Because none of us deserved it in the first place. And yet God still loved us. So I think we have to start from the premise that we are loved by God, and out of that love, we can love others, even difficult people. If you see the buildings on fire then yeah, pull the fire alarm.

Yeah. I see the questions piling up. Before we turn to questions from our viewers, I do want to ask you about the church and that, you know, you’ve mentioned in your book that churches and pastors are often under a lot of pressure to essentially supply a therapy as part of the process of leading the church.

Yeah.

And it also seems like a lot of churches have struggled both with therapeutic culture and political culture. Essentially two different frameworks that have tried to overstep their bounds. And you’ve said that the church should neither reject nor imitate therapy, despite all the pressure that pastors are feeling. What does that look like in terms of a healthy church?

Yeah. I would say I think the healthiest thing that a church can do is to do the things that only the church can do, right? Like you can’t, in terms of giving the sacraments, proclaiming the word, worshiping God together. These are gifts that are given to the church that no other human institution has. And so when a church embraces its identity and its uniqueness, then that church, I think, will flourish. And there will be people, I think there are definitely people who go to church because they want their pastor to do politics and because politics is the thing that they find their identity in. And so they become disappointed when the church does not do the politics thing for them. But if you want to go to a political rally, go to a political rally. Don’t go to church because you want it to be a political rally. Go to church because that’s where the gospel is preached. That’s where you can get the body and blood of Christ.

With therapy culture, if you want to go to therapy, then go. If you need to go to therapy, go to a therapist. A pastor is going to do a really lousy job doing for his congregants what a therapist ought to do, right? And I think the biggest danger for a church though is going to be in trying to rephrase everything. You know, Christian doctrine, teaching the scripture in terms that are palatable to people shaped by a therapeutic mindset. And so they’re going to edge away from questions of sin, wrath, judgment, demons, those uncomfortable subjects. And they’re going to express things in a way that makes sense to people kind of bathing in therapy culture, which, I think occasionally you have to do some a little bit of translation. But if you’re constraining your message to only be acceptable on therapy culture’s terms, you will end up with a very pale imitation of the gospel.

Yeah. We’re going to turn to questions from our audience. And I see them piling up here. And just a reminder that if you’re interested and have a question for Doctor Loftus, you can not only ask a question, but you can also like a question, which gives us a sense of what some of the more popular questions are. And for the first question, I’m actually going to combine two because they both have to do with essentially, what then should we do? So John Kyle asks, he says, this seems like a knife’s edge. Fall on one side and we end up discouraging people from getting legitimate mental health therapy. Fall on the other side, and we end up overusing therapy and creating therapy culture. If you could change one practical thing to help people remain on the knife’s edge, what would it be? And I’m going to combine that with a similar question from an anonymous attendee who says, ask, can you suggest any good diagnostic questions to ask oneself or others to discern if we’ve fallen into this culture in an unhelpful way?

Yeah. No, those are good. I think the diagnostic question to ask is am I telling myself a story in which I am justifying to myself things that I later regret because I perceive myself as a victim or helpless to change? One thing I heard a long time ago in a recovery meeting I’ve always thought about is before I do something asking myself, is this something that I’m going to be glad I did five hours from now? Like, I know it’s going to feel good ten minutes from now, but five hours from now, how am I going to feel about this? And I think that has kept me out of trouble many times. I think at least in my life, the way that I experienced this is the sense of, well, I had a really stressful day or I’m really stressed or I’m really not doing; I’m doing so much to help people or I feel depressed I feel sad, I feel like the medication is not working the way that it’s normally working. And if I’m using that to do things that I know to be sinful or just unwise, scrolling YouTube mindlessly for 45 minutes or eating a whole bag of chips or whatever, that story that I’m telling myself about being a helpless victim who deserves things that I know to be bad for me. Then I think that that’s a very, very sensitive way to stay in that middle ground of like what am I doing?

Yeah. So another question from an anonymous attendee who says, you briefly mentioned suffering. Could you talk a bit more about how therapy culture relates to Christian perspectives on suffering and loss? What do believers miss by turning to medicalized approaches?

Mm. Great question. There’s a whole chapter in the book about it. I think a Christian perspective on suffering looks at suffering as a part of life, something we can’t fully expunge from life, something that Jesus chose on our behalf because of his love for us and through that suffering. Hebrews says he became perfect. That through that suffering, we become perfect too. So, even though we are looking forward to a time when there will no longer be any suffering, we recognize that suffering is something that can do good things for us. We don’t intentionally like seek it out because it’s a good in of itself. But we do recognize that we will have suffering that is put on us. That we don’t choose, whether that’s a difficult relationship with someone who’s unlovable or illness or mental illness, physical illness, whatever. But also suffering can always be a teacher. And there are many different reasons why we suffer and many times we don’t really know the reason or it’s not a very fair or doesn’t seem like a good reason to us. But that suffering is always an invitation to draw near to God, to cry out to him and to be with Christ on the cross.

Yeah. So another question from an anonymous attendee who’s asked, how might someone weaponize this book and how do you want it not to be used?

Mhm. Yeah. Great question. I don’t want people to read it and then go after, go whack somebody that they care about over the head with it to say, see, what you’re doing is bad. I don’t want, I definitely don’t want people to use it to say that therapy or psychiatry are always bad or corrupt because obviously this is still what I do in my day to day work. I encourage people to go to therapy. I prescribe psychiatric medications for my patients. I think I left enough in the book that someone who is looking for an anti therapy jeremiad is going to be disappointed. Or someone who believes that PTSD and ADHD aren’t real. They will be disappointed if they actually read the book. But in terms of relationships with other people, because people are going to read this book and think about someone in their life right? My wife did that when she read the book and I think what I want people to do in that situation is just to have a conversation with that friend and try and instead of hitting them with, Doctor Loftus said, Doctor Loftus said, to ask them questions about whether or not the therapeutic process has been good for their mental health, what they are doing in their own lives to increase their sense of agency. I think that is a much healthier response than beating them over the head with it.

Yeah. There’s actually a question on exactly that topic. Who, our anonymous attendee asked, how do we love people who are deeply immersed in therapy culture and talk with them about this without seeming to endorse its concepts? It feels like disagreement with them is perceived as threat. I get the impression that some of my friends who are very into therapy culture would react in anger if I disagreed with their point of view. So sadly, it doesn’t feel “safe” to talk about this with them.

That is the problem, right? Is that once someone identifies something, once someone identifies and perceives something as a threat to their mental health, it’s like sacred. It’s like you’re threatening to stab a knife in their back or whatever. But that’s all based on their own perception of what’s safe. And again, with the medicalization, it’s just expanding and expanding, expanding the list of things that can be considered unsafe or threatening or harmful. Right? Just major inflation of the concept. And that’s hard because, right there, the people who are most immersed in it are the ones that are going to be the most, for them broaching the topic might be a, it’s going to be painful. And for them, the idea of that kind of pain is you harming them. So I think you just have to sort of find a foothold somewhere. Something where you know they have a nub of truth somewhere. Whether that has to do with like, the value of exercise for people who have a mental illness or the sense that getting psychological treatment should be increasing your agency. I think finding that nub and finding ways to ask them, hey, how do you feel like this is working out in your life? Like, in what ways do you feel like you’re getting better? And yeah, it’s a hard thing for sure.

Yeah. So question from Julia McCluskey. And Julia asks, how have you noticed therapy culture influencing churches? What are some of the effects on a congregation or parish?

Yeah. So I think when the story, the experience that kind of helped crystallize some of this for me was that I was going to a church in the US. I was just visiting, so I don’t know if this is what they’re normally like. But there was a sermon and the sermon was like 20 minutes of therapy speak. And then there was like a Bible verse at the end. I’m like, you got it backwards. You can have a little bit of therapy speak to try to get people’s attention. But then, you know, I came to church because I want the Bible. So for churches, I think the way that this constant pressure to reframe everything in terms that are acceptable to therapy culture. And so sin can’t be offending a holy God. It has to be a rupture in the relationship. Like you can say, yes, of course, a sin is a rupture in a relationship. That is true. But is that everything sin is? I don’t think so. And it just sort of taking out anything that might be perceived as psychologically harmful. Unfortunately, the Christian life is not always great for your mental health. Jesus voluntarily died on the cross. And psychiatrists do not recommend that for your mental health. Again, this is a place where therapy culture and actual therapists and psychologists disagree, we have to accept life with all of its rough edges. And certainly within Christianity, we’re sometimes called to embrace those rough edges. For the sake of proclaiming the gospel, for the sake of loving others.

And finally, Matthew, as discussed, want to give you the last word.

Thanks, Cherie. You are loved with an everlasting love. And God’s love for you is so incredible, so amazing, so powerful and so total that whatever suffering that you’re experiencing and especially the suffering from mental illness, you can be healed by Christ. That healing may not be perfect or complete in this life, and for many of us, it won’t. It will be partial in this life and complete in the next. But because God loves you, you have the power to live a life that is full of joy, where you are loving others no matter what your circumstances are and making changes that help you to connect with that love and be connected with other people. That’s the last word.

Thank you. Matthew. It’s been great to talk with you today. And thank you to all of you for joining us. Have a great weekend.

Yes. Thanks, everybody.