The Evisceration of the Human in Contemporary Psychology

Many of my students, I don’t know where they pick this up, start their reports on clients with a list of categories. I often read something like this: Mr. A is a male-identifying, cis-gendered, Indian-American, heterosexual, non-practicing Hindu. My response, typically, is, “What do you have against people with dwarfism? You didn’t say he was of normal stature.”

I think the practice of listing identity categories leads to the clinical approach of blaming all of the patient’s life problems on politics, economics, and social forces. If the client has only intersecting categories and no individual personality, there can’t be anything wrong with the way the individual personality collides with itself, with others, and with reality. The new definition of mental health pervading clinical psychology is not an absence of or a resolution of mental illness or psychopathology; mental health is instead, nowadays, a claim that mental illness should not be stigmatized, and that therefore there’s nothing wrong with the person, as if pronouncements of normalcy are as good as treatment. When a therapist or a doctor says you’re fine, it feels reassuring, but it doesn’t help you get better.

You’re no longer an individual struggling with the particularities of your individual personality—for example, a clash between a desire to be admired and a desire to fit in, or a conflict between the joys of the body and the desire to be the pictorial but not biological image you project on social media. Instead, you are a person with anxiety (if the conflict is imminent) or depression (if the battle to fulfill incompatible goals has been joined and lost). You don’t need someone who can relate to your conflicting selves and help them make peace; you need a pill, some workbooks, and above all to be convinced that anxiety and depression are perfectly normal.

This view of people as intersecting identities rather than as individual personalities eviscerates us of all that makes us unique. But it can’t eliminate the fact that when we look at a menu or a potential lover or a job opening, we still want something that appeals to us personally. I don’t think we’re yet to the point where a White woman ordering a burrito in a restaurant is decried as “appropriating,” but neither do I think we’re far away from that either, especially when the woman in question does not perceive herself as a unique individual but as an example of White womanhood held accountable for the category rather than to her desire for dinner.

The result is a generation of clinicians that includes many who act as if they themselves are merely members of identity categories (race, sex, gender, theoretical orientation, as examples) without individual personalities. Ironically, that is one of the primary features of borderline personality disorder, known as identity diffusion. Borderline personality is a useful analogy to the current tendency to treat everyone’s identity as an intersection of categories rather than as an individual personality (i.e., the things about us that make us different from categories and situations).

Identity diffusion leads to other features of that disorder arising with relative frequency in the current crop of practitioners: conflating blame with the need to change, excessive anger, splitting, and psychotic transference. Identity diffusion I’ve described above: the sense of being indefinite, a creature of circumstances, rather than a cohesive self with customary response patterns. It’s a painful condition because suffering is not absorbed by a resilient self, and little is deeply pleasurable as a counterweight. To savor food, relationships, and accomplishments, one needs a cohesive self. Psychology has largely gone from helping people with diffuse personalities develop a self to treating people with cohesive selves as if they are only an intersection of categorical identities.

Dialectical Behavior Therapy was invented to help people with borderline conditions accept psychotherapy. Their condition interferes with therapy because they are enraged by the idea that there’s something that they can do about their own unhappiness. Agency is equated with blame, and they would rather give up a sense of agency than feel blamed. Nowadays, we take people who are perfectly aware that they are stepping on their own feet and convince them that it’s not their doing.

Borderline conditions are marked by excessive anger, often instigated by abuse or abandonment, and the intensity of the anger leads to rejecting any agency and to identity diffusion. But apparently, it can work in the other direction as well, as psychology fosters rage by treating people as if they don’t have individual personalities and have no agency. This rage is often directed not at other people’s personalities, but at identity categories that are defined as antithetical to their own. The miserable despise the happy, men despise women, and so on. The rage is enhanced by the lack of agency: if you are only a set of categories, there’s not much you can do for yourself. This produces a deep sense of helplessness and fragility, blamed on others, which leads to rage.

Rage leads to “splitting,” seeing others as all good or all bad. If all anger is intense, then all objects of anger must be evil.

Lastly, a central feature of borderline functioning is known as “psychotic transference,” the belief that one’s therapist really does love you or hate you or whatever, rather than recognizing the belief as arising from one’s own history and as not really true. We see this in those who are merely categories and not individual personalities because personality is the touchstone that enables us to realize that our emotions are misplaced. When we are only professors and they are only students, or vice versa, there’s no self to gut-check against. You can’t ask if maybe it’s you; you ask if category members historically fit your emotion.

Evisceration of the self also produces what I call “psychotic countertransference,” the therapist’s firm belief (rather than a passing fantasy) that she exemplifies the category of therapists, with all its wisdom and beneficence, and doesn’t just act as herself—that she has the authority, wisdom, and power to “validate” or “affirm” a patient’s self-worth by simply saying so. She’s a second-year graduate student who still hasn’t learned how to start a session, but she thinks she can remove self-doubt and internal conflict by uttering a blessing.