What next? Thinking about Therapy and Politics

As of Friday, May 17th, I possess a Ph.D. in Communication and Science Studies. I defended my dissertation War, Trauma, and Technology: The Making of Virtual Reality Exposure Therapy in front of my committee: Chandra Mukerji, David Serlin, Kelly Gates, Charlie Thorpe, and Joe Dumit.

While the defense went smoothly overall, it became clear to both me and Chandra (my adviser) that I had not done enough in the dissertation to take a clear stance on the politics of therapy in situating my project. My data about the development and promotion of VRET was interesting, but the bigger picture was somehow missing.

At various points in writing, I found myself working with questions of Foucauldian ideas, such as biopolitics, governmentality, and discipline. I asked what kind of power was being created through the development of virtual reality systems promoted as doing part of the work of remembering a traumatic event for a military service member in therapy. I thought about Donna Haraway’s concept of the Informatics of Domination and Gilles Deleuze’s proposal of the Society of Control as ways of thinking about information technologies as post- (or better yet, neo-) biopolitical forms of power over populations and bodies. I thought a lot about cyborgs and their subjectivity.

But none of this made it into the thesis because every time I went down that path, I lost site of what my data really showed me. Now that the data is written up into some 280 pages, it’s apparent that these are topics I’m going to need to address again.

Here are a few thoughts:

  • Many people have criticized the medicalization of PTSD because it makes a disorder out of a “natural” or “normal” experience. I’m not sure I buy this. Not everyone who experiences trauma has long-term, debilitating suffering. This is not to say that PTSD should be considered an abnormality or weakness, only that it truly represents a kind of suffering that is worthy of intervention. The question is whether therapy or other forms of medical intervention are appropriate ones.
  • We don’t have a great system, currently, for evaluating therapies. All we have is “empirical support” data based on short questionnaires that suggest that someone’s symptoms have remitted over the course of therapy, but these cannot really tell us if someone has healed–only that they have changed their answers to the questions.
  • How could we evaluate therapy, including that for PTSD, based on ethical criteria? Are medical interventions inherently problematic in their conceptualization of disorder and healing and if so, why? Is there a way to have interventions within medical/therapeutic frameworks that also adhere to particular ethical criteria? In order to answer these questions, I need to be explicit about what I believe is ethical, what is problematic in medicalization, and whether the medical and the ethical are inherently mutually exclusive. I really don’t think they are, but I need to be able to explain why this is.
  • In fact, I think therapy can be a very good thing. Unlike someone like Thomas Szasz I don’t just think it’s an instrument of the state to keep folks in line. Rather, I believe that mental illness can actually be a major source of suffering in and of itself (not just because of stigma or social exclusion) and that therapy can be an important part of a journey towards regaining well-being and even agency. People who hide away to save themselves from painful stimuli are not merely socially oppressed subjects.
  • However, I must also address the question is therapy can be ethical when administered in the service of an ethically problematic institution, such as the military. Would I really agree that all therapies are unethical when used in the service of healing combat-related PTSD? Not at all. But then, what would it mean, especially in this context, for a therapy to be ethical? Would it necessarily have to conflict with militaristic goals, or is there a way to conduct healing that is good for the individual without taking an explicit stance towards war itself?

Well, these are all questions I’m going to need to think about seriously as I move forward towards making a book manuscript. I plan to make more use of this blog as a space for thinking through these ideas in the coming months. Stay tuned for elaborations on my thinking about Foucault, cyborgs, and therapy, among other things.

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