Smith is in no doubt about the damage she believes is being done within — and by — her profession. Psychology should be a lifeline for youngsters struggling with their mental health. Yet according to a small but growing number of clinicians, their ability to help is being undermined when it comes to those experiencing gender dysphoria.

At the center of their concerns is the rise of so-called “affirmative care”: an approach which treats a young person’s declared gender identity as something to be validated rather than explored. Complicating the matter yet further is the Conversion Practices Bill, which will criminalize any attempt to instigate conversations around sexual orientation and gender. In other words, it will criminalize those psychologists who attempt to prompt deeper thinking in minors who are gender confused.

I spoke to dozens of psychologists for this investigation, all of whom expressed fears about the professional consequences of speaking openly. The institutions that should be defending them have instead helped create a climate in which voicing skepticism can carry serious consequences — both for clinicians themselves and for the vulnerable young people in their care.

***

Michael Kerr, 34, describes himself as “a walking example of what’s wrong with trans ideology and affirmative healthcare”. When he was 18, and not long out as a gender non-conforming gay man, Kerr was raped in a nightclub. Traumatized by the experience he used drugs and alcohol to cope, wanting to dissociate from his body. He fell in with a queer crowd in the gay scene, who tried to persuade him that he was really transgender, and should live as a woman. His GP referred him to the Sandyford gender clinic (known as the “Scottish Tavistock”) in 2018, and his first appointment was in 2020.

He was, he says, affirmed by every medical professional he met. “From GPs, to receptionists, the gender clinic — [they] all instantly started referencing me as a woman. It was almost intoxicating to be recognized like that.” After a couple of sessions, he was told he could go straight onto a course of hormones even though he was also struggling with depression and self-doubt. No questions were asked, except which pharmacy he wanted estrogen to be dispatched to.

From then on, Kerr says he was led down a path to full transition. “I now know that my problems came about because I had been raped and had no support to deal with it,” he tells me, “but I was just sent on a single path towards transition, and ended up living as a woman for seven years before realizing it was a huge mistake, and starting on the path to detransition.”

Kerr, who set up Detransition Pathway UK this year, has suffered numerous health conditions since stopping estrogen and starting testosterone. He is almost always in chronic pain, and has gynecomastia — excess breast tissue. But, he says, there are no agreed protocols to support people like him.

Neither his GP nor anyone at Sandyford suggested Kerr might try generic mental-health support. “Any decent clinical psychologist should be able to recognize that so many of the young people presenting with gender identity issues have got underlying trauma under conditions,” he argues. “I am a living, breathing example of how not to deal with someone in mental distress.”

Transactivists have long argued that the number of those who regret transitioning, or revert back to their actual sex, is small, tending to estimate the figure at perhaps 0.1%. Kerr believes the figure is far higher, and suggests this is the fault of medical professionals looking after them. Even when he voiced doubts about his gender treatment, he says, the clinic told him to “keep going”.

Hilary Cass foresaw the problem back in 2024 when she published her review of gender identity services for children and young people. Back then, she addressed the fact that some practitioners had become reluctant to provide psychological support because they feared being accused of “failing to affirm a young person’s gender identity or of practising conversion therapy”. Cass was anxious that any future legislation “should not make workforce problems worse than they are”.

The British Psychological Society (BPS) does have a Code of Ethics and Conduct (2021). This outlines four key principles to adopt when working with patients: dignity, privacy, consent and self-determination “of all persons”; working only within one’s trained expertise; avoiding harm and safeguarding welfare; and honesty and transparency.

These principles are particularly vital when working with children and young people, for obvious reasons. The trouble is, the body that is supposed to be advocating for children and professionals is failing to properly care for either.

Two years on from Cass’s review, the psychologists I spoke to attest that, if anything, things have got worse. Underlying complex presentations remain unexplored and insufficient time is given to evaluate psychological needs. As the conversion practices bill strides ever closer to legislation, fear within the profession is growing — yet hardly anyone dares to speak out. Of that small but significant minority of child clinical psychologists who have questioned the affirmative approach of “gender medicine” — all have been roundly punished. Some have lost their income, been labeled transphobic, or worse, held responsible for the deaths of “trans kids”.

“I’m seeing kids now who really need a psychologist who isn’t going to instantly affirm them and send them down the ‘gender’ route,” says Nancy Reed*. Clinicians are afraid to speak out, says the clinical psychologist based in London. “If they heard bad things about me [professionally] and their parents took them away from my care, they would be instantly affirmed by someone else, and that would be the end of that.”

The current model for gender treatment resembles what clinical psychologist Leslie Jones* describes as a “trans conveyor belt”: the affirmation approach leads to social transition, which in turn leads to puberty blockers, cross-sex hormones, and seriously risky life-long medical trajectories. We already know this. But what’s surprising is that the direction of travel isn’t changing. Jones was “horrified” by the “ideological stance” that had gripped the private gender clinic he worked in. Gender became the sole focus, with all of the problems which may have been behind the gender distress unexplored and left to fester. And as another clinician confirmed, we have “gone miles from evidence-based psychological thinking. It’s infiltrated everyone as well as the systems, the people, society.”

***

Consultant psychiatrist Az Hakeem believes the ideological capture of the mental health establishment first took hold two decades ago. When he began practicing in 2000, Hakeem specialized in using psychotherapy to treat adult gender dysphoria. He trained in forensic psychotherapy at the Portman Clinic. This went on to become part of the Tavistock, where the now-disgraced and closed Gender Identity Development Service (GIDS) clinic, itself entirely focused on clinical psychology, was located. For Hakeem, who worked at the Tavistock until 2012, psychology was a crucial part of the diagnosis and treatment. He has always seen gender dysphoria as a “symptom” of broader mental-health problems, not simply a medical one. There is a significant distinction, as he saw it, between the work the psychologists were doing, and the work the physicians carried out. “The surgeons [carrying out sex reassignment procedures] were like master craftsmen,” he tells me. “They didn’t know what was happening in the mind of the patients; the psychiatrists simply referred them for surgery.”

In the early days at the Tavistock, he says he couldn’t keep his mouth shut. “It was just horrific what I was seeing. All I could see were children who’d just be gay. They were like camp boys and tomboy girls. And I remember saying to the person who ran it, ‘Isn’t what you’re doing mad?’”

Hakeem was an early heretic, one of eight clinicians working at Tavistock to sign a 2002 letter published in the Telegraph which criticized a European Court ruling allowing a trans-identified male to marry his same-sex partner. The signatories described it as “a victory of fantasy over reality”. He knew, unlike many outsiders, exactly what was going on because he had worked closely with both pre-operative and post-operative transsexuals. “They gave me a very good insight into how transitioning unhappy people with psychological problems is not the answer,” he told me. “In fact, their problems are almost always exacerbated. Some of the post-operative group members warned those that hadn’t yet had surgery to avoid it at all costs.”

In any other context, he says, the medical professional would explore a patient’s beliefs and motivations, in order to understand what else might be going on. And yet, right from the start, this was not the approach taken by mental health professionals with gender confused patients.

As far back as the early 2000s, in other words, concern was being expressed, and indeed allowed to be expressed, about the fact that little, if any, treatment other than cross-sex hormones and surgery was available to gender-distressed patients. But if Hakeem was able to be relatively open about his views, the professional culture soon started to change.

***

Sam Wood*, a clinical psychologist for some decades, says the rise of transactivism “really hit hard a decade or so ago”. Such is the degree of its current entrenchment that the vast majority of clinical psychologists will avoid expressing any disagreement in public. Indeed, many are choosing not to work with gender distressed children because of the requirement to either affirm them or be accused of practicing conversion therapy. “You’re going to get attacked by transactivists, including colleagues,” she tells me. “They can wreck you.”

Many clinical psychologists warn of this “chilling effect” when discussing the draft conversion practices bill, currently at the pre-legislative scrutiny stage. The Government claims the legislation is designed to criminalize abuse, as opposed to punishing parents or psychologists who resist the push to affirm. The problem is that what Cass suggested in her review two years ago is already coming to pass. Clinicians fear they will be accused of conducting conversion therapy if they take an exploratory approach with the patient — essentially, doing what they were trained to do. And so, instead of questioning the kids, they are urged to enable them. Psychology, it seems, has forgotten what it is for.

As Anna Hutchinson, a clinical psychologist with significant experience in child and adolescent mental health says: “Psychology is not just a profession that provides support and reassurance. It is supposed to be a scientific and clinical discipline, which requires us to question assumptions, scrutinize evidence and consider different explanations in all kinds of ways for all sorts of things. Gender shouldn’t be made an exception. If we lose the freedom to do all of this, we lose something really fundamental.”

Tony Lane*, who trained as a clinical psychologist in 2020, makes a similar point. “One of the first things I was told was: ‘If you have a butch-presenting girl, or a feminine boy… you’re going to have to affirm them as trans, unless their parents are hostile to the idea, and then you’d probably be sacked for conversion therapy’.”

He added: “I thought they were exaggerating, but it turned out they weren’t.” More worrying still, Lane says he was constantly told that being transgender was not a mental health problem despite the repeated insistence that if these children were not seen and affirmed urgently, they might end up suicidal. “Surely that is a clear sign of extremely precarious mental fragility?” he asks. “I felt like we were being told: ‘agree with everything your patient says, do not scrutinize, meet their demands or they might die, and then you’ll have blood on your own hands’.”

It hardly helps, Sam Wood* says, that there “isn’t much of a backbone in the profession”. She tells me that as a result of this lack of resolve, “trans activists can easily steamroll, and just take over, delivering the training courses on gender, and writing the rules pretty much”.

The backbone should be provided by their representative body, the BPS, which is supposed to advise and advocate for its members. But instead, supported by charities and lobbyists such as Gender Plus, Gendered Intelligence, and Pink Therapy, it is delivering courses which pretty much uniformly encourage the affirmation approach. As one old hand who attended such a course complained: “It was hard-line DEI, with constant talk of how race, class, disability, and all the other currently popular oppressions overlap with gender identity.”

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That politicization is now standard, with the BPS silencing any skepticism and pushback. “Their view is, anyone who hasn’t worked with gender is ‘not an expert’,” one former GIDS employee told me. “This mystical ‘expertise’ simply means being willing to affirm anyone and everyone who says they are the opposite sex.”

“If you want an easy life as a psychologist affirming people, [it’s] a dream!” says Lianne Smith* who isn’t smiling. She is deeply frustrated by what has happened to her once meaningful clinical practice. “It takes a high cognitive load to sit with someone for 50 minutes trying to attune to their words, body language, [and] subconscious. Then there are the deeply traumatic stories of rape, childhood abuse, and loss. Gender affirming care takes away all the negativity and just leaves clinician and patient feeling happy and productive.”

What particularly upsets her is, somewhat ironically given the avowed commitment to diversity, is the one-size-fits-all approach. “The kids I work with, they are so varied,” says Smith. “The fact they’ve got the same diagnosis is utterly ridiculous.”

“There’s a lot of victimhood about,” another whistleblower tells me. “There are individual [practitioners] using the fact that they are LGBTQ+, or autistic, or black as a qualification, as opposed to their skills as an actual clinical psychologist.” Indeed, she goes as far as to say that within the profession there are those “who are not cut out to be psychologists” — they simply want to “‘be kind”’.

If the affirmative model dictates that gender dysphoria is not a disorder — and the only “treatment” which can be offered is to kindly say “yes” to any request from the patient, fearing that to do otherwise would be an inducement to suicide — then the inevitable result is medicalization. As Smith explains: “All identity is socially constructed, trans is no different. And in the case of ‘trans’, the identity has been constructed by and with medics and psychologists. No other identity needs medical affirmation to be legitimate, but this one does. It wouldn’t exist — in its current form at least — without medical and psychological compliance.”

There are some who dare speak out. But the consequences can be grim. Anne Woodhouse is an independent consultant clinical psychologist with over 25 years of experience. She nearly lost her job when, in 2022, she was reported to the Health and Care Professions Council (HCPC) for posting and interacting with Twitter posts critical of transgender orthodoxy. Only after three years of investigation was she cleared when no compelling evidence was found that she was unfit to practice. Regardless of the outcome, though, “the process has been the punishment,” she says. “Those three years were so stressful, and to have this serious threat to my professional integrity and career, pretty hellish.”

“I had completely missed how all the organisations had been captured,” she continues. Her case perfectly illustrates the stakes of professional disagreement. Any questioning of the orthodoxy could lead to complaints not just from within the professional body, but also from the general public. In fact, Woodhouse was referred to the HCPC by the deputy head of her child’s school — a part-time drag artist.

I did find another psychologist to push back on the record. But Sandra Pertot is retired and in Australia, whose psychological society likewise refuses to support any form of mental health practice that does not “affirm” children who say they are transgender.

Pertot specialized in sex therapy before retiring as a clinical psychologist four years ago. “In the Seventies and Eighties, I saw a lot of young kids who were confused about their sexuality. I used what has become called ‘watchful waiting’ with them and didn’t tell them whether they were gay or not gay.”

In 2006, Pertot moved to a small town and “naively” began airing her concerns about the rise in children presenting with rapid-onset gender dysphoria at her practice. “I knew nothing about this transgender drama that was going on in the rest of the world,” she says. “And I saw these young kids come in saying they were trans and I didn’t think anything of it. I just did some work, watchful waiting and the interesting thing was none of them suicided, none of them threw hissy fits.”

Then, around 2019, Pertot saw two girls who both independently determined they were male. Unconvinced they met the criteria of persistent gender dysphoria, she sought the opinion of a psychiatrist who specialized in gender. She was told: “Sandra, If they’re saying they’re trans, they are trans.”

“Both of them ended up going on hormone therapy, but it really bothered me,” Pertot continues. “So I started to question this, and this is where I got into trouble.” Like Woodhouse on the other side of the world, she received a complaint against her, and was told she was “the most hated woman in the Sydney queer community”. She’s only speaking out now because she’s retired. As she told me: “They can’t do anything to me now!”

***

So who protects the psychologists? The BPS, which represents 50,000 practitioners and shapes standards and the public debate, is the profession’s representative body. It should advocate for the integrity of the profession. But every single person I spoke to for this investigation holds that the BPS is, at least in part, responsible for the current climate of fear. It has failed to reassure practitioners that legitimate clinical disagreement will be protected. Indeed, it has shut down attempts by those within psychology to stand up to activism — and it has failed to stop activists from embedding themselves within the profession.

Pat Harvey, a retired BPS office holder, is among the Society’s most outspoken critics. She helped set up BPS Watch with other retired clinical psychologists concerned about the organization’s direction. For her, the problem is not merely the BPS’s public position on gender, but how it has responded when members have challenged it. Its position is represented by the in-house magazine, The Psychologist. Harvey has made several official complaints about Jon Sutton, its long-standing editor, accusing him of personal bias and failing to foster balanced debate around gender ideology. Instead, she claims the publication has “regularly promoted the views of proponents of transgender ideology… actively suppressing those of gender critical or sex realist psychologists”. She also claims that the BPS’s gender guidelines were resolutely “affirmative” and minimized the importance of co-morbid mental health concerns. Sutton, meanwhile, bats the complaints upstairs, confident that he will be supported.

Nowhere is this clearer than in the magazine’s promotion of the online clinic GenderGP. Run by Helen Webberley along with her husband Mike Webberley, the controversial service regularly prescribed puberty blockers to children with only minimal consultation. Helen was suspended for two months by a tribunal after putting three patients at “unwarranted risk of harm”, and Michael was struck off by the General Medical Council following a “catalogue of failings” and serious misconduct. When Harvey contacted Richard Stephens, at the time chair of the BPS’s editorial board, and now chair of its research strategy board, to complain about The Psychologist promoting GenderGP, he told her that the magazine’s advisory committee did “not propose to advise amending the article”.

“[Stephens] wrote that the day after the final Cass report was published,” Harvey says. “Doctors had been told that they should not prescribe puberty blockers or cross-sex hormones on the advice of GenderGP as it does ‘not provide physiological or psychological support to patients’. This clearly indicated that they should amend the entry or remove it.” Eventually, they took it down.

Others have submitted similar complaints about being silenced and curtailed from doing their jobs effectively to no avail. One said that he was called a bigot for questioning the “trapped in the wrong body” narrative and told he shouldn’t be practicing as a psychologist.

Sutton, says Leslie Jones*, is “ideologically signed up” to trans ideology. “He said explicitly to me and several other people that he’s not actually going to produce any questioning or critical content relating to trans stuff, it’s all going to be affirmative because ‘trans people are the most marginalized and oppressed’.”

For Harvey, all this runs counter to the very purpose of psychology. “Psychology is supposed to be there to help people navigate their way through difficulties in their mental health, and understand how they became unwell,” she insists. It does not exist, “to validate social justice causes.” However, this is what happened to the BPS. And without the supportive oversight of the body purporting to protect its members, any psychologist exercising critical thoughts — essentially practicing according to their training — is left at the mercy of activists.

Trans rights activists these days wield a lot of power when making complaints about “transphobic” clinicians. The Trans Safety Network (TSN), formed in 2020, extensively scrutinizes the work of healthcare professionals, in particular clinical psychologists and those working in gender-identity services. Its stated mission is that it will “record evidence to understand the timelines and escalation of organized harm against trans people in the UK.” It looks into institutions to ascertain whether or not they are “transphobic”, and reports on alleged misdemeanors. “Trans people are not required to transition in particular ways, experience particular feelings, or obtain medical approval in order to be considered trans,” reads its values section.

In 2021, TSN was successful in its efforts to cancel a conference for trainee psychiatrists, hosted by Great Ormond Street Hospital, claiming that attendees would feel “unsafe” because two “trans skeptical” speakers would be attending. “There is no possible way in which this event can be a ‘safe environment’ for LGBTQ+ and especially trans participants,” they wrote. Health Education England agreed to cancel the event.

The TSN has also devoted considerable time and resources trying to discredit the Cass Report. It has opposed Wes Streeting’s decision to ban puberty blockers; and it has poured scorn on the NHS for failing to immediately validate “trans children” and offer instant access to “gender affirming” drugs. The TSN also takes aim at the Royal College of Psychiatry, criticizing anyone who suggests that puberty blockers and cross-sex hormones may not be good for children.

For his part, TSN’s director, Mallory Moore, has invested a great deal of time harassing clinical psychologists, and making numerous complaints to regulators and management. In an article published in 2023, Moore wrote: “I’ve been reporting conversion therapists to professional medical and therapeutic bodies in the UK for over two years, facilitating survivors to make complaints”.

It’s worth remembering, here, what Hilary Cass said about clinicians worried about the affirmative approach: “The majority of [their] patient presentations were extremely complex, with a mix of trauma, abuse, mental health diagnoses, past forensic history, ASD and ADHD, and therefore this limited assessment was inadequate. These other clinical issues were not addressed or considered in decisions to prescribe masculinizing or feminizing hormones.”

***

Audrey Taylor* has worked with gender-distressed children and young people for her whole career. “I became known as the one that parents struggling to talk to their kids about sexual identity, or the difficulties they were having approaching puberty, would come to, because they trusted me. I’m a bit gender-unconforming myself, and I know how both boys and girls internalize punishing rules about how they should behave.”

Initially, Taylor, who qualified in clinical psychology in the early Nineties, suggests that the kids who came to her would more often than not turn out to be lesbian and gay — or simply not fit the traditional mold of boys and girls. But, as she tells it: “Things got much more confusing once we got into the 2010s and beyond. Kids started telling their parents what to think, and the tables were turned.”

“Parents were being dictated to by their children who told them that they had no idea what it was like to be trans,” Taylor continues, “and that they knew exactly what the issues were, and that they didn’t need a psychologist to work it out for them. They diagnosed themselves.” She adds: “And the parents, this later cohort, appeared to be frightened of their own children.”

Taylor recalls that parents would initially make contact and tell her that their child was suffering from gender dysmorphia, or simply that they were transgender. “I’d never had patients or their parents self-diagnosing. I wasn’t sure what my role was anymore. I would try to scrutinize what the issues were, but I was usually shut down as soon as I started exploring other issues, such as trauma, potential neurodiversity, or some kind of mental health condition.”

Indeed, it’s hard for parents to know how to manage gender confused children, who may get kudos from their peers for identifying as trans, and validation from schools and social services. Given the ever-lengthening waiting lists for psychological help from the NHS, and the explosion in anxiety and autism among children, many desperate parents will seek help elsewhere — and private psychologists are happy to help. “If they are going through difficult times, for all kinds of reasons, they’ll just put all their eggs in one basket and say: ‘We’ve got a gender incongruent child’.” Private clinics will then give them instant validation. “Then the problems really begin.”

By this she means medication. Despite the warnings in the Cass Report about the weak evidence base for prescribing puberty blockers to treat gender dysphoria, this is an increasing problem. Not counting those who are in private treatment, today, more than 250 primary age children, some as young as four, are in line for “gender care” treatment at NHS clinics. What this care actually consists of is unclear. Although the use of puberty blockers has been banned, Cass has thrown a crumb to the activists, who may be able to access medication via clinical trials; Cass believes that otherwise, children will procure drugs from “unregulated and dangerous routes”.

In the meantime, with the explosion in mental health problems among the young, NHS waiting lists are growing ever longer, and private providers are thriving. In 2024, a private clinic called Gender Plus Hormones, for “gender questioning” young people, became the first service of its kind in the UK to receive approval from the Care Quality Commission (CQC). Part of the provider Gender Plus, it offers hormone treatment to those over the age of 16 following psychological assessment “by a team of clinical psychologists across a minimum of six sessions”. Its CEO is Aidan Kelly, who in 2024 wrote in the Guardian that clinicians should be the only ones deciding whether or not to ban puberty blockers, not politicians. He points out that puberty blockers can be helpful for a “carefully selected minority of transgender youth who have a clear and consistent understanding of their gender identity”. The trouble is, if these children have been affirmed in that identity without challenge from a young age, as seems to be the case within the profession now, how are they to know that this is truly what they want?

Currently, Gender Plus Hormones is unable to prescribe puberty blockers, but they have commissioned what they’re calling “an independent review” to assess the evidence behind the decision to ban them for children. Dr Gideon Meyerowitz-Katz has been commissioned to write it: he has referred to the Cass ban as a “moral panic”.

So while a few clinical psychologists are battling to discuss whether their young patients have underlying trauma, others are applying to gender dysphoria the same logic that they might apply to preventative dental work, i.e., the earlier we get in there, the better.

This tortured debate over puberty blockers raises a serious question for psychologists: how are the effects of transition actually measured in the young? And this is something David Freedman, a retired social science researcher, has studied in depth. In 1998, he co-edited a book by the founder and former director of Tavistock’s Gender Identity Development Service (GIDS), Domenico DiCegli, called Stranger in My Own Body: Atypical Gender Identity Development and Mental Health. “At that time,” Freedman tells me, “there were relatively tiny numbers of people who claimed to be trapped in the wrong body.”

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Some years later, as he saw growing disquiet within the profession with regard to children presenting with gender distress, Freedman came out of retirement to examine an early intervention study by GIDS and University College Hospital. The study involved 44 children aged between 12 and 15 recruited over three years. It concluded that the puberty blockers brought “no changes in psychological function”.

The methodology included information compiled from questionnaires from both parents and children about feelings, relationships and depression. Yet when Freedman, along with Professor Susan McPherson of the University of Essex, re-analyzed the data, they found a huge range in the outcomes in terms of mental health. While just 29% had improved, 37% showed no change, and 34% had deteriorated. Their 2024 paper on the topic caused consternation among transactivists who had previously argued that puberty blockers do not cause harm.

“I felt children were actually being abused,” says Freedman, “and that they were being entrusted to a service that was not offering the best possible treatment to them.”

“Puberty is crucial,” he continues, “children build bone mass and [the drugs] suppress growth spurt and skeletal strength. We don’t know yet exactly what effect it has on the brain, but we know it can and does affect functioning. This is unforgivable abuse.”

Nonetheless, following the closure of the GIDS and a growing call for the puberty blocker trial to be canceled, Cass told the British Medical Journal that she still considered it justified. “Her own review found that the evidence for puberty blockers is extremely weak, that there is no demonstrated benefit, and states that the longer-term risks are unknown,” says Lianne Smith. “And now Cass is a staunch defender of conducting a trial involving 250 child guinea pigs…”

***

Could there be another motivation behind the push for blockers? Joanne Hall*, who worked with young adults in a gender service, believes there might be. She says she discovered the limits of her freedom when she began questioning whether patients’ wider psychological needs were being adequately addressed. “Of the patients that come to the clinic, there is high rates of autism, of complex trauma, of abuse. Those things are clearly relevant, but I was called transphobic for saying it.” Hall says she took her concerns to senior managers, but was eventually pushed out of her role. She recalls confronting one manager: “I said, “We’re castrating people as a treatment option when this is about trauma and autism.” He said, “I agree with everything you’re saying. The thing you don’t understand is that the gender service bankrolls the mental health service in this city.””

Her account raises a question that is arguably bigger than the dispute over gender medicine per se: what happens when someone’s clinical judgment comes into conflict with the priorities of the institution employing them?

***

Today, Parliament will hear the first oral evidence on the Conversion Practices Bill. Which way will it go? And will the outcome be indicative of whether this bitter battle is lost or, finally, won? It is worth remembering Cass’s emphasis, in her review, that young people experiencing gender distress should receive comprehensive, evidence-based mental-health support, just like any other child with similar psychological or neuro-developmental needs. But that would require psychologists to be brave and robust enough to stand up and say that their profession doesn’t advocate for this approach any more. It would also require their regulatory body to support them.

Will the BPS do that? The jury is out. I contacted them, offering a right of reply regarding the numerous complaints made by members and former members. And I also asked what they had to say about Sallie Baxendale’s shortlisting for the Maddox Prize, following her research into the effects of puberty blockers on brain development. The prestigious prize is awarded to scientists “whose courage and persistence in promoting or defending evidence despite facing obstacles have had significant real-world impact”. And, as Baxendale pointed out: “It is a sign that something has gone very wrong when ordinary clinical enquiry and following the evidence needs to be recognised as an act of courage.”

“The BPS should have been the strongest advocate of the concerned clinicians at the Tavistock,” she says, “and should now be celebrating them as examples of the very best of us.” But while the BPS declined to respond, there is a glimmer of hope. A number of psychologists have gravitated over to the Association of Clinical Psychologists (ACP-UK), which does take a firm stand against the instant affirmation model.

What will this rupture do to the practice and integrity of clinical psychology? Today’s parliamentary hearing will give an early indication of how this battle might play out. But amid all the furor, a more important point risks being forgotten. Those who have the most to lose from this struggle aren’t the psychologists or the credibility of their discipline; the greatest price will be paid by the vulnerable people it exists to help.

* Names have been changed. 

Social media would have us believe that this dynamic is now the norm in heterosexual relationships. Men err like bumbling toddlers; women manage and chastise and cajole them. These videos are fed to me continually on TikTok: women telling horror stories about terrible dates; women offering advice on harnessing “dark feminine energy” to manipulate love interests; women fresh out of breakups denying the value of romantic love at all. Associating with men, these videos tell us, is a matter of tragic compromise — an embarrassing slip into an enclosure of backwards baboons destined to disappoint us. The assumption, borrowed from the language of motherhood, is that girlfriends have a monopoly on reason and on perspective; their partners, on the other hand, are hopelessly in thrall to impulsive urges and emotions, base creatures reliant on sex and drink. In this dynamic, the woman’s celestial faculties have one major source: therapy culture.

The cult of the Therapy Girlfriend was thrown into relief last week in a skit which went viral on X. In it, a woman sits across from her date; she quizzes him on various attributes. Age? 28. Attachment style? Secure. Credit score? 780. Therapy? Once a week. So far, he passes muster. But then the guy scuppers the deal by asking her to “go to my place”; she weighs anchor.

Yet it wasn’t the woman’s skittishness about casual sex that summoned discourse; it was the fact that attending regular therapy was on her list of requirements — once a week being the bare minimum for dateability. Assessing it later, the commentator Colin Wright wrote that the requirement made sense because of “how thoroughly many Left-wing women view nearly every interaction through a kind of ‘therapy ideology’ with its own special language”. He went on to describe how such women conceive of therapy as a sort of “mental-health gymnasium” — part of the necessary upkeep of every healthy adult.

Rather than emerging fully fledged into the adult world, there to deal with the ups and downs of life, therapy culture has us with one wing dangling from the chrysalis — always ready to be bashed by a gust of wind. To go through life unscathed requires Joan Didion’s vision of self-centered psychological labor: “[We are] something to work at, work on, ‘make an effort’ for and subject to an hour a day of emotional nautilus training.” With all this self-discovering, who has any time for seduction?

Clearly, there are occasions when therapy serves a purpose. Men and women alike benefit from it when living with grave psychiatric disorders; in many cases, these interventions should be lifelong with otherwise disastrous consequences. But should all men, even those without troubling histories, be marched off to a headshrinker for the mere purpose of neutering defects, buffing out the bad before they are allowed near a relationship? Any reasonable dater would say no.

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And yet, increasingly, social media pins romantic disappointment on the sins of untherapized men. The language of relationship “attachment styles” is a nauseating example — a bullshit taxonomy of daters said to be doomed by early parental relationships and who, in a better world, would simply be called “desperate” (instead of “anxious”), “not into you” (instead of “avoidant”) and “normal” (instead of “secure”). The greatest trial sent a dater’s way seems to be to fall for an “avoidant” — those who run from intimacy because their mother didn’t rush in when they cried in the crib, or something — and advice on how to “handle” such partners is everywhere in the online femosphere. Such women would do better to avoid those who don’t like them back. Put that on a T-shirt. But the comforting delusion that this attachment-style discourse affords women is that it lets them avoid the horror of simply not being wanted; instead, they are free to meditate their way through an “avoidant discard” (when said partner ups and leaves out of nowhere) by a man whose inner child feels abandoned, and so is scared of intimacy, or whatever the rationale may be. As usual in the theater of hyperindividualism, everyone else is to blame. Easy to see how this flattering framework might have gained traction.

Equally, any amorous mishap can be palmed off on a partner who has failed to do “the work”: the usual, devastatingly reasonable causes of breakups — loss of feeling, wandering eyes, the contempt of familiarity — are traded for ego-friendly explanations: “He is frightened by his enormous passion for me”; “He wants to be with someone less emotionally challenging”; “He is afraid of replicating the mistakes of his parents’ marriage” and so on and so on. Let’s not face the fact that, sometimes, he’s just not that into you. Humility and resilience around this truth is an essential lesson of adulthood — far more valuable than any therapy package going.

This is not to say that the Therapy Girlfriend intentionally weaponizes counseling-speak in her romantic campaigns. In fact I’d contend that the assumptions of therapy — that we must continually enforce “boundaries”, manage “disclosures”, hold “dialogues” and seek “growth opportunities” — pervade Millennial and Gen Z dating culture to an extent that they no longer bear the antiseptic stench of their clinical birthplace. Therapy culture is hopelessly in bed with identity politics, and adherents of one are all but guaranteed to cleave to the other: its obsessions are the same, primarily the unimpeachable traumatized individual, whose needs and expectations supersede those of all others. Its emphasis on “empathy” always seems to go only one way: towards the therapy subject. Even in the context of couples’ therapy — something which, shockingly, I have known unmarried couples in their twenties to do in London (just end it!) — the “discoveries” of therapy seem far more likely to advantage the woman, who is encouraged by our culture to be more analytical, perfectionist and cautious in heterosexual dating. We go through our teens and twenties being told by TikTok dating gurus to fear and loathe men who are both guaranteed and determined to take advantage of, two-time and/or abandon us, such is the culture of fear around relationships; therapy culture is the peg with which we can hold our noses if we must associate with one. We women are encouraged to wield theories about personal growth and the emotional trigger as a sort of disinfectant: get with the program or be cast out — you’re a romantic biohazard.

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Now, don’t get me wrong — our exasperated kitchen-berator from the bed-puke breakup video can clearly do better: this man is an unsalvageable loser. The problem is that when women are encouraged to use the teacherly language of pop therapy (which, unlike real therapy, flatters the help-seeker rather than challenging them), they make losers of everyone they date. Yes, some men — like some women — are unstable to the point of being beyond saving; but a reasonable dating culture would tell us to avoid them, not to reconstruct them. But the Therapy Girlfriend necessarily turns the entire male dating pool into a shuffling army of bashful apologetics, self-flagellating for their criminal lack of “inner work” or suffering through ritual weeping sessions to show their emotional literacy.

And, critically, the Therapy Girlfriend avoids all fun. Love interests should not be cowed by a watchful therapist lingering in the background of all amorous encounters, like the forever-scowling HR team of a midsized corporate office. Men are right to be suspicious of women steeped in the language of “grounding” and “journeys”. These concepts are so often rigged towards things that do not a good relationship make: cautiousness, endless analysis and fragility. At the precious center is always the therapized person, cradling their own self-esteem. In striving to be perfect, placid and invulnerable beings, we miss out on the thrill of romantic risk; the pleasure of being around people who are perhaps not precisely like ourselves. Falling in love is by its nature “dysregulating”, a spinning blizzard, a waking dream. It very often ends in tears — but it’s always worth it. Therapy Girls reading this: send your inner child off to crèche. At some point the grown-ups have to do the talking. If not, you might just let the good times pass you by.

The audience — from gray-haired professors at the top of their game to undergraduates, there to present a poster  — whooped, cheered, and clapped enthusiastically.

We were five minutes in, and I, an ethnographer with a doctorate in anthropology and 30 years’ experience, already felt not-at-home. The speaker, Jason De León, an academic star who has won every major award the academy can bestow, began his talk by recounting how he’d “remained silent” during an event he attended at which colleagues offered public condolences for the recently murdered Charlie Kirk. He’d been disturbed by the sympathy, he said, because “Charlie Kirk was a peddler of hate speech.” However, his silence had “inhibited” him, and his speech for that prior event was mediocre, he told us, because he had not been “true to himself.” 

Next, he issued a trigger warning before diving into a tale of his traumatic childhood, his identity as a man of color, his emotional numbness, his therapist, his need for danger, and his fieldwork among human traffickers. He showed us childhood photographs. He wept. He said he’d told the traffickers that he was “fucked up, too.” They were “damaged, fearful, angry men,” he said: “so am I.”

De León is not an outlier. He represents a new academic persona of Therapeutic Scholar-Hero, whose ascendancy spells nothing less than the death of the university: not the first time this death has been predicted, to be sure, but the first time it feels earned. This persona claims its authority not from intellectual credibility or scholarly rigor, but the capacity for emoting. The narcissism of the Therapeutic-Scholar Hero isn’t a bug, but a feature. 

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Over the next three days, I witnessed similar behavior at numerous symposia and presentations. At the symposium on “feminist ethics,” organizers handed out a book list that featured exclusively “disabled scholars.” The first presenter announced her pronouns as “she/they,” and told us that her disability had “flared,” ahead of the conference, preventing her from preparing. She’d also been sidetracked by “urgent” campus activism: “I almost didn’t come, but I needed to publicize my book!” The audience loudly cheered. 

This was rank self-promotion, disguised as vulnerability. Her talk, unsurprisingly, was thin, disorganized, and derivative. She ended with a call to resist the “fascist state” because “ICE is coming to this town next.” More rapturous applause. 

Or take the symposium on autoethnography, a subfield of anthropology in which researchers use their own lives — their emotions, relationships, and personal histories — as data. The room was full long before the talk began, with several high-profile scholars in attendance. One after another, the speakers shared personal or familial stories adorned with ethnographic commentary. One presenter suggested that the dust that had settled near a nuclear test site during her grandmother’s youth caused her grandmother’s early death. This was autoethnographic evidence of the American war machine — and an instance of “missing kin” and “intergenerational trauma.” 

In each case, the ethnography merely served to illuminate the personal narrative, rather than to advance a theory. The insights were predictably underwhelming. Although each speaker insisted that story was more accessible than theory, and was more likely to resonate with the “public,” none addressed the central problems of this method: what distinguishes self-expression from scholarship? What are the limits of subjectivity as data? What about distortion, selective seeing, the dangers of solipsism? 

The speakers were apparently unbothered by these elementary concerns, preempting scrutiny or critique by deploying the concept of “positionality.” To acknowledge “positionality” is to explore how one’s own biography shapes the questions one asks, and informs both the things one sees and doesn’t see. To speak from a particular position or identity can yield insights, though it also makes blind spots inevitable. The concept was never intended to confer automatic authority or serve as a replacement for analysis. 

One speaker concluded by asking, “What does it mean when the story truly leads the way, and arguments emerge out of stories, rather than the other way round?” This question was intended rhetorically, but I can answer it: if the story leads, the story sets the terms. An argument that “emerges” from a story is not an argument, but a statement of feeling. And when emotional revelation is framed as expertise, and scholars are rewarded for being rather than knowing, the university mission becomes therapeutic narrative rather than scholarship. Once who you are is treated as epistemic authority in itself, feeling replaces analysis, and identity displaces argument. 

“Being rather than knowing” was on particularly vivid display among the early-career academics at the conference. Young men wore berets, soft floral shirts, and scrunchies on their ponytails. Young women were in army jackets, boots, and elaborate earrings. The clothes were deceptively expensive; the attitude reminded me of 1990s gay clubs, where knowledge of the dress code determined entry. Attendees paired the aesthetic with an aggressively casual decorum: arriving late, eating noisily, putting socked feet on chairs. The message was clear: I reject hierarchy; my comfort is political.

Such conduct provoked in me a sensation I’ve recently grown familiar with: being subtly rebuked — a quick glance, a sidelong smile — by young colleagues. If scholarship is now confessional and moralizing, if identity confers sacred authority, then early-career researchers, even students, can be just as “insightful” as their elders, perhaps more so.

At one panel, a young scholar responded to a methodological question with a short speech about rent and “precarity,” ending with the extraordinary line: “I’ll let you sit with that.” It wasn’t the point that startled me, but the tone: a novice addressing senior scholars in the therapeutic register, as if counseling them. In that small flourish, the collapse of hierarchy revealed itself perfectly. 

These younger colleagues are bold in a way unimaginable in my early years, when I was acutely aware of how little I knew and how much I had to prove. I trained under Godfrey Lienhardt, an exquisitely sensitive ethnographer and master of the discipline, whose magnum opus came much later than his doctorate. He believed in form, structure, and the metaphysical stakes of ethnography. His lineage did cosmology, mapping a community’s entire worldview and belief system. The new cohort does identity. And only identity.

But this inversion is not the fault of the youth; academia no longer allows people to ripen. PhDs are time-limited, rewarding speed, compliance, quick conclusions, and ideologically safe frameworks. The old apprenticeship model, in which seriousness and self-knowledge matured slowly, has vanished. The death of the university is, in part, the death of spaces where maturity matters.

Nor are all senior scholars resisting this shift. At the conference, many older professors were fully aligned in tone, performance, and politicized moralism. There were still serious thinkers doing rigorous work, of course, and I attended some of their sessions. But they no longer set the atmosphere of the discipline — the language, incentives, and epistemic norms. And they no longer shape its future.

Nowhere is the decline of analytic clarity more visible than in the university’s treatment of sex. As a category, it has collapsed entirely into “gender,” sliding from the empirical and material into pure subjectivity. At the conference, this was reflected in the pronoun badges we were encouraged to wear. (After several attempts, I managed to delete mine online and print a badge with only my name and university.) 

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It also appeared in presentations featuring the all-too-familiar patois of gender ideology: “female-identified bodies,” “womxn,” and pregnancy as something that happens to “people.” One paper described “pleasurable violence” within a Central American trans-feminist community as “healing” when consensual, collapsing harm and care into the same category. Another uncritically mapped contemporary Western “nonbinary” gender categories onto non-Western cultures, regardless of the local realities, in the name of decolonization. It was jarring to confront scholars unable to distinguish vastly different cultures and civilizations, and committed to romanticizing pre-colonial systems.

The slide from empirical clarity into therapeutic reassurance wasn’t confined to the panels. Some of the same conceptual moves on display here have already appeared in high-ranking journals: a reminder that these tendencies are not fringe aberrations, but are increasingly institutionalized as “scholarship.” In the book hall, Princeton University Press was prominently displaying Sex Is a Spectrum, the establishment’s polished argument that biological sex can be dissolved into gradations and feelings — a theme reinforced by the book’s author, who was ubiquitous at the conference. Here was another face of the Therapeutic Scholar-Hero: more philosophical than performative, but still committed to dissolving material categories in favor of subjectivity.

I have had a front-row seat at this unraveling, across many disciplines and arenas. The American Anthropological Association conference was hardly unique; but what I saw there was the distillation of the trend into its clearest form. The tragedy is not that universities have become ideological; it is that they have become unserious. A culture that once prized discipline, depth, and rigor now rewards emotional display, political conformity, and autobiographical performance.

The university has forgotten what it was for: to preserve and extend knowledge across generations. That requires hierarchy, apprenticeship, discipline, shared categories, and a recognition of material reality. When these collapse — when reality becomes optional, subject to feeling and “lived experience” — there can be no transmission of knowledge, only performance and self-display.

The old university was often cruel; brilliant older scholars could crush young ones, intentionally or not. I experienced this myself. For this reason, and others, it took me years to find my voice, and more time still to mature into having something worth saying. But the old university also met the world with humility, patience, and an understanding that social science is, at heart, an encounter with the other, not a stage for the self. It was a craft that taught me to pay attention to the world before attending to myself, to question before confessing. That formation shaped my intellectual life, and what I learned then is simply no longer being handed on.

The university once existed to clarify reality. Today, it obscures the real. Everything else follows.

Soon enough, the program demystified the material for him, and was easy to interact with. That quickly led to her son using ChatGPT as a therapist. “I’m having these feelings, what should I do?” he would ask. ChatGPT would duly answer: “This is how to think about your negative thoughts; these are the exercises you can do.” Natasha feels its advice is essentially the same as what his therapists and parents have been offering for years: but better organized, more detailed, available on-demand — and free. Encouraged by early successes, Natasha and her son fed ChatGPT detailed information from past evaluations and therapists. “And that,” she adds, “was even more useful.”

Natasha’s son’s situation sounds like a nearly ideal case. At 22, his usage is private, but is supported by clinical data and in-person care. Others, however, are experiencing the same rapid uptake and obvious benefits: just with fewer guard rails. Recent statistics on AI usage have revealed a critical-mass shift towards personal-emotional use, with “therapy/companionship” becoming the most popular reason people turn to tech.

ChatGPT alone had 5.9 billion monthly visits in May: a lot of people turning to AI for their most intimate needs. A Harvard Business Review study found therapy and companionship have knocked “search” and “generating ideas” from the top three usages entirely. Of the people I spoke to who are using AI for therapy, most mentioned a trio of obvious benefits: price, availability, and lack of the judgment or drama you might experience with a human being. Everyone I spoke with felt it was beneficial for them.

Monique, a college professor in her early 50s, writes over email that she has been using ChatGPT 4.0 “obsessively” for the past several months, as she works through a conflict she has been having with colleagues. She says it has helped her gain perspective during moments of catastrophizing, and avoiding burdening friends with the “repetitive revisiting of the same worry I couldn’t let go of.” Monique feels that she can ask “more reckless” and personally revealing questions than she would her regular therapist.

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Dane, a 37-year-old software engineer in New York City, has gone more personal still. He’s been using AI for around a year to discuss problems in his relationship, and spends hours at a time with it during crises, sometimes pasting entire text-message “novels” to the machine. He finds that it provides “immediate emotional relief” and helps him avoid conflict with the woman he’s dating. She uses it too. During fights, he says, “we reference it as if it’s an authority on our relationship.”

Reagan, a 24-year-old copywriter, is more cautious, writing over email that she avoids discussing topics that are more important to her or central to her identity. But she uses it to “deal with my hypochondria,” not annoy her boyfriend with endless worries, and decode confusing work interactions with people she doesn’t “totally understand” or who strike her as “insincere or mind-gamey.”

The problems chatbots can create when they encounter unstable personalities is an emerging issue, as reported recently in The New York Times. There’s also at least one lawsuit underway from a mother who believes that her otherwise healthy teenage son was lured to kill himself by a relationship gone awry with Character AI. At the same time, there may be reasons to question even what seem like the highly positive interactions experienced by the people I spoke with.

I tried soliciting the advice of the basic free version of ChatGPT on a friend-conflict of my own, doing all the due diligence suggested by my interview subjects — telling it to “take a clinical position,” as recommended by Monique, and to “be brutally honest with me,” as suggested by Dane. Its insights felt spot on. ChatGPT’s analysis allowed me to feel that I was in the right in the conflict with my friend; it was very complimentary, and it picked up on a character trait of mine regarding conflict that felt revelatory and will, I’m afraid to say, change the way I think about myself.

I’ve had similar insights from in-person therapy, but never so easily and directly obtained. This had frightening addictive potential. I am a single, divorced mother who sometimes spends the evening with a bottle of wine, doom-scrolling and stalking her exes. How about a date with ChatGPT instead? We can talk about me! All the next day, I felt an itch to return to the interface and input a “more reckless” personal query, as Monique put it. The interaction also seemed to have a mood-lifting quality that I associate with digital flirtation — a pleasant, nearly subconscious feeling that there’s something good to get back to online.

Falling for the flattery and validation seems like one obvious danger — and is notably distinct from what it usually feels like to visit a therapist. Another is the extent that the people I spoke with tended to believe in their AI of choice’s powers of judgment. They were aware, as Dane put it, that they were “speaking to an echo chamber,” but it didn’t seem to sink in. Monique provided me with documentation of her work exploring its decision-making methodology. It was clear that she’d been probing it to reorder its parameters to support her position — and, surprise, it complied. But does this really mean she’s correct and her colleagues are wrong? When I reconfigured my query to represent the conflict from my friend’s point of view, ChatGPT gave me a nearly opposite reading on the situation.

Therapists, naturally, have grave reservations. Sherry Turkle, the founding director of the MIT Initiative on Technology and Self, has written about the ways new technologies have changed our deepest understanding of what it is to be human — often, she has found, by luring us to view ourselves as more machine-like. Turkle warns that “pretend empathy” from AI may shift how we define empathy itself. In addition, in her view, the very things we’re trying to avoid by talking to AI — the uncertainty that comes from interacting with a real person — might come to seem like “bugs” and not an essential part of being human.

I felt a version of this in my interactions. In any ordinary conversation with a person, I would be polite and thankful if they were patiently indulging me while I talked about myself, but behaving that way felt silly when talking to ChatGPT. I had to push myself not to do so. Why say goodbye when you can just log off? It’s reasonable to expect that this might affect how I treat real people over time. Being courteous might begin to seem fluffy and irrelevant, and the person who responds badly to brusque treatment might seem oversensitive.

Luke Burgis, a founder of the Cluny Institute, an organization that seeks to promote “the flourishing of the human person,” voices similar concerns. “When content is divorced from incarnational realities,” he says, “it doesn’t have any real power to affect change.” Burgis has “pulled back” on using AI even for work-related purposes. “There’s no life in the AI,” he says, “and the more we interact with dead things, the deader we ourselves become.”

Claudia Krugovoy, a psychotherapist in private practice in New York City and Westchester County, provides a down-to-earth, daily-practitioner’s viewpoint. She describes herself as “open-minded” to AI therapy’s possible benefits, such as affirmation and helping to point out behavior patterns, but says, “I don’t believe it replaces the value of a real relationship with a therapist.” Therapists both affirm and challenge — and unlike AI, they read non-verbal cues and offer real empathy.

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Also, Krugovoy says it can be healing when people learn in therapy that “they can develop a relationship with someone and they won’t be rejected.” Ideally they take that trust and insight into the real world. When people choose to specifically avoid real people by interacting with an LLM, it may fail to “challenge their deeply held, and perhaps false, beliefs that they can’t bring their full self to a relationship.” (This called to mind the sentiment expressed in various ways by Monique, Dane and Reagan that they used AI specifically in order to not annoy or upset friends or partners.) Krugovoy also worries that the usage will ultimately reinforce a feeling of loneliness. “We need community more than ever,” she says.

Regardless of these drawbacks, the benefits to families like Natasha’s are compelling. She and many others also bring up the difficulty of finding a good therapist and the downsides of interactions with bad ones, as a reason to turn to AI. “We’ve tried hundreds of therapists over the years,” she says, “and 90% of them are disappointing.” Every time a person tries out a new therapist, they incur expense and put in painful emotional investment that can itself be traumatic. Reagan adds that “all of these professions have become so robotic anyway. I think they should face competition… Maybe a potential development could be the original industries becoming more human?”

Whatever a rational cost-benefit analysis might be, we’re unlikely to perform it in our current political system. In a functioning democracy, we might debate the benefits versus the dangers of unrestricted access to AI, and then vote on it. (Universal mass student cheating, who’s for it? Custom porn chat for kids, yay or nay?) Instead, AI has been unleashed upon us, and we have little recourse against the tech gods who have done so. We’re also on softened ground, as Turkle notes, already shaped by phones and social media, and ready for the next step of an entirely “artificial intimacy.” I’m sympathetic to families like Natasha’s, and can imagine cases where a prescription for supervised AI therapy could be an incredible tool. But personally I wish I’d never touched it — and I’m afraid I’ll do so again.

In advance coverage of Notes, Didion’s executors (a cohort that includes her agent, her longtime editor, and Knopf’s current publisher) take special care to emphasize that when the memos were discovered, they had been printed out and arranged chronologically in a file folder near the author’s desk, as if the gesture of organizing documents in a 50-cent folder constitutes an instruction to publish its contents in a glossy $32 hardcover decades later.

Didion’s life and work were governed by her infamous capacity for restraint. She exercised an almost anachronistic degree of discretion, a level of dignity that would not be possible for public figures who came after. But even casting aside Didion’s persona, this was a writer famed for her meticulous perfectionism, a woman who rewrote her drafts dozens of times until every sentence sang. It’s difficult to imagine her agreeing to publish a book whose first line is, “Re not taking Prozac”. Perhaps if Didion had the opportunity to fashion these memos into a project with more direction and economy, this book would have earned its place within her body of work. But as it stands, one wonders whether Didion would even grant that Notes to John qualifies as a proper book, a unit of composition that could be stacked alongside Didion’s masterful nonfiction collections like Slouching Towards Bethlehem and The White Album.

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In her private transmissions to her husband of nearly 40 years, Didion comes across as guarded and self-censoring. In a work of this nature, we hope to unearth at least a few stray details that might complicate our understanding of the author’s inner life. The only interesting aspect of this project is the gesture itself — the impulse to catalogue her therapy sessions and report them to her husband. But the tone is perfunctory and clinical, written as if under a court order to document her therapeutic insights.

Didion & Babitz, Lili Anolik’s tabloid-adjacent double biography of Didion and the artist Eve Babitz, published last year, delivers many times more compelling insights into Didion’s mindset. Anolik writes, “Engraved at the top of her stationary was Joan Didion Dunne, but she always … ran a line through the Didion”. This prompts Anolik to wonder: “If ‘Joan Dunne’ was how she wished to be known, why didn’t she order stationary with a Joan Dunne engraving? Was it because she wanted to call attention to the fact that she, a major writer, was allowing her identity to be subsumed by that of her husband, a minor writer?”

In this case, Didion’s scattered personal effects are more revealing than her private writings to her closest confidante. Anolik isn’t the first observer to clock the author’s cosmetic deference to her husband, although she provides the most complete accounting of it. Also from Didion & Babitz, a letter that Babitz wrote but did not send to the diminutive Joan Didion in the Sixties: “Would the balance of power between you and John have collapsed long ago if it were not for the fact that he regards you a lot of the time as a child, so it’s alright that you are famous? And you yourself keep making it more alright because you are always referring to your size.”

The balance of power in the Didion-Dunne marriage was delicate. The couple’s lifelong friend Dan Wakefield remarked on their shared magazine column: “The Saturday Evening Post wanted Joan to do a column called Points West. She said she would, but only if she could alternate writing the column with John, and only if she and John could each have their own separate byline.”

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Like Andy Warhol, Didion saw something in American culture before the culture saw it in itself. She was ahead of her time, a sort of proto-trad-wife — a breadwinner masquerading as a beauty queen. Didion would have married into an affluent single-income household had that been her ambition, devoting herself to motherhood and family life, writing in her spare time. But, as Anolik keenly observes, Didion wanted both “the democratic fame of a popular hack and the aristocratic grandeur of an acknowledged literary genius.”

Like the tradwives that came after her, she could not suppress her careerism, nor could she suppress her appetite for fame and attention. Contemporary conservative influencers monetize the performance of motherhood and housekeeping, but Didion carved out the archetype when it still possessed an aura of newness, rejecting the burgeoning counterculture, conforming to an Old World model of femininity and making it look cool. She’s rarely credited for her supreme contribution to the phenomenon that is the socially conservative It Girl. Every time she denounced the spirit of the age — the Sexual Revolution, the women’s movement, almost every aspect of the Sixties — her star rose higher.

But Didion continually failed to live up to her traditional aspirations, even in her fantasies. She told Dr. MacKinnon: “I keep hearing that small girls imagine themselves as brides, princesses in wedding dresses. I never had: my earliest picture of myself being ‘married’ was getting a divorce, leaving a courthouse in a South American city wearing dark sunglasses and getting my picture taken.” Indeed, at no point did she encourage her daughter, Quintana, to date or consider marriage. She spent the bulk of these therapeutic sessions bemoaning Quintana’s unwillingness to seize the opportunities Didion found for her in photograph. She continually expressed frustration that Quintana’s focus seems to be on “leaving her job rather than going somewhere specific”.

It apparently didn’t occur to Didion that work might not provide the same salvation for Quintana as it did for her and Dunne. Status was Didion’s prescription for alcoholism and depression. Superficiality was her prized maternal wisdom. She told her doctor, “I had said repeatedly over the past few years — when Quintana expressed unhappiness or hopelessness about her situation — I had tried to explain that she had to make a decision to be happy. That there was an actual benefit to putting on a happy face”. Over the course of a few dozen sessions, the author cobbled together an impression of Quintana’s well-being based on her enthusiasm for her professional life and her capacity to manage basic daily tasks. In one of her first sessions, Didion expressed confusion at Quintana’s backslide into addiction, saying, “She had seemed fine, a blizzard of efficiency — I had even today gotten a check for medical reimbursement, with the paperwork all efficiently highlighted, ready for filing”. And that’s what the Didion estate has delivered with Notes: efficient paperwork, ready for filing.

The notes that were originally printed in Didion’s files end in 2001, although the collection includes an additional brief from 2003, recovered from Didion’s computer, written eight months before Quintana’s death. The picture these transmissions paint is of a woman whose capacity for understanding the people in her life extended only to her husband. Even then, there were instances in which the mask slipped, and Didion’s cultivated docility to her husband disintegrated. In 1969, Didion wrote that she and Dunne were on vacation at the Royal Hawaiian hotel, “in lieu of filing for divorce”. Another telling moment from Didion’s biography: after miscarrying in her early 20s, she expressed regret at “having missed an interesting moment in Cuba”.

This flippant cynicism — abortion reduced to tourism — is not entirely in line with Didion’s carefully cultivated persona: a good Protestant girl, the debutante from Sacramento who got her start in National Review. These disclosures reflect what Anolik calls Didion’s “contradictory extremes … concealment and exposure, mystery and blatancy”. The paradoxes are expertly woven into her memoirs Blue Nights and The Year of Magical Thinking, written when Didion was at the height of her abilities, and could reflect on Quintana’s death with transparency and control. The problem with Notes is that it is devoid of paradox; it’s exposure without concealment, blatancy without mystery, a woman writing to and for her husband. Whether or not these memos were interesting to John Dunne at the time of their writing, they are unlikely to be of interest to the general reader.

For these commiserators, the spectacle of the diminutive President Zelensky being mocked, interrupted and chastised by the saffron-skinned patriarch and his henchman was less a portent of war than a scene from their own childhoods, a cruel jab in the ribs reminding them of their fate as victim. I get it — this presidential shitshow was remarkable. But must they make it about themselves?

Therapy culture’s answer will always be a resounding yes. And its solution to the fraught dynamics of family life is, increasingly, to go “no contact” — a proposal which licensed therapists deny encouraging, but which would-be patients feel empowered to do by the slow bleed of therapyspeak into civilian life. Stories of “breaking up” with abusive family members are juicy gems in American magazines, and the no-contact vogue is everywhere on TikTok, with minor influencers staging extended “storytimes” about how they one day stopped speaking to their sibling. Perhaps relatedly, estrangement is on the rise, with one study in Canada and Australia reporting a “silent epidemic” of broken families.

Cutting people out is also the supreme theme of “Raised by Narcissists”, that doom-laden Reddit board. To read these forums is to dive into the chaotic family lives of strangers, who introduce themselves not with names and jobs but detailed delineations of neuroses. For most, the dreaded narcissist — the supreme enemy of these boards — is within the family itself, and there are plenty of references to “nmother” or “nbrother”. The users speak in the cultish language of someone who spends more on shrink sessions than groceries — the hated “GC” is the golden child; “flying monkeys” are a narcissist’s minions and enablers; “hoovering” is when a narcissist tries to suck you back into their life; and “WOES” means walking on eggshells. The mind boggles.

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These posters are paranoid; in the normal, awkward, hurtful, strained dynamics of daily life they see shadows of abuse, diagnosing colleagues and friends and bus drivers with personality disorders. One poster, for whom I feel genuine pity, reports that they “constantly feel like everyone doesn’t like me” or “is talking behind my back”. Another, a 17-year-old girl, reports that her mother “threatened to kill my mental support animal” (she joked, it transpires, about “unaliving” her rabbit). She pleads “am I right to feel hurt?” Once again, the answer is yes, always and forever.

We have all known people who have just had too much therapy. The signs are immediate and alarming: scrutinizing the behavior of others to root around for explanatory trauma; using the language of self-help to excuse bizarre overreactions (“I am just protecting my boundaries,” they say, severing ties with their oldest and dearest companions for not liking their Instagram stories). Constantly referring to the sainted pronouncements of “my therapist”, who becomes an anonymous Eye of Sauron in the lives of entire friendship groups, casting judgments and conjuring diagnoses from on high — usually in favor of the person who pays them.

The therapy often begins for an understandable reason — bereavements, eating disorders, unabating teenage gloom; it then holds the victim’s hand into the following years and decades, it cannot be done without. It provides weekly lessons on the most fascinating subject of all time: yourself. It arms bad daters with good verbiage: “I am struggling with emotional connections,” they say, right after shagging you and right before getting with your friend. And it gives terrible housemates excuses for hogging the drying rack: “I am at capacity right now. Your communication style is overwhelming.” Therapy so often leads us to an inevitable conclusion: that the only way to “protect your peace”, to avoid the natural and normal human experiences of heartbreak, embarrassment and regret, is to go “no contact”.

A fantastic recent episode of This American Life featured a family rocked by their father’s disappearance down an evangelical, pro-Trump conspiracy-theory rabbit hole; after coming out, his daughter quite reasonably cuts him out for telling her that he simply doesn’t believe she is a lesbian, and God would not want that for her. Here, as in countless other stories in the news, on social media and among friends, enforcing “no contact” becomes a major plot point, the terminal stage of a toxic familial relationship. It carries a sense of sacrilege which does not come with the collapse of friendships: blood is thicker than water, we are told. The premium put on family ties probably comes down to this: to reject someone who has known you your entire life is the greatest possible expression of identity, of the triumph of individualism over the tribe.

In America in particular, the family tableau has re-entered political life: close-knit clans like the Trumps and Vances recall the Kennedys’ dreams of Camelot. Meanwhile normal families are increasingly divided along red and blue lines: Marmite MAGA politics drives a wedge between parents and their children, brothers and their sisters. For horrified Harris voters, nixing Republican relatives is a form of resistance.

Often, “no contact” makes complete sense. Nearly every family has an estrangement story — about 25% of people will be estranged from a sibling in their lifetime; about 20% will be estranged from a father, and 9% from a mother. Most children grow up remembering blurred faces of relatives “we don’t speak to”; most absorb the clan lore, most have hazy recollections of shouting in the kitchen, of frosty encounters in the dried goods aisle at M&S. It is nothing new; legendary and irreparable fallings-out are a depressing fact of life. What is new is the prevalence and the intrusion of therapyspeak, which has so completely saturated everyday language that it rolls off the tongues of those who have never seen the inside of a shrink’s office. It started with Boundaries, John Townsend and Henry Cloud’s guide (“Boundaries define us. They define what is me and what is not me,” goes the 1992 bestseller). It ends with baffled septuagenarian parents being iced out by their children for careless comments made 50 years before.

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Therapy terms have bled into the general lexicon because they are useful — not because they are particularly understood or relevant or critically considered, but because they confer a sense of saintliness on the doer, giving them the whiff of officialdom. Telling someone to bog off and never darken your door again seems petulant; telling someone that you are “enforcing no contact to protect your boundaries” sounds teacherly, sober and worthy. One only has to think of the ultimate Millennial therapy bro, Prince Harry, who executed the most newsworthy no-contact policy of all time with Megxit: this was described, in the Sussexes’ statement, not as a “sod off” but a “transition” which required “support”.

So often in these narratives, the elderly are shunned for simply being part of a generation which thought differently. For those who grew up in wartime to be asked to understand grandchildren who define themselves principally through psychological labels and neo-identities is absurd. But on a grander scale, the obsessive reinforcement of our individual boundaries, bespoke needs superseding family, friendships and community, is frightening. Therapyspeak’s tendency to favor the patient is a barrier to compassion, and to resilience, which I’m sure qualified therapists resent. Confrontation, and coping with difference and difficulty, is part of life; as families become more polarized, and both the elderly and the young become lonelier, we should surely look to dissolve boundaries, not pile them higher.

Living in the age of “no contact” is confusing. The normalization of therapy was meant to equip us with a shared framework for understanding the world; it was intended to encourage empathy and self-knowledge. The problem is that the therapy subject is so rarely at fault; to spend any time around someone with BetterHelp brain is to pass the hours with a perennial victim, who is incapable of having a normal argument without needing to use the scaffolding of pop psychology to taxonomize their hurt. We should be wary of any philosophy which tells us always to be on the lookout for emotional abuse, which teaches vigilance instead of resilience. And most of all, we should resist the biggest draw of therapy culture: the delicious appeal of only thinking about ourselves. It makes us bad friends, bad lovers and boring bastards.

But this time around, as many reviewers have already pointed out, we are presented with a maturer version of Rooney’s concerns — and a longer book with it. Gone are the characters who write for a living. Gone, too, are the earnest disquisitions on capitalism and inequality. Her characters are now more likely to discuss logic puzzles, or Christianity.

There is Ivan, and there is Peter. The brothers Koubek, who have just lost their father. The much younger Ivan is a brilliant chess player, who could have ended up as an incel but is instead having an affair with Margaret, a woman 14 years older than him. The older Peter is a lawyer and one-time debate champion. He’s also something of a Zhivago, with one woman to suit his heart’s deeper yearning, his former girlfriend Sylvia, and another to suit his needs, his sort-of-girlfriend Naomi, a younger collegiate OnlyFans type, who is such a cliched self-destructive beauty, she seems to have wandered in from Rooney’s first two books.

It’s not, then, all that new. But there is the injection of something, which marks a real divergence from her other novels: an attempt at self-conscious prose style. Rooney has never been much of a stylist, confessing to relative indifference to the language itself. When writing about Ivan or Margaret, Rooney works in her traditional third-person present-tense narration — a partial return to the mode of Normal People. But when writing about Peter, Rooney adopts an internal monologue generally broken up into terse, subjectless fragments.

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This monologue will probably get Intermezzo called Rooney’s most Joycean novel. Though other than her essential Irishness, the charge doesn’t properly stick. There’s nothing like Stephen Dedalus or the toddering Leopold Bloom, ordering the whole cosmos in his head, as if he were both God and Falstaff. Not even if the conspicuously educated Peter Koubeck is constantly referring to Hamlet, or the philosopher Ludwig Wittgenstein. Nevertheless, the most interesting writing in the book is often here, in the certain wandering monologues of Peter Koubek:

Says she’s staying with Max for the month, good old Max.
See him sometimes at Sylvia’s still. Useless he was too in
competition. Too nice, not ruthless enough, always seeing both
sides. Funny though. All her friends are. Lightly she has to hold
the world, lovingly but lightly…

It’s the first time I’ve read Rooney and felt the excitement of the writer at work with words. After reading those lines, it’s hard to say that Rooney is a writer uninterested in language. Even if it’s sometimes laboured, the freer syntax is a welcome change — it made me realise just how bare and overly-crafted her writing could be before. And as her former embarrassment with the artier side of the equation evaporates from many of the novel’s best pages, Rooney can now write something like that last sentence: “Lightly she has to hold the world, lovingly but lightly.” It’s among the most musical, most balanced phrases in her oeuvre.

Unfortunately, she cannot really sustain such a musical construction. Perhaps this isn’t entirely fair on Rooney: chess, logic, and debate are more clearly the organising themes of the book. And they’re especially good metaphors for all of her books, which have featured tight units of desperate people, engaged in romance as if it were a game they somehow had to win. Intermezzo is much the same, reading like nothing so much as Rooney’s account of a chess match. The way characters manoeuvre to get what they want, while poring over their own motives. These character dyads are very much opponents, and Rooney writes them as though forced to chronicle every last rhetorical move.

This makes the novel absolutely infuriating. And it brings me to the crux of Rooney’s wild success: that Rooney is indeed the perfect writer for our times, but that this may be a very sad thing for our times. For as good a writer as she often is, Rooney’s novels are stubbornly, even obsessively, about constructing ultra-realistic accounts of social behaviour between individuals in the 21st century. Rooney is consumed with psychology. So are her characters. Margaret, Sylvia, Naomi, and Ivan and Peter Koubeck are only the most recent in a long line of Rooney characters who are constantly musing about their own psychology, constantly searching for breakthroughs and finding that their insights don’t always bring them the peace and confidence they’re looking for.

This is wisdom on the part of Rooney, I must admit. She’s too smart and fine a writer to allow a character to have a revelation and then wrap it up, pat, in a nice truthy ribbon. She’s too cunning a psychological portraitist to let her characters off the hook. All are to blame, all are selfish, yet all need grace and compassion. One of the reasons people adore her books is, I imagine, because they would very much like to reach out and cradle these characters the way they, too, wish they could be cradled. I feel it when reading her books: an immense tenderness for these poor lonely people, the desire to help them because they remind me so much of me.

In this way Rooney is the great portraitist of the age — and that is precisely what depresses me. Because ours is an age so dreadfully and myopically concerned with its own psychology, often at the expense of everything else. What else but a self-obsessed culture would be so consumed with therapy as a substitute for life? The trouble with Intermezzo is just how little there ends up being in it besides this exhaustive play-by-play of human behaviour. In the narcissistic jail of contemporary life, Rooney is hardly a Prison Warden, yet neither is she a true accomplice in the escape. More like a priest on the eve of execution, there to dispense forgiveness but incapable of intervening in our ultimate doom. This is not to say she must intervene: there’s nothing Rooney ought to be doing, if we’re to regard literature as free in any meaningful way.

But there is, I think, a failure to interrogate the deeper myths which her books have all come up against, and skated over. This isn’t unique to Rooney — she’s merely in the position of most exemplifying it, because she’s become so adept at realising the minutiae of our contemporary psyches. The first of these myths is the most contemporary one. Our culture is fundamentally still reeling from the introduction of the idea of the Blank Slate, somewhere during the Enlightenment, after aeons of belief in essential nature. It’s there in contemporary gender theory, just as much as it is in the Silicon Valley techno-utopians transforming themselves into efficiency-machines. It’s the myth that at bottom we are infinitely changeable — that there is no bottom, really. Only the infinite input of senses, into an empty box.

Early in Intermezzo this rears its head in Peter’s monologue, as he muses about “classical conditioning”. It haunts the rest of the book. Isn’t it all just conditioning? Isn’t it all just bodies cajoling, persuading, conforming to other bodies, atoms colliding blindly in the dark? Yet in our world, this myth has become inseparable from another: that of the passing away of Nature. Just as we are watching a planet slowly dying because of our technological progress, so we’re trying to choke ourselves of any sense that there is a similar Human Nature — any set of instincts, beauties, or talents which are mysteriously inherent, or inheritable. We’re not sure which to hate more: the idea that there is something inherent in us, or the idea that there is not.

However, what lingers at the edge of Rooney’s fictions, and of all our contemporary fictions, is something deeper and stranger. Something we can’t quite seem to give ourselves up to. In Rooney’s work, it’s generally there in her allusions to the Catholicism of her native Ireland, and it buzzes around the boundaries of her work. In Beautiful World, Where are You, it was Alice and Eleanor’s conversations about Jesus, their wonderment at their perfect and pious friend Simon. In Intermezzo it resurfaces: Ivan or Margaret or Peter will think briefly about Jesus, about God, about bigger plans. But they will, like Rooney does, come just shy of admitting that there’s some more transcendent thing at play. This is the predicament of so much mundane fiction today: it insists that we must be concerned with the real world of practical socio-political problems, yet largely exiles the imagination, the capacity of fiction to open up the world for play.

There’s a logical paradox to the Blank Slate, which I’m sure Rooney herself would appreciate. If all we are is what our senses take in, then where does the capacity to compare things come from? How do we choose what to focus on? There must be something innate that can tell one sense from another. But this is a hard thing to accept. Rooney’s best quality is that she wants to take the confusing questions of nature vs. nurture head on. The issue is that she has chosen a very predictable form of fiction, all about the question of whether characters can change or not. Her project is to map out the webs of motives and reasons that drive her characters’ psychologies, but this only ends up reproducing the worst patterns of our contemporary self-absorption.

As in real life, her characters’ psychological revelations are Russian nesting dolls: self-discovery is ultimately as good as repression for continuing to lie to oneself, which is what her characters are continually doing, even as they confess their sins to one another. As a portraitist of our age, Rooney is at least wise enough not to say that this is the end of the story. Her books always wrap up at the moment her characters finally collapse and admit their problems. And this is a fine and ancient project for a book, to take characters from alienation to reconciliation. But in Rooney’s language, in the language of behaviour alone, it ends up looking conspicuously like therapy. And to paraphrase something the great prophet of modern narcissism, Christopher Lasch, once said: a narcissist is someone who can survive infinite therapy.

Nothing quite boils the blood of middle-aged men more than the departure of the Duke of Sussex for a better life out West, an upside-down Steinbeck protagonist. Most will claim to be enraged by the duke’s abandonment of duty or some such sniffy notion, but we all know that his great crime — greater even than that suggestion that his wife once made the sainted Princess of Wales cry over bridesmaid dresses — is self-involvement. His 2021 interview with Oprah alongside his wife Meghan confirmed our most sickening fears: that the toxic creed of “speaking your truth” had become irreversibly lodged in good old Harry Windsor’s brain.

Despite having two of the most unpopular qualities in British culture — he is, after all, a ginger posho — Harry was always respected among the bulk of the public (who, we must remember, regard the royal family with nothing more and nothing less than detached, bemused affection). He was the light relief to William’s sombre nobility, the cheeky spare who winked at Noughties lad culture and seemed to enjoy his privilege rather than wince at it, frolicking around in states of controversial dress (or undress) and injecting a sense of normality — fun, even — into a unit which had been so wracked by tragedy and, worse, off-putting stuffiness.

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But his capture by millennial therapy culture signalled the death of this happy-go-lucky persona. For those who once grinned that Harry was a “rum lad”, this was a personal affront precisely because of the loss of that pleasing irony, the sauciness and levity which turns even bluebloods into good drinking partners. When the winks stopped, we sobered up and realised we had been sat opposite a quiffed clown, made up to look like a cheeky friend. The slipping of that mask must have hurt — particularly among those middle-aged men, for whom any association with the touchy-feely bollocks of California is not just embarrassing, but offensive.

Prince Harry is, without a doubt, the most millennial millennial to ever have breathed. In his trajectory from cheeky chappy to earnest, self-regarding counselling patient lies the story of his generation’s downfall into cringe. Though he sees his transformation as a journey to his authentic self, it is crystal clear to everyone not living under the glass dome of American therapy-speak that he has simply journeyed from one posture to another, each freighted with unbearable artifice. For the first, 1,000 years of monarchy and the straitjacket of the British class system determined his route from genteel thicko (he left Eton with a B in art, a D in geography and a dash of notoriety for smoking weed) to Army to nice girlfriend called Cressida. Had he been a commoner, he would have ended up as a mid-level consultant in Putney, probably in the shadow of his barrister brother William. Raffles has lost a lot of custom since his enlightenment.

But this second, new persona — one which he hard-launched with the Oprah interview — is no less fated. With the awakening of West Coast elites comes a compulsory set of fixations, which I like to imagine their shrinks laugh about together at dinner parties. First and foremost, the wrongs of your parents, childhood trauma. Of course, Harry has more of this than most, and that is fair enough. But the endless remonstrations with your family, friends and “support network” — and a compulsion to cut them out for historical wrongs — is so distinctively millennial, and something which Abigail Shrier has rightly identified as having engendered complexes and neuroses in people who, for the most part, would have otherwise chugged along without a problem. Harry represents the great millennial task of seeing yourself as a kind of project, and the fallacy that it is not what you do, but how you feel about what you do, which matters.

His description of his teenaged family dynamics in Spare is so typical of the desire to frame ourselves as victims at the centre of a great conspiracy to hurt us, and to seek to “call out” and shame those responsible for the problems they have landed us with for the rest of our lives. It is a selfish culture of retribution, under the guise of “boundaries” and “transparency”, which has motivated Harry and countless other special children who have grown up to be the insufferable, childlike adults we all know. Harry has traded quiet, fair reconciliation for what amounts to a protracted family shouting match at a restaurant, the sulky teenager coming home from university armed with a new vocabulary and a clutch of crimes for which they’ll get justice now. I have been that person — most of us have — but to do so on the cusp of middle age, and via the bookshelves of Waterstones, is quite another matter. And in place of the grown-up realisation that your parents might have had no idea what they were doing either, he has trapped himself in a perpetual fantasy where he is a little Cinderello, describing Camilla as a “wicked stepmother” and his brother as an “arch-nemesis”.

So, childhood trauma? Check. Second millennial mania: a pathological obsession with privilege. If anyone should feel guilty about being a nepo baby, Harry should. But it has consumed his life, so that every sun-soaked, truth-living Californian minute is an act of repentance for chilly privilege in dreary old England. Harry and Meghan’s discussions around race are not the egregious sacrilege some newspapers claim them to be, nor is Meghan unjustified at all in complaining about the hideous, sexist coverage she has had to endure. An old colleague once described her, with great, sickly pride, as the “People’s Prostitute” — and the ire middle-aged men hold for her is definitely about something more than her being annoying. But what really sticks in the craw is not the Sussexes’ progressive values — which I find to be admirable, requiring considerable bravery in today’s media climate — but the damned hypocrisy of it all. It is difficult to be told to “check your privilege” by two Montecitan millionaires, and I fear they represent a very millennial crusade for justice: that is, one which privileges Instagrammable opportunities over substance. Besides, an obsession with one’s own privilege is really another opportunity to practise that terrible habit of the over-therapised — wanging on about ourselves.

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Overall, the Sussexes — and Harry, in particular (we cannot fault Meghan for being from wet-blanket Los Angeles) embody the great tragedy of the millennial: the generation which, faced with new, strange waves of social disharmony, decided to do nothing about it and think about themselves instead. Harry is a harbinger of the turning-inwards of youth culture, a preference for introspection over duty, and the self over the whole. He is, too, a model of the irreversible way American obsessions have crossed the Atlantic, and planted themselves in the formerly funny, sardonic and self-knowing English.

Whether social media’s preference for the mooningly internal over the societal persists for other generations is up for debate; my own has seized it for its brand of activism — for instance, on Gaza — which yet may prove as hollow as the Sussexes’ Archewell Foundation Instagramming. Harry’s millennial earnestness has gone down like a cup of warm Sancerre with Gen Z who are, on the whole, much funnier and much less cringe. And right behind us, Gen Alpha is ready to snatch the crown from their parents’ receding hairlines: Prince Louis will no doubt prove that we ain’t seen nothing yet.

One wonders how Harry’s own story will end. Commentators, admittedly licking their lips over any perceived cracks in the ducal union since day one, have speculated that all is not sunshine and reiki for H&M. Harry’s teenagery conduct has left him rather rootless, and if speculation proves correct that Meghan is having a much better time of it than he is, rubbing shoulders with Ellen DeGeneres and launching lifestyle brands, then the “pootling” prince might find himself up the proverbial creek. If an attempt to rejoin the fold is ever on the cards, it would be to reunite with a family who has grown eminently more loved by the public for each year of his absence. It is hard to imagine Harry ever commanding the affection that Kate does, nor the public ever tolerating a sepia-toned Enid Blyton-style video of the Sussex brood like the one released this week upon the princess’s announcement that she was now cancer-free.

At 40, you may not have to give up the lifelong task of exploring your terribly interesting self — but at the very least, you must have grown up. My own birthday being the day before Harry’s, I’ll raise a glass to the ghost of the cheeky duke: and to all the reformed Eton boys who came before him. Sadly, my special day will not involve the automatic inheritance of £8 million — but at least I’ve got all my hair.

The movie follows an 11-year-old girl named Riley who grows angry and unhappy when her parents move her from her happy life in cold Minnesota to San Francisco, with its one boring season and its weird pizza. Guided by cutting-edge, real-life academic research on emotions and memory, Pixar’s writers and animators enter Riley’s head, portraying her five core emotions (Joy, Sadness, Anger, Disgust and Fear) as different-coloured characters conferring and contending with each other at Mission Control, their headquarters inside Riley’s brain. As Riley grows more miserable in the outer world, two core emotions — Joy and Sadness — get sucked into a funny and harrowing misadventure inside the sprawling world of her memory.

This is where the super-poignant moment happens (spoiler alert). Joy and Sadness meet an adorable sack of fun named Bing Bong — Riley’s imaginary friend when she was three or four — who joins them on their quest to get back to Mission Control. When they all fall into something called the Memory Dump, a deep pit where expired memories collect as charred husks, Bing Bong sacrifices himself to help Joy and Sadness escape. As Joy and Sadness float safely to the bright surface of working memory, Bing Bong descends into the darkness of dead memory, fading and disappearing before our eyes. That is, we’re seeing the moment after which, whenever Riley’s parents wistfully bring up Bing Bong and ask if she remembers him, Riley will think hard and say, “Not… really”.

Strangely, I didn’t find this scene so terribly poignant. But my younger two kids did. The Bing Bong death scene undid them like it was supposed to undo me. Of course, my younger, who was only four, had simply grown fond of this Bing Bong fellow and was sad to see him die. But his older sister was an intelligent seven-year-old. She’d always had a spooky sense for adult meanings, and I had to suspect she was experiencing Bing Bong’s death in the way adults were supposed to, that is, abstractly and nostalgically. It wasn’t just cute funny Bing Bong she was mourning. It was the idea of the extinction of the memory of Bing Bong, and the adorable time in Riley’s life betokened by that stack of concepts, and the way the sweet stages of a child’s life slip from your awareness before you can think to preserve them. In that moment I was wondering — and this might have blocked my own sweet impalement, come to think of it — if it was “developmentally appropriate” for a seven-year-old to be getting sad and nostalgic about how the sweet stages of a child’s life slip from your awareness before you can think to preserve them.

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Of course, it wasn’t just a seven-year-old who saw that scene and was induced by its virtuosic manipulations to weep when it ended, or at least to grasp it as really sad. It was millions of seven, eight and nine-year olds taking in this vivid rendering of a child’s inner life as the content of powerful melodrama, something so intense in its significance that, when they watched it, the adults around them got weepy too. For some, if not most, of those young viewers, it wasn’t just Riley’s inner feelings being rendered as tearful climax, but their own selves being touched with this second-order melodrama, these soaring and piercing emotions about emotions. I can’t say without further study that kids being induced, via the saturating medium of Pixar animation, to get nostalgic about their own childhoods and emotional about their own emotions is harmful. I will venture that, in historical terms, it’s pretty weird, a narrative archetype rarely invented by prior cultures. 

In the sequel, because Riley is now 13 and entering puberty, the five core emotions have been joined by four new teenage emotions of Embarrassment, Envy, Ennui, and Anxiety. One more feature of the maturing Riley joins these nine feelings inside her brain, her Sense of Self. This appears as a pale blue entity that luminesces on a pedestal behind the emotions, its weave of shapes suggesting an even mix of the two main parental influences in San Francisco — genetics and yoga. 

This Sense of Self is just a passive, pretty object. The emotions are the real characters, and they’re impressively accurate, even as comic exaggerations. I was dubious going into the original Inside Out, suspecting that a children’s movie about a child’s psyche would fall back on the corny and tired inner-child schema, and its dramatic form would be the usual doltish Hollywood story of emancipation, the freeing of this inner child from emotional repression so that the kid can be herself. But I was quickly surprised at the complexity and sophistication of Inside Out’s psychological mapping. Watching that movie, I thought: “Wow. Those Pixar people are smart.” As I’ve already suggested, though, this level of smartness, when applied to mapping the inner workings of children’s brains, and then presenting the map for children to consume in movie form, is a little unsettling. It hints at other achievements eerily tinged with reflexivity and promethean insight — like unlocking the power of the atom, decrypting our own genetic code, or programming computers to think like we think. There’s probably minuses as well as pluses, in other words. 

Inside Out 2 is no less smart than the original in its mapping of Riley’s mental terrain, and in its dramatic control of the stuff that happens there. It all makes impressive sense, starting with the main character in its augmented cast of emotions, fast-moving, speed-talking Anxiety, who simply appears one day and makes herself the boss of Mission Control. It’s not just the centring of this emotion in the brain of a high-achieving teenage girl that feels apt. It’s the stuff Anxiety gets up to. When, by way of justifying her authority, she announces to all the other emotions that her specialty is the future, coming up with possible scenarios that Riley should consider in advance, she’s describing what’s practically useful and what’s potentially volatile about this capacity we have. Anxiety’s self-accounting rings true, to the adult who knows this emotion, and it promises a Pixar sort of comic wildness, which the movie quite delivers.

In the end, Anxiety’s power is reassuringly reined in by the other emotions, and by the importance assumed by the non-emotional things that make up Riley’s sense of self, her beliefs about how she should act, the kind of person she should want to be. Anxiety starts out spinning her future scenarios, which appear on little oblong TV screens, in sepia tones, and then she spins faster and faster until she’s spun herself into a literal tornado of movement, producing new scenarios so fast that Riley is finally overwhelmed by them and has a panic attack.  

Again, the portrayal of this anxiety mechanism makes both intuitive and conceptual sense — the increasing pace of worry, the way these worries seem to generate other worries. But one important detail is missing from Anxiety’s scenarios, one character, if you will, that should appear and reappear in these TV dramas of Riley’s worries but does not. That character is Anxiety herself. Surely one of the classic fears that overcomes the anxious person at some point in her descent into paralysis and panic, hastening that descent, concerns her own anxiety. She realises that the thing she’s anxious about is more likely to happen because she’s anxious about it, and then she gets anxious about her anxiety, and then anxious about this new anxiety she just gave herself by thinking about the old anxiety, and then she’s really screwed. She’s trapped, at least subjectively. Every effort to think her way out of her trap just pushes her deeper into it. 

Not making this move seems like a missed opportunity. Had Anxiety thought to place herself in one of her own scenarios, it would have given Pixar’s animators a chance to do something very Pixarish — portray a plunging regress of worried scenarios, Anxiety staring bug-eyed from a TV screen, on which is another, smaller TV screen from which another bug-eyed Anxiety stares out, on which is another, even smaller TV screen, and so on, two mirrors-style, infinitely and instantaneously. 

Then again, even if doing this could have yielded a very funny frame — the infinite duplication of Anxiety’s very funny face — it might have struck the movie’s creators as too scary as well. Or, it may have hit too close to home. Riley’s ability to escape her climactic panic attack, with the help of emotions and friends which together lift her from her worried spiral by turning her outward, is reassuring on several levels. To the young viewer it shows that a panic attack is not a death sentence, that there are practical ways to escape a spiral of worry. And to the older, philosophically stodgy viewer, it reveals the Pixar team to be working from a sort of pop-Aristotelianism, which is no less praiseworthy for being easily digestible. They show Riley’s thoughts and feelings, her individual self and her social life, training each other, teaching each other how to be in the world. They show concrete practice and concern for others as moral and psychological touchstones, healthy and virtuous corrections to vanity and selfishness, at both their common registers and their neurotic extremes. This all gave me a warm feeling as the movie ended. Gratefully I thought, “These Pixar people are not cretins.”

On the other hand, had they shown Anxiety making herself regress infinitely on TV screens, it might have pointed a little too directly at what this movie, like its predecessor, is also doing. Inside Out 2 sends a message of escaping from the individual self, of combating its unhealthy fixation on itself, but it also feeds our culture’s intensifying focus on individual psyches, especially the psyches of young people, which, one would suspect, makes those selves ever harder to escape. Let’s not forget, young viewers of Inside Out 2 are watching a movie about the dangers of selfishness and self-obsession that spends most of its time inside the head of a 13-year-old girl, and this head is obviously an avatar for their heads. This, for a child or adolescent of our therapeutic culture, is par for the course. 

A six-year-old enters his school for the first time and is confronted with a colourful poster announcing the school’s anxious interest in his Mental Health. Perhaps a school nurse or psychologist makes a visit to his classroom to reiterate the poster’s message, to let all the children seated at their little desks know that if any of them ever needs to talk to someone, about something they’re sad or worried or troubled about, the school takes their Mental Health very seriously. Six-year-olds of prior eras had literally no occasion to ponder their own psyches, especially from the outside perspective of a doctor or school functionary openly worried these psyches might need medical treatment. They just lived in their psyches, mindlessly as it were. But our six-year-old gets to confront his psyche as a topic, an institutional theme, every day, with that poster in the entry to his school, and the occasional visits and solicitations of outside helpers who tenderly address themselves to his Mental Health. And he’ll get to do this every year of school, as his psyche matures and, from the changing perspectives of those different years, revisits itself as a reification, a topic, an object of observation because a potential source of medical trouble.

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A 10-year-old gets an iPhone and immediately signs up with TikTok, whose algorithm nudges her to follow near-peers, girls a couple years older who’ve won lots of views and likes by talking about their Mental Health. Thanks to their own training in their own schools, these kids are old hands at therapy-talk. They might even have an entry or two in the DSM memorised. Our 10-year-old, already school-equipped with a therapeutic vocabulary, enters an online market of status and imitation where fluency in this vocabulary gives an apparent advantage. Casually, she and her friends start diagnosing themselves and each other and other kids they know at school. By anatomising her self in therapeutic terms, she may or may not be improving her Mental Health, but she’s definitely adding new symbolic matter to this self, new traits and definitions and layers of significance she can dwell on, wonder about, perhaps worry about. 

This is in addition to the intensified self-awareness summoned from her as she consumes and contributes to social media, even when the explicit theme isn’t teenage self-diagnosis — all the new occasions to think about herself and compare this with other girls as they submit their own selves to these new forms of publicity. By this process of constant self-publicising and self-diagnosis, her mere participation in a youth culture formed by social media and informed by psychotherapy, she has made her self much more interesting to itself than was the case with prior cohorts of young people, whose selves were quite neglected by comparison. Thanks in turn to this neglect, these selves had much less symbolic matter attached to them and were, thus, much lighter to lug around. 

These are just a few of the many ways in which our culture of augmented selfhood has grown into a many-tentacled system of spiritual meaning that changes those who live within it. I’m trying to limit myself to expressions of wonder at the historical strangeness and novelty of these processes and technologies of selfhood, rather than claiming that they’re objectively harmful. But documents claiming with some persuasiveness that they are harmful are multiplying. Ethan Watters’s 2013 book Crazy Like Us tracks the migration of American-style therapeutic understanding to non-Western countries. It shows how these understandings don’t just corrode the ways other cultures cope with spiritual pain. They sometimes propagate, as if virally, the disorders whose Western names and diagnoses they introduce into these new places. This should make us wonder about our own selves and our own culture, which are much more systematically exposed to the therapeutic paradigm. And more recently, within just a few months, the idea that therapy culture is untherapeutic has moved from figures of controversy like Abigail Shrier to arbiters of mainstream common sense like The Atlantic. 

It appears that our modern way of understanding and inhabiting and attending to our selves has turned itself into a feedback loop, a trap, that the greater cultural and institutional influence of psychotherapy begets greater need for psychotherapy. This places the subpopulation of scrupulous, virtuous, therapeutically useful people who work in the larger world of mental health in a tragic bind. At least some of the trouble they’re enlisted to treat is likely the result of the therapy apparatus they are a part of and whose influence they increase as they do their useful work. 

The creators of the Inside Out movies are in a parallel bind. They strive to portray young selves in a way that is as scientifically faithful, and as philosophically serious, as one could hope for in a computerised cartoon that’s also expected to make a billion dollars at the box office. But they do it by feeding children a picture of their spiritual lives that, while smarter and more scrupulous than what happens in schools and on social media, is still part of the same machinery of selfhood. A movie that shows anxiety as a barely controllable tornado inside an adolescent girl’s self, even if the anxiety is eventually brought under control, is still making anxiety, as well as the many other characters that animate a self and contend with anxiety, and that self itself, very urgent things for its young viewers to be aware of. It’s still adding more emphasis on the self to the culture of childhood, and a picture of that self as a place where some disturbance with a scientific name might happen at any minute. It’s still making the selves of children more interesting things for them to dwell on than the selves of prior eras ever were.  

I have hinted that the makers of Inside Out 2 are hip to these dilemmas, their involvement in the mechanisms of hypertrophic selfhood. As I described above, the first Inside Out gave a dramatically central role to nostalgia, cueing its child-viewers to cry about the evanescence of their own childhoods. This, I noted, was pretty strange, and perhaps not age-appropriate. 

The makers of Inside Out 2 seem to be thinking the same thing. A funny emotion-character makes a handful of cameo appearances throughout the sequel. In obvious ways she doesn’t belong with the other emotions. They’re young and she’s, well, old, with a pile of white hair and reading glasses worn low on her nose. This character is, yes, Nostalgia. Nostalgia periodically dodders in through a side door, wistfully, weepily reminiscing about the younger Riley, and the other emotions yell impatiently for her to get lost, because neither Riley nor the children watching are ready for Nostalgia yet. Dutifully, old Nostalgia backs through her door and disappears. This is pretty clever, the sequel’s creators taking a dig at themselves about the original. Yes, they seem to be saying, the first one did jump the gun a little, with the weepy nostalgia stuff about Bing Bong. They seem to be admitting that, in portraying the selves of children to those children, they might also be forming those selves in unknowable ways, and they are aware of this. Part of me wanted to give them credit for these cheeky metatextual moments, the hints of seriousness they contained. But another part of me just wanted to say, “Sorry. Too late.”

“After careful consideration, I’ve decided to resign as I find that my personal values no longer fully align with the direction of the organisation,” reads the Instagram post from UmaSofia Srivastava, the 17-year-old winner of the 2023 Miss Teen USA title. Although Srivastava described her decision as months in the making, many were struck by its suspicious timing — just days after the resignation of the 2023 Miss USA winner Noelia Voigt, who announced that she was stepping back from her duties to focus on her mental health. A coincidence? Maybe, but between the reference to “values” in Srivastava’s post and the ominous tone of Voigt’s (“Never compromise your physical and mental well-being,” she wrote), the general impression was one of impending crisis, and of the pageant queens fleeing an unstable structure on the brink of collapse.

A week after their announcements, the sense of scandal lingers, with interested parties glued to the drama as though it were a glittering spectacle all its own. This is entirely in keeping with the broader role of pageants in American culture, where the notion of depth, terrible or otherwise, beneath the beauty queen’s jewel-encrusted gown and plastered-on smile has been the basis for blackly funny satires (see: Drop Dead Gorgeous, Insatiable), as well as the entire reality show oeuvre represented by Toddlers and Tiaras and its ilk. The pleasure of the pageants themselves is as much about spotting cracks in the contestants’ picture-perfect veneers as admiring their beauty and accomplishments — hence the incredible virality of moments like the 2007 meltdown of the Miss Teen USA contestant from South Carolina, who appeared to short-circuit while trying to answer a question about Americans’ lack of geographical literacy. In a post-feminist world, the entire concept of beauty queens feels like a bizarre relic of a less-enlightened era, and one that should be viewed with suspicion — which might be why it took all of five minutes for a commenter on Voigt’s Instagram post to notice that if you isolate the first letter of the first eleven sentences of her statement, you get the phrase, “I AM SILENCED”.

If it’s unclear just what this hidden message-within-a-message means, it is nevertheless spectacularly effective bait — as is Srivastava’s post with its clever use of the Nietszche quote. If you look closely at this second item, you’ll notice the ghost of a photograph, faded but discernible in the negative space not overlaid by text: a picture of the teen beauty queen weeping and clutching her heart as she’s crowned the pageant queen.

The attention-grabbing nature of these posts, with their implicit suggestion that you may see true horrors lurking beneath the surface if you examine them closely enough, gives permission to the audience to do what they already wanted to do anyway, which is look and theorise and look some more. The whiff of scandal inside the Miss Universe organisation is tailor-made for the era of what the writer Phoebe Maltz Bovy calls “photogenic feminism” — a catchy term to describe the women’s issues “that lend themselves to two readings, one earnestly feminist, the other lowest-common-denominator titillation”.

Whatever may have happened to these women, it seems certain that nobody would be paying this kind of attention to a similar story that did not include images of pageant princesses in bejewelled leotards and high heels. The beautiful woman in sensational and titillating peril is no more urgent a victim than a minimum-wage worker in a hairnet getting groped by her boss, but that first story is the one people want to read.

All of this is only slightly complicated by the possibility that what happened to these women may be nothing much — or at least, nothing they didn’t sign up for. The nature of the pageant circuit is such that, by the time a woman wins a national crown, she’s been sashaying across the stage at regional and county and state competitions for years. It’s virtually impossible that either Voigt or Srivastava failed to realise the nature of the business they were in, or the compromises they would be expected to make, including but not limited to the signing of contracts delineating their duties as Miss USA representatives. Some have attempted to spin these documents as a form of sexist exploitation — “This is an organisation that preaches women’s empowerment,” one former pageant winner said, sardonically — but surely an empowered woman can decide for herself whether the price of admission to any given organisation is one she’s willing to pay. The contracts may be draconian — or maybe they just feel that way to a generation that doesn’t seem to entirely grasp that there’s a difference between courageous whistleblowing and just talking shit about your boss in public — but the women did agree to sign them, for whatever that’s worth.

Indeed, how you interpret the resignations of Voigt and Srivastava probably depends on this last thing: having agreed to abide by a certain set of rules, how obliged should the beauty queens be to fulfil said commitments? The sympathetic take, of course, is that stepping down is a brave and daring sacrifice, one that sends a powerful message. The more cynical one is that they found a way to avail themselves of all the attention and influence and resources afforded to pageant winners while abdicating the attendant responsibilities — and all under the unassailable pretence of self-care.

I genuinely have no idea which of these interpretations hews closer to the truth. But what seems undeniable is that if you are a beautiful and gifted young woman, you can renege on practically anything just as long as you invoke mental health as the reason for doing so. It’s the same phenomenon we’ve seen in recent years in the sporting world, when Naomi Osaka and Simone Biles bowed out of press engagements, competition or both, citing struggles with depression and anxiety — and amid a similarly polarised debate over the difference between care and coddling.

Then, as now, questions arose as to whether we had overcorrected from the days when traumatised young women were dismissed as hysterical or attention-seeking, to the point where we were now instilling in them a complete intolerance for even ordinary and necessary discomfort. Add to this the unprecedented focus amongst young people on mental health, one that some clinicians worry is resulting in the pathologisation of everyday annoyances as crises requiring medical intervention.

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It makes it difficult to know, when someone like Voigt suggests that pageant queendom was a danger to her “mental health and well-being”, if she’s truly in crisis or merely availing herself of the one socially acceptable excuse for flaking out — which in turn raises the question of whether every invocation of mental health should be taken at face value. Does it serve young women to treat the spectre of their emotional distress as simply too precious to question? Is there any scenario in which a person in Voigt’s position might still be told that her discomfort is regrettable, but something she’ll have to deal with, for no other reason than that she made a commitment and people are counting on her?

The answer to this question may in fact be “no” — or at the very least, that keeping one’s promises is no longer something we place all that much value on as a society. At one point, I tried to figure out if there had ever been a similar situation in which a man abdicated his responsibilities while citing the same need for self-care. What I came up with is not perfectly analogous to the Miss USA snafu, but nevertheless compelling: an actual prince cutting ties with an actual monarchy in the name of his mental health.

It is true that some people supported Harry in this, most crucially the ones who lauded him as the latest patron saint of American therapy culture. But there was a fair amount of gleeful mockery, too, and this seems instructive: a man may play the mental-health card by way of breaking a promise, but it won’t make him a hero. This sort of strength in fragility, and power in vulnerability, is reserved for women — and particularly for the youngest, prettiest ones. Which makes the trajectory of the abdicated pageant winners ironic, if nothing else: when the weight of her jewelled tiara becomes too much to bear, the best way out for the savvy beauty queen is to play the damsel in distress.

I would venture that most people would find this scene, relayed to me by a friend, largely innocuous. At the risk of stating the obvious, faceless corporations don’t care about your mental health. And they don’t care about the “stigma” surrounding the expression of feelings. To them, your feelings are just one of many unpredictable variables that must be brought to light, their risks neutralised, managed and controlled.

Yet many on the Left have received the sudden and unprecedented attention to mental health over the past decade as a triumph. Unions, understandably seeking to protect workers from new work hazards, routinely demand attention to emotional wellbeing in the workplace; their student counterparts, meanwhile, have moved from the fight over fees to overseeing the expansion of “mental health” to include an ever-broadening array of human experience.

And in both cases, they are pushing at an open door. For ultimately, managerial jabber about breaking down stigmas is a thin veneer for their view of you as a liability. Your unruly emotions are a potential risk to business, institutions, even society as a whole — you could go off sick, you could go on strike, or you could otherwise be unpredictable in ways that hurt the bottom line. But the corporate obsession with mental health is only the most obvious and easy-to-critique manifestation of a much more profound societal malaise: our whole culture has shifted towards a deep and pervasive concern with human behaviour — to the point that humanity itself is a risk.

Every day, we are told that we are living in the “Anthropocene”, whereby the “irreversible impact of human activity” has permanently scarred this planet. Part of the story of how humanity got too big for its boots is its apparently erroneous belief in its own rationality. If we could approach people as they truly are — not the mythical rational subject of the 18th-century Enlightenment but as truly emotional beings — then we could harness our feelings and transform them from risks into assets. Maybe “climate anger” can be harnessed for climate activism, suggests one study. Maybe the “mindful consumer” can change the world, offers another.

As a good person, employee and citizen, you learn to consider that exercising your free will without the careful consultation of expertise as reckless. You must consider yourself not just as “at risk” but also “risky”. You should be perpetually insecure, constantly surveilling your inner world, and ready and willing to seek guidance when you find a problem. Core to this worldview is disclosure. You must not only be on the lookout for risky thoughts, feelings and behaviours in yourself and others, but must openly identify them since doing so opens the door to training.

Bupa, for example, enjoins us to “open up” and make “mental health a normal topic of conversation in the workplace”. Doing so entails four steps, the first two dealing with identifying and expressing potentially risky emotions and “issues”, and the latter two with “training” and “treatment”. Its “Managers guide” even recommends adding staff discussing their wellbeing as a standing agenda item in team meetings. Unilever suggests embedding “wellbeing ‘rituals’ into the everyday”. A mental health toolkit for construction workers states that a “sound mind = a safe site”. Those who do not disclose are a workplace safety hazard. Emote — then seek the rules, the guideline, the script.

At the heart of these initiatives lies a concerted effort to cultivate a new mindset among employees and citizens — one where individuals are encouraged to view their thoughts and feelings as risks, who bring their “whole self” to work so that it can be assessed for hazards that can be managed and controlled. This is a necessarily “inclusive” mission: your whole self includes the expression of everything about you. No one and nothing must escape the lens of the bureaucratic machine. Everyone, it’s time to talk.

But what are we supposed to talk about? Here, talking about your feelings is the only safe, neutral territory. Translate material problems into the language of feelings and these can be converted into something safer, something more productive, something less risky and unruly.

Of course, many interventions and advice for maintaining mental health are harmless in and of themselves, and will undoubtedly help many people. But populations have been doing this for decades — and there doesn’t appear to be a movement of “mindful consumers” changing the world, or young people with self-esteem so high it’s vaccinated them from social ills; there are no fewer “mental-health problems” and no drastic decline in suicide. And every time, despite each intervention failing, bureaucrats fail to ask themselves whether emotion management really was the best path to solving problems. Instead, they become more pessimistic about humanity. And they become more zealous in their pressure to penetrate deeper, to exert more control.

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The underlying propulsion toward bureaucratic control extends to the use of mental health as a governing strategy at the beginning of the 20th century. Back then, however, it was called “mental hygiene”. Since the dawn of the industrial revolution, those in power had found themselves frustratingly bound by the willingness of the lower orders to work or not work and their reluctance to fit into the new world of round the clock production. Mental hygiene was intimately and unabashedly tied up with control of populations, treating their unruly behaviours like diseases infecting the healthy social body. Expanding the purview of emotion management to the healthy, it promised to cure social ills through education, adjustment of self, life and work, and “breeding out defectives”.

Mental hygienists adopted the view that emotions were central to all behaviour and personality development. This new class of bureaucratic servants pioneered large-scale survey instruments that promised to quantify the emotional reactions of populations. Once expressed in a measurable format, emotions, like a lack of worker or soldier morale, could now be pinpointed as the source of problems and “rehabilitated” accordingly. For instance, the phenomenon of soldiers losing the will to fight had long been an issue for those waging wars. New forms of emotional surveillance allowed them to identify and label these potentially destabilising elements and offered up new scripts that contained their distress. The horror of what these individuals had been through and their unwillingness to endure any more could now be safely identified, given a destigmatising medical label, quarantined from infecting the remainder of the military body, and honourably discharged.

This may sound well and good. But mental hygiene had a darker side. Its two-pronged focus on maintaining as well as preventing mental ill-health meant that eugenics had been an integral part of the movement from early on. While vociferous proponents of eugenics for the promotion of national mental hygiene, such as the German psychiatrist Ernst Rüdin, initially emphasised voluntary measures, they would eventually oversee the forced sterilisation and murder of psychiatric patients during the Second World War.

This isn’t a Reductio ad Hitlerum. The point is that underlying both the kind and extreme versions of mental hygiene was a strong belief that, if only people could be made to feel, think and behave in the “right” ways, business could proceed as usual. Some were simply more hopelessly resistant to intervention than others. From this perspective, you can’t be trusted to have an inner world that is all your own because it is that inner world that is pivotal for business, social and economic success. And if any of those things are threatened, so too is your freedom to think and feel freely and, above all, privately.

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Tarnished by this dark history, the term “mental hygiene” fell out of favour during the Forties. However, many mental hygiene organisations simply rebranded themselves with a concern for “mental health”. This more recent concern is obviously charted much more humanely than the bleak path its forebear travelled. Yet its fundamental understanding of the role played by unruly emotions remains just as intact as it is mistaken.

It is tempting to believe that all of this is going somewhere. But it is precisely because society has given up on having any kind of goals at all that such an outlook can flourish. Today, the path to freedom is no longer located in the outside world, in grand projects of societal transformation, but instead in the heads of individuals. Big ideas have shown themselves capable only of leading humanity to ruin. And so the modern individual has learned to understand freedom and emancipation as a kind of “self-care”.

In this world, expanding the regulation of everyday life, subjecting it to rules and increasing its predictability become ends in themselves. If those in power cannot solve social problems, they can at least teach fragile subjects to be “resilient” to a world beyond their control. As Christopher Lasch wrote back in the Seventies, modern people don’t seek religious transcendence nor even worldly success so much as “mental health” as the “modern equivalent of salvation”. And as a result, we are being sold our own bureaucratic iron cage as a kind of freedom.

Back then, the father was a central figure both in culture and children’s development. He stood for authority, hierarchy, boundaries and individuation. He was both exemplar and competitor for a developing boy. This view underlies Freud’s theory of the Oedipus complex, and was also central to complex civilisations: in Moses and Monotheism, Freud argued that a hero “is a man who stands up manfully against his father and in the end victoriously overcomes him” and that this is a keystone of Judeo-Christian culture.

Today, though, psychoanalytic theory is more likely to view the symbolic father as a reactionary holdout to be dismantled. Meanwhile, as I discovered when I took a four-year psychotherapy training course a decade ago, men have retreated almost entirely from talking therapies, whether as clients or practitioners.

Does this disappearance matter? A new book by Wall Street Journal writer Abigail Shrier suggests that it may have far-reaching ramifications. Bad Therapy: Why The Kids Aren’t Growing Up is an uncompromising study of therapeutic child-rearing across individual therapy, pedagogy, governmental data-gathering and the culture as a whole. Bad Therapy argues that far from helping, these practices make everything worse. The children and young people raised by boundary-negotiating, feeling-validating, trauma-exploring, “talk it out” parents and educators, marinaded in the therapeutic worldview are not, as hoped, happier, more confident, and more emotionally literate. They’re neurotic, anxious, and self-absorbed; alternately fearful of the outside world and adept at exploiting soft-authoritarian therapeutic institutions for personal advantage; above all, they are profoundly unhappy.

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Shrier doesn’t suggest a causal relationship between the retreat of men from therapy, and the emergence of therapeutic parenting. But both are clearly aspects of the same wider trend, toward a symbolically fatherless world. And this has left the field to a monolithically maternal style of child-rearing: one of nurture, understanding, care, and boundless empathy. Paradoxically, though, this has not empowered mothers but stripped them of agency too. For as Bad Therapy shows, the turn away from authority has not resulted in greater emotional literacy or even more kindness, but anxious, uncontained young people, and a ballooning field of increasingly intrusive therapeutic professionals.

Bad Therapy takes a sledgehammer to every article of therapeutic parenting and pedagogical faith. No, setting boundaries and punishing does not traumatise children. And even early difficulties usually produce not “trauma” but “resilience”. No, “trauma” is not “stored in the body”. Validating children’s feelings does not make them feel safer. No, asking children how they are feeling all the time does not produce more capable, confident children. Making allowances for “Adverse Childhood Experiences” does not produce better results for children who genuinely need to overcome adversity; nor does giving children endless meaningless choices while constraining their options to the sanitised and risk-free.

But these beliefs have become holy writ for liberal America — and, by extension, wherever American culture propagates. Shrier documents the mushrooming body of school counsellors, psychologists, social workers and other auxiliaries who have proliferated in response, dedicated to helping children according to their precepts. Among wealthier Americans, therapists are routinely hired to help a child “work through” losing a pet, or kept on retainer as backup for every emotional glitch. For those unable to afford a private on-call therapist, the same worldview produces batteries of semi-trained educators delivering a “trauma-informed” pedagogy.

Shrier shows that this culture encourages children to forsake resilience for introspection at every turn. Emotional “check-ins” at the beginning of school days seem designed to yank children from an “action” mindset to a helpless, introspective one. Maths lessons have to crowbar in “social-emotional learning”. And kids barely into puberty are routinely subjected to questionnaires that invite criticism of their parents, encourage them to self-identify as mentally ill, and in some cases provide so much information about methods of self-harming or attempted suicide in the course of enquiry that, to a suggestible child, they might easily be confused for instructions. And lest anyone suggest that a shortage of therapists will curb this all-out push to make everything therapeutic, relax; Tech startups are proliferating, promising “Therapy For Every Child” delivered by AI or text message.

Is this producing a nation of happy, well-adjusted kids? Not so much. Shrier argues that far from encouraging resilience and emotional literacy, it’s incentivising under-performance among the genuinely disadvantaged, by encouraging teachers to bend the rules for the very pupils who benefit most from clear boundaries and high expectations. And among the well-off, it’s creating a generation of young adults who need a therapist to make a phone call, or to prepare them for trying to make friends in high school or college. Reports today that British workers under 40 are considerably more likely to take time off for mental health difficulties suggests that something similar has already spread as far as younger adults in the UK.

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Bad Therapy argues further that therapeutic parenting has coincided with an explosion of psychic distress at home and bad behaviour in schools: “Kids having utter meltdowns, tantrums, screaming, yelling, throwing things, crying, threatening to kill themselves” in “a school regime that demands no self-discipline from students, believing such expectation unreasonable if not unevolved”. In this authority-free regime, playground violence goes unpunished save through “restorative justice”, in which attacker and victim sit in a circle and talk about their feelings. The result, in extremis, is violent young people left at large, until sometimes — as in the case of the “Parkland shooter” — they kill.

Even the ones who aren’t violent are learning to be “mean as hell” — by weaponising institutional empathy. From girls ostracised at expensive private high schools for causing “harm” with a careless social media post, to the adolescents screenshotting their peers’ “problematic” online utterances as ammunition for future interpersonal conflicts, Shrier describes this superficially cuddly culture with cold anger, as “corruption of character” and “sustained flirtation with evil”.

Bad Therapy paints a grim picture of young people simultaneously under- and over-parented. Of adults who both want to be involved in every detail of their children’s lives but who shrink from being seen as authority figures while they do so, preferring to be their child’s “best friend”. Why is this happening? Why are we Gen X “latchkey kids”, left to fend for ourselves while both parents worked, so fearful either of taking an authoritative stance with our own children, or of seeing them experience the slightest discomfort or obstacle?

Bad Therapy is a work of cultural criticism, not social history. But in Shrier’s view, close to the heart of the so-called “youth mental health crisis” is Gen X and Millennial parents’ aversion to being the symbolic — and literal— Father for their children. Instead, she argues, anxious “gentle parents” hover with platitudes about “big feelings” while their toddlers screech and bite, or defer to experts when their teenagers are struggling. These parents reject the “more masculine style of parenting” Shrier characterises as “knock it off, shake it off” — an approach that rebuked misbehaviour briskly, and expected minor setbacks to be dismissed. Instead “all traces of tough love and rule-bound parenting have been supplanted by a more empathetic style, the one once associated with moms.”

Less explicitly spelled out is the way the same dynamic has also outsourced mothering — and opened the door to its replacement by what Jordan Peterson calls the “dark mother” or “devouring mother”. For Freud, this “Oedipal mother” stood in contrast with the “good mother” who, for Freud, “necessarily fails” at nurturing, thus setting the child on a path to independence. Instead of setting her children free, though, the devouring Oedipal mother keeps them tightly enmeshed forever.

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The plot twist, in the therapeutic childrearing and educational cultures excoriated by Shrier in Bad Therapy, is that today this dark mother is not an individual but a set of institutions, norms, and practices. For, as Bad Therapy argues, it’s less that these unhappy children are tied to their literal mothers’ apron strings, than that they’re enveloped by the devouring mother of institutional “care”. Over time, it can end up displacing literal and symbolic parents of both sexes.

Shrier doesn’t speculate as to why or how. But somewhere along the way, Gen X and Millennial parents allowed themselves to be persuaded that the way forward was deferring to paid parenting “experts” — and, in return for ceding authority, hoped their kids would like them. Except, as it turns out, it’s had the opposite effect: children don’t like their parents more for being needy and permissive. Nor are they even freer, but — often — simply more radical. Shrier draws a straight line from the loss of authority in parenting to political extremism, noting that extremist movements from BLM to the far-Right often attract young people from homes where authoritative guidance is lacking. She quotes Myrieme Nadri-Churchill of the deradicalisation nonprofit Parents for Peace, who puts it starkly: “It’s almost like extremist groups have replaced parenting.”

What, then, is to be done? The book’s central message could perhaps be summed up as: less tech, more agency, better boundaries. In her view, the first course of action is to remove the factors obviously making adolescents’ lives worse: the therapy-speak, the climate alarmism, the “hunt for repressed trauma”, the suffocating micromanagement, and the anxious reluctance to allow children to develop independence. Crucially, she argues that the most obvious intervention of all for improved youth mental health is not more institutional devouring Mother, but an authoritative “no” by the symbolic Father: specifically, banning smartphones from schools.

But this would mean employing the very authority that makes Gen X wince. “Teens manage fine with flip phones. They aren’t weaker than you — unless you make them so.” She leaves the question implicit: are you Father enough to hold the line? We can perhaps infer from Bad Therapy that if anyone needs (good) therapy it’s not the kids but their parents — most centrally, in making peace with the symbolic Father. For if Shrier is correct, my generation has killed him — only to turn away from being the hero who takes his place. In his stead, we’ve enthroned a faceless, institutional devouring mother.

And perhaps, again, the only way to escape this dark, smothering pseudo-mother is to make peace with the necessity, as Freud put it, of failing as real mothers. In any case, grappling with our own anxieties and disappointments as adults and parents is easier said than done, as Shrier acknowledges. She describes how effortful she finds it to grant her own children increasing access to independence.

Nonetheless, she argues, it’s on parents to do battle with our own deep-seated fears: about harm to children, about failing as nurturers, about being hated for saying “no”. What is preventing Gen X from doing so? Perhaps the “latchkey generation” carries more childhood wounds than we realise.

There is also a worry that vague statements of gratitude, launched diffusely into the void, perversely make it less likely that we will give credit to real human benefactors where it is actually due. It’s so much less effort to mentally thank the universe than to thank a friend out loud, after all. But such misgivings seem to put me in a minority. Along with kindness, the bland social capital of unfocused gratitude has been surging for a while now — much beloved of yoga teachers and Instagram influencers, and perfect for a humblebrag when you want to show off about that new kitchen extension without making it seem obvious (#grateful).

In a similar vein, various academics and medics frequently extoll the benefits of a daily “gratitude practice” for things such as combatting depression and boosting the immune system. We are presented with psychological case studies like that of the unfortunate “Susanna”, described in one influential journal article from 2013. Immediately after her husband had a terrible motorcycle accident and went into a coma, Susanna discovered that he had been having an affair with her friend for years. And that wasn’t all — she also found out that he had been secretly addicted to gambling and had emptied their bank account. Still, luckily for her, the article reported that Susanna was able to shift “to a context of thinking about all she still had in her life, as well as a stance of gratitude for the opportunities that remained open to her”, and so was able to continue functioning despite these crushing blows.

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Though it wouldn’t work for everyone, I’m glad that some people can find relief from despair in this way. Still, as with other attempts to motivate people into prosocial behaviours by saying they will be good for you — see also kindness, forgiveness, and empathy — it seems to me that the general line of defence misfires.

It’s not just that ethical behaviours such as gratitude are by definition outward-facing and other-regarding, so that to reduce them to narcissistic exercises in self-improvement is to destroy their whole point. It’s also that it’s difficult to disentangle whether any supposed resultant physical or psychological benefits come from the particular behaviour itself, or rather from a surrounding self-congratulatory awareness that, by displaying the behaviour, you are doing something that would be approved of by your peers. Milan Kundera once characterised “kitsch” as causing “two tears to flow in quick succession. The first tear says: How nice to see children running on the grass! The second tear says: How nice to be moved, together with all mankind, by children running on the grass!” In effect, the challenge for psychologists is to work out whether the supposed health benefits of gratitude stem from the sort of feelings accompanying Kundera’s first tear, or those accompanying his second.

Equally, in cases like Susanna’s, the explanation for any resulting psychological improvement seems even more overdetermined. Was it really her feeling grateful that helped her recover her equilibrium? Or was it simply the act of reminding herself of some good things in her life that made it all seem less bleak? You could easily do the latter without feeling the former specifically, and it might work quite as well.

In any case, it seems that we are all a bit like Susanna these days — desperately trying to bat away the incipient darkness by clinging onto thoughts of what isn’t already completely terrible or spoiled. It surely will not have escaped your notice that there is very little good news around — a state of affairs obviously not helped by awful wars, but not wholly caused by them either. Declinism and doom-mongering are in vogue everywhere you look; and, though they take on different flavours on the Left and Right, the net result is still bloody depressing. Whether it’s the collapse of the environment and the implacable rise of bigotry, or the collapse of Western civilisation and the implacable rise of cultural Marxism, there’s not much out there to put a spring in your step. In fact, it’s almost as if all the despairing and all the gratitude were two sides of the same psychically dysfunctional coin.

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And nor can it be said that we tend to look upon bad news with a countenance more in sorrow than in anger. Grievance and resentment are now absolutely mainstream. Practically irrespective of its content, people rush to find the angle in the latest piece of news that most satisfyingly fits their vision of an unjust universe. The point is well-established for the Left – albeit that their catastrophising is usually done on behalf of histrionically imagined others — but applies equally to the Right. Increasingly among social conservatives, there is a kind of deliciously grim, told-you-so satisfaction at the thought that we are all going to hell in a handcart.

No doubt there are many reasons for the human tendency to attend disproportionately to the bad rather than to the good in life. A basic one is adaptive: a lot of human attention is geared towards eliminating personal risk. But just as merely noticing the good things in life doesn’t automatically mean feeling grateful for them — because a range of quite different emotions might accompany an identical observation — so too finding bad things in life need not automatically mean feeling aggrieved. Other attitudes are also available: detached curiosity about root causes is one, and stoic resignation another. One’s first thought does not always have to be about whose fault it probably is.

Jonathan Swift once observed that “men are grateful in the same degree that they are resentful“; perhaps noticing that with both gratitude and resentment, there is often an accompanying desire for payback. Centuries later, philosopher P.F. Strawson identified the two kinds of feeling as his paradigmatic “reactive attitudes”: when properly formed, each involves an attribution of responsibility to another person, and an assessment of his or her original intention in forming how you feel in response. Strawson wrote of resentment, for instance, that:

“If someone treads on my hand accidentally, while trying to help me, the pain may be no less acute than if he treads on it in contemptuous disregard of my existence or with a malevolent wish to injure me. But I shall generally feel in the second case a kind and degree of resentment that I shall not feel in the first.”

These days, though, something strange is happening. While we no longer treat the good things in life as intentionally produced, or as the responsibility of anyone in particular, we seem unable to treat the bad things in life as anything but. And as feelings of gratitude get more scattered, resentment and grievance seem to get more laser-like: directed without deviance towards favourite cultural or political bête noirs, whether those are Tory politicians or cultural Marxists.

Or to put it another way: the dominant attitude to happy tidings is barely reactive, in Strawson’s sense, at all anymore — but the attitude towards more ambivalent events is all reaction, all the time. When gratitude loses its moorings from a proper relation to another person’s intention and responsibility, we end up with nice vibes. When resentment does the same, we end up with increasing amounts of conspiratorial rage. And unfortunately for us, the former doesn’t seem to have the power to cancel out the latter.

The entire episode parallels the global reaction to the Ukraine war, in which solidarity with Ukraine as a victim of foreign aggression or empathy with Russia as a victim of Western hegemonic overreach divided the world. Some might view this phenomenon as a hallmark of human compassion and care — the result of greater awareness of human suffering owing to the power of modern technology. Still, there are numerous examples of brutal conflicts and atrocities that do not capture international public and governmental attention and thus remain local and ultimately ignored.

Judging by history, this global internalisation of distant wars by outsiders is a highly unusual, and rather pathological, development. It happens when both the ruling classes and the civilian populations across the world begin to perceive a far-off external conflict in existential terms and put themselves at the centre of it as a messianic protagonist. The question is: why?

On the one hand, the Ukraine and Gaza wars are distinctively modern — both because of the sheer magnitude of destruction and because they are conflicts of nationalism, a contemporary ideology that links the future of peoples to states. On the other hand, the global milieu within which they take place is one of a profound crisis of meaning and legitimacy exacerbated by the identitarian turn taken by both the Left and the Right since the Sixties, and the complete politicisation of all aspects of life in late or hyper- modernity.

In today’s globalised world, identity-based existence, muddying the boundaries between the political and the personal, has become a poor man’s substitute for the deep-rooted and embodied meaning that was previously derived from communal, traditional life and held in common within a culture. Stemming from an external locus of control, all modern identities thus reflect what Nietzsche called an inherent “ressentimental” drive and are constructed around overcoming the systemic oppression of an abstract and highly symbolic “us” by a privileged “them” that is subsequently cast as evil.

In this metaphysical account, being downtrodden is morally superior. Privilege and power are inherently evil. And one can become righteous by projecting oneness or identity with the virtuous victim. In both Israel and Ukraine, we can see how this ontological, if tragic, struggle for coherence within the modern self through self-identification with the “disempowered” is carried over into the realm of global geopolitics.

Regardless of the actual historical context of the globalized conflicts and the ostensible animosity between the partisans of the two sides, the underlying motivation for the opposite sides of these seemingly binary and zero-sum conflicts (who don’t actually experience the war and its violence) is a contestation over oppression and a struggle to determine the “virtuous” victim.  In other words, real wars over land, resources, and survival are co-opted by the rest of the world and transformed into wars of victimhood with which they can intrinsically relate. War thus becomes therapeutic and is turned inward as yet another means for identity formation in one’s internal quest for social identity.

For the civilian populations living abroad, therefore, these faraway conflicts are more than mere distractions: they are an opportunity for catharsis. They offer the fleeting possibility of escaping the existential angst of an atomised life lived under the automatism of modernity, and for feeling a sense of unity, purity and spiritual community forged in the virtual fires of war — all from the safety and comfort of their digital devices. As Ernst Jünger wrote in an often-overlooked monograph War as an Inner Experience, “action in itself is nothing, conviction is everything” — and the lost mimetic souls of hypermodernity epitomise it.

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But not only are these wars co-opted by the global masses seeking transcendence; they are also simultaneously internalised and instrumentalised by the establishments in foreign countries to buttress and justify their political regimes. Where civilian populations’ ontological insecurity stems from an essential need for meaning and permanence, the ruling classes suffer from an additional insecurity that is rooted in the need to legitimise their power (even to themselves) in a world where all institutional authority is increasingly doubted.

Modern statehood is predicated on political regimes, all of which, whether we are conscious of this or not, legitimise themselves according to modern ideologies that claim to be liberating and righteous. Even as modern universalist ideologies such as liberalism and Islamism dismiss each other as tyrannical and unjust, both these state ideologies, in different ways, profess to transform the world for the better by eliminating oppression as such.

Within the framework offered by globalised social justice, modern entities such as Ukraine, Israel and Palestine are removed from their concrete territorial contexts and transformed into pet projects and ideological proxies by different foreign actors. Ukraine thus becomes existential to the United States, even though the fate of Ukraine will never have a decisive impact on America’s national interest or the collective interest of Americans. Israel’s cause, meanwhile, is forever identified with the post-war liberal international order and the triumph over National Socialism: our commitment to it must thus remain sacrosanct and unwavering. Because the North Atlantic establishment essentialises liberal internationalism as part of its institutional identity, both Ukraine and Israel become places where Western political leaders can fight against the disintegration of the liberal order and hence baptise themselves in the cathartic waters of foreign wars.

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Similarly, to the vanguard of the Islamic Republic in Iran backing Hezbollah (or the Muslim Brotherhood revolutionaries backing Hamas), “Palestine” has for years symbolised what Ukraine now represents to the Atlanticist elites in the West: the physical embodiment of a world-transforming “cause” and the symbol for a self-righteous ideology animated by eliminating suffering, imperialism and exploitation. In both cases, the ideological proxies become the scene for a Last Judgement, a Rapture based on a highly religious framing about innocence and transgression, purity and stain. Each ruling class sees displaying solidarity and support — whether for Ukraine and Israel or Palestine — as a test for moral purity, and victory takes on an existential and millenarian meaning, signalling the final unveiling of history to justice and salvation.

None of this is meant to discount the fact that there are genuine geopolitical causes behind these conflicts, but to emphasise that, when it comes to their globalised nature, often ontological insecurity and ideology drive foreign powers’ geopolitical interest in that region in the first place. Just as the Palestinian cause serves as a lever for Iranian influence within an Arab world steeped in post-colonial trauma and paranoia, the historical trauma many Central and Eastern Europeans experienced under Russian communism makes them understandably anxious about Russian aggression and eager to join the Western camp. Nevertheless, for the major powers outside these regions, interjection in conflicts abroad is not simply a cold calculus in realpolitik, but an opportunity to bolster their legitimacy by siding with the state or cause which serves as their ideological proxy.

Together, the civilian and political drivers that motivate the global internalisation of local wars explain the strange phenomenon already perceived by George Orwell in the 20th century as “transferred nationalism”: “Transferred nationalism, like the use of scapegoats, is a way of attaining salvation without altering one’s conduct.” Transference allows one to be “much more nationalistic than he could ever be on behalf of his native country” and gain moral capital and social prestige while doing so.

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Despite the protestations from the dissident Right and the anti-war Left, Ukraine is the paradigmatic example of this; consider the overwhelming consensus between the ruling class and its civilian base in the universities, media and the professional-managerial class as to the identity of the virtuous downtrodden (hint: it wasn’t the Russians), and how this consensus mirrored by European capitals galvanized the West behind Ukraine. Yet these exercises in generating ersatz nationalism for the political regime are not always seamless, and can quickly turn toxic and corrosive.

As seen with the Israeli-Gaza conflict already, trouble arises when a regime’s establishment and its sources of civilian support find themselves on the different ends of the oppression narrative spectrum. The current rift between the Biden administration’s unquestionable support for Israel as the victim of terrorism and a large section of the Democratic base condemning what they call the “Palestinian genocide” is a clear indication that they fundamentally disagree on the identity of the “virtuous victim” here. A similar dynamic can be observed in Britain’s Labour Party. In this way, internalisation of foreign wars can become a source of political instability and domestic strife.

Moreover, not only could such internalisation of wars abroad be a source of social discord, but the public and political fixation on them could motivate more than virtual engagement — resulting in physical intervention in distant conflicts that could possibly escalate them into real regional and even world wars, not to mention completely warp the national interests and security priorities of the intervening power. After all, ideology and fanaticism resent rapprochement and diplomacy.

In one of his final commentaries before he died in September, Christopher Coker, the international theorist and scholar of war, wrote: “the existential dimension [of war] is no less important [than its political side] for it also involves power, or more correctly perhaps, the empowerment, both material and spiritual, of those who do the actual fighting.” To this we must add: “and also the desire for empowerment by those who don’t do any of the actual fighting — but who nonetheless live vicariously through it.”

When we encounter murderous healers, as we have in the cases of the British GP-turned-serial killer Harold Shipman, the homicidal American nurse Charles Cullen, and now Lucy Letby, the instinct is to cry “monster!” and make every effort to distance ourselves from such horrific behaviour. Surely these people are mentally ill? Psychopaths, deviants: people totally unrooted in basic human compassion.

In reality, this doesn’t stack up. Shipman and especially Letby seemed to be confusingly normal people living mundane lives. They were well thought of — if that is, they were thought of much at all. Shipman was a former rugby player who expressed remarkably compassionate and forward-thinking ideas, very much current today, about care for people with mental disorders. Meanwhile, Letby has been characterised as “beige” — not a word that springs to mind for many serial killers. She was a fan of salsa dancing, adopting cats, and taking holidays with her parents while in her mid-twenties — and was so “nice” that doctors initially discounted her as a possible cause of the deaths. The explanations of her motives: that she had a crush on one of the consultants; that she feared never having children of her own; that she suffered from Munchausen’s Syndrome by proxy or psychopathic tendencies, seem contradictory.

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In my many years of working with murderers, serial killers, and criminals with a range of complex mental troubles, I have learned that when things seem most confusing, the answer often lies in a person’s life experience, and especially in the “obstacles” they have tackled in their personal relationships. As psychoanalytic theory shows us, people are often poor narrators of their own reasons for doing things: instead, their actions tend to powerfully echo their life experiences. Harold Shipman, for example, at the age of 17 watched his mother die a slow and horrible death of lung cancer, eased only by the use of large amounts of morphine. This was exactly the method he later used to kill his own victims as they struggled (on the whole) with illnesses that they would have recovered from, something that as a GP he would have known.

When it comes to understanding this drive towards death, we must naturally start with Sigmund Freud. Freud believed that there were two “drives” in everyone’s unconscious: an Erotic drive towards pleasure, procreation and life; and a Thanatotic drive towards destruction, pain and death. Each is important because we all eventually have to face up to the temporality of sexual relationships and the inevitability of death. But unfortunately for those of us working in forensic psychiatry or psychotherapy, Freud wrote a great deal more about the Erotic than he did about death. This means that a lot of thinking about perversion — the turning away from life and towards death — has been filled in by other writers and psychotherapists since.

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Estela Welldon, a forensic psychotherapist, writes particularly powerfully about “dancing with death”; the idea that for some people a closeness to death provides a kind of life-affirming excitement, a reminder that they are still alive. It doesn’t matter whether this is their own death, as is the case for people who self-harm or consider suicide, or the death of others who choose to express this outwardly (and certainly not always fatally if we think of extreme S&M sex play). Very often, this takes the form of what Freud called a “repetition compulsion”: a compulsive desire to recreate important circumstances from one’s past in a way that induces the excitement of the “death dance”, but provides a sense of control over it. Shipman is an obvious example, but I have worked with many male offenders who cannot seem to help but repeat upon their loved ones the violence they saw inflicted on family members by fathers they swore they despised.

For Letby, her own birth was a “near-death” experience; she was told that her life had been “saved” by the nurses who helped her mother through a difficult childbirth. This has been cited as the main reason Letby went into nursing herself. But what was it that appealed to her so much? A sense of debt to the profession, possibly, although it must have seemed awesome to her that another individual had such power over life, and that she herself could take on this power.

As someone who trains aspiring psychologists and psychotherapists, I meet a lot of “wounded healers”: those who chose to follow such a profession because of their own life experiences. There is nothing wrong with this, in itself, and of course talking therapies equip people with considerably blunter tools for helping and harming than those wielded by doctors and nurses. Yet several ambitious people I have trained have subsequently left the caring professions because the realities of working every day with suffering people can often be more oppressive and harrowing than it can be life-affirming. Young women who seem hell-bent on deliberately harming themselves; middle-aged men with depression so crippling they can barely mumble a sentence in their clinic session; people from migrant backgrounds who can barely speak English, but their distress and trauma seem to seep from their very pores and cause your voice to choke in your throat. All of these cases, day after day, and some of it reminding you of — even triggering — your own past traumas and obstacles. We politely call this experience “compassion fatigue”.

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It shows great maturity to abandon your dream when you realise that your fatigue is so strong that you cannot continue. But I imagine that this must be even harder to do if you genuinely believe your life has been saved by the profession you have spent countless hours training in. In that case, where does this fatigue from a constant experience of death and near-death go? The natural, unspeakable response would be to try to exert some kind of control over it; to show that the life-affirming experience of her birth could be repeated through an equally potent act. But, lacking the skill to save truly sick babies, her only way to exert this power, to show that she still lived and her life was worth living, was to take the lives of others in her care. Quietly, and with minimal suffering, perhaps, but was this a choice of convenience rather than compassion?

As the respected forensic psychologist Naomi Murphy has said, to take life in this way is a callous, almost psychopathic response — but the uncomfortable truth is that it is also oddly human. Letby is not anything so straightforward as a monster or a psychopath. Confronted repeatedly with suffering and loss in a world she so fervently believed she belonged, her drive to sustain life became perverted into a drive to inflict death. Only in this way could she feel that her identity, her power — that instinct to care which, in others, kept her alive and then gave her a reason to exist — could be sustained.

It always astonishes me that while those of us working in mental healthcare are expected to receive regular, even daily, supervision and therapy to “detoxify” us from the psychic pain, those in physical healthcare — who, frankly, see far more death and trauma — receive no such consideration. In the face of suffering and death, which was already worryingly common at Countess of Chester Hospital long before Letby worked there, NHS workers are expected to simply get the job done. It feels unreasonable to suggest that, amid a staffing and funding crisis in the NHS, regular psychological support should be offered to those who regularly work with death. Yet at the same time, this would be one way to spot those for whom compassion fatigue had started to eat away at their empathy — and paralyse their drive to life.

War tends to increase social cohesion, leaving those statistically at the edge, exposed. And in the aftermath of World War Two , discrimination against gay people reached its zenith. “Homosexuals” were thought too different to be tolerated: they were criminalised and given a psychiatric diagnosis and “treatment”. Considered relatively benign, the so-called “conversion therapy” was deemed a way for troubled people to avoid worse fates and social rejection. Some gay men and women requested the “therapies”, presumably with the hope of passing through life more easily and being socially affirmed as “acceptable”.

Today, conversion therapy is at the heart of another war, as the Government attempts to ban it. Again it involves a marginalised cohort, who despair of fitting in. But this time, “conversion therapy”, which was always ill-defined, has taken on several different meanings.

The term is used to describe a range of medical and psychotherapeutic interventions, early versions of which were offered to gay men and women on the NHS during the Fifties — although these were focused on aversion more than conversion. Pavlovian attempts were made to disrupt any association between (same-sex) sexual stimuli and sexual responses, with electric shocks or medically induced vomiting. Later therapists attempted to actively re-orientate people’s sexuality towards heterosexual stimuli. Methods also included religious counselling, talking therapies, and finally, for some gay men, hormonal treatments.

These attempts to either avert homosexuality or convert lesbian, gay and bisexual (LGB) people to heterosexuality didn’t work — and even killed people. Alan Turing committed suicide two years after opting for “chemical castration”, rather than imprisonment.  Eventually, though, society started to shift. In 1967, homosexuality was decriminalised in England. In 1973, the term was removed from the 2nd version of the Diagnostic Statistical Manual (DSM-II), a handbook used by healthcare professionals to guide the diagnosis of mental disorders. Outside of LGBT communities, the concept of conversion therapy may have comfortably drifted out of consciousness for a while.

The collective amnesia did not last long. In 2011, The Guardian reported that some religious therapists were still trying to convert gay men. This forced therapy organisations in the UK to confront their history, and in 2015 the first Memorandum of Understanding (MOU) on Conversion Therapy was signed by 16 organisations. All agreed that it was unethical for a therapist to try to change someone’s sexual orientation via any means. Two years later, a second memorandum — the MOU2 — was announced. This one had expanded the concept of conversion therapy to include any “therapeutic approach, or any model or individual viewpoint that demonstrates an assumption that any sexual orientation or gender identity is inherently preferable to any other”. The inclusion of “gender identity” is significant.

Gender identity is the term used to describe the profound internal sense that some people have of their maleness, or femaleness, or neither. Gender non-conformity didn’t escape diagnosis for long; when the updated DSM-III was introduced in 1980, the concept of “gender identity disorder”, previously absent, slipped into the gap left by homosexuality.

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In July 2018, the day before the MOU2 was officially launched in parliament, the government presented the results of its National LGBT Survey. The online survey of more than 108,000 self-selected respondents stated that, overall, 5% of respondents had been offered conversion therapy, and 2% had taken it up. This rose to 9% and 4% of transgender respondents.

The idea that conversion therapy could still happen in modern Britain is abhorrent to most. And this is why there has been a move to ban it in parliament.. Yet feelings and facts matter. The LGBT survey did “not provide a definition of conversion therapy”. As such, the survey measures whether people perceived something to have been conversion therapy. Furthermore, for those who did feel they had been offered it, only 19% said that it was via a healthcare provider or medical professional. No one knows how many of these were in the NHS.

It is easy to think we understand what we are talking about when it comes to conversion therapy when maybe we don’t. And given the controversy over Government’s decision to include trans people in criminalisation of the practice, it’s vitally important that we do.

In 2018, no one claimed to be receiving electric shock treatments, or medically induced nausea. These interventions are of course already and rightfully illegal. So what is it exactly that people are experiencing? In the NHS, the only conversion therapy treatments that are still offered — albeit not with the aim of “converting” homosexuals — are talking therapies and hormonal interventions.

Let’s address talking therapy first. There is no doubt that some “therapists” will have actively tried to alter their patients’ gender and sex-related thoughts, feelings and/or identities. We have troubling anecdotal evidence that this has happened to some trans-identified people in modern Britain. Whether this is happening away from religious settings — in the NHS or mainstream clinical or psychological practice — is harder to ascertain, but it is possible. After all, potentially damaging interactions between mental health professionals and trans- or gender-questioning people aren’t a new phenomenon.

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Treatments attempting to convert gay and lesbian people to heterosexuality were just as unethical and also failed. But they gave rise to an affirmative practice which has taken hold today and which includes medicalisation. “Gay Affirming Therapy” was developed in the early Eighties as a reparative response. This approach wasn’t intended to be a whole-scale model of care, but a therapeutic position wherein the clinician demonstrated warmth and acceptance of a client’s non-heterosexual identity to counterbalance negative messages from society.

It is this affirmative position which has been adopted, and adapted, by clinicians working with transgender adults and gender-incongruent children. But the term “affirmative care” has changed. It has morphed to include, the offer at least, of “medical affirmation” — or hormonal intervention. Medical gender affirmation aims to help reduce an individual’s suffering by trying to better align their physical body with their felt gender identity. The World Health Organization defines it thus: “Gender-affirmative health care can include any single or combination of a number of social, psychological, behavioural or medical (including hormonal treatment or surgery) interventions designed to support and affirm an individual’s gender identity.” Note here how the idea of hormonal interventions has been turned on its head, previously offered as a “conversion therapy” for gay men.

Despite the fact that there is no consensus or good quality evidence to demonstrate that — on balance, on average and over time — these novel gender-affirming medical interventions do reduce suffering, and despite the evidence that they will certainly harm some, many people report that for them, personally, they have felt “life-saving”. These evocative first-person narratives have led some to argue that access to gender-affirming medical interventions should be a human right. From this vantage, anything other than immediate affirmation can be considered equivalent to conversion therapy. As a result, psychotherapy, which might explore different ways of understanding ourselves and in doing so may delay medical intervention, is now understood by some as inherently harmful.

This leaves us in a position whereby offering a medical intervention to someone who identifies as LGB is very clearly understood to be conversion therapy, while not offering the (sometimes same) treatment to someone who identifies as transgender is also understood, by some, to be conversion therapy. Meanwhile, offering psychotherapy that aims to reduce distress by increasing self-acceptance without the need for change is seen as the right approach for LGB people but, sometimes, the wrong one for transgender people.

To complicate things even further, the population of people understood to be transgender has broadened. “Trans” has become an “umbrella term” under which a broad range of experiences are collated. As well as those who identify as the opposite sex, the category now includes gender-questioning people, gender non-conforming people and the gender fluid, among others — depending on who is defining it. The term non-binary, used to describe people who identify as neither male nor female, entered the clinical literature less than a decade ago, but is already being medically treated in the NHS.

We must also note that the demographics of those who identify as trans have also changed significantly over the recent years. No one yet knows why. These changes are particularly striking in younger people, with the number of adolescents and young adults questioning their gender and sexuality has increased exponentially in recent years in particular among young women.

On top of this, sometimes the same individuals move between identity categories — from LGB to T or T to LGB for example — increasing the risk that a treatment felt to be right, lifesaving even, the first time can be experienced as devastatingly wrong for the same person the second time. One person’s affirmation therapy might be another person’s conversion therapy — but no one can agree on which is which.

History doesn’t repeat but it often rhymes. And the NHS is once again trying to reduce the suffering experienced by some gender non-conforming people. Once again, it is offering a range of treatments that don’t — yet — have sufficient evidence to allow us to guarantee any outcome. Once again, people seeking to pass through their lives with more comfort are requesting treatments. And once again, the profound uncertainty about what will work for whom leads to inevitable medical risk-taking. If a patient can’t always predict how they will feel about something in the future, then a doctor or therapist certainly can’t.

No one can envy Dr Hilary Cass, the paediatrician charged with delivering an independent review of the NHS’s gender identity services and find a way forward, for children and adolescents at least. She finds herself on a battlefield where people are fighting over how to define key clinical terms, not least the concept of conversion therapy itself. Yet a quick search of her interim report makes it clear that Cass isn’t too worried. The word “conversion” doesn’t feature once. Instead, without taking medical treatments completely off the table, she calls for the NHS to increase access to psychotherapy. According to Cass, then, gently supporting people to explore identities in therapy is not akin to conversion therapy as most people understand that term.

As we turn our minds to the future, we must keep one eye on the past. Wars, cultural or otherwise, aren’t good for anyone, particularly minority groups. No ethical clinician wants to repeat history and inadvertently hurt the very people they are trying to help. We must focus now on developing therapies that will be acceptable to and appropriate for everyone who might seek them, minimising the risk of current or future harm. To do this we must accept that when it comes to issues of sex and gender, uncertainty and cultural change are the only things we can predict.

It’s fair to say that the morbid fixation on mental health among a certain class of visible and voluble teenage girls has grown to be its own mental health crisis. Yet, the PR teams at psychiatric hospitals can say without laughing that people who would speak of mental health must first overcome a culture of silence, and that the people who do manage to pierce the layer of stigma, who defy the heavy shame to voice the forbidden theme, they are heroes. This includes those who celebrate the brave heroes mentioning mental health, since they also are mentioning mental health.

I’m generally torn when I hear these solemn, delusional pronouncements. On the one hand, I find them irksome. However sincere or sympathetic the intention, they express the interests and ways of thinking of powerful institutions that are, I think, increasingly destructive. On the other hand, in the sheer scale and clarity of their falseness, and the vaguely religious tenor of their repetition, they’re kind of funny. The devolution of psychotherapeutic expression from the clinic and the couch to the individual’s bedroom and his TikTok account, and the valorising of this common form of status-chasing as rare and brave, are undeniably comic, from a certain angle.

This undeniable comedy is something Michel Foucault captures about the moral melodrama through which our therapeutic age celebrates itself — especially in Volume I of his The History of Sexuality. I’m tempted to say that this book, along with his other main historical work of the early Seventies, Discipline and Punish, belongs to the formal division in classical theatre between comedy and tragedy — the traditional comedy being about sex (and ending with a wedding), and the standard tragedy being about death (and ending with, well, a death). Discipline and Punish begins (rather than ends), with an 18th-century prisoner’s prolonged and gruesome execution by a method I’ll call “enhanced dismemberment”. The History of Sexuality, on the other hand, begins with a quick paragraph that lets us know we’re descending into a lampoon, impish mockery of a familiar “story”: “For a long time, the story goes, we supported a Victorian regime, and we continue to be dominated by it even today. Thus the image of the imperial prude is emblazoned on our restrained, mute, and hypocritical sexuality.” Foucault sets out to show that this “story” is so distorted and self-serving it’s funny.

The “story” that Foucault wants to expose as a sort of kitsch, a corny inverse moralism, is often told by sex professionals (sex doctors and sex bureaucrats, that is, not prostitutes), as well as by the influential historians Foucault is making fun of in this book. It says that, thanks to habits and methods codified in Victorian times and then revived and intensified in the conformist years of the Fifties, we are heirs to a culture of sexual repression. Even today we struggle to cultivate open, authentic relationships with our own sexuality. Queen Victoria came to eponymise the themes and methods of this culture, indeed to embody them as the sovereign frump of a mighty empire. But she didn’t found this culture. Rather, the story goes, it began to take form a century and a half before her reign. And this — the dating of this culture to the 17th century by influential historians — is powerfully convenient. Foucault writes: “By placing the advent of the age of repression in the seventeenth century…, one adjusts it to coincide with the development of capitalism: it becomes an integral part of the bourgeois order.”

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With a droll professional insult — “one adjusts it” — Foucault places conventional histories of sexuality and repression within their own inherently comic narrative of desire. Unconsciously but earnestly and systematically, the historian makes certain pleasures available to himself by “adjusting” the history of repression to coincide with the history of capitalism. With this concurrence in place, he can cloak himself in “the honour of a political cause” simply in doing his job. If sexual repression emerged to serve capitalism, then merely talking or writing about sex “has the appearance of a deliberate transgression”. Such transgressions add up to a piquantly rewarding political programme — sex and sexual frankness as resistance to capitalism — that “combines the fervour of knowledge, the determination to change the laws, and the longing for a garden of earthly delights”.

Attached now to a political programme, this erotic longing provides both the inner drive and the highest goal in a total vision of historical progress, which bears certain comic similarities to religious conviction. Conspicuous within the historians’ “discourse of sexual oppression”, Foucault writes, is “something that smacks of revolt, of promised freedom, of the coming age of a different law”. In this discourse, “some of the ancient functions of prophecy are reactivated”. The rousing lesson of this prophecy, its final message or promise about the future, is: “Tomorrow sex will be good again.”

Within this hopeful vision of liberation through sexiness and sexual frankness, however, Foucault locates a darker motive, a hint of puritanical loathing familiar to students of both religious enthusiasm and revolution. He asks: “Why do we say, with so much passion and so much resentment against our past, against our present and against ourselves, that we are repressed?” This resentment is also semi-conscious at best, fraught with irony and cognitive dissonance, and so Foucault can treat it in a comic register as well. Indeed, for almost a page he repeats his question in forms so overt in their jokey wordplay it’s like he’s doing — as comedians call it — “material”. “By what spiral did we come to affirm that sex is negated? What led us to show, ostentatiously, that sex is something we hide?” “[W]hy [do we] burden ourselves with so much guilt for having once made sex a sin?” “How have we come to be a civilisation” that prudishly judges itself for having “sinned against sex?”

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The received histories of sex deserve this comic summary because their story of repression is not just errant or wayward, a little off in its critical heading, but diametrically wrong. The real story as Foucault tells it points in the exact opposite direction. The 300 years that the historians circumscribe as a time of repression actually saw an “explosion” of talk about sex. This time is marked by the furious, incessant creation and multiplication of sexual discourses, as an intensifying scientific spirit of observation and classification discovered people’s hidden sexual worlds in their infinite potential as objects of study. Far from being silenced or repressed over this period, people were increasingly prompted and prodded and harassed to name and describe the sexual truths they bore in their souls, by priests, doctors, psychologists, government bureaucrats, and employers, whose power grew with the sexual details they collected and collated. After you read The History of Sexuality, the classic scene in which a repressed person is freed into psychosexual hygiene — “empowering” herself against the forces of shame and repression by divulging her sexual secrets to a professional psychotherapist — appears in a very different light. You’re newly inclined to see empowerment happening not in the speaking — as our melodrama of psychotherapy would have it — but in the listening.

This reversal of the political valence of sexual discourse and sexual silence, and Foucault’s killing mockery of the sexual ideology of the New Left, have recently won him admiring readers outside his original fan club of literary academics and other postmodern Leftists. But a deeper affinity between him and his new readers owes to the fact that Foucault was 50 years ahead of his time in emphasising the deep moral power of administrators and bureaucrats, doctors and psychologists deputised by sovereign and corporate authority to burrow inside people’s minds and bodies, extracting secrets and implanting helpful suggestions. He showed how institutions deploy a sort of relentless inquisitorial energy that remakes their charges into new and more pliant types of institutional subject, more agreeable to administrative power precisely because they’ve been rendered more open about their inner selves.

Diversity training is a telling recent example of this sort of power, a vivid analog of the forms of sexual study and discipline Foucault describes, resting as it does on a pageantry of confession, of redemption into moral fitness through acts of self-narration and self-description. It would be simpler and cheaper, and almost certainly more effective, for employers to minimise racial offence among their white employees by simply telling them what their non-white co-workers are likely to find offensive or racist, and perhaps why. But the idea of piercing the understandable reticence on racial matters of their nervous employees, goading them to “open up” about the racism they hide inside themselves, is simply too attractive to pass up. These records of racial resistance and confession are a source of immediate pleasure and value and power for the department of human resources and its partners in the Diversity, Equity, and Inclusion (DEI) consulting world.

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For my part, I came to a curious realisation two decades ago, while researching the politicised, dim-bulb scholarship prominent in teacher-training programmes in the US. The more an educational approach bore the influence of supposedly Foucault-inspired postmodernism, the more “critical” or “constructivist” it was, the more its retail methods resembled the models of institutional power that Foucault describes in History of Sexuality and Discipline and Punish. Educational relativism reverses the flow of language in a classroom. Instead of receiving agreed-upon knowledge from a stable authority (an arrangement that, let’s be clear, is not without its disciplinary potentials), prone students are induced to produce discursive performances for an authority who, instead of lecturing and overtly prescribing, is now observing, listening, notating, patiently waiting through awkward pauses, prodding the student to keep talking when useless silence threatens to dominate.

When content and curriculum are demoted as teachers’ duties, what tends to replace them is a therapist’s probing interest in inner states, attitudes, and dispositions. This is the direction of virtually every faddish innovation in education. Instead of students learning about the outside world from teachers, it is teachers learning about the inner selves of students, from the students’ own confessional output. I always imagine Foucault hearing the popular slogan from teacher-training programmes, “the child-centred classroom”, and shuddering.

The growing centrality of this psychotherapeutic outlook to our moral culture and the perpetual, self-fuelling revolution of sexual expression and identity continue to make Foucault look like a visionary 40 years after his death. As I note above, therapy-minded young people now commonly perform — upon themselves, often for a public audience of social media followers — the main psychological operations, the patient’s confession as well as the clinician’s diagnosis. They (and we) have internalised not only the expressive imperatives of the clinical setting but also the analytical biases, the drive for identifying and classifying and subdividing human types, that marks the human sciences to which psychology belongs. In this analytical process, the ambiguous, changeable matter of human behaviour is translated into legible categories of human person.

Like the institutions that observe and nurture and mould us as we pass our days within them, we are impatient to specify what human type we belong to. We are keen to nestle into a nice category, match ourselves with a diagnosis, map ourselves on the great taxonomy. This is a lot of things besides funny, but it’s also funny. Foucault is taken to be a great inspiration for the sort of “queer theory” that informed, or at least provides a stockpile of quasi-academic jargon for, the ongoing revolution in sexual and gender identity. To its ideologists, I imagine this revolution appears in dialectical terms, suppressed or hidden “subjectivities” pushing against the harm and violence of outdated understandings, emerging into the light of dignity and recognition, properly seen, finally, for example, as asexual.

But Foucault didn’t buy into the dialectic of history. Anyone truly inspired by him would watch as another pastel strip is added to the gender flag, as the quivering “+” at the end of the list of initials invites a new identity into the official fold, and see something very different from history being steered toward ultimate justice by ever-freer self-expression. They would see the techniques of the human sciences — now devolved to us, internalised by our suggestible selves — doing the unending work of analysis and classification and discipline. Remembering their reading of Foucault, they would find this all so absurdly familiar they’d have to laugh.

There is something dystopian about people competing for the attention of a famous podcast host to solve their most intimate problems. Hundreds of couples apply for a handful of opportunities to share their stories with Perel, along with her legion of listeners. Her 2006 bestselling guide to marital relations, Mating in Captivity, established her as TED-talking international authority on relationships. By the time Where Should We Begin? launched in 2017, Perel was listed in Oprah Winfrey’s SuperSoul 100 list of “spiritual luminaries”. Her podcast has been downloaded 50 million times since its launch.

It’s not hard to see why. As radical new ways of ordering relationships have proliferated, we no longer hold a set of principles for living in common. Liberalism’s marketplace of ideas has given rise to a marketplace of moralities: as free unbounded agents, we get to decide what is right for us. But when our bespoke moral stories clash with those adopted by other people in our lives, things get tricky: how do you resolve a conflict when you cannot agree on the rules that mediate it? Who do you turn to, to help you decide?

Enter Perel. She is fair, philosophical in encouraging a big-picture view of how to live well, and gently tough at making sure that the dynamic never falls into that of victim and aggressor. Nothing is sensationalised, and no one is demonised. She is something of a radical in the Anglosphere, where our one-strike-and-you’re-out attitude to cheating has remained intransigent even as non-traditional, non-monogamous relationships have become increasingly common. With divorce rates estimated at 42% in the UK and 45% in the US, and 27% of US adults estranged from a close family member, Perel’s more charitable approach to conflict might have merit.

She is also part of a trend. Therapists are increasingly becoming a kind of free-market priesthood, jockeying for the territory that actual priests once oversaw. With the decline of religion, we have lost any sense of a unifying story about how to live, without which we’re more likely to be miserable — as the mental health gains from being religious can attest. The claim of therapy is that it helps you shape the overarching narrative with which you make sense of the world, and how to live well in it. At best, going to one’s therapist is a substitute for confession, a time for honest reckoning; too often, though, clients see it as an indulgence, a means to divest one’s conscience of interpersonal responsibility. Once, we could have taken solace in doing the right thing by others; now, the feeling of solace comes first.

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Perel is too tough, and too professional, to let her clients avoid hard truths. But other therapy-as-content offers people that easy way out, dwelling purely on the solace. If Instagram laid the groundwork for the therapy influencer phenomenon, all pastel-coloured quotes and exhortations to set boundaries, TikTok took it to the next level. Therapists on the video-sharing site seem to see everything as a sign of trauma: transient negative emotions, feeling under-motivated, feeling over-motivated, feeling uncertain. Things that cause trauma include having to do homework, dead celebrities, and understocked supermarkets. If anyone suggests that these things might not actually cause trauma, TikTokers argue that they are “invalidating” that trauma — which, they insist, causes further trauma. The therapists who say things like this make their followers feel understood, offering sweet relief from the harsher offline world — and building their influence as they do.

An obvious concern of the influencer model of therapy is that anyone can set themselves up as a mental health expert, without any training or expertise. But most successful influencers on TikTok and Instagram are verifiably qualified therapists or psychologists. They’re careful with disclaimers too, reminding their audience that their content isn’t therapy.

But if it isn’t therapy, what is it? And who does it serve?

In The Genealogy of Morality, Nietzsche describes the emergence of a priesthood class that gains its influence by stirring up resentment. Until the priests come along, you may not even have understood that you were suffering. It is only when they point out injustices that the extent of your distress becomes apparent. They present you with a new, inverted moral code in which suffering is honourable and weakness is good, while the previous virtues of strength are abandoned.

The therapy influencers peddling trauma are straight out of the priesthood playbook. If the Nietzschean priesthood is all about radicalising the underclass against its oppressors, TikTok therapists have identified a vast new audience for this. Whipping up new flavours of trauma with every new social justice movement, they target a demographic who genuinely lack full autonomy, who have resented this since forever, and who spend a lot of time online: teens.

The #teentherapists’s USP is that they get it — your parents don’t listen, they don’t validate your experiences, they’re actively undermining you. The demands of school are too much right now. Setting consequences for your behaviour is abusive parenting, and it doesn’t work anyway. They’ll even shout at your mum for you. They argue that “reparenting” is required to fix all this trauma, setting themselves as the adults you really can trust.

Much of what these #teentherapists identify as abusive behaviour looks alarmingly like differences in opinion in how to navigate the world, or jarring communication styles. The information they’re sharing is bitesize, in videos that aren’t usually longer than a couple of minutes. It’s also general: whereas Perel offers insight into a specific relationship dynamic or individual psyche, TiKTok therapists are presenting universal “life lessons”. The brevity of the messaging and its attempt at catch-all appeal does little to help its audience discern abuse from ordinary conflict. There’s also something uncomfortable about adults cultivating mass parasocial relationships with kids, especially when the implication is that these distant adults are better authorities than those who are present in a teenager’s life lives.

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The TikTok therapists have an appealing moral sales pitch — they can reach out to a massive audience who would otherwise have been ignored. The app is more accessible than therapy. But in order to get their voices heard, therapists have to actively seek followers. If a TikTok influencer takes a strong line, viewers feel heard and vindicated, they get to blame someone else, and they want more of the same kind of validation. TikTok therapists get validation, too, from follower counts, and the book deal that might accompany them. They might even get to be the new Esther Perel.

But Perel isn’t speaking to you; she’s speaking to the couples in her session. Where most therapy-as-content cares little for the public good — it tells stories about our inner lives that can only atomise us further — Perel focuses on building, rather than destroying, social relations. Her branch of therapy is closer to genuine spirituality than the TikToker’s: the sociologist Émile Durkheim saw religion as a force for ordering interpersonal relationships, creating meaning and bringing people together to communicate and affirm shared values. It’s a version of spirituality that only works when it works in common, and you can’t achieve that in a me-centric universe.

Then again, the marketplace of meaning isn’t a uniquely postmodern phenomenon. The decline of the traditions of the Roman republic brought in weird new religions, which were mixed and matched to suit people’s temperament and station, just as elements of spirituality are today. Individualist spiritualism is nothing new, either: William James wrote about the cheesy affirmations of wellness-adjacent New Thought at the turn of the 20th century.

What is new is the impact of technology. The internet gives would-be priests access to souls worldwide, and allows them to repackage their advice into compelling, publicly-available content. The reality TV show Couples Therapy has had 50 million viewers, for instance. While Perel’s episodes conceal the identity of their subjects, Couples Therapy has not only real names but faces. A misanthrope might wonder whether that accounts in part for its wild success — there’s nothing like watching a real relationship melt down in real time. We watch Love Island for the drama of hot 20-somethings cycling through new relationships. How different is it to watch a 30-something couple conclude on TV that this is probably the end, skilfully assisted by a therapist?

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Perhaps it’s about how the therapy-as-content is presented. If it exists only as emotional pornography to feed our outrage, resentment, or lust for drama, there’s nothing very therapeutic going on. When it gives us the opportunity to think expansively about what sacrifice, loyalty or trade-offs mean in our interactions with one another, then it carries both personal and social benefits.

The way those stories are packaged and sold inevitably shapes the way we use them in the wild. Create shorts for kids that introduce a layer of conflict to ordinary hardships, and they’ll probably end up more lost and distressed. Edit a day of footage showing couples bickering by the poolside into a half-hour show of shallow emotions, and you’re arguably complicit in manipulating them for malign ends. Carefully stitch together real-life therapy sessions to represent a couple’s deepest challenges, with their informed consent, as Couples Therapy does, and you’ll have a largely thoughtful audience who, though titillated, are also inclined to care about the interpersonal conflict presented, and its broader social implications.

Likewise, Where Shall We Begin? avoids the hyperinflated trauma, lurid revelations and psychobabble that get the attention on TikTok or television, instead teasing out nuance and deep understanding from its subjects. Like a good priest, Perel offers her flock pastoral care, even when she is saying things it’s hard to hear. Perel’s clients are parables for her congregation. Every session, focused on one interpersonal relationship, poses big-question questions: about what it means to be a man, or married, or loyal. Each encourages us, therefore, to think a little harder about the principles for which we no longer have a blueprint.

REBT is characterised by a kind of rugged psychic individualism. In this view, if you hope to be psychologically fixed by relying on others, if you seek healing from interpersonal woo-woo like transference, you’ve already made a key philosophical error. You’ve outsourced your agency. And that’s before getting into the most eccentric elements of psychoanalytic theory — penis envy, the Oedipus complex, Melanie Klein’s baffling idea of the bad breast as persecutory object. To read Freud is to grit one’s teeth at the relentless dogmatism of his prose, the certainty with which assumptions that look absurd in the context of observable reality somehow grew legs and ran for decades. If you are looking for relief from mental distress, is it wise to procure it from people who believe in resentment-drenched theories that could only ever make sense to the pathologically horny and disturbed?

More generously understood, psychoanalysis is based on the idea that mental distress tends to arise from unconscious inner conflicts, and that past experiences — especially those of early childhood — exert a long-term effect on our thoughts, feelings and actions. The analyst assists the patient in exploring the depths of their mind, unearthing hidden meanings. Change happens by means of the therapeutic relationship, with the patient unconsciously acting out past conflicts. The process can take years.

Albert Ellis, the originator of REBT, was a psychoanalysis refusenik, as was Aaron Beck, the father of CBT as we know it today. Their early careers were largely an accident of history: both happened to train in clinical practice in the post-war era, when psychoanalysis was dominant. Both soon observed inconsistencies between the theoretical claims of how analysis worked and their own observations of patients. Beck noticed that negative views of the self, the world and the future characterised depressive episodes in patients, rather than the repressed feelings that Freud held to be their cause. The psychoanalytic process was only supposed to work if you saw the patients daily, maintaining the relational magic, but Ellis noted that his patients who only came in once a week did just as well, and that they did even better when he ditched the psychoanalytic theory and talked to them about philosophy instead.

What emerged from this was cognitive behavioural therapy. Rather than getting stuck into the past, it operated in the here and now, looking for the habits of thought and behaviour that maintain our distress, and finding ways of thinking and behaving that might work better. The therapist’s role was not as ersatz parent or interpreter, but as Socratic teacher, helping guide the patient’s reasoning to more pragmatic ends. This seems to have worked well: in the English-speaking world, the dominance of CBT makes Freud look more like a kooky curiosity in the history of ideas than the father of psychology.

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The ideological descendants of Freud have strong feelings about this. They’re not all psychoanalysts: there’s a genealogy of therapeutic styles that see human distress as the product of relational problems, from maternal attachment to structural oppression. They tend to see the solution as lying in the deepest layers of the self. Another thing they often have in common is really, really hating CBT.

The arguments vary. Psychodynamic psychologist Jonathan Shedler has suggested that its evidence base for CBT is skewed by selective reporting. Its heavy reliance on manuals, which therapist Nancy McWilliams criticises as rigid and simplistic, leads it to be mistakenly thought of as scientific. By focusing on the individual locus of control, CBT is a tool of neoliberalism, ignoring the systemic inequalities that shape people, telling us to grit our teeth and smile rather than try to change the world. For Jungian psychotherapist Paul Atkinson, CBT mostly serves industry, rather than the people it’s supposed to treat; it’s designed to make you a better cog in the machine. Since 2008, it has been provided for free by the Improving Access to Psychological Therapies (IAPT) programme, conceived by New Labour’s “happiness czar” Richard Layard, to improve economic productivity by way of public wellbeing. As a public investment, CBT was a good one: it is short-term, taking as few as six sessions to complete in straightforward cases, and therefore cheap. It is also highly structured, gathering its own data via regular symptom inventories, meaning it could be accountable to the public purse. Choosing CBT was following the science.

This infuriated CBT’s detractors, provoking a backlash against IAPT and CBT in general. Doubts have been raised over whether IAPT data supports the impressive results it claims; studies of CBT’s efficacy elsewhere have found it to fall over time, with one finding it no more effective than its nemesis. Given that it’s being offered for free to anyone who wants it, if CBT worked, you’d expect things to be going pretty well by now. Instead, we are less happy than we have ever been, with the ONS finding the UK prevalence of moderate or severe depressive symptoms at 21%. If, as the accusers declare, CBT isn’t really therapy but a coercive lever to make people economically productive, it’s not working: record numbers are out of work due to mental ill-health.

Each era brings its own problems. In Beck and Ellis’s time, sexuality was repressed in favour of propriety, which fed depression. In the 21st century, our wellbeing has been eviscerated by technology; the impact of the internet and smartphones is well-documented. Relationships, as we used to understand them, have collapsed. The world of work has changed: there are fewer casual, pleasurable digressions between colleagues; work is increasingly seen as something that happens in isolation, rather than in concert with people you care about. If the online world turns out to have rewired our attention, this may undermine our ability to maintain the cognitive control that allows the mechanics of CBT to happen.

Economics plays its part, too. Even before inflation and housing shortages piled on extra pressures, it was hard for a family to keep a roof over its head without two adults working full-time, which impacts time spent with loved ones. You can blame this on the capitalist pursuit of profit, or the creep of technological slavery, but the outcome is the same either way. We’re swimming in material goods, and relationally impoverished. This is where the psychoanalysts might have a point. Even if cognitive-behavioural therapists can train our thoughts, downplaying the influence of the external world on our wellbeing is unwise. Psychological studies are in agreement: the quality and quantity of our relationships strongly predict our wellbeing.

But there’s something perverse about the very idea of therapy when we think about it, as the psychoanalysts do, in the terms of a relationship. We have always spent money on the services of soothsayers, acupuncturists or hairdressers, but those transactions weren’t intentionally about paying for human contact. We have also always exchanged money for sex, though it has usually been social taboo. Now we pay similar prices for the more basic intercourse of being listened to. We don’t trust people who sell sexual affection, because that affection lasts only while they’re paid, but we place uncritical confidence in those who sell us empathy.

CBT may not be the panacea it was hoped to be, but psychoanalysts accusing it of neoliberalism are being hypocritical. Selling committed, long-term relationships looks a lot like commodifying humanity. And if state-funded therapy threatens your livelihood, you’re more likely to get cross about it.

Beck described the therapeutic relationship as necessary but not sufficient for change, which comes, first and foremost, from the patient methodically practising new habits of action and mind. By contrast, the labyrinthine doctrines and relational focus of psychoanalysis make it easier to abandon agency: you can hand over your wellbeing to someone with a parental-style command of what is really going on in your head, who can give your world meaning and keep you feeling safe. It’s more comfortable, at least in the short term, to be told that our problems came from others, but it carries interpersonal risks. Being told we’re victims of fate tends to make us resentful. If you’re feeling low and you’re told that the reason is probably a failure on your mother’s part, your attitude to relationships probably won’t improve. The same is true if you’re feeling bruised from a tricky break-up and are told that you’ve been traumatised.

CBT is, in some sense, classically liberal, in that it sees the individual as having autonomy over one’s own mind. It’s harder to pin down a single position for its detractors. A relational view of the world — especially one where attachment to the mother dictates later wellbeing — is fundamentally conservative. Current discourse around attachment and trauma, rooted in socio-economic forces, is mostly Leftist in character. The philosophies underlying therapeutic approaches should, in theory, have a profound impact on patient outcomes. But this doesn’t happen.

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Psychological studies find that there’s remarkably little difference in outcome between wildly different therapeutic styles. This is known as the Dodo-bird effect, from the famous scene in Alice in Wonderland where all must have prizes. The stories we tell about our minds may have social consequences, depending on what or whom we find accountable when things go wrong, but they don’t make much difference to therapy itself. Individual studies of this or that approach will continue to make grand claims of their power. Other studies will erode them. But therapy’s value seems to stem from sitting in a room being listened to by someone we like. In which case, can’t we replicate this experience with friends or relatives in our lives?

What we can say with certainty is that in the decades since we normalised paying to be listened to, we haven’t become any happier. We know, too, that we do best when our lives are rich with relationships and meaning. Maybe it was always a stretch to think that these things could be bought, or provided by the state. Internecine squabbles between opposing forms of therapy might disguise a conclusion that looks bad for all of them. We don’t need shrinks or ever-growing datasets to work out if we’re okay: we’ll know things are looking up when we stop employing people to listen to us talk.

At the start of November, an assortment of 29 high-profile UN representatives, human rights lawyers, academics and LGBTQ lobbyists flocked to the sultanate city to attend a conference at the Gadjah Mada university. There, over four days, they hunkered down to craft a document they would call the Yogyakarta Principles.

Having tried and failed to convince conservative countries to include protections based on sexual orientation and gender identity in UN resolutions, the drafters, led by Irish ex-priest Michael O’Flaherty, sought to demonstrate how any country that had signed up to the Universal Declaration of Human Rights was obliged to grant them anyway. Their ambitious interpretation claimed “the right to recognition as a person before the law” automatically included the right to legal gender self-ID, while “the right to health” obliged states to “facilitate access by those seeking body modifications related to gender reassignment”.

The Principles were not legally binding, nor did they cite any legislation. Indeed, according to one of its signatories, O’Flaherty insisted that his fellow drafters ignore the legal reality. The Yogyakarta Principles, then, were simply a wish list. Perhaps it was hoped that the heft of the reputations of the drafters would be enough to cajole NGOs, legal professionals and governments into taking them seriously. If so, they seem to have been right.

Sonia Onufer Corrêa, a Brazilian activist and one of the attendees, later admitted that Indonesia was only chosen because the drafters wanted a Muslim country, so as to avoid the impression that the edicts came from the decadent West. It bears noting that the Sultan of Yogyakarta himself never adopted the Principles for his own city; in fact, the situation for LGBT people there had become so untenable by the time the Principles came up for review in 2017 that they had to find a friendlier host city, Bangkok.

Never mind. The location was always just a smokescreen. The real unveiling of the Yogyakarta Principles came in 2007, when they were officially launched in New York and Geneva. It was undoubtedly a triumph. While O’Flaherty and his crew were unable to convince conservative African and Islamic countries to adopt the Principles, Western nations were more than eager to get on board. Pick a country and evidence abounds; from legal self-ID, to hate speech laws, to conversion therapy bans, the drafters have had more success than they surely could have hoped for.

At the heart of their campaign was a raft of evidence alleging to show the use of torture against gay, lesbian and trans-identifying people. Such abuse had been reported as early as 2001 by Amnesty International, who described the brutal violence suffered by the travestis of Central and South America at the hands of police and the johns who paid them (or not) for sex.

According to Article 5 of the UN’s Declaration of Human Rights, “no one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment”. The Yogyakarta drafters interpreted this to cover conversion therapies based not just on sexual orientation or sex characteristics, but also gender identity and even gender expression. Expanding on their rather short interpretation, one of the key organisations behind the Principles, the International Commission of Jurists (ICJ), helpfully provided a more detailed technical guide for legal professionals in 2009.

There was one problem, however. “International human rights systems,” warned the ICJ, “have not yet dealt with an individual petition or communication specifically relating to issues of sexual orientation and gender identity in relation with the prohibition of torture.” In other words, there wasn’t sufficient evidence.

But a group of lawyers in the US, led by the National Council for Lesbian Rights (NCLR) in collaboration with the Trevor Project, was working on it. Since 2009, a movement to expose the horrific practice of conversion therapy against gays and lesbians (though not trans-identifying people) had been underway in America. And in 2013, the NCLR began planning a campaign to convince lawmakers that conversion therapy constituted a breach of the Convention against torture, to which the US was a signatory.

With the support of the UN’s special rapporteur on torture, who had just issued a report on ill-treatment in healthcare settings that included “reparative therapies” carried out on LGBT people, they sought an audience with the bodies that oversee the UN Convention Against Torture (UNCAT). These were made up of committees of experts in torture from around the world, one of whom was Victor Madrigal-Borloz.

At the time, Madrigal-Borloz was secretary-general of a Danish NGO called the International Rehabilitation Council for Torture Victims. According to an anonymous source, once in the job, he began planning an expensive multi-day showcase event in Mexico City which plunged the NGO into an extremely precarious financial situation. The situation was exacerbated by the fact that the NGO was not producing results, and funders were pulling out.

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An FOI request by journalist Dorte Toft later found that the Danish development ministry, DANIDA, ordered an external investigation that concluded IRCT’s travel budget didn’t make sense based on the activities of the organisation. They also said the secretary-general’s salary was too high and that he had too much power over budget decisions. Overall, they concluded, the management of IRCT — financial and otherwise — was a disaster. By this point, however, Madrigal-Borloz had skipped off to this next appointment as the UN’s “independent expert”.

In November 2014, around the same time that the IRCT was haemorrhaging money intended for torture victims, the NCLR had been granted an audience with Convention Against Torture treaty experts in Geneva. They brought along a star witness, who tearfully spoke of the horrific electric shocks and beatings that his therapists and parents had subjected him to in an effort to turn him straight. His name was Samuel Brinton, and he would later become known as the non-binary Biden staffer caught stealing women’s suitcases from airports.

According to one of the lawyers who brought Brinton to Geneva, his testimony elicited gasps from the UN panel. How could this still be going on in 2014? After all, state-level efforts were already underway to outlaw conversion therapy. And media reports from the time suggest that existing bans covered “ex-gay” practices familiar to most people: the religious ministries and pseudotherapy sessions that sought to turn homosexuals straight.

But this wasn’t just about gay conversion therapy. “Gender identity” had also started to appear in legal texts around the subject, despite the fact there was scant evidence that praying away gender identity was a thing. This was about to change. Just a few weeks after Brinton’s performance in Geneva, the contents of which journalist Wayne Besen has convincingly called into question, a trans-identifying teenage boy allegedly walked out in front of a tractor-trailer on a highway in Ohio. In a Tumblr suicide note, Leelah (born Joshua) Alcorn criticised his parents, who chose “biased” Christian therapists to help him deal with depression, and who wouldn’t allow him to medically transition.

His mother, a Christian, was vilified for misgendering and deadnaming him. She told reporters that he had only mentioned being transgender once, that she had never even heard him use the name “Leelah”. She also claimed that he was deeply depressed. His neighbour, apparently a close friend, also used male pronouns throughout his TV interview.

But while it wasn’t the Brinton-style torture story the transactivists had perhaps been waiting for, it was enough. A few days after his death, a White House petition calling for “Leelah’s Law” was launched. By March 2015, Obama said he would support a federal ban. By September, UN agencies officially began officially referencing torture in relation to violence against LGBT people.

Malta was first out of the gate in December 2015 with a ban; Germany, France, Belgium and some parts of Spain have all since followed. Mardrigal-Borloz, who had by this point taken up a gig as the UN’s independent expert on sexual orientation and gender identity, immediately started pushing for states to legislate for conversion therapy bans.

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In 2017, the UK first commissioned research into the practice. Organisations such as Stonewall exaggerated the results of that research, even leading their coverage of polling on the subject with the claim that one in five trans people have suffered conversion therapy, when the data reveals nothing of the sort. The proportion, according to the survey results, of LGBT people “pressured to access services to question or change their sexual orientation when accessing healthcare services” was 5%.

Interestingly, after a failed first attempt to introduce a ban in 2018, Ireland is now having another go. This time it is backed up by an all-island (including Northern Ireland) group called the Anti-Conversion Therapy Coalition. While, from the outside, this might look like an inspiring cross-border initiative, it’s more likely to be because no evidence was found in the Republic, leading Irish activists to look forlornly to the North’s fire-and-brimstone protestants who have been known to offer (though not force) pray-away-the-gay services.

In France, things were even more weird. Lawmakers wanted proof that the country was suffering from an epidemic of conversion therapy that would necessitate a new law. In response, Laurence Vanceunebrock, parliament’s rapporteur on the subject, insisted that they had to pass the law in order to reveal the crime. As evidence, Vanceunebrock repeatedly claimed that there was a secret clinic carrying out electroconvulsive therapy on homosexuals in Montpellier. This drew the ire of the region’s medical association, which claimed that such a clinic would require specialised equipment and expertise that couldn’t possibly have passed under their radar. No witnesses ever came forward, despite an appeal.

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Then, in 2021, when the law was already a done deal but not yet in force, a teenage trans-identifying female called Enzo was kidnapped, brought to a barn in the French countryside and tortured, in order to exorcise her of her transness. The rainbow NGOs kicked into high gear; #LiberezEnzo trended on social media, activists scoured the countryside looking for the barn, and Vanceunebrock was finally vindicated.

It soon transpired, however, that Enzo was at his grandmother’s house the whole time, and the family were working through their issues. The police, and Enzo, asked everyone to calm down and leave them alone. The barn was never found. Yet the law is now in force in France; efforts to modify or reprimand a person’s sexual orientation or gender identity can be punished by up to €45,000.

As for the Yogyakarta Principles, they received an upgrade in 2017, when Victor Madrigal-Borloz came on board as a signatory. And the newer version is even more extreme; it explicitly calls for an end to sex registration at birth.

Madrigal-Borloz, meanwhile, will step down from his UN mandate at the end of this year, and the extent of his success is currently being evaluated. All the signs suggest he will be lavished with praise. But as the 16 years since that fateful meeting in Yogyakarta have demonstrated, making a crime out of conventional therapy for gender-distressed teens has hardly been a victory.

How naive I was. Putting on a clerical collar changes how people treat you. It is such a powerful symbol, so freighted with meaning, that you instantly become an object of projection. Put on a little circle of plastic around your neck, and the person gets obliterated by the parson. I felt I had disappeared. In time, I came to hate wearing it. I still do.

So, despite the many and various ways in which I have been outraged by Harry’s attack upon his own family, the one batsqueak of sympathy I have for him is my understanding of what it feels like to be hidden behind one’s role. Not just hidden, but almost obliterated by it. In Spare, he explains that one of the things that attracted him to former girlfriend, Chelsy Davy, was that she had not been struck down by “throne syndrome”. Unlike so many others, she didn’t see a prince, she saw Harry.

In the months after I started wearing all the churchy kit, I noticed some strange and rather foolish changes to my behaviour. For one thing, I started swearing more. Nothing too wildly offensive — at least not with parishioners — but enough to attempt to disturb the grip that this little magic ring of plastic had on other people’s imaginations. I also over-shared. It sounds childish to state it so bluntly — and it was pretty childish — but I wanted people to see me. I felt the need to re-assert the identity that I felt had been surrendered to the office.

Though the priesthood carries with it a whole world of expectation, my experience of projection is nowhere near that experienced by members of the Royal Family. Nonetheless, it does give me a small insight into the temptation that Harry has unfortunately given in to: the temptation to draw back the curtain and tell the world who you really are. “See me!” this poor troubled man is screaming, “See my pain!”. In Harry’s case this act of defiant self-disclosure has been turbocharged by the whole Californian culture of authenticity. Of being true to yourself. This couldn’t be more different from the “never explain, never complain” iron curtain philosophy of his family.

To those who admire the “be true to yourself” mantra, Harry is a hero of self-expression; to those who don’t, he is a self-absorbed cry baby. Mostly, I don’t.

The philosopher Charles Taylor has written with great insight about how this difference chimes with a centuries-long shift in European culture about where meaning is to be found. It used to be the case that meaning was found beyond oneself. As the psalmist put it: “I will lift up mine eyes to the hills, from whence cometh my help.” Meaning is to be discovered out there, in God’s order, in nature. Our purpose is to follow the star, or something beyond oneself. God doesn’t really mean some big quasi-person from whom you receive instructions; it means something more like an understanding of things — universe, human existence — as seen from the widest possible angle. But secularisation has shifted this emphasis: meaning is no longer out there, but in here. You follow your own star. Your star, your truth.

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The tragedy of Harry is how badly he has been let down by this expressivist philosophy. Because the problem with “see me” is that not everyone will see the same thing. And not everyone will like what they see.

In that fascinating movie The Two Popes, there is the following little exchange:

Pope Benedict: This popularity of yours, is there a trick to it? 
Pope Francis: I just try to be myself. 
Pope Benedict: Huh. Whenever I try to be myself, people don’t seem to like me very much.

I doubt Pope Francis would ever say anything so crass as “I just try to be myself”. But in so far as this is a fictional conversation between personifications of modernity and pre-modernity, it captures the difference rather well. My sympathies are with the fictional Benedict because, like him, I often don’t feel particularly likeable — which doesn’t matter so much if meaning and affirmation is to be found outside the self. But Harry’s overwhelming desire to express all the details of his inner life puts him straight into the jaws of the tabloid press, who can make anyone look unlikable. “See me” is a dangerous thing to utter when the audience is Rupert Murdoch.

Benedict, by contrast, knows that his God is a very different kind of judge. And his rueful shrug at not being as popular as Francis contains a kind of freedom from fear that “I just try to be myself” has not yet discovered. There is enormous liberation — and not only in the priestly vocation — to be found when you realise “it’s not all about me!”. The psychological hell of Harry Windsor is that he has made it all about him. And the poison of this position is leaking everywhere.

None of which is to disparage the workings of the inner life. As it happens, I had the same psychotherapist as Harry’s mother, and she pretty much saved me from emotional disaster. At its best, therapy is not about “my truth” but about reality and how one learns to live with that reality when it doesn’t necessarily have your ego’s best interests at heart.

Harry may think that telling his truth is all part of his healing process. But many of us will only remember an entitled brat dissing his father and his brother, and telling us too much about his frostbitten penis. No healing will come from this.

Julian is the protagonist of Paul Schrader’s 1980 masterpiece American Gigolo, made in the golden age of the erotic thriller. He’s played, and overshadowed, by Richard Gere, who made history as the first leading man to get full-frontally nude in an American studio film. This was another golden age, after all — of sexual freedom — between the invention of the Pill and the horrors of the AIDS crisis.

Why was Julian like this? Why was he so talented at languages, and suave, and erudite; and why was he so into making older ladies feel good? Why was he selling sex, anyway? And what about that murder he was framed for? Nobody cared. The plot was always secondary to the style, merely a support structure for a case study in early Eighties seduction. The point of Julian, if there was one, was his narcissism: he’s a shiny shell draped in Armani suits, who may well have absolutely nothing inside. Later, Schrader actually disavowed Julian a bit, calling him “really just a thin guy”, superficial without knowing it. In that way, maybe, he represents that brief, proto-Reagan paradise: a little stupid, a little evil, but kind of cool.

He was a man of his time, but now, Julian is back. Showtime has created an American Gigolo miniseries, out last week. A hodge-podge of sequel, prequel and remake, the show seems so singularly hellbent on destroying its source material that one wonders: why on Earth was it made? Schrader is apparently wondering, too: though credited as a “corporate consultant” on the final product (his salary was $50,000), he has called the show a “terrible idea” and vowed not to watch it.

A wise choice. Julian has been reimagined as a generic, pitiable, weeping loser, a superannuated sad sack in disgusting hoodies with greasy hair. He’s 45 years old. He’s played by Jon Bernthal. And he shares nothing but a profession with the original character. Julian’s sexiness, it seems, doesn’t work with the archetypal protagonist of prestige television: the sensitive man obsessed with his childhood.

Viewers of the original American Gigolo didn’t care why Julian did what he did. But the new show insists on providing us with a hackneyed backstory, in the form of shot-for-shot flashbacks. Sometimes, there’s the same footage twice in the same episode. Here’s the post-prison Julian grabbing a fence; here’s him doing so as a poor boy in a generic Dust Bowl setting, with his extremely simple mother. Oh, there he goes sleeping with her friend. Fetish understood. And then we find out why he sells sex: a mysterious French-speaking brunette named Olga shows up to the family shack in an extraordinarily short tweed skirt suit, asks to look in his mouth, hands his mother an envelope, and tells him she’ll be waiting in the car. Julian asks his mom: “What?” She sobs: “You’re gonna go to Hollywood and you’re gonna be a big star!” He again asks: “What, Mom?” She screams: “You need to get the fuck out of here right now!” He’s then sent to, it would appear, a high-class gigolo camp.

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To ensure that the audience can congratulate itself on watching virtuous prestige television attuned to the havoc wrought by toxic masculinity — not the reality shows that their less successful cousins watch — Julian must now have “feelings”, “trauma”, and “pain”. To ensure the creators have ten hours of material, in a business model premised on streaming audiences no longer leaving their homes, or even their beds, to consume “content”, he must also have an incessantly — and very slowly — rehashed “past”.

It is difficult not to see the new American Gigolo as the latest absurd iteration of the media’s anxious, obsessive search for trauma, victimhood, and injury in what, until now, have been recognised as happier chapters in the American story. As Mike Hale has aptly put it in the New York Times, it “remakes an era-defining film for the current age of victimisation”. The whole point of the original Julian was that he was young, confident, and the sexiest man imaginable, a man so alluring that the gorgeous wife of a prominent politician would risk literal death to be with him. But the new Julian is a bundle of pathetic clichés of the repentant male: “I’ve done dumb things.” “I’ve hurt people.” “If I sat on your feet, would you feed me?”

Low-effort psychology, apparently, is a key tenet of prestige television these days — as is box-ticking political lip service. American Gigolo has been reinvented to conform to our current sexual mores: all the sex in this tragic remake are more ferarum and a little rough. In the original, the only BDSM scene, which completely turns off Julian, is orchestrated by a disgusting creep who murders his wife. The whole film revolves around Julian’s sexual tenderness and care toward his love-hungry customers. But whatever! Now it’s hot for a traumatised male to “explore” kink and subsequently cry about how he’s caused “pain”.

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And perhaps it’s impossible to emulate the sexiness of the original American Gigolo at a time when sex is regarded as suspect, and “sex workers” themselves embody an inscrutable mixture of saintly victimhood and feminist triumph. Plus, the day-to-day of today’s young escort is a lot more mundane: see Pacho Velez’s performatively boring portrayal of sugar babies in his recent film Searchers, just staring at their iPhones as they scroll through options. That’s a lot less compelling than the original Julian Kay sliding into fancy lounges and waiting for a lady with big earrings to walk over with her cocktail.

The new American Gigolo is, then, as representative of its moment as the first one was. The late critic Mark Fisher wrote about the cultural exhaustion of the 2000s, of the inability to create new artistic forms. In the decades since the Reagan era, he argued, with crash after crash punctuated by booms of ever more inequality and precarity, society became increasingly fearful of the future and ambivalent about the present. Culture, therefore, could be nothing more than a tranquilising and unchallenging rehash of stale nostalgia. American Gigolo is a case in point: its creators, I suppose, vaguely remembered American Gigolo as cool, thought other middle-aged people would, and most importantly, couldn’t think of anything better to make.

The series is part of a larger and more depressing trend toward anodyne, cookie-cutter, sad-sensitive-male remakes. Most cynically, perhaps, is the tendency — part of streaming services’ “microtargeting” strategies based on harvesting demographic data — toward clumsy, politically correct updates of exciting black media. Amazon’s 2021 Coming 2 America, a sequel to Eddie Murphy’s beloved 1988 film, is so lazy it de-ages the actors using CGI to recreate scenes from the original; but for contemporary audiences, it inserts unwieldy references to women’s rights. The 2019 Netflix film Dolemite is My Name likewise stars the now 61-year-old Murphy. Here he portrays Rudy Ray Moore, stand-up and Blaxploitation director best known for Dolemite (1975). In both films, Murphy’s lines are far less shocking than in his Eighties triumphs.

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What made the originals funny would never be acceptable today: the humour of Coming to America largely rode on Eddie Murphy’s “African voice”; the humour of Dolemite rode on the Blaxploitation genre’s radical redeployment of Black stereotypes. Today, they have been revised to cleanse the edginess, anger, and discomfort of their originals, in the relentless march to neutralise everything that could possibly risk controversy. Like the woke-washed American Gigolo, the rehash of Dolemite includes absurdly stiff, laundered dialogue. A toothless liquor store haunt says: “Hotel Dunbar: that used to be the centre of Black arts and entertainment.” Snoop Dog, as a Rasta, turns down Murphy’s music: “Sometimes our dreams don’t work out, brother.” The original Dolemite is pretty much known for his catchphrase “Do-lo-mite!” (like “Dy-na-mite!”); now we must suffer Murphy saying things like: “I don’t have a lot of good memories of back home.”

Not even the Classics are safe. In fact, they offer the most absurd example of this bleak trend. Robert Icke, who has been described as the “great hope of British theatre”, has decided to turn the earliest extant work of Greek tragedy, set approximately 3,000 years before the invention of psychology, into another struggle session about trauma. In his adaptation of Aeschylus’s Oresteia, during a sold-out West End run, Icke had Orestes recount what he experienced after the end of the Trojan War to a therapist, in a move so inappropriate that even the Guardian called it “neurotic”. In the adaptation’s New York run this summer, Agamemnon was a selfish politician making cynical remarks to a television journalist about how difficult democracy is — despite the fact that the play was set in a pre-democratic era. The adaptation has been dubbed a “masterpiece”.

Most astonishingly, every reference to Greek gods was gone: in their place, Agamemnon, the infamously selfish and infinitely brave antihero of Greek epic, was talking about how his religion “helped” him cope and how he wished he could spend more time with his family. At his trial, Orestes protested that people who’ve been hurt in turn harm others. Yes: the leading British theatrical talent of our day has taken Aeschylus’s timeless and unsurpassed poetry about divine prophecy and replaced it with pabulum about how “hurt people hurt people”.

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Taken together, these terrible cultural offerings reveal the unrestricted seepage of cut-rate therapy and its wooden jargon into the very furthest reaches of history. The past has been terrorised and defused, and audiences no longer, apparently, are considered adult enough to consider events without a pre-packaged trauma narrative to delineate who’s good and who’s bad. The gigolo must be sad; Dolemite must be wounded; and even the House of Atreus must be analysed with all the subtlety of an Instagram self-care post explaining “PTSD”.

The impact is palpable: in a major way, the purpose of art is to show that a past existed, and that it was different from the present. These bowlderised and ham-fisted revisits brainwash viewers into a terribly misleading idea: art has always been one way, as has psychology, as has politics, as has religion, as has everything. “Source material” is less marshalled into new interpretations, more colonised into uniformity. It is a sad day when Julian Kay, Dolemite and Agamemnon somehow all have precisely the same thing to say: “I’m in a lot of pain, and I’m sorry!”

When the first antidepressants were developed in the Fifties, the condition was considered so rare that the drug research seemed like a waste of money. But in a 2017 survey, 12.7% of Americans had taken antidepressants in the past month (and nearly twice as many women as men). It is not to deny the existence of catatonic states of despair to suggest that there may have been a definitional leak.

One might retort that “depression” was simply “under-diagnosed”, but equally present in every earlier stage of human history. Consider, though, the discovery of SSRIs, a class of drugs that combined lifetime use with a better safety profile than earlier antidepressants (just weight gain, sexual dysfunction, and the occasional suicide upon withdrawal). And consider the context of that discovery: a world where pharmaceutical companies fund much of the research used in their own regulation, and that research is easy to skew. In short, it is a truth universally acknowledged that a pharmaceutical company in possession of a new drug shall be in want of an endemic illness. As the GlaxoSmithKline slogan bluntly went: “Does your soul have a cold?”

Still, it would be sophomoric to think that depression was wholly and solely constructed by Big Pharma. Until recently, it was understood that “no man living is free, no stoic, none so wise, none so happy, none so patient, so generous, so godly, so divine, that can vindicate himself; so well composed, but more or less, some time or other he feels the smart of” melancholy. So wrote Robert Burton, a reclusive life-long fellow of Oxford, four centuries ago, in his freewheeling account of sadness, The Anatomy of Melancholy.

Burton was writing in one of the last periods where the role of the writer wasn’t to express an individual thesis, but instead to summarise everything. As such, his Anatomy has little in the way of synthetic thought. As Burton says, “I have read many Bookes, but to little purpose, for want of good method, I have confusedly tumbled over divers Authors in our Libraries, with small profit, for want of Art, Order, Memory, Judgment.” He can’t even settle on a definition of melancholy — “whether it be a cause or an effect, a disease or symptom … I will not contend about it” — but he does examine some potential causes. Black bread, melons, hot air, cold air, excessive exercise, defective exercise, the stars, God, hot baths, a hot brain, Calvinism, Catholicism, excessive studying, excessive merrymaking, excessive “chamber-making”.

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As for melancholy’s symptoms, “the tower of Babel never yielded such confusion of tongues, as the chaos of melancholy doth variety of symptoms”. Indeed, it’s sometimes difficult to separate cause from symptom, as in the glorious description “lascivious by reason of much wind”. Burton’s aim is to “adventure yet in such vast confusion and generality to bring them into some order; and so descend into particulars”. Many of these loopy excursions come to a familiar enough conclusion: melancholy’s cause is sin, and its cure is God: “We ought to fear our own fickle estates, remember our miseries and vanities, examine and humiliate ourselves, seek to God, and call to Him for mercy.”

But Burton does not deny the importance of strategies to combat melancholia. These include behavioural changes — drink a glass of water upon waking; seek hills or mountains; “be not solitary, be not idle” — and mental ones — avoid prolonging passionate thoughts; avoid believing in predestination; “be meek, merciful, and patient”. There is comfort here, for the post-modern reader. Thanks to the rapid rise of neuroscience and the branding of depression as a “brain disease”, many third-party carriers reimburse doctors for medication management only, and many depressed people are simply handed a prescription by a general practitioner and told to check in in six weeks. In Burton’s day, the old Galenic system of humours did emphasise the physical. But these days depression is treated like heartburn; in more exploring reaches, it’s treated by impersonal, one-size-fits-all cognitive behavioural therapy, now the province of therapy apps advertised by Instagram scroll.

At the extremes, the “chemical imbalance” theory raises troubling questions about human character; and its Brave New World-style treatment can make the human being feel like an unruly dog. No matter how many analogies one can make to infectious disease or broken legs, depression is experienced at a complicated level inextricable from one’s most virtuous traits — sensitivity, self-criticism, ambition — and to think of oneself as merely a malfunctioning machine or a bundle of “trauma reactions” can impoverish the self.

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The experience of The Anatomy is one of overload, and perhaps it is best to read it with the desperation and joy of Samuel Johnson, who “frequently resorted to [The Anatomy] for the purpose of exhilaration” while running his tiny, failing school at Edial Hall. Its very eclecticism and capaciousness is its virtue. Perhaps reading anecdotes about ancient kings won’t cure you: but given that depression rarely is “curable” at all, there’s something beautiful about feeling this continuity of human experience, across time and space, to feel one’s sadness as part of a world history full of delight and variety. Compare the experience of the sad person today, asking their doctor for Prozac or maybe playing with an adult colouring book, to the experience of a Samuel Johnson. The first is made to feel small and simple; the second is made to feel himself more intelligent, more dignified, more ambitious. Moreover, as any reader of Shakespeare’s tragedies will know, the early Moderns had a way of laughing about despair, solitude, even suicide — a kind of manic sad clowning found absent from the way most people talk about mental health now, both infantilising and deadly serious. Burton, after all, wrote The Anatomy under the name Democritus Junior: the laughing philosopher.

I read The Anatomy the winter after my first law school exams, ambivalent about a course of study that was beginning, nonetheless, to gel into inevitability. I was staying on the couch of a family member in Florida, in a condo surrounded by red and orange tropical plants and buzzing constantly with the exertions of a leaking air conditioner. Through the screen door, at any hour of the day or night, I could see the recently discharged woman next door swaying silently in front of a blue-fuzz TV. Against her state, obviously, The Anatomy is of little use. But for the sort of low-grade malaise I found myself in — the sense that my fears would never disappear but my possibilities, one by one, would — The Anatomy made me feel a little bit better. I read it on the beach, I read it over diner milkshakes, I read it on hot and sleepless nights, on that orange leather sofa that congealed to my skin.

The Anatomy clocks in at 1,392 pages — my paperback quickly broke in half — and any paragraph swims through a dizzying array of references, Homeric through Renaissance; medical, theological, and philosophical. On the one hand, its difficulty made me feel accomplished; and on the other hand, it made me feel, basically, that it was fine to be scared, to still be doubting. I could try cabbage one day, clear water another, oranges, opening windows, perfume, walking in fields, sweet-scented baths, confessing to a friend, faith in God, eating earlier, fasting, seeing sunlight upon waking, reading Herodotus, reading Elizabethans. And above all, as Burton’s last section of course requires, truly and steadfastly resisting despair.

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Small consolations, it’s true, but ones that fit into a life well lived — unlike antidepressants, with their dubious efficacy and their near-certain, unpleasant side effects; and unlike so much of self-help, with its individualism, and its transactional focus on convenience and utility. Burton’s salves are enriching, not subtracting. They make the reader feel, in some small way, in control of their condition, an active agent. As the habit makes the monk, the medicine makes the patient, and against the pop psychology and medical cocktails more commonly on offer, there’s something to be said for the demanding and delightful sublimations of The Anatomy. That the book is often baffling only further recommends it. It feels good to do something difficult; and it feels good to get out of one’s own time, to defamiliarise one’s own condition: though people may have always felt sad, they felt differently about feeling sad.

The Anatomy of Melancholy won’t cure depression. But there’s something comforting about this futility: if sadness has always existed and always will, even for those, like Burton, of exemplary learning and unparalleled discipline, even in the most foreign reaches of time and place, even after 13,000 pieces of advice and 400 years, then we might try to make something generative of some of the pain, to “write of melancholy, by being busy to avoid melancholy”.

Ruby is a paedophile.

Ruby is an anomaly in a paedophilic world dominated by men; one doctor told me that only three of the 10,000 he’d treated were female. Rarer still, she’s managed to form a relationship with a man with similar urges. Last year, she met Sirius on an online forum for non-offending paedophiles. By chance, they lived in the same village.

I’d been talking to Ruby for more than a year, at that point, as part of an investigation into the murky world of paedophilia and to work out what can be done to curb child sexual abuse. Her pseudonym came from the Latin for Little Red Riding Hood: rubra cucullo. “People think I’m the little girl,” she told me. “But actually, I’m the wolf.”

With time, Ruby came to trust me, and invited me to meet her and Sirius. They were waiting for me on the platform when I arrived on my train from Berlin: dressed in black hoodies and loose jeans.

They stood petrified, mute. Ruby began to weep. Sirius, 27, couldn’t meet my gaze. I was the first non-paedophile aside from Ruby’s mother they’d told.

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As we walked, and I talked, they gradually began to open up about their Age of Attractions (AOA) which both insisted they would never act upon. I’d been investigating paedophilia for more than a year, but their confession involved one of the most disturbing descriptions I’d ever heard.

Ruby went on to describe her unhappy childhood; her father made her feel unwanted, never expressing love or attempting to bond with her. She first realised something was off as a teenager, when she became aroused by Japanese animé depicting young boys.

She explained how being able to talk about her urges with Sirius had offered a reprieve from loneliness, and saved them both from suicide. Despite not fitting one another’s attraction briefs, they are now in love. During sex, which they have at least once a day, they take turns to pretend to be a baby.

***

Germany has a torrid relationship with paedophilia, having run a state-sponsored programme in the Seventies that deliberately placed paedophiles with homeless children. It remains a black mark on the nation’s recent history, one that stems from an astonishingly misguided push from some on the Left to include paedophiles in their support for LGBT rights. The reputation of the nation’s Green Party has never fully recovered.

Yet, somehow, a liberal strain continues to lace the country’s approach to paedophilia. In the UK, the US and Australia, reporting paedophiles to authorities is mandatory. Not so in Germany.

As a journalist who specialises in controversial subcultures, I stumbled across the Don’t Offend clinic in Germany while seeking my new topic.

Run out of Berlin’s Charité Hospital, the clinic invites what it terms “minor-attracted persons” to come in and talk without fear of being reported. In effect, it means letting known sex offenders back on the streets where they could abuse again. The clinic — which introduced me to Ruby — counters that this is the only way to get them to come in for therapy to learn to control their urges.

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I met Maximilian von Heyden, a social worker and senior researcher at Don’t Offend. He admitted that it’s unlikely his patients will ever erase their urges. “But they come to therapy to improve their lives and try to cope with this better.”

I’m curious about whether he would let his children hang around with one of his patients. “I wouldn’t leave my children with someone I don’t know,” he replied. “We have quite a good success rate when it comes to establishing behavioural self-control, but we don’t succeed all the time, so there’s always a risk. In general, if I have a good relationship with a patient and he’s opening up and telling me about his sexuality… I’d probably be more cautious.”

He tells me that the clinic has discovered that around 4% of the general population have an attraction towards minors. And, like most researchers in his field, Von Heyden, he states that research and clinical experience point towards it being stable throughout life. However, a small minority, including those behind the UK’s Stop It Now! programme, maintain that it is a curable illness. The difference in opinion is stark, and shows just how far we are from a thorough understanding of paedophilia.

Donald Findlater, director of Stop It Now! told me: “Von Heyden is trying to take over the world with [Don’t Offend]. They’ve spent years touring the globe and convincing politicians in Germany their version of the world is correct. They’re very clear that it’s a sexuality.”

“I’m saying it’s not. It’s part of a learned behaviour that’s come often from adverse childhood things that happened to them. It therefore has the capacity to change, unlike homosexuality and heterosexuality that tend to have a strong biological component.” Findlater also points out that Don’t Offend doesn’t record the names of their patients, so has no way of knowing how successful it is at curbing child abuse; other sexologists in Germany have also attacked the way the clinic labels patients so rigidly with the condition.

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But, for the most part, it has escaped criticism in Germany, where its adverts adorn the insides of metro carriages: “Don’t be an offender. Get help.” It appears the lack of mandatory reporting and empirical evidence is a loss that many Germans are prepared to take in the battle to curb child abuse.

The clinic separates paedophiles into four types. There are those who would never offend, and don’t need help. There are others who are psychopaths; realistically; little can be done about them. There is also a subsection of OCD sufferers who falsely believe they’re attracted to children, to the point of inventing false memories of having been abused. The clinic will send them to OCD specialists.

But where it clams to make the biggest impact is with the fourth type: those paedophiles who let biases sway them. Von Heyden said: “Working on cognitive biases is a big part of what we do. They think: ‘Oh the kids want it, they love it, they tease me.’ But they have to realise normal behaviour from children isn’t sexual and even if does seem like the child is teasing you, it doesn’t mean you’re allowed, as an adult, to follow that impulse.”

Does it work? For Ruby and Sirius, it appears that talking to one another about their urges has helped them to keep them under control. But until they collect sufficient data, it is impossible to know if the clinic’s claims are true.

And so we’re left with a debate that is unlikely to be resolved any time soon. On one side of the argument are those who point to the fact that Don’t Offend has enquiries from prospective patients from all over the world, with many moving to Germany for the therapy. On the other, there are those who’d rather point to the message recently scrawled outside von Heyden’s office: “Hang the Paedos.”

Katy Perry’s Firework was perhaps the ultimate chin-up-tits-out song for the first generation to be fully net-native from childhood onwards. And not just because in the official video Perry shot sparklers from her boobs.

Her song struck a chord with many: Firework peaked at number three in the UK charts, and number one in the US. Her prescription for feeling bad is simple: don’t feel bad. Instead, all you have to do is “own the night like the 4th of July”.

But how, in practice, is one meant to “own the night”?

A new book offers some suggestions — aimed, it seems, at the adults who were once teenage Katy Perry fans. Why Has Nobody Told Me This Before? invites us to see becoming less paper-thin as an important form of self-improvement. “To me,” opines author Dr Julie Smith, “working on maximising our mental health is no different to working on our physical health.”

Looking through the problems Smith describes, one can infer a few things about the implied reader and their struggles. This person is anxious, perfectionist, keen to be liked, prone to minutely dissecting social interactions, spends a lot of time scrolling through social media and worrying about others’ perceptions.

This suffers “low mood” and “anxiety”, struggles with “stress” (there’s a whole chapter on it) and thinks a great deal about couple relationships (another chapter). Typical self-limiting beliefs include imagining that failing at one thing makes them a ‘loser’, or that because someone hasn’t called in a while it’s “because she hates me”.

Dr Julie never explicitly addresses her book to one sex or the other. But I’m willing to bet you know more women than men who fit the description above, an egregious bit of stereotyping that is supported by studies which show women consistently score more highly for anxiety, perfectionism and neuroticism than men.

It’s tempting to suggest that the kind of neuroticism addressed in Dr Julie’s book is new: a product of the navel-gazing social media age, perhaps. And considerable evidence has been amassed now to suggest that social media is making young people more neurotic — especially young women.

A few months before Firework reached number one, in October 2010, Instagram was launched. In the four years that followed, as girls sang along to Katy Perry’s song about transcending your insecurity to wow the crowd, the rate of hospitalisation for self-harm among American girls aged 10 to 14 doubled.

Similar trends are visible in the UK: the Guardian reported in 2017 that over the decade 2007-2017 the rate of hospitalisation for self-harm among girls under 17 had risen by 68%. And Instagram is heavily implicated: summarising its effect on self-perception, a 2019 internal presentation by Facebook, Instagram’s parent company, reported: “We make body image issues worse for one in three teen girls”.

But delving into historic medical literature on women’s mental health suggests that while Instagram may not be helping, it’s possible that the platform is exacerbating something that already existed. Feminists have long written critically about sexist portrayals of women’s emotionality in medical literature. Over three centuries ago, in 1681, the physician Thomas Sydenham offered a description of what he calls the “hysteric diseases”, which sounds strikingly like the emotional world experienced by Dr Julie’s implied reader:

“They indulge terror, anger, jealousy, distrust, and other hateful passions; and abhor joy, and hope, and cheerfulness… They love the same persons extravagantly at one time, and soon after hate them without cause… So unsettled is their mind, that they are never at rest.”

Unlike Dr Julie, Sydenham wastes no time in attributing this form of mental distress more to women than men. Few women, he asserts, “are quite free from every species of this disorder”. But unlike the ancients who thought neurosis was a function of female physiology, Sydenham thought it was mostly an effect of material ease.

In his observation, women who do hard physical work don’t suffer from “hysteria”, while men “who lead a sedentary life, and study hard” do. Sydenham called this male version “hypochondria” rather than hysteria, but describes both ailments as characterised by similar symptoms: “lowness”, “disordered mind” and “incurable despair”. For Sydenham, this ailment of ease inevitably includes more women than men, for men “cultivate the earth, hunt and kill wild beasts for food, and the like”, while the wealthier a woman gets the more likely she’ll be to be exempt from such gruelling work.

But perhaps material comfort is a double-edged sword. We might infer from Sydenham’s comments that without a healthy channel for aggression, and a sense of being able to act on the world around us, both sexes grow restive — and a historically sexed division of labour has made this especially the case for women. The accompanying sex role stereotypes, meanwhile, have long since taught women to bury all such dark and dangerous emotions.

Far from pursuing agency and a full range of emotional expression for its implicitly female readership, Has Nobody Told Me This Before? continues the time-honoured tradition of teaching women to internalise. Sigmund Freud based his theories of the human psyche on the twin pre-rational drives of sexuality and aggression; but these, considered fundamental human drives by psychoanalytic psychotherapy, barely feature in Dr Julie’s manual for self-optimisation: two mentions each. In contrast, “anxiety” appears 77 times. And while there’s a brief discussion of anger, this is only in the context of grief. Implicitly, anger is never about aggression — it’s always a cover for something cuter and more deserving of sympathy, such as fear or loss.

At the micro-scale, the book offers uncontroversial and often practical advice on how to be slightly less neurotic. Our minds can play tricks on us, Dr Julie advises, so troubleshoot practical reasons for feeling low, such as tiredness or thirst, before you catastrophise. Try not to obsess about things that go wrong: go for a short walk and think about something else. Write down three things a day you feel grateful for. Get enough exercise, sleep regularly and for long enough, eat real food and not too much of it, stick to a regular routine.

But its overarching message is unnerving. In Dr Julie’s world, there’s no question of using kinetic emotions such as anger or aggression to change anything around us. Rather, when experiencing strong emotion, she encourages the reader to use “physical movement” to “use that physiological arousal in the way it was designed to be used”.

I doubt Dr Julie has in mind the physical movement of her reader’s fist toward someone else’s face, which is arguably how the “physiological arousal” of anger is “designed to be used”. But this bait-and-switch exemplifies the pervasive message of this book: that somehow, we’re all alone in a world of shadows, where authentic encounters with other people are not possible. Nothing we feel can ever be expected to change anything, so it’s best we learn to manage it.

When experiencing strong feelings of any kind, she advises, the solution is never to act on them but rather “build your awareness of how you respond to various emotions” so you can “practise stepping back from them and responding to them with compassion”. In other words, “managing our mental health” means not becoming more immediately present in your social world. It means learning to detach from the kind of strong, kinetic, engaged and embodied feelings you’d need if there were real people out there, and instead detonating excess emotional force in a carefully controlled vacuum.

And this should be enough, the book implies, for each individual contains the solutions within them. As Katy Perry puts it:

It’s always been inside of you, you, you
And now it’s time to let it through

The chapter on “values” makes this clearest of all — for it invites the reader to compile her own ex nihilo. “Getting clarity on our personal values can guide us on setting goals that will bring meaning and purpose,” she declares, a statement that a cynic might observe is on the circular side: deciding what you understand the meaning of life to be will help you to determine the meaning of life.

One might also wonder if it’s a little cruel to ask an anxious, neurotic, socially uncertain and emotionally labile perfectionist to conjure a viable personal philosophy into existence without help from external referents. But leaving that aside, Dr Julie doesn’t acknowledge how the demand that each reader determines her moral system in a vacuum can backfire. For while it holds out a promise of self-containment, it also explains why anger is so curiously absent from this book.

For there are forms of righteous anger that aren’t covers for fear, loss or past trauma. This kind of anger is a fundamentally social emotion that expresses outrage at some other or others violating a set of shared principles. But in Dr Julie’s world, there are no shared values. And this means anger can never be righteous – and thus can only be detonated safely, in isolation, and never employed constructively in social encounters.

This presents further difficulties, too. For losing the shared terrain on which legitimate anger might be expressed doesn’t eliminate the underlying human tendency to aggression — even if Dr Julie doesn’t acknowledge that such a tendency exists. And if Sydenham catalogued the psychic distress more than three centuries ago of people who lacked healthy means of expressing agency and aggression, those means have shrunk still further today.

This is especially the case for girls, 84% of whom were shown in a recent study to be too sedentary — a higher figure than for boys, just as in Sydenham’s day. At the same time, studies show girls are more likely than boys to be both the victims and also the perpetrators of online bullying.

No wonder, then, that girls and young women are miserable. We raised a generation with few direct outlets for healthy aggression, and the most sedentary lifestyles in history, and told them not to assume any shared values with those around them — which meant they could never be legitimately angry. Then we handed them a set of social media tools for covert interpersonal aggression and watched their mental health implode.

Fittingly, Dr Julie first attained the fame that landed her this publishing deal on Instagram. She has thanked her audience by writing a book which denies the existence of any basic human drives and disavows the social importance of any shared values, while reinforcing every young woman’s essential isolation and concurrent duty to self-improve.

I’ll say this for Dr Julie’s book: it offers some useful tips to the Instagram generation, in coping with the main modern delivery mechanism for covert female aggression: Instagram. But it offers nothing to broaden the Instagram view of life: a competitive, value-neutral performance, where self-optimisation is everything and other people aren’t entirely real.

Every young woman is a firework; every young woman owns her own night. And no one is coming to help her with it.

There was backlash from religious groups, calling the move “eugenics”. But was it? The word “eugenics” can be used to refer to things like mitochondrial donation, insofar as it means something like “efforts to remove ‘harmful’ genes from the gene pool”. But the classic example of eugenics are things like the Nazi programme of forced sterilisation; a programme that did awful things to people against their will.

Using the term “eugenics” to refer to both was, I think, a semi-deliberate tactic. Opponents of mitochondrial donation were trying to associate those evil things in people’s minds with the more complex cases. That doesn’t mean that mitochondrial donation is automatically right. But the fact that a loose definition of the word “eugenics” can be used to apply to both it and Nazi murders does not make it necessarily wrong.

A similar sort of tactic appears to being deployed in the ongoing debate over the Government’s proposed legislation to ban conversion therapy. 

It was not that many years ago that homosexuality was viewed as a mental illness requiring curing: the Diagnostic and Statistical Manual of Mental Disorders (DSM) listed same-sex attraction as a psychiatric disorder until 1973. And as I’ve written before, there’s not much evidence that you can change someone’s sexual orientation, while the methods used to do it have often been brutal: zapping people with electric shocks while showing them homoerotic images; chemical castration; even lobotomy, as recently as 1969.

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“Conversion therapy” is, therefore, rightly held up as something unacceptable: the classic example of conversion therapy is a gay man or lesbian woman being forced, against his or her will, to submit to something approaching torture, in an almost certainly unsuccessful attempt to change his or her sexual orientation.

The Government’s legislation, though, refers not just to efforts to change a person’s sexual orientation, but also to efforts to change their gender identity. And I’m concerned that, just as with the word “eugenics”, using the term “conversion therapy” like this stretches it to beyond the point of usefulness.

Of course if someone is trans, they should not be told that they are not — or told that they are inferior, or defective. But sexual orientation is a fairly stable and well-defined concept: we know what is meant by being sexually attracted to one sex or another or both, and, on the whole, people’s sexual orientation remains the same throughout their adult lives. Importantly, also, if someone does change their sexual orientation, all they need to do is start dating people of the appropriate sex.

That’s not true of gender identity. While there clearly are many people who don’t identify as their biological sex, exactly what is meant by a “gender identity” is unclear. The Human Rights Campaign defines it as “one’s innermost concept of self as male, female, a blend of both or neither”. How one feels is important, but it is subjective — and unlike sexual attraction it’s not tied to obvious behaviours, such as choice of sexual partner.

It’s also not clear that it’s stable. While some young people are clear from a very young age that they do not identify as the sex they were born in, and remain so until adulthood, that’s not true of everyone. According to several medical textbooks, perhaps as many as 85% to 90% of prepubescent children who are diagnosed with gender dysphoria — that is, severe discomfort in their birth sex — no longer do by adolescence, although they do say that if those children are still dysphoric in early puberty, it is “almost certainly permanent”.

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And, crucially, the decision about whether a young person is trans or not can be much more consequential and irreversible than the decision about whether they’re gay or not. Full transitioning may involve hormones, drugs to delay puberty, and surgery.

All of which may be absolutely necessary and right; there are plenty of examples of young people who transitioned and became much happier and healthier. But the combination of an unstable concept and a major, consequential life decision means that we need to be careful about deciding whether someone, especially a young person, is “really” trans or not.

That’s why we should be concerned about the use of “conversion therapy” as an umbrella term. Of course, if there are therapists telling trans people that being trans is shameful or sinful, or that it is a defect that needs to be purged, then that is wrong, and those people should be punished. But I don’t think it’s very common.

The Government’s own research refers to two main kinds of conversion therapy: spiritual, “pray the gay away” versions, and “psychological methods” such as talking therapies. About 5% of lesbian, gay and bisexual people in the UK have been offered conversion therapy, mainly of the spiritual kind, usually because their sexual orientation conflicts with their community’s religious beliefs.

There is much less research into how common gender identify conversion therapy is. But the Government’s assessment does say that “a much higher percentage of transgender respondents (29%) than cisgender respondents (15%) said their therapy had been conducted by healthcare professionals”.

That would make sense, if some therapists are assessing that some patients are mistaken about their transgender status, and offering them alternative routes — for instance, watching and waiting, or treating some mental health condition that they have — and patients are unhappy at the lack of affirmation of their condition. And often such assessments are reasonable: gender dysphoria is often found alongside other conditions, such as autism. There are also other conditions, such as borderline personality disorder or dissociative identity disorder, which can lead to patients having unstable senses of self. While it’s important to listen to patients, that doesn’t mean always assuming that they’re right in their self-diagnosis. 

The Government’s proposed legislation does make room for therapists to “support a person who is questioning if they are LGBT”. But as one GP says, “lots of my patients are not questioning; they are very assertive that they are trans”. Sometimes simply affirming a patient’s, especially a child’s, beliefs about his or her identity, is not the right thing to do.

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Perhaps the safeguards in the proposed law will protect doctors and therapists who want to be more cautious about affirming patients’ gender identity in every case. But some therapists are clearly concerned: the GP quoted above goes on to say that “The way this is worded at the moment, I could end up in prison.” Surely it will not come to that, but it would be deeply concerning if there was a chilling effect on medical professionals’ willingness to talk about gender to their patients.

Like the term “eugenics”, the term “conversion therapy” is powerful: it summons up images of torture, of homophobia, of religious and institutional abuse. And just as with eugenics, that power needs to be directed carefully. The arguments should never be “because we use the same term to describe them as we used to describe Nazi atrocities”. 

Of course, there may sometimes be excellent reasons to affirm children’s gender identities, rather than challenge them. I suspect it may be best to let clinicians use their best judgment, in some cases. But we should be careful about using the term “conversion therapy”. Something has gone wrong if doctors are worried about going to prison for discussing the best treatment for their patients.

In their understandable desire to get on with trials that might help people who are suffering, many researchers have sidestepped the question of what depression actually is. Instead, they’ve simply agreed on a definition and stuck to it. The Beck Depression Inventory is a questionnaire routinely used to diagnose and define depression: if you’ve ever spoken to your GP about feeling low, you might have come across it. It’s named after Aaron Beck, one of the most important figures in the history of psychiatry (who died aged 100 on November 1st this year). He came up with 21 questions that cover guilt, feelings of failure, weight loss, insomnia, and suicidal thoughts, among other common depressive complaints.

The problem is that the medical profession, and psychiatry researchers, might be relying a little too much on that list of symptoms. Indeed, in an odd, unintentional, circular move, they might have actually turned lists of symptoms into the very definition of depression. An essay by the eminent psychiatrist Kenneth Kendler argues that this is a fundamental mistake: the number of boxes a patient ticks on the list of symptoms that get you a diagnosis isn’t the same as “depression” (nor is their Beck Depression Inventory score) — even if psychiatrists and researchers often act like it is. The Inventory is very often used as the criterion for improvement in studies of treatment: if you achieve a 50% drop in symptoms as measured on his questionnaire, you count as having been positively affected by the treatment. But these criteria are a decent index of many of the common symptoms — not all of them. We know anxiety commonly comes alongside depression, Kendler notes, but it’s not on the standard diagnostic list. If we confuse the disease itself with a useful-but-limited list of its manifestations, we’ll find it harder to truly understand patients’ experiences.

Some researchers have gone a step further: should we stop using the concept of “depression” entirely? One study of thousands of depression patients found over 1,000 unique combinations of symptoms that all still count as “depression”. Maybe it’s time, argue some, to focus on understanding subtypes, or even just specific symptoms, rather than the monolithic entity of “depression” itself.

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In some senses — and perhaps ironically — this accords with Beck’s philosophy: he was known for being sceptical of focusing on the ultimate, root causes of mental illness. Which brings us to the other major contribution for which he is remembered: Cognitive Behavioural Therapy. Beginning in the 1960s, Beck reacted against the most popular form of therapy at the time, which was based on Freud’s psychoanalytic theories of the mind. Beck — who himself was originally trained to administer psychoanalytic therapy — began to doubt that depression symptoms were always caused by childhood traumas and unconscious repression. Some of the Freudian theories were rather far-fetched — as Tony Soprano says to his psychoanalytic therapist, after she suggests for the umpteenth time that he might be harbouring some Oedipal desires: “I don’t wanna fuck my mother! I don’t give a shit what you say — you’re never gonna convince me!”

Instead, Beck suggested a much more proximal reason for the disorder: depression patients (and those with other disorders) are suffering from “thought distortions”. For example, they might catastrophise, blowing minor unfortunate occurrences in life out of all proportion. They might overgeneralise, thinking that a fallout with one friend means that they’re hated by everyone they know. As well as focusing his Depression Inventory on these kinds of thought patterns, Beck argued that therapy should target them and train patients out of them, rather than looking for some underlying explanation for all their symptoms.

Beck won the argument: although psychodynamic therapy still exists, CBT has now become the most popular — and by far the most studied — type of psychotherapy. New guidelines, announced this week, give patients the option of group CBT as the first line of treatment for mild depression; but even before then, it was extremely widely used. Its application goes well beyond depression: the language of CBT, with all its ideas about catastrophising and perfectionism and self-blame, is now, as Scott Alexander has memorably argued, “in the water supply”. But “popular” and “culturally influential” doesn’t necessarily mean “good”. What do the studies say about whether it works?

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Despite the sheer volume of research, the evidence is actually quite poor. The meta-analyses (reviews of all the studies that have looked at a particular question) do conclude that CBT works compared to doing nothing (a common control group, to which the therapy is compared, is made up of people who are on a waiting list for treatment). But it’s worth remembering that positive studies are more likely to be published than ones concluding that the experiment in question doesn’t work. And the overall literature on psychotherapy does show signs of this kind of bias.

So, even if the studies are right that CBT is beneficial (and in my view they most likely are), the extent of the benefit might be somewhat exaggerated. Those meta-analyses compare CBT to other common forms of psychotherapy, including the psychoanalytic kind (these days usually called “psychodynamic” therapy). The general picture is this: the effects of CBT are essentially the same as any other kind of psychotherapy. They all reduce depression symptoms, and they all still seem to work up to a year later (this particular kind of meta-analysis has to assume all the trials are comparable, though — and that’s often quite a big assumption).

It’s a very similar story for drugs: the meta-analyses show that essentially all forms of antidepressant work better than placebo. But these effects are likely a bit overblown by all the dodgy practices in the scientific literature. And the evidence for one antidepressant being substantially better than another is, to use the kind of language one often sees in the review studies, “limited” (which means researchers only have the vaguest clue).

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Although this is good news in one sense, it’s worrying (even depressing) in another. There is evidently a gaping hole in our evidence base on treating depression. If essentially all the major therapy types work to the same degree, despite being based on entirely different — often opposing — principles, it’s pretty difficult to pin down exactly why they work. What exactly are the therapists doing in their sessions that makes the treatment effective? Can we really say that Beck was correct about CBT being the best treatment if other forms of therapy, which take an entirely different approach, can do the same job?

Maybe it doesn’t matter whether therapists stick to Beck’s plausible cognitive theories or Freud’s absurd psychosexual ones. Maybe just having a regular interaction with a smart, sympathetic, well-organised person who focuses on your problems is what helps. That wouldn’t explain, though, why the analyses showed that some forms of self-directed therapy can also make a difference. Either way, all this raises the question: how can we make our therapies better if we don’t know the active ingredients? But then, how can we establish the active ingredients if we don’t even know what we’re treating?

You can call Samaritans for free on 116 123, email them at jo@samaritans.org, or visit www.samaritans.org to find your nearest branch.

Yet how dull “the literary phenomenon of the decade” turned out to be — and what was stranger, how knowingly, coyly dull. I had assumed the almost insolently underwhelming name on the tin — Normal People — was an ironic joke, and that the contents would be abnormally original, with unusually vivacious, insightful writing.

I was wrong. Rooney isn’t into vivacity, as her dour expression and flat, understated style of writing might suggest. What she is into is sex, and most particularly the tears and apologies that seem to surround it for the young erotic adventurers of today. The result is a prose I found hypnotically low-pulse.

But with over a million copies sold worldwide, first prize in the Costa and Waterstones Book of the Year and plenty more accolades, Normal People clearly answered to a global appetite. The TV adaptation was inevitable, and lo, it was released last week to instant roaring success.

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Once again, a dutiful investigator, I found myself glued to the BBC’s version of Rooney’s coolly flat world while also bored. What is it about this story that has captured us so?

Most obviously, it is the sex, which manages to be both ‘hot’ and firmly didactic — just how we moderns like it. Most episodes — and there are 12 — contain what can only be described as great coitus between the lead characters, with emotional intensity driving on the obvious physical urgency and pleasure. At first, in school, the popular Connell (Paul Mescal) is too embarrassed to be associated with the weird and friendless Marianne (Daisy Edgar-Jones), and so their sexual relationship is secret. Though Rooney and now the directors work hard, and successfully, to render this relationship tense and meaningful, they obviously have a keen eye for the plainly arousing.

There is something unsettling, almost dishonest in this. Packaged as the sometimes difficult, vulnerable-making and above all authentic sexual experience of ‘normal people’ (i.e. ‘damaged’ people, of which more later) these are not the kind of sexual experiences I remember from school and university — and there were plenty of ‘normal’ (i.e. ‘damaged’) people in both places. In the first place, their looks and the calibre of their sensual experience for their age are exceptional.

Readers of the book had to infer from Connell’s thoughts that Marianne is in the essentially sexy category of unpopular girl, despite being bullied about her looks at school. By contrast, the makers of the TV programme settle the question of their universal sexual appeal immediately: Edgar-Jones is a knock-out — the sinewy, delicate, quiet and mysterious ying to the big handsome, blue-eyed athleticism of Mescal’s Connell. Both are equally libidinous, so that the production often feels more like high-end pornography than drama, even if the sex escapes gratuitousness by marking the waning and waxing of their relationship. Either way, their goings-on are hardly ‘normal’; nor are they ‘damaged’. They’re enviably perfect.

Suggested reading

No sex please, we're brutish

By Louise Perry

I was discomfited to note the quiet but firm moral running through the production: great, truly hot sex is the reward for beautiful, and above all thin girls with stylish hair — Marianne’s fringe and charcoaled eyes, along with her delicately picked-out clavicles and hip-bones, quite often steal the limelight. The same moral is maintained in the sex scene between Connell and his college girlfriend Helen: here is another toned, fatless woman with long brown locks that sexily tousle with sweat as she enjoys Connell. Meanwhile Marianne’s less beautiful friend Peggy (India Mullen) is sexually invisible, and her best friend — a very overweight, sensible girl called Joanna (Eliot Salt) — is rendered entirely mumsy, a foil. Nothing happens to her.

If the sex in Normal People silently reaffirms the enduring gold standard of female slenderness and the kind of sultry mysteriousness evident in Marianne’s long, dark silences, then it is very explicitly didactic in other ways. All sexual exchanges are peppered with nervy utterances of ‘is that OK?’, ‘if that’s OK’, ‘if you want me to’ and so on. The sex between Marianne and Connell is as much about trumpeting the virtues of constant and enthusiastic consent-seeking — indeed of the softly softly feminist man’s approach to shagging — as it is about raw desire. “If you want to stop or anything we can obviously stop, if it hurts or anything we can stop, it won’t be awkward, just say,” says Connell in the first sex scene, when Marianne loses her virginity. This was an object lesson in smart sex for the woke age — take no steps without express permission, especially where women are concerned.

Marianne and Connell’s virtuous sex scenes gleam with a knowing, seductive touch because they were expertly choreographed, emotionally and physically, by an intimacy coordinator. Since MeToo, as sensitivities around consent have been heightened, intimacy coordinators have become mandatory on most major productions to ensure no liberties are taken filming sex scenes and that the actors feel ‘comfortable’.

For Normal People, the BBC hired the sought-after Ita O’Brien, a former dancer and actor who oversaw the action in fellow teen bonk fest Sex Education. Just as the characters constantly seek mutual assurance of emotional comfort, the intimacy coordinator ensures the actors feel just as comfortable.

The language of intimacy coordination, with its emphasis on constant emotional temperature checks, perfectly matches the ideology of the book and — at last — helps shed light on what is meant by ‘normal’. In a world obsessed with policing violated boundaries and outing emotional discomfort, ‘normal’ means either ‘weird’ or ‘damaged’ — which, therapeutic wisdom has it, are traits we should celebrate (unless they involve holding offensive political opinions). “How I act with [Marianne] is my normal personality,” Connell tells a jealous Helen in response to her question of why he is so ‘weird’ around Marianne. “Maybe I’m just a weird person,” he says, concluding a scene crafted to signify who he really belongs with (Marianne).

Suggested reading

Why is the Left so hypocritical about sex?

By Sarah Ditum

Normal People has been hailed for its relatability, with the inference that we’re all weird, we’re all damaged, and we are all saved only by those who truly and authentically love us. Indeed love and damage go hand-in-hand, and emotional vulnerability has become the ultimate aphrodisiac. The scene in which Connell and Marianne’s love enters a new more serious phase revolves around her tearful musing: “I don’t know why I can’t make people love me.” Marianne hints for the first time at the abuse visited on her by her odious brother, confessing to a shocked Connell that she hadn’t told him yet because “I was afraid you’d think I was damaged”. Magic words. Connell’s love surges, as he tells her none of it is her fault and that she is loved. A rush of lust follows.

Later, following the suicide of a friend back in Sligo, and with frequent panic attacks, Connell himself seeks out counselling, and the therapeutic process lends the final episodes their dramatic thrust, winning plaudits from men’s mental health activists. Tick.

Normal People chimes with the growing consensus — even in Britain — that therapy wins all. Indeed, from Wanderlust to Sex Education, no contemporary British drama is complete now without an extended therapy scene. The therapeutic journey is also the dramatic heart of Dolly Alderton’s best-selling Everything I Know About Love, now being made into a TV series too (Alderton was runner-up to Rooney at the 2018 Waterstones Book of the Year Awards).

Neither the fascination with rendering the ‘true’ self fully transparent nor the belief that only through being vulnerable shall we be free are new. Freud unleashed on a mass scale the conviction that our ‘true’ drives lurk below external presentation, but it wasn’t until the 1960s and 1970s that therapy culture and practices really began to suffuse approaches to everything from relationships to feminism to management. As observers noted at the time, this could yield a strangely closed-feeling, narcissistic system of interaction, in which self-discovery was the end point for all endeavours. By the mid-1980s, a series of new women’s magazines were targeting a readership that was, in magazine historian Anna Gough Yates’s words ‘vulnerable’, ‘self-critical’ and ‘insecure inside’. A fit description of the characters in Normal People.

Normal People is the perfect product for a generation taught to seek out and proudly lay claim to sexual and emotional vulnerability. In the past, sex scenes packed full of the considerate, careful hesitation we see here might have garnered laughter and shrieks of ‘get on with it!’. But today, virtue and the erotic go hand in hand. The message of MeToo seems to have won out: respecting boundaries is as hot as the sex itself.

No one can be certain of his motives, but as British Muslims on social media began to talk about it, the suicide acquired a significance beyond the act itself. Suddenly, a place of worship and sanctuary became the cornerstone of a discussion for which no-one seemed really ready. One rooted in issues of cultural trauma, family, honour and an overzealous belief in prayer being the solution to all problems.

There had been uncomfortable attempts by the community to grapple with the issue of mental health previously but this one moment – of a man plunging to his death before what Muslims regard as God’s House – became a signal that silence could no longer persist. People had to talk.

For too long the response of British Muslims, particularly those of south Asian heritage, to such stories has been problematic. Though some have spoken poignantly about the problem, others have underlined the ignorant attitudes prevailing within the community.

Further reading

Poor mental health is bad for the economy

By Charlotte Pickles

In their eyes, the dead man had committed an abominable act directly before God. The mention of mental illness was not enough to stir them to pause and reflection. As they saw it, he had stained himself in the worst way, in an inexcusable manner.

Sadly, this unforgiving view is why many British Muslims struggle to discuss mental health. The man wasn’t seeking redemption or excuses for his sins, but probably hoping for an end to his suffering; he may have wished God’s House to be the last thing he saw on earth. There’s something deeply saddening in that; worse still is the fact that so many refuse to attempt to understand his case and others like it.

There was little compassion for this man’s suffering – even though it led to his death. Many Muslims see sin as a human flaw, but mental illness is not a flaw in that sense. It’s not a human weakness conditioned by our own behaviours and actions, but something uncontrollable.

The absence of compassion is a symptom of the wider struggle to discuss mental health within British Muslim families, which arises from a toxic fusion of religious misunderstanding and cultural values. Islam supposedly tells people life is a test and that they should embrace its sharp edges and desolate moments. To speak about mental suffering, in that interpretation, is to reject God’s plan and not to have faith in religion to solve the pain.

Further reading

'The Inner Level', inequality and why sad is the new hip

By Richard Godwin

It doesn’t matter that that pain can leave you feeling like you’re drowning in constant black waves. Faith, and particularly prayer and its power, is the log you are supposed to hold on to stop you from being swept under. Dr Ghazala Mir, a researcher at Leeds University, argues that “This stigma does involve the idea that maybe if you need treatment, there might be something wrong with your faith identity in the first place.”

This is the retort that has greeted many who try to discuss the issue, or to argue that prayer alone isn’t enough to solve mental illness. People are told their weak faith is the cause of their depression – yet depression can affect enthusiasm for anything, including praying. There is fear and guilt in thinking prayer won’t solve the problem. So when you pray and find the solution slipping further away, you feel helpless. Your despair spirals.

Religion is often entwined with culture; most British Muslims of a south Asian background are influenced by their cultural roots simply by the differences from Muslims of other ethnic backgrounds. In particular, a tight-knit family structure is central to their identity. There is a constant demand to protect a family’s reputation and not to disappoint, to be what religion and culture demands, and avoid what the community gossips about.

Further reading

The bureaucratic fracturing of government can destroy lives

By Peter Franklin

For women, the ties and obligations to family are even tighter. Secrecy, fear, shame and honour mean everything. Reputation is everything, especially for a woman, because – to put it crudely – it can lower her value for marriage in parts of the community. Stories of ‘honour’ violence and supernatural possession are examples of the misogyny they face within families. The concept of demonic possession, in particular, affects women who exhibit signs of mental illness; the prescribed solution requires an exorcism but damages their name and status irrevocably. And of course, how as Muslims can you deny that demons exist?

I lost years of my life to mental illness. It was always there like a shadow, returning when I least expected it. After years of struggle and grind I thrived in university, feeling as if I had been unshackled. But my religion became an obstacle, deepening the problems. Faith strangled me with doubts, shame – and terror that I was sinning for refusing to accept prayer as the only road out of this gloom.

I lost count of how many times I stood on a train platform thinking there was a way for these thoughts to stop. Maybe it was the fear of God that stopped me from acting then, but it was also the fear of God that for years stopped me exploring solutions beyond prayer. Reconciling with roots I felt were holding me down but still couldn’t break from, was and remains a struggle.

Further reading

Young British muslims are putting their money where their mouth is

By Katie Harrison

Finding a solution to mental illness is not easy, especially to those of us suffering from it for years. Understanding it is like wading into an ocean of bottomless depths, or as a friend put it, “trying to keep a door open with a piece of string.” Perhaps it’s an inner war with no end that we will always be fighting. That’s how it feels.

But cultural values of family honour and pride, as well as religious demands of confidence in God, should not become deterrents for talking about illness.The mental health charity Mind has begun working with British Muslim communities to tackle this, reporting positive feedback.

What has certainly helped is exposure to western culture. As the older generations of British Muslims were more swayed by their cultural roots, younger generations are more influenced by a British culture which has started to challenge the stigmas around mental health, particularly the gender stereotypes which prohibit men – and women – from displaying emotional vulnerability

Will things change? If the traditional ‘stiff upper lip’ is now allowed to tremble. I can only hope that the same thing will happen within my community. The shameful silence imposed by my religion cannot persist.