Adam Omary: This is the Human Progress Podcast. I’m Adam Omary, a psychologist and research fellow at Human Progress. Today I’m joined by Jonathan Alpert. He’s the author of ‘Therapy Nation: How America Got Hooked on Therapy and Why It’s Left Us More Anxious and Divided.’ Jonathan, welcome to the Human Progress Podcast.
Jonathan Alpert: Adam, thank you so much for having me.
Adam Omary: I should begin mentioning, since Human Progress has an international audience and we report on international trends, including mental health trends, that though the subject we’re talking about today, psychiatric overdiagnosis, the therapization of culture, is a problem in America, particularly in terms of mental health spending and psychiatric medication, we’re seeing similar trends across the developed world, similar trends of therapy nations.
Jonathan Alpert: Yeah, you’re absolutely right. And I have heard from colleagues in Europe who have written to me and have told me that they are seeing some of the same trends that I wrote about in Therapy Nation in the countries where they’re practicing. So as America goes, so does the rest of the world sometimes.
Adam Omary: I’ve written about this, I’ve termed it the psychological paradox of progress. And many people, when they see rising rates of depression and anxiety, they might say, “Well, historically there was so much stigma, people were underreporting their mental suffering in the past.” We’re seeing rising rates, but how do we know that this isn’t actually a sign of progress? Like cancer rates are rising, but we’re living long enough to see cancer develop because we’re not dying of some other cause at younger ages. So could we look at these rising rates of depression and anxiety, how much of it do you think is genuinely increases in suffering and how much of it might be greater awareness?
Jonathan Alpert: Yeah, and it’s worth discussing that. And with cancer, of course, we have better ways of detection, early detection, better tests that are available, so that makes sense. But with mental health, a lot of people will ask, “Well, if there’s so much therapy and mental health services available, why do we have higher rates of anxiety and depression?” which we seem to have. And it may simply be that there’s more awareness, more people are open about their mental health issues, we do have better ways of detecting or diagnosing it, and therefore the rates are higher. That’s one possibility. The other possibility is that we actually are sicker. We have more to be stressed out about, we have more to feel anxious and depressed about. The truth is, we may not know. I think we just don’t know exactly what’s going on inside an individual’s head and within our society. But certainly there’s greater awareness, and that’s a good thing. There seems to be less stigma than there once was around mental health issues. We have more celebrities and public figures coming out and talking about their struggles with mental health. Senator Fetterman from Pennsylvania has talked about his own struggles with depression. So this is all helpful. It helps to raise awareness. If we see people in the public eye discussing their mental health issues, then we might feel a little less uncomfortable discussing our own issues. So in that respect, it’s good. But my profession, I do worry, has contributed in part to some of the pathology that we’re seeing. And that’s really the thesis of my book, Therapy Nation. I argue in that book that therapists have pathologized ordinary life experiences.
Jonathan Alpert: So, for example, if we’re having a bad day, that’s a very normal life experience, and that doesn’t necessarily mean that we suffer from major depression. It means we’re having a bad day or a bad week. But a lot of therapists are quick to put a label on that, put a diagnosis on that person. We saw recently the University of Michigan, they have a new grading policy where they’re eliminating grades for freshmen in certain programs. Instead of using the letter grades, it will be pass or fail. And the reason they’re doing that, they say that there’s a mental health crisis that’s created as a result of grades. And I think that’s a perfect example of an institution that is pathologizing what I would consider a normal college experience. Sometimes we do poorly in classes and that’s part of growing up and learning. But I see this in a lot of areas in our society, and my book does address a lot of that.
Adam Omary: As much as it seems like a grim topic to talk about the mental health crisis on the Human Progress podcast, it is useful to think about the context in which we talk about these ordinary struggles. My colleague here at Human Progress, Chelsea Follett, has a book coming out, ‘The Grim Old Days: An Introduction to Pre-Industrial Life.’ And she talks about how throughout most of human history, the levels of suffering, day-to-day suffering in struggle for survival, the struggle to find enough calories, to find shelter, were much greater than anything most people, certainly anyone with the luxury of being able to listen to a podcast like this, would face. So it’s interesting to frame that from an evolutionary psychology perspective. If we have these innate threat detection systems that are configured to our early environment, like, we’re gonna have a stress response and anxiety response to what is bad, not in objective terms, because this is fundamentally a subjective measure, but what’s bad relative to what our normal day-to-day baseline is. And paradoxically, as much as that has gotten dramatically better, particularly within the last one to 200 years, post-enlightenment, if our day-to-day existence is so comfortable, then ordinary discomforts, such as as you just mentioned, getting a bad grade, can for young people really induce this sense of anxiety, this sense of threat.
Jonathan Alpert: Yeah, and I think some people would argue that we’re not helping young people or even older people by pathologizing experiences such as getting a bad grade or having a conflict with a colleague or a fight with a significant other. I mean, if we’re looking at these things through the lens of pathology, we’re really not doing people any favors. And I’ve seen in my profession also the over and misuse of diagnostic labels and therapy speak. Spend five minutes on social media and you’ll likely see terms such as PTSD or trauma or borderline or toxic being thrown around. And we have influencers who are putting that information out there, and these terms have just become part of our everyday lexicon to the point where people will just throw these terms out there and label their friends or significant others with these very serious clinical terms. And again, I think it’s creating some fragility and some pathology in our society. And ultimately, it doesn’t make us a stronger society. I think it makes us a weaker one and in a more divided society.
Adam Omary: When people self-diagnose or really come to identify with their diagnosis, sometimes people say it’s very validating. It helps them understand their struggles, to put language to it that they didn’t previously have. Sometimes they say it helps them find community, especially online. But as you mentioned, it can also contribute to fragility or a sense of victimization and internalizing the disordered label and perhaps limiting one’s growth mindset. I’m curious as a psychotherapist, Jonathan, how you see these different dynamics play out. How can you tell when a diagnosis is going to truly help someone, and under what conditions could it actually leave them, say, more anxious?
Jonathan Alpert: Good question. When a diagnosis is accurate, it can be helpful, but all too often I think the diagnoses are being inaccurately applied or used and labeled. I think post-traumatic stress disorder is a really good one to talk about here. So PTSD, there are certain criteria that need to be met in order to be diagnosed, and one thing that needs to be evident is the threat of death, having experienced the threat of death or perceived danger or threat of death. So that might be someone who was in a bad accident, certainly someone who was in wartime, a soldier. Those probably would lead someone to have PTSD. But what we’re seeing lately, people just labeling themselves or therapists labeling their patients as suffering PTSD if they had a fight with a boss or say a bad housemate. That’s usually not a threat to the person’s life. It might be a really bad fight or a really bad day or week or work situation or housing situation, but usually not life-threatening or perception that your life is threatened. So we’ve had the loosening of these terms, and the real danger in that is people identify as that and it might make them actually weaker. The other danger in that is that people who actually do suffer from PTSD, it kind of waters down the diagnosis a bit. And if everyone’s being labeled as PTSD, then probably no one is.
Jonathan Alpert: So there’s a real danger in that, and the people who suffer from it may not be getting the proper attention that they need. And that’s very concerning to me. I tell a story in my book about an accident that I had a few years ago. I was biking and I got hit by a car, and it was an awful experience and I ended up breaking my leg. It was a really bad experience, but I can walk, I can bike, and I’m okay now. But after the accident, when I would see a big black SUV, which was the vehicle that hit me, I would get a little tense and anxious, but I was okay and I certainly didn’t suffer PTSD from it. Maybe a little upset and anxious, but not clinical PTSD. But a lot of therapists would probably be willing to throw that label of PTSD on that incident that I had, and it’s wrong. It wasn’t life-threatening. I survived. So I think my profession really needs to take a closer look at what they’re putting out there.
Adam Omary: A lot of the generational gap that we see in psychiatric diagnoses seems to be that there’s a similar gap in how the language is used as you’re being raised and as culture has shifted in this more therapeutic, over-expansive direction. So rather than interpreting it as we’re in the midst of a youth mental health crisis, what is the cause? Is it smartphones? Is it social media? Which certainly can contribute to ordinary difficulties and in some case more extreme difficulties. But I tend to look at it, like you’re mentioning, on social media, much of the discussion is self-diagnosis. It’s applying these clinical labels to ordinary struggles that are very real, but nevertheless don’t seem to meet traditional clinical DSM guidelines. And even where they do, because the DSM itself, the psychiatric manual, has gotten progressively more expansive and easier to diagnose, especially for some of these more broadly defined conditions like autism spectrum disorder. In the latest edition, the spectrum disorder inherently implies, well, there’s a whole wide continuum that you can fall onto even without experiencing clinical pathology or impairments in day-to-day functioning, where most other disorders are defined by it has to have a clinical impairment in day-to-day functioning to meet diagnostic criteria. But certain new conditions, including ASD, don’t have that feature. And no surprise, then, you’re gonna see many more people that are eligible for the same diagnosis.
Jonathan Alpert: Right. But nonetheless, a professional needs to be the one to diagnose a spectrum disorder, not your favorite social media influencer who’s just putting out a checklist of five things to look for to diagnose, say, autism or spectrum disorder or ADHD. I see a lot of that. I have people who come in to see me and they say, “I think I have ADHD,” or “I think I’m depressed,” or “I think my friend is on the spectrum.” And then I start to ask questions, “Well, why do you think that?” And as it turns out, their favorite influencer is putting out information that they lock into and then use to make the diagnosis in their friend. So I think there’s potential harm in that because then we’re running around labeling people, and most people are not licensed mental health providers and they don’t have the skill set to do that, but they are. And it just… We’re at a point where so many people are being labeled as on the spectrum. I think it’s a bit of an excuse, too, that people use. If someone is, say, socially awkward or anxious about interacting with people or has strange behavior, they might be quick to be labeled as on the spectrum. In a similar way, if someone misses an appointment or is disorganized or forgets things, they might be quickly labeled as having ADD or ADHD, and that’s not always the case.
Adam Omary: But as you write about, even among licensed mental health professionals, there is a trend towards over-diagnosis. The criteria themselves have gotten more expansive, and on top of that, there’s tremendous disagreement between providers. You may be more conservative with how you use the diagnostic labels. Others might see any slight hint of symptoms and decide, well, even if it’s for the sake of insurance coverage, because there are incentives both on the patient end and the provider end that a diagnosis unlocks certain benefits that wouldn’t otherwise be possible. Some mental health providers have this mindset of their job is to expand access to care and the diagnoses, they don’t necessarily represent ground truths, they represent tools that simply need to be used to provide whatever help they can. And sometimes that might mean knowingly misapplying a label, but with the patient’s best interest in mind. Do you see that happen?
Jonathan Alpert: Yeah. And I’ve been practicing for about 20 years, and early on in my career, I did see more of what you’re referring to, where insurance companies would be not as generous in allotting sessions, covering sessions. So they may say they cover 20 sessions, and then there would need to be some sort of review to get more sessions allowed. But that’s changed a lot. Honestly, when I think about my patients, I don’t think any of them have restrictions that are put on them by their insurance company. So creating a more serious diagnosis or label just for the sake of getting insurance coverage, I think that’s a very old way of thinking. And if a therapist is doing that today, I don’t think they’re helping their patient and they probably need to look more accurately at what’s actually going on with the patient and use the appropriate diagnosis. We have a diagnosis that’s called adjustment disorder with mixed mood, and that’s often what I see with patients. So an adjustment disorder might be someone who, say, is adjusting to a new career and is anxious or getting over a relationship or the loss of a loved one. Any life transition or adjustment could qualify as an adjustment disorder with mixed mood, such as anxiety and depression. And I’ve seen full coverage for that by major insurance companies.
Adam Omary: That seems to exemplify the problem that you’re writing about in Therapy Nation. It’s difficult life circumstances requiring a period of adjustment. Why do we label that an adjustment disorder?
Jonathan Alpert: Well, that’s a really good point. Well, this is the mental health field, and we need to categorize behaviors and feelings and thoughts, and that’s probably how we came up with that. It might also have come about because it holds less of a stigma than a more serious disorder such as major depression or bipolar disorder. Most of us go through some period of adjustment, whether it’s to a new job or relationship or any other life events like that. But, yes, you raise a good point. Like, why is it disordered? It’s probably not disordered if it’s causing a little bit of anxiety and stress and depression, but if it starts to impair our functioning in terms of taking care of ourselves, relationships that we may have, then it probably leans closer to a disorder.
Adam Omary: To what extent is therapy about getting us back to a healthy baseline, and to what extent do patients use it to optimize? Because in principle, there’s no upper limit to your mental health, your social functioning, your career functioning. Someone can decide that they want to pay to talk to an expert simply to help them with any particular adjustment period of life. So they could become a chronic patient, and that’s not necessarily a bad thing. Although once it’s applied with medical language, you have in the subtitle of your book, Got Hooked on Therapy. How can you tell the difference between someone who’s getting hooked on therapy in a way that might be counterproductive versus someone that, let’s say they’re already relatively mentally healthy, but there’s always things that we can improve on and it can be helpful to have outside help, especially people with expertise in this area? Where’s the line between, again, you write about the downsides of this mentality of everyone should be in therapy, everyone can benefit from therapy. Certainly there are downsides. So does everyone have something they could benefit from therapy, or is there a limit?
Jonathan Alpert: You know, I think therapy should be used properly. And what I mean by that is if you have an actual issue, if you’re depressed, if you’re anxious, if you’re having trouble in a relationship or managing your stress, those are probably good reasons to seek professional help. But if you’re just going to a therapist to vent and get stuff off your chest and feel better in the moment, maybe there’s a place for that, but I don’t think it’s proper use of therapy. You could vent to a friend and probably feel better and save a whole lot of money. If you go back to 2012, I wrote an op-ed piece for the New York Times called In Therapy Forever? Enough Already. And in that piece, I talked about what you’re referring to, endless chronic therapy, where people just go in week after week, they vent, they feel better in the moment, and then they go back and do it all over again in six days or 13 days, feel better in the moment, and it just becomes this cycle that the therapists themselves were reinforcing. The therapists would benefit because they would make money, they would maintain a strong practice, and the patient would feel better in the moment, but they would spend a fortune. And when that article came out, it was polarizing. People would write to me and say, “Wow, I’ve been in therapy for 20 years doing exactly what you wrote about. I didn’t know there was a different approach.” So that felt good to me to know that people got the message. But then therapists, my own colleagues, wrote to me and said, “How dare you out our profession and talk about us like this?” NYU, one of the commencement speakers talked all about me and said I’m ruining the profession, only because I was advocating for better use of therapy. So I guess the roundabout answer is what I just provided, but I think therapy should be goal-oriented. There should be an actual problem that’s being addressed, and it probably shouldn’t be just going in week after week to feel better. But I do think therapy has become for some people almost like a lifestyle. And there’s probably not huge harm in that, but it’s probably not the best use of therapy.
Adam Omary: The Surgeon General said a few years ago the United States is in an epidemic of loneliness. Is that true? And if so, how much of the push to seek therapy is really just seeking someone to vent to that might historically have been a friend, family members, religious community? Is therapy serving as a substitute for community that we’ve lost in the digital age?
Jonathan Alpert: I think in many ways a therapist is a stand-in for a friend or a relative. And you’re essentially buying a friend for 45 to 60 minutes a week. And I think if that’s what you’re doing, you probably should use that therapist in a different way and maybe talk to the therapist about how you can go out into the world and make actual friends that you don’t have to pay for. Maybe it’s developing social skills or interpersonal skills, maybe it’s working through anxiety or social anxiety that you may feel that prevents you from going out there and interacting with people. But a therapist should not be a fill-in for a friend or a relative.
Adam Omary: You also say that in addition to the paradoxical effect that increased time ruminating, applying these disordered, victimized labels to oneself, that aside from therapy or the therapeutic culture sometimes having backfiring with respect to mental health, that it’s left us more divided, that it’s fueling polarization and tribalization. How is that happening?
Jonathan Alpert: Yeah, and I see a lot of therapists in my profession as a whole doing more than maybe what they were trained to do. And we saw this play out, I’d say over the past decade when Donald Trump entered the scene as president, where therapists were not maintaining their neutrality in their practice, but were voicing their opinions about whether they disliked Donald Trump or liked him. And I think they were influencing their patients one way or the other or, in a way, I think attracting a certain type of patient. Therapy should be a safe space for people. Whether you voted for Trump or Biden or Harris, you should feel comfortable and safe speaking to a therapist. But all too often, and I’ve heard countless stories about this, people are made to feel ashamed of how they voted. I’ve heard cases where therapists refused to treat someone if they voted for Trump. To me, that’s just a violation of ethics and how we were trained. We should not be discriminating against patients just because of how they voted, whether it’s for a Democrat or a Republican. We should look at the person as an individual. But a lot of graduate schools these days are categorizing people as rich, poor, oppressed, oppressor. And in my profession, therapists love to put people into these boxes instead of looking at the person as an individual.
Adam Omary: The therapist should certainly be looking at their patient as an individual. Does it make sense for the patient to seek out a therapist that shares their group characteristics and maybe they think they’ll relate to them better?
Jonathan Alpert: Yeah, I think that can be helpful. You have to be a good consumer when you’re looking for a therapist. You may be looking for a certain gender or a certain age, someone older, younger, ethnicity, maybe you feel like you can connect with that person or that person will better understand you. So I think it’s just human nature to seek someone out who is similar to us and maybe holds a similar worldview. But I’ve seen a trend lately, and I tell a few stories in my book where therapists are looking at people based on certain ethnic features. So I tell a story about a Black patient who saw me, and the therapist that he saw before me was hyper-focused on him being a Black man and would bring everything back to his ethnicity. And that’s really not, wasn’t an issue for him. He wasn’t seeking help because he was Black. He was seeking help to deal with some stress and anxiety. And he felt disrespected by the therapist because she kept bringing it back to that. And I’ve heard similar stories from patients whose previous therapists would be fixated or hyper-focused on them being gay when that wasn’t an issue. They were just seeking help with stress or dealing with anxiety. So, I do think my profession has gone too far and has maybe in some ways overcorrected and are just so fixated on some characteristics of people and they’re actually missing the boat and missing a lot of the clinically significant parts of the person.
Adam Omary: This seems like a difficult balance to get right as a therapist, because occasionally you might have a client who presents to you and says, “Here are exactly what my problems and goals are. Let’s work on this.” And they might be right. And occasionally you might have someone that’s more closed off or slow to open up, or simply doesn’t know what they need to work on. So you have to figure it out. And there’s a certain amount of projection that comes into play there. You have to guess what their problem is and help orient them in that direction. And occasionally you even have people that might be in denial or they say their problem is one thing, but there’s actually something lurking underneath the surface and you have to sniff that out. But of course, you can be wrong or other therapists can be wrong and they can project what they think might be the salient problem and that might not be right. So how much guesswork is involved in therapy and what does it look like when it’s done right?
Jonathan Alpert: Yeah, and it’s our job as a therapist to properly assess and evaluate the patient and do a very comprehensive evaluation of their health, their mental health, their psychosocial history. I guess our job is made easier if the patient comes in and says, “I think I’m depressed, I’m not feeling well, it’s been going on for this long. This is what I want to work on.” But it’s not often the case where someone comes in with that detailed information. So we need to be, I think, objective and ask the right questions to really gain an understanding of that patient. But the danger is what I was just talking about, if we’re just fixated or hyper-focused on one feature or one part of that person, say their ethnicity or their religion or their sexual orientation, we may be missing bigger issues for the person.
Adam Omary: The recurring theme that’s coming up here is there’s a sense that greater awareness of mental health is a good thing. It’s a good thing that people can name their problems and seek out support. And some of that seeking support might be looking for community that they’re lacking, just looking for someone to be able to listen to them and be able to provide advice. But that can backfire. And it can backfire both at the level of the individual seeking out these disordered labels in a way that might just fuel a victimized identity. And it can also happen on the part of the therapeutic provider. And there are ways that there are perverse financial incentives, including to have the patient stay in therapy longer and continue paying them, or in the case of pharmaceutical industry, incentivizing medication that might just be treating symptom rather than root cause. So there’s a whole set of different incentives that keep this therapy nation going. And in some sense the problem is easy. It’s just make sure the labels accurately describe what’s going on and make sure the intervention is the minimal necessary intervention necessary to help. That’s easy to say, but how do you implement that when it seems like the structural incentives are exactly opposite of that? Again, the people who create the diagnostic codes, the people who stand to financially benefit from having looser diagnoses and patients who stay in therapy longer or who are on more medication, all of the financial incentives point in one direction. And in the United States in the last 20 years or so, as mental health spending has tripled, as we’ve poured more than $100 billion into this problem, we’ve seen, as you point out, the rates of depression and anxiety only continue to rise. So it seems like supplier-induced demand. The assumption of therapy is, well, the more care and resources we give the people, the more we can address the problem. And if anything, the trends seem to suggest the exact opposite, that the mental health industry might fuel the mental health crisis. What do we do about that?
Jonathan Alpert: Yeah, there’s the paradox. There’s more awareness, but we seem to have more mental health problems. I think therapists can start to make some adjustments and changes. I think we can start to make sessions more about outcomes and hold ourselves responsible and maybe do a proper assessment of the patient, set goals early on, collaborate with the patient, really try to understand what they hope to accomplish. Cognitive behavioral therapy, I think works great with things such as anxiety and depression. It’s also a form of therapy that’s widely studied and we have good data on it. We have good outcomes that we’ve seen. Other forms of therapy, say psychoanalysis, old-school analysis, it’s not measurable the way that cognitive behavioral therapy is. With cognitive behavioral therapy, we may rate how the patient feels, like say one to ten, how bad are the symptoms. So there’s some quantifiable information that we can use, but psychoanalysis, in my view, is a bit outdated and not easily studied and measured. So I think if we can get to a place where we use outcome-oriented approaches, maybe practice in a way that’s similar to medicine where we try to diagnose the problem, identify the goal, the treatment plan, and monitor how the person is doing, we may end up moving therapy to a place where it’s less of a lifestyle and more of a tool.
Adam Omary: One more objective set of data that we can look at to see how much of this mental health crisis is driven by this paradox of prosperity, the fact that greater awareness can sometimes produce heightened prevalence rates despite not necessarily reflecting worse rates of mental health across the board, is looking at suicide rates and self-harm hospitalization admits. Grim, but more objective and very tightly linked to depression and anxiety if you’re measuring what you think you’re measuring. And an interesting set of data that we’ve seen worldwide is, on average, in most countries, though we’ve seen depression and anxiety rates rise, particularly within the last couple decades and particularly within young people, suicide rates and self-harm rates have remained flat or decreased across much of the world. But the United States stands out as an outlier where suicide rates, particularly among young people, have increased in the last several decades. Why do you think that is?
Jonathan Alpert: Well, I’m not entirely sure. It’s concerning, I mean, we have more awareness of mental health issues. I honestly don’t know why the rates have increased. Social media might be playing a role in this where it’s almost like normalized feeling bad. To be a kid nowadays and have access to information on social media and all this information, I mean, you can even see ways to take your own life. We see ChatGPT and other AI models enter into our society where we’ve seen some tragic cases of people, especially young people, utilizing AI as a therapist and have been terribly misguided on how to handle their mental health. And there have been a few tragic cases of young people taking their lives. I think connecting with people is key. I think having a sense of community and feeling comfortable enough to speak to a family member or a teacher or a friend about these struggles could help to ward off some of these crises and attempts.
Adam Omary: What’s really key to this mystery for me is a lot of the hypotheses that you’ve named, whether it’s technology, whether it’s cultural changes, changes in terms of lacking community, or changes in terms of increased therapeutic culture, pathologizing ordinary struggle, sense of victimization. We see those across wealthy developed nations. And if you look at the mental health trends and also these broader cultural and technological trends across the US, across the UK, Canada, Australia, very similar trends both in terms of mental health trends, technology adoption, these broad cultural trends. And yet again, if you look at the mental health data referenced against the suicide data, they’re inversely correlated across much of the developed world excepting the US. And the US, we still see this increase in suicide and self-harm. Some people will say it’s because we have more guns or we have more opiates, but that doesn’t account for the increase in youth suicides. Most are not by firearms and most of the opiate-related deaths are among middle-aged men rather than teenage girls where we’re seeing a lot of this increase in self-harm.
Jonathan Alpert: Yeah, no, I don’t know if we can pin it to one factor. I think we have a society where there’s a lot of unhappiness. We have people who have lots of grievances. I don’t think that’s helping us to be healthier. In our developed society, we have people who are hating wealthy people and billionaires and successful people, hating on corporations. So it just creates this idea or this message that you’re less than other people. I’m not saying this causes suicide, but it does create an unhappiness and gripes with society that just are not healthy. And we’ve seen this play out in terrible ways. I guess Luigi Mangione has become sort of a poster boy of this grievance culture. And he has admitted to killing the CEO of UnitedHealthcare because he had his complaints about the health insurance industry. We’ve seen it play out with the assassination attempts on President Trump, the killing of Charlie Kirk. These people had their gripes with society and took matters into their own hands. We’ve seen it play out in other ways. People dislike corporations, so they justify stealing from stores. I think the new term is micro-looting, where they justify stealing a small item from, say, Whole Foods. Whole Foods has a lot of money, they mistreat their employees, therefore it’s okay for me to do this. So there’s a lot of unhappiness, there’s a lot of blame, there’s I think a lack of accountability and self-sufficiency that might be contributing to the collective unwell of society. And again, I’m not saying that causes someone to be suicidal, but it certainly isn’t making a person healthier and happier.
Adam Omary: On that last point, outside of your book, you’ve also written about the psychological appeals of socialism despite its repeated failures, that there’s some emotional logic behind a lot of political and economic discussion today and really throughout history.
Jonathan Alpert: Yeah, and I think socialism to some people is very seductive. If you think the government will provide housing and buses and grocery stores and make your life better, you might be looking to the wrong people to improve your life. And there’s a concept in psychology known as locus of control. And what that means is to what degree do you feel like you have control over your fate, your destiny, and to what degree do you feel like others do? So one would be an internal locus of control, the other would be external. So what I’m seeing with a lot of people who are embracing this socialism, they have an external locus of control. They feel like their fate, their outcomes are determined by other people. And that’s where you start to see the hate towards wealthy people or billionaires. They feel like they’re interfering with their success instead of looking at what they can do, what they have control over. Can they go out there and get an education and start a business or get a job? Can they create their own wealth? And instead they’re just relying on the government. And as you alluded to, the socialist model has not really worked in our modern society or even historically.
Adam Omary: Much of this seems to relate to Maslow’s hierarchy of needs. You have at the base of the pyramid needs for food and shelter. You have needs for belonging and community, then for autonomy, fulfillment, self-actualization. And those more material goods, one can in principle imagine government or someone else solving for you. But the further up the pyramid you move, self-actualization, it can only be done by oneself. It requires this internal locus of control. And relating to this paradox of prosperity, I wonder how much of it is driven by the fact that we’ve seen this remarkable human progress in science, in technology, in material abundance, the fact that most people across most of the world have enough to eat and don’t have to focus on their day-to-day survival. There’s not a question of where your next meal is gonna come from, of whether you can have these basic goods of food and shelter and clean water that, again, anyone who’s listening to this podcast with this access to technology very likely lives in a developed world where these fundamental problems of survival are basically solved. So as much as you would expect that we’d be celebrating that, really we have this tendency to just price in the good things and focus on what remains to be attended to. We have this innate negativity bias, this hedonic treadmill. And as adaptive as it’s been for survival, it can leave us with this sense of, okay, what’s next? And if what’s next is this monumental task of self-actualization and if you’re expecting that that’s gonna be solved for you or expecting that it can be solved with external goods or external social arrangements, as opposed to reorienting one’s own set of values and optimizing one’s mental health and community and belonging, it is not surprising that among the best time in history to be alive, we’re seeing this paradoxical rise of discontent.
Jonathan Alpert: Yeah. And so much can be accomplished if you look at notable figures in our country who went from rags to riches or absolutely nothing to remarkable people. Dolly Parton just passed away, and in hearing her life story, she grew up dirt poor, one of, I believe, 11 or 12 kids in a small house, and she went on to become a global superstar that will be known for centuries, hopefully. I mean, she’s a great example of someone who probably didn’t spend her time hating the world and coming up with excuses to achieve monumental success. We need more people like that, whether it’s in industry and science or academia or athletics, music, whatever it is. We need more people in the world who see challenges not as obstacles, but as opportunities to reinvent themselves, to try harder, to work harder, to achieve success. But I do believe that there are some people in this world, in this country, who just need someone to hate. They’re consumed by it, whether it’s hating a politician, hating a CEO, hating industry leaders, they just need someone to hate. It becomes part of their makeup, and it’s unhealthy. And I do try to work with some of those people and get them to shift in their thinking and reframe. Sometimes I’m successful, other times I’m not. But I do think the people who sit in that hate and misery, they’re not doing well, and they could certainly improve the way that they look at life and the world.
Adam Omary: Do you think the mental health field remains net positive on society?
Jonathan Alpert: I think yes. There’s a lot of work to be done still, and I do think that my profession needs to make some changes. We need to move from this victimhood mentality to one of helping people to feel more empowered. We do need to, I think, move away from this division that so many of my colleagues are creating in society. We need to look at what bonds us and binds us rather than what divides us, and really teach people to tap into their strengths and things that are within their control instead of just putting labels on people and creating this victimhood mentality.
Adam Omary: Closing advice, Jonathan, for expanding one’s internal locus of control, sense of optimism, mental health, expanding human progress.
Jonathan Alpert: Such a big question. I think a lot of what we talked about, really trying to focus on what you actually have control over, being reasonable and realistic in your expectations. You don’t go from wanting to run a marathon to actually running 26 miles in a day. You start with a mile and add to that and train. And that’s true with most things in life. If it’s your desire to find a healthy, loving relationship, most likely you’re not gonna just walk down the street and make that happen. There are probably things you need to do to make that happen. If your goal is to start a business or a company, you don’t go from nothing to a billion dollar company. So I think people need to get back to grit and hard work and accountability and dreaming again. I think so much of that ability to dream and see big things has been lost and too many people are consumed by hate and blame and hating politicians. And our country is so divided. There was once a time when people, neighbors could vote differently for president, but they could still be friends. And I do think if we can get back to what unites us instead of what divides us, we’ll be much better off.
Adam Omary: Thank you, Jonathan, and thank you for sharing Therapy Nation with us.
Jonathan Alpert: You’re very welcome, Adam.