It sometimes seems like historians should be the first to provide some perspective when something in our lives seems to be going downhill. Like many readers, I felt that sense when reading a recent New York Times article about changes in the experience of psychiatrists and their patients. The professionals interviewed clearly feel regret and loss about changes to the nature of their work, and I suspect their patients might feel the same, if they had any sense at all that things used to be different. But it’s hard to think about how to explain a change that has so many moving parts.
Sometimes people are simply wrong about a change like this, and what they think is worse is unquestionably better. Sometimes when the world around us changes, it’s neither better nor worse, just different. Still, sometimes things really do get worse by any standard. I don’t think there’s anyone over the age of forty who thinks that airplane travel today is generally a more pleasant experience than it was thirty or more years ago. Maybe planes fly a few more places than they once did, or fly more often, maybe the relative cost of a few fares is lower than it once was, but that’s about it. This change, however, is not altogether that hard to understand. The cost of fuel, the consequences of deregulation, and a business model where the pursuit of profit margins has so far done nothing that could erode the inflexible need of a large subset of customers for air travel.
The mysterious cases are the ones that trouble us because they frequently involve no obvious or easily targeted villains, no apparent solutions, and the terrifying sensation of being on a very unfun version of Mr. Toad’s Wild Ride, only one with no madcap amusement value at all. The case of changes in clinical psychology described by the Times, however nuanced we might make it by adding in more details or complications, is one of those baffling instances where what we now do is very obviously worse than what we used to do. We could start listing the reasons why it’s happened. The intensification of profit-seeking in medical treatment both by the medical and insurance industry and among individual practicioners, the power of the pharmaceutical industry, the loss of professional autonomy by many psychologists, the complex failures of many past non-pharmaceutical therapies, an increasing number of patients pursuing treatment for mental health issues, and the widening income gap leading to fewer middle-class patients who can afford anything but highly standardized care are explanations that leap to mind. None of them would be easy to reverse through policy or organized social pressure.
The feeling of bafflement in the end comes from something more elemental. Only thirty years ago, psychologists could see and come to know a good deal about their patients from sessions lasting for an hour or more then at prices that many middle-class patients could afford. Are we so much poorer a society now, so that it is obvious that this is absurdly lavish, impractical, or implausible, a snapshot from a vanished golden age? Despite recession and war, that degree of loss and failure doesn’t seem to leap out at us at every moment.
Paul Krugman’s March 6th column on education underlined a similarly disorienting moment. Krugman’s argument is that most college education is rapidly losing value because most of those educations trained a white-collar middle-class to do modestly skilled but repetitive forms of clerical work that can now be done much more cheaply either directly by computers or by using information technology to subcontract such work to similarly trained workers outside the United States. Whatever you think of Krugman’s argument that the decline of the union movement is the key explanation for this transformation, I think the basic observation is fairly accurate. Maybe one thing this shift tells us is that those jobs were always a profound misuse of human capital. On the other hand, I’m as optimistic as anyone that there are new professional niches and functions waiting for the properly educated college graduates of the future but even I don’t really have an idea of how those niches could possibly support a white-collar middle-class the size of what we had thirty years ago. Without some kind of far broader commitment to restock the economic and social middle of the income distribution and to pinch back the tails, there’s nothing that even the best-designed system of higher learning can do to make headway. Again, it just feels like life is worse and it’s not clear why it must be so.
The number and density of feelings of this kind in my life lately has a lot to do with why I found President Obama’s “Win the Future” slogan to be one of the more repellant political visions of the past three decades. I wish it were merely an empty marketing slogan. I wish it were merely a cynical toss-off. I wish it were merely as silly and irrelevant as “Whip Inflation Now”. But it’s not. “Win the Future” is the central credo of the people who are steadily losing us any hope of a future that improves upon the past. It is the slogan of misdirection and humbug, a motto whose best translation is, “Nothing up my sleeves, pay no attention to the man behind the curtain”.
Behind the slogan was the 21st Century version of dark satanic mills: we must be ever more dire and invasive in the way we ratchet competitive pressures into education and work, ever more aggressive in how we extract productivity at every stage of social and economic life. The speed setting on the treadmill must go up each week without fail. The usual range of boogeymen was trotted out: in China they are prepared to eat their own young, so we must as well! In India they chain their elementary-school students to a slave barge fueled by the study of calculus and SQL, and so must we!
“Win the Future” is about re-imagining human life as the worst massively-multiplayer online game ever designed, an endless boss raid without a poopsock in sight, perpetually amassing the gearscore necessary to take on the next boss, the next expansion pack, always having to outdo the other l33t guilds by surrendering ever vestige of a life which might be about something other than the game, and never a moment to rest, never a sense of real progression.
Where’s the vision of an easier, better, more satisfying life? A richer life in both material comfort and leisure time? A more satisfying spiritual life, or a life more fulfilled by intimacy in family, community or love? A life which progresses us towards freedom or discovery or truth? Towards new technologies whose deliverables are something other than, “Work hard to make more technologies after this technology!” A future based on reflection or wisdom or understanding? Anything besides, “Those guys over there are coming to eat your lunch, better get your nose to the grindstone!”
I’m the first to see the folly and sometimes serious danger of past projects to envision and create better futures. But the very worst feeling of all that I have of being delivered into a present which is mysteriously so much worse than the memorable past is the hollow misery that comfortably lounges inside “Win the Future”.
Maybe planes fly a few more places than they once did, or fly more often, maybe the relative cost of a few fares is lower than it once was, but thatâ€™s about it.
Actually, my understanding is that planes fly much more often and tickets cost much less (inflation-adjusted) money than they did 30 years ago, and that is the exact reason behind the decline in service. Nostalgists will talk about the days when flying was an experience you dressed up for, but it also used to be much more the preserve of people who dressed up (i.e., people with money).
I would love to see some hard numbers on how the practice of mental health has changed. Are there more people seeing practitioners? Has quantity gone up but quality gone down?
I often think about this. A while back there was an article that basically said we should all be working 20 hour weeks and taking six-week vacations. I hate the feeling of racing to get nowhere–as that movie, Race to Nowhere exposes in education. I find myself simultaneously helping kids participate in that race and helping them find balance. In the competitive environment I find myself in, it’s a tough challenge. The norm is to go, go, go. But that often leads them to burn out. Encouraging balance goes against the norm and can lead to more stress. I hate that their behavior is actually preparing them for the “real” world. I wish that after many years of education, they could settle into a more balanced life, but I think that’s not going to happen.
“Whereâ€™s the vision of an easier, better, more satisfying life? A richer life in both material comfort and leisure time? A more satisfying spiritual life, or a life more fulfilled by intimacy in family, community or love? A life which progresses us towards freedom or discovery or truth?”
It’s a bit much to expect this from a politician who probably has to code everything he does in terms of its business friendliness in order to get re-elected. Leisure time is for losers in their model.
On the psychiatry, wasn’t the point that when there was only one treatment for psychological problems (talking cures), it was paid for by the insurance companies, but then when the drugs came along they were no longer willing to pay for it. The other subtext was of course the profiled doctor wanted to stay rich.
The real reason for all this tension is nicely summed up in the Kids are Alright when the donor Dad character says college wasn’t for him and there’s all that sudden tension as if he might infect the children with such an idea. It’s most middle class parents’ *nightmare* that their child would actually seek out a life of community, love and leisure – that’s for those who don’t get into a good college, otherwise known as downward mobility. Until this is solved, complaining about the competitive culture is like sitting in your car complaining about the traffic.
Check out Goodhart’s Law— the idea that any measurement which is used to guide policy will become corrupted. I think we’re living in Goodhart’s Hell because of the belief that policy must be guided by measurement.
Just to do a little cheap psychologizing, I think GWBush’s educational policy was shaped by a hatred of school, and Obama’s is shaped by a highly competitive temperament.
Nice topic, but nostaglia is a bear …
“Still, sometimes things really do get worse by any standard. I donâ€™t think thereâ€™s anyone over the age of forty who thinks that airplane travel today is generally a more pleasant experience than it was thirty or more years ago.”
Really? 3x as many passenger miles were flown in 2005 vs. 1978 – lots more people experience it as price comes down … As a small d democrat, the fact that more people experience a (diminished) product outweighs the loss felt by those who used to “own the skies”.
I see that as similar to college – instead of ~25% of high school grads going to college, we’re up to +70% today. Certainly has gains (more educated society and students) and losses (college is a lot less elite, more vocational in orientation, and I’ll leave aside the discussion about cost, except to snipe if colleges had been as competitive as airlines in controlling costs since 1978 much of the student loan debt bubble and vocational orientation of students might be avoided…
It’s a good point. I’m gonna stick to my guns that the visceral, physical experience of flight is worse, but it’s right to point out that there are counterweights. Elsewhere, folks have pointed out that ticketing is better now, that you don’t need a travel agent, and so on. Yes, all improvements. It’s true that nostalgia easily becomes a comprehensive declension story, a pining for a Golden Age that was not really all that golden.
“Only thirty years ago, psychologists could see and come to know a good deal about their patients from sessions lasting for an hour or more then at prices that many middle-class patients could afford.”
I spot false nostalgia here. Do you know of anyone who was *helped* by this sort of therapy? I’m not old enough to have experienced that era directly, but all the fiction that I’ve consumed from then (and bits of not terribly related nonfiction) seems to indicate that talk therapy was indeed the pastime of the idle rich.
My own experience has been that simply talking about, cogitating over, and contemplating my problems has done nothing at all to solve them, no matter how deep an “understanding” of them I might achieve.
I’m completely willing to believe that talk therapy is in decline simply because it was a bad idea in the first place, never delivered results, and has been supplanted by something that is slightly less bad.
I’m only 28, so I know on some level I lack experience or perspective on longitudinal changes, but what shocks and disturbs is, as a relatively young person, the extent to which I feel a palpable decline over my life time in the US. In the past 10 years or so, it feels like a large swath of Americans have abandoned what I thought were shared values and commitments of living in a wealthy industrialized society. Perhaps this has always been true of a certain group of people, but, like you talk about in your post above, it now is becoming acceptable to say that you don’t believe in providing common goods and services in a community, or that we have we no longer a commitment to a minimal standard of living for all or to the collective future of our nation.
In particular, I feel like the right has grasped on to the language of entitlement, language which used to be used by the left, to browbeat my generation into setting our sights lower. Suddenly things our baby boomer parents (who are spoiled brats, of course) took for granted, like stable jobs, livable wages, affordable housing, health care, etc. are luxuries reserved the upper middle class, and if we want those, well, we’re being whiny children, because don’t we realize so many other people have it worse?
In the past 30 years we’ve seen the proletarianization of blue collar work, now we’re getting the proletarianization of the white collar as well.
What particularly frustrates me in particular is that while it is true that large global structural changes–tied in part to technology and other things–are changing (and should change) the structure of society, there are certain choices we can make, certain trade-offs we can decide are or aren’t worth it, but that the leadership of the US isn’t willing to make. I know this because I have lived in other places, and I know the “sacrifices” we are asked to make in the name of our free market system aren’t required. I’ve lived in Australia and my family is from Northern Europe. Neither of these places are utopias, but somehow other industrialized countries have managed to retain more of a commitment to certain quality of life for their citizens without losing the rat race.
Likewise, I’ve lived in China, one of the developing boogymen you mention, and the very qualities of Chinese society that the Republicans want to adopt are those that pretty much everyone in China feels necessary to shed to become an industrialized country. Moreover, much of it–the endless studying, the endless anxiety over slipping into real poverty–come from being until relatively recently an extremely poor and overpopulated country. China is, not unproblematically, trying to turn a large rural agrarian nation where famine was a serious problem until the last 2 decades into a wealthy industrialized country with a solid middle class and a sense of material security for even its poorest citizens. What gets me is that we are taking a wealthy industrialized country with a solid middle class and turning it into something far less functional than Maoist-era China, basically, a failed state.