
Countercultural or Counterproductive? On Woke Culture's Uses of “Mental Health” Discourses
Darragh Sheehan
3 February 2025
If R.D. Laing and Franco Basaglia could see the newest generation of “woke leftists” obsessed with psychology talk, identity classifications, and diagnoses, I imagine they would say “What in the countercultural hell is going on!?”
I echo their “What the hell?” and argue that we need to analyze why certain people influenced by woke culture – including contemporary psychotherapists, social media mental health influencers, and their tens of millions of followers – are obsessed with psychological lingo and psychiatric diagnoses. Digital-capitalism has undoubtedly fueled not only the rise of “pop psychology,” but also wokeism (which will be defined later) on social media, where diagnoses are casually tossed about. Yet, woke culture's use of psychological language undermines both leftist ideals and effective mental health care by depoliticizing systemic issues and reinforcing neoliberal individualism.
The marriage of psychological lingo / psychiatric diagnoses with the “left” is in reality a perversion of leftist countercultural movements, which have typically opposed mainstream conceptions of mental health and diagnostic categorizations of pathology, viewing them as tools of social control[1]. Concepts of normality and pathology (alongside treatment approaches) are shaped by the needs of power / community structures, material conditions, and modes of production within any given historical or cultural context. However, this basic materialist perspective is notably absent from woke discourse on mental health. Instead, psychiatric diagnoses are being ironically used as countercultural statements.
Contemporary psychotherapy discourses that embrace wokeness paint a certain brand of psychotherapy as “liberating” or “radical.” While this discourse appears left-leaning, it obscures psychotherapy’s historical role as a technology of power – a term introduced 50 years ago by Michel Foucault to describe how power is exercised and reproduced unconsciously in modern society via the dissemination of various practices, professional knowledge, techniques, and institutions.
Awareness campaigns, de-stigmatization efforts, social media content, crisis therapy (now offered even at protests), formal / informal mental health advertisements, mental wellness apps, and everyday psychology talk all promote an obsession with “healing.” This cultural obsession inadvertently contributes to the “privatization of stress” (Fisher, 2009). When mental health[2] is framed as an issue of individual “disorders” to be privately managed in therapy, distress becomes detached from the broader context of inadequate public services and infrastructure. This inadvertently reinforces ideology that drives austerity measures (Frazer-Carroll, 2023). We fail to remember that the democratization of childcare, education, healthcare, housing, and transportation, as well as economic and labor policies that advance fair living wages, is the bedrock of (mental) health.
The seemingly harmless idea of promoting mental health services carries the hidden assumption that psychotherapy or psychopharmacology is somehow better than culturally specific social or spiritual practices, or public social programs for that matter. Furthermore, the promotion of psychotherapy obscures the broader social, political, and economic factors driving mental health disparities, especially among marginalized groups. And when mental health services are framed as solutions to ending “intergenerational (political) trauma,” we divert ourselves from focusing on present-day concrete political change.
The rise of neoliberalism and the process of deinstitutionalization (i.e. the widespread closure of public hospitals for individuals living with severe mental illness from the 1960s to 1970s) parallels the rise of homelessness and the criminalization of serious mental illness (Scull, 1997). This coincides with the rise of the prison industrial complex in the United States. Approximately 200,000 individuals were incarcerated in the 1960s, (U.S. Census Bureau, 1963) growing to 360,000 people in the 1970s (The Sentencing Project, 2021). Presently there are over five million people under the supervision of the criminal legal system and nearly 2.3 million individuals incarcerated in prisons and jails, of whom a disproportionate number are Black (The Sentencing Project, 2021).
Conversely, there has been a 64% decrease in psychiatric inpatient care since 1970 (National Association of State Mental Health Program Directors, 2017), which has led to an increased burden on underfunded community-based (not-for-profit, i.e. privatized) services. The breakdown of public health infrastructure has resulted in correctional facilities being used as de facto mental health institutions for individuals with severe mental illness (often those who lack not only access to proper treatment but also social programs and other structural support)[3]. These shifts reflect broader neoliberal trends that prioritize privatization and individual responsibility over public investment in mental health care, social programs, and comprehensive public health approaches toward drug use.
How can we account for the growth of the mental health profession and the increasing focus on “mental health” and “healing” in this context? Micha Frazer-Carroll (2023) argues that in part the rise of “mental health awareness” campaigns attempts to normalize mental health disorders, making them appear non-threatening. In this sense, those “whose Madness / Mental Illness cannot be easily realigned with capitalist metrics of exploitability, are excluded from the project of mental health awareness. This helps bolster the idea that they are unsalvageable, and therefore legitimate targets for incarceration and other forms of state violence” (Frazier-Carroll, 2023, p. 41). At the same time, common claims in woke culture like: “mental illness is a result of capitalism” are reductionary, and seem to stem from a eugenics framework, evoking the idea of a utopian post-capitalist society where all people are sane (“pure”) individuals-–as if madness were not a part of our human experience (Frazer-Carroll, 2023). The contemporary popularity of the “mental health discourse” must be situated within these shifts and processes. Contemporary woke culture fails to center this analysis.
What is wokeness anyway?
While those on the far right have always bemoaned wokeness, those of us on the left, who might have initially been seduced by its promise of social change, are starting to realize its role in establishment politics. Despite the vagueness of the term “woke,” thinkers are gradually articulating how woke culture is used to diminish class consciousness and reproduce ruling class ideology (see Olúfẹ́mi O. Táíwò, Norman Finkelstein, Susan Neiuman, Christian Parenti, Catherine Liu, and more). Even if their critiques are incomplete (and sometimes unorthodox), if the left doesn't critique wokeness, the right will seize the opportunity to do so, advancing their political agenda. Take for example the increase of PEP (Progressive Except for Palestine) people weaponizing a critique of wokeness to support the Israeli genocide of the Palestinian people (see this New York Times Israeli Propaganda piece as an example: NY Times Article).
Christian Parenti defines wokeness as “politics as etiquette” (2024). In his article, "The Cargo Cult of Woke," (2024) he succinctly outlines six key characteristics of woke culture. He states that one of the key features of woke discourse is that it is “imbued with a therapeutic mentality expressed in safety-obsessed incantations about harm, trauma, healing, care, and ‘doing the work.’” Parenti adds, “This leads to an excessive focus on subjectivity, which itself becomes an unacknowledged methodological individualism that posits personal struggles as political struggles, and vice versa” (Parenti, 2024). While I believe woke culture is mostly well-intended, underneath it lies something more subtle and harmful.
Mark Fisher (2009) writes that “anti-capitalism is widely disseminated in capitalism” (p.12) and woke culture’s use of psychology can be viewed as a manifestation of “gestural anti-capitalism,” which “actually reinforces it” (Fisher, 2009, p. 12). Woke culture perpetuates practices by which we can enact the idea that “so long as we believe (in our hearts) [and demonstrate with virtue signaling] that capitalism is bad, we are free to continue in capitalist exchange” (Fisher, 2009, p. 13). The use of ‘psychology speak’ or the marketing of the “radical / decolonial psychotherapeutic experience” are perfect media through which we can engage in this type of performative anti-capitalism that posits personal struggles as political ones.
Wokeism has become a form of cultural capital in contemporary professional life. As a social worker in a community clinic, for instance, I was once reprimanded by a colleague for using the term “homeless” and corrected with the term “unhoused.” While a core component of social work practice is to use the language of the person you are serving, if all my years as a social worker have taught me anything, it’s that “unhoused” folks in New York City could give a shit about my verbiage. This experience and others like it solidified to me that the creation of an exclusive language for the non-profit class is meant as a signifier of professionalism that separates the professional class from the folks they serve.
Issues of poverty do not exist in the linguistic realm, but rather within the realm of material conditions. And a lot of people on the “left” are not poor, nor have they been poor, nor have they been around poor folk for that matter…and it’s showing. In “woke” discourse, marginalized groups are often centered based on their identities[4], while people living in poverty rarely are, nor their realities discussed. Instead, woke culture takes place primarily within the world of middle-class etiquette that is deeply aporophobic. Aporaphobia is a term coined by philosopher Adela Cortina in 1995 that describes a fear and rejection of the poor. As such, woke culture and its lexicon assist in distancing the professional classes from the harsh realities of poverty, while being able to virtue signal moral support thereof.
An emphasis on correct language places undue focus on individual politeness, higher education, and aligning with “social justice” ideals and an increasing pressure to be on the “right side of history,” all of which are now becoming a part of professional identity, in particular in the helping professions. Those who fail to adopt this evolving lexicon are often perceived as less competent, less educated, or even outsiders. This positions psychological knowledge, vernacular, diagnoses, etc. as having a high exchange value within a political economy of etiquette (a term used by Greg Godels in an interview). In this economy, a hierarchy is created that privileges those with access to the latest discourse and marginalizes those without it. The American Psychological Association’s “inclusive language guide” (see: https://www.apa.org/about/apa/equity-diversity-inclusion/language-guidelines) is indicative of promoting the belief that “carefully chosen words” can combat oppression. While surely well-intentioned, it is an example of reducing the integration of the political and the psychological into linguistic expression as professional development (and as such a non-inclusive class-based language).
Additional Functions of Wokeness
Social media is a hyperreality, (a term introduced by Jean Baudrillard in 1981) where the line between simulations of reality and real experiences is blurred. Through hyperreality, the practices of woke culture often take place as a simulated version of awareness, activism, and virtue signaling in social media (and our everyday lives). This enables us to enact our fantasies of participation in social change, reducing our anxiety. Beyond its ideological functions, wokeness can serve as a mechanism for soothing one’s sense of “inner badness” for inaction and complicity. For instance, I have observed people use woke language to ease ethical or intellectual discomfort when confronting contradictions or ethical dilemmas. I have also seen students and supervisees dismiss important clinical theories because the language wasn’t woke. Rather than grapple with the complexities of the distress of feeling complicit in systemic harm, students and many others may turn to familiar woke frameworks or language to reduce internal conflict and maintain moral certainty. It’s as though tolerating contradiction risks the complicity in “harm,” in other words “contamination.” This aligns with Parenti’s (2024) observation that “Wokeness has a deeply anti-intellectual concern with moral and political hygiene that constantly draws a distinction between the politically clean and unclean.” Woke culture invites us to “clean ourselves” with the magical thinking that we can address systemic harm by reducing linguistic harm.
It is no surprise to me that Donald Trump won a larger share of the student vote, most likely as a backlash against wokeism’s “left” moral hygienic posturing and shame-based linguistic culture in University settings. He is the archetypical embodiment of “anti-wokeness,” proudly “anti-trauma informed” and “challenging authority for the working person.” He appeals to working-class frustration because the “authority” working-class people encounter in their daily lives are not billionaires like Elon Musk, but rather managers and middle-class professionals that belong to the Professional-Managerial Class who enforce corporate (and non-profit) policies in daily management via Human Resource Departments[5]. Barbara and John Ehrenreich (1977) define “the Professional-Managerial Class [PMC] as consisting of salaried mental workers who do not own the means of production and whose major function in the social division of labor may be described as the reproduction of capitalist culture and capitalist class relations” (p 13). Individuals belonging to the PMC, according to Ehrenreich and Ehrenreich, encompass a wide range of income levels, skills, power, and occupations, a few examples of the former include nurses, doctors, academics, engineers, lawyers, welfare caseworkers, artists, among other professions, including mental health professionals.
This professional class promotes wokeness through inclusive language, DEI trainings / programs, and “mental health” awareness initiatives. All the while managers who promote it maintain the status quo with subsistence pay and minimal benefits (in particular, the health benefits that we so direly depend upon). Moreover, instead of creating economic distribution, DEI initiatives promoted by elite white liberals, have primarily created “intra-class competition between the PMC and the diverse professional-managerial class (DPMC) over who can access elite institutions and the economic opportunities gained from doing so” (Wheeler-Bell, 2024, p. 87). Thus, DEI programs, frequently portrayed as redistributive, often exclude many white and non-white poor communities. This exclusion makes these initiatives ideal political leverage for the right wing to gain support from the working classes.
Catherine Liu (2021) states: “In terms of etiquette and new forms of mutual address, PMC elites have pioneered a language of liberal tolerance that the working classes have not mastered. PMC elites, consciously or unconsciously, want to humiliate their adversaries by attributing to them a desperate lack of intelligence, empathy, and virtue” (Italics added, p. 55). This class-based humiliation deepens racial, class, cultural, and social divides that amplify resentment toward managerial elites and middle-class liberals, who view the working class as culturally backward “deplorable” idiots (Liu, 2021). In short, understanding the functions and impact of wokeness (and its uses of mental health discourses) is not merely a theoretical concern but a concrete one.
Psychiatry's Bible Meets Woke Culture: The DSM & Woke Mental Health Discourse
The belief that stigma is reduced by educating the public that mental illnesses are “biomedical disorders” is widespread. Yet studies have revealed the opposite, that when mental health is framed biologically (rather than within a biopsychosocial framework) social stigma increases (Watters, 2010). The popularity and promotion of a biomedical view of mental health is due to the dominance of both the American Psychiatric Association and their Diagnostic and Statistical Manual of Mental Health Disorders—TR 5 (DSM) otherwise known as “The Bible of Psychiatry.” Mental health professionals across fields and professions (from social workers to mental health counselors to psychiatrists) are obliged to use it for diagnostic purposes—often without questioning why—simply because the DSM (a psychiatric text) has the monopoly on insurance reimbursement.
When something becomes hegemonic, it typically means that it has become “common sense” (i.e. ideology that is lived and no longer seen). As such, the DSM has shaped how we all understand ourselves, even if we aren’t aware of it. Diagnostic language lends to a form of self-fragmentation (McWilliams, 2021, p. 568) in which we increasingly relate to ourselves not only medically, but in terms of “having a disorder.” This includes binary ideas of what is “healthy vs unhealthy,” which happens to parallel woke cultures’ focus on political hygiene (“clean vs unclean”). This not only reduces the complexity of the ways in which we relate to ourselves but also limits possibilities for healing in the psychotherapy room (McWilliams, 2021).
Psychoanalyst Nancy McWilliams (2021) states: “Now a person with [the] concern [of being shy] is likely to tell me that she ‘has’ social phobia – as if an alien affliction has invaded her otherwise problem-free subjective life. People talk about themselves in acronyms oddly dissociated from their lived experience: “my OCD,” “my eating disorder,” “my bipolar.” There is an odd estrangement from one’s sense of agentic self, including one’s behavior, body, emotional and spiritual life, and felt suffering, and consequently one’s possibilities for solving a problem” (p. 568). While it's understandable that many patients may find relief and clarity in a diagnosis (OCD is a common one I hear patients refer to as being useful), this does not mean we shouldn’t question as a profession how labels can confine (and define) one’s sense of self, nor how it has influenced the practice of contemporary psychotherapy.
The DSM has faced extensive criticism, with a central concern being its tendency to medicalize normal human distress (Horwitz, 2007; Kostić, 2024). Many argue that, rather than being a scientific text, the DSM reflects American cultural values and political realities, which combines legitimate neurological disorders (such as Dementia and Autism) with entirely socially constructed “disorders” (like Oppositional Defiant Disorder among a plethora of others) (Johnstone, 2023). Even by scientific standards, the biomedical psychiatric model in the DSM faced, and faces, major issues in terms of reliability and validity, (Kirk & Kutchins, 1992, Horowitz, 2023) as well as conceptual validity (Wakefield, 1992). In fact, the psychiatrist Richard Spitzer practically wrote the DSM III alongside committees of “data-oriented people” who “voted” on these disorders after heated discussions (see Spiegel, A. 2004, December 26, The Dictionary of Disorder. New York Magazine Link). Meaning that many of the diagnoses in DSM III were added via committee discussions and voting (Horowitz, p. 58, 2023). It goes without saying that diseases such as tuberculosis and leukemia, as well as blood disorders like anemia and hemophilia, aren't classified based on a simple show of hands by doctors!
The critique of the DSM is so pervasive that even the Chair of the DSM IV committee Dr. Alan Frances once said: “You cannot define mental disorders, it’s bullshit” (Sullum, 2011, Cohen, 2016). Yet despite widespread criticism from a variety of perspectives, it has become increasingly popular in woke culture to normalize and non-critically adopt psychiatric disorders as identities, or use them in casual expressions in everyday language. Apart from psychological jargon, diagnoses from the DSM, such as ADHD (Attention Deficit Hyperactivity Disorder), BPD (Borderline Personality Disorder), MDD (Major Depressive Disorder), GAD (Generalized Anxiety Disorder), PTSD (Post-Traumatic Stress Disorder) etc. are commonly used these days in both mainstream and woke culture.
The identification with and use of diagnoses increasingly appears to function as a form of social capital that at times resembles secondary gain – a psychoanalytic concept that describes how symptoms and problems can provide indirect psychological or social benefits, such as attention, evasion of responsibility, validation, or a sense of belonging. For instance, I recently encountered a “radical therapist” on social media requesting compensation for their social media labor as a producer of “liberatory psychotherapy education” on Instagram. The post requested money from “white able-bodied folks” and highlighted the influencer/therapist's various identities and psychiatric diagnoses. While this can be interpreted in a variety of ways, we can analyze how by framing their labor as “liberatory,” grounded in personal struggle/ identity, the therapist might be securing a position where critique becomes difficult, thus shielding themself from potential challenges, criticism, or dialogue. The post also reflects the socially accepted trend of “individual repair” as a solution to larger political issues on the supposed “left” and the acceptance of using identity and diagnoses as individual acts of “activism.” In the end, all of this leaves little room for dialogue, disagreement, and collective action.
The disability rights movement, which was originally framed as collective, is increasingly being reduced to individualized identities and struggles. To assert one’s “disorder” publicly (akin to “coming out as Bipolar”) on social media or in other spaces seems to be equated with bravery– even at times with activism–a “woke act that counters stigma.” This is evident in the increasing trend of “woke” therapists and other social media influencers describing themselves as “neurodivergent” due to being diagnosed with ADHD, where they seem to present their personal struggle as a political statement on ableism.
In an ironic twist of events, the CIA also jumped on the “woke” pop-psychological bandwagon in a 2021 video recruitment Ad where a Latina intelligence officer states: “I am a cisgender millennial, who has been diagnosed with generalized anxiety disorder…I am intersectional, but my existence is not a box-checking exercise…I used to struggle with impostor syndrome, but at 36 I refuse to internalize misguided patriarchal ideas of what a woman can or should be” (Italics added, The Guardian, 2021; Parenti, 2024). Even the military is increasing advocacy and discussion around “trauma-informed leadership” (see: https://www.armyupress.army.mil/journals/nco-journal/archives/2023/october/trauma-informed-leaders/). I guess that they will soon be developing “trauma-informed bombs,” since liberals are apparently seeking “humane forms of genocide.”
What’s even more bizarre about woke culture's use of the DSM is that it is well-critiqued as a mechanism of institutionalized racism, homophobia, transphobia, etc[6]. Diagnoses also serve as societal tools for validating practices that grant or deny individuals access to essential resources, based on professional knowledge of who is deemed "deserving" or "undeserving,” which influences who is stigmatized versus accepted. Bruce Cohen (2016) states: “The psychiatric discourse (...) reflects the emergence of neoliberal obsessions with efficiency, productivity, and consumption. So when we conceptualize psychiatry as a ‘public language’ in the DSM, it must be recognized that this language is not neutral and value-free but rather reflects a dominant ideological rhetoric of the specific epoch, in this case, the crisis in welfarism and the emergence in neoliberalism” (Italics added, p. 79). To emphasize this point, he points out that the words “work,” “working,” and “worker” are mentioned in the DSM-5 a total of 288 times (Cohen, 2016, p. 79), whereas “unemployed” and “unemployment” are mentioned on 46 occasions, and “business” is named 11 times (p. 104). Last but not least, have I forgotten to mention that the promotion of the biomedical model by the DSM is conveniently connected to a growing multi-billion global pharmaceutical industry? The mainstream psychiatric discourse on mental health cannot be divorced from neoliberal priorities and constructs of productiveness, yet woke culture on the whole can’t seem to put this together.
Many woke psychotherapists[7] who identify as “liberatory or decolonial” often fail to critique the medicalization, and deskilling of psychotherapy, as well as the popularity of mental health as part of larger socio-economic and political processes. Instead, they often align with these trends, while paradoxically promoting “awareness of systemic issues” as if that alone were a form of “decolonization.” I have observed many of these therapists focusing on their political and personal identities, and increasingly, their own diagnoses, as though these were therapeutic modalities. Has wokeness impacted psychotherapy to the degree that the therapist's “identity” is being centered as a “therapeutic modality” instead of clinical theory and practice?
With this said, I find it important to clarify that my intention is not to deny the value of psychopharmacology or diagnostic categories in treatment, but rather to critique its hegemony[8]. As a psychotherapist, I do not disregard the complexity and utility of diagnoses or psychopharmacological medication, which when used judiciously can be valuable (even life-saving) interventions in treatment settings. I hope to encourage mental health professionals to reconsider (and question the political function of) the very concept of diagnosis and the flawed logic behind the appropriation of psychiatric disorders as identity frameworks and personalized activism within woke culture. To this end, it is essential to continue to develop a historical sense of our development as a profession.
Medicalizing Experience: How DSM Diagnoses Reframe Subjective Reality
Mental health symptoms are not fixed nor universal, but are rather culturally bound expressions of suffering, shaped by social, political, and economic contexts. Symptoms vary not only across cultures but also across historical periods, e.g. people don’t walk around with hysterical leg paralysis these days (Watters, 2010). However, the woke discourse somehow seems to view the American mental health discourse as static and universal.
The exportation of the American psychiatric model raises major concerns about the impact of subjectivity and cultural diversity. In Crazy Like Us; The Globalization of Mental Health (2010), Ethan Watters highlights how the spread of Western mental health frameworks (grounded in the DSM) is reshaping not only treatment approaches but also how psychological suffering is experienced and expressed around the world. This process carries profound implications. By advancing a Westernized framework of mental illness, researchers, clinicians, and mental health professionals unintentionally perpetuate a homogenization of symptoms, erasing cultural nuances and non-dominant cultural or traditional ways of expressing and understanding psychological distress[9].
Watters is a white cis-dude who looks like he owns waterfront property in Connecticut. While he may own property, he lacks capital in the so-called “woke economy.” It’s also unclear whether he identifies as a leftist. His book, at times, idealizes the resilience of “the other.” If we forgive him for his “sins,” we can see that he is addressing something far more significant for those of us seeking to explore the political potential of psychotherapy, something more impactful than what many self-proclaimed “radical psychotherapists” are offering. This is because he provocatively points out that the act of naming, diagnosing, and intervening according to Western paradigms reshapes the way one experiences suffering, which also implies that it shapes self-knowing (i.e. subjectivity).
This suggests that clinicians have a role in shaping not only knowledge, social norms, and discourse through our specialized expertise, but also how we co-create the expression of suffering and subjectivity through the healing technologies we use (see Michel Foucault’s notion of apparatus and Phillip Cushman’s idea regarding psychotherapy as a healing technology).
Furthermore, mental health symptoms are not universal, but rather unconsciously shaped by cultural symbols and narratives that a society or community recognizes. Chris Chrisitan (2019) adds “Symptoms must be contextualized in order to render them sensible. [S]ymptoms are inevitably a referent to a relationship with someone (p. 122).” Meaning that when we experience mental health symptoms, we are often unconsciously seeking to share our pain with a culturally familiar witness (Chris Christian uses the term “unfamiliar witness” when referring to cultural dissonance between patient and clinician, 2019). As the American psychiatric model globalizes and more professionals worldwide are trained in this model, these professionals, alongside public mental health discourses[10], act as what I would refer to as “globalized familiar witnesses.” As individuals across the globe increasingly turn to the language of American psychiatric symptoms (as a pool from which to draw) to express their distress, it creates a feedback loop between the clinician/healer and patient in this new shared hegemonic language, i.e. increasing these “disorders” worldwide (Watters, 2010).
The implications are profound. The current direction of the mental health discourse increasingly aligns with American cultural imperialism and woke culture ironically plays into it. Woke culture mistakenly seems to consider psychology a universalistic discourse that can assist in fixing our social relationships if psychotherapy is “properly decolonized.” As American and Americanized mental health influencers and psychotherapists proliferate this discourse internationally within a matter of seconds on social media, what will be the effects of this? How will this impact the way we relate to ourselves and others? And how can we counter this hegemonic framework as a profession, rather than feed into it?
The Trauma Discourse, Identity, & The Construction of a Compatible “Left”
The “Post” Trauma Narrative
“Trauma” is a central concept in both mainstream psychotherapy and contemporary woke culture. Medical anthropologist Allan Young observed that “the spread of the PTSD diagnosis to every corner of the world may, in the end, be the greatest success story of globalization” (as cited by Watters, 2010, p. 71). It’s well-documented that the concept of Post-Traumatic Stress Disorder (PTSD) emerged from Western culture, particularly in relation to the wars of the 19th and 20th centuries, alongside the growing bureaucratic need for classifications and organizing systems (Horowitz, 2023). For example, the term “shell shock” surfaced during World War I, originally as a way to treat soldiers in order to return military personnel to the battlefield as quickly as possible (Leese, 2002). Similarly, the U.S. Army’s “Medical 203” classification manual (one of the various precursors to the DSM I) was used to categorize soldiers’ reactions upon returning to civilian life after World War II (Horowitz, 2023).
When PTSD was first included in the DSM-III in 1980, it was largely due to the activism of the Vietnam Veterans Against the War, who intended the diagnosis to capture the specific trauma of forced participation in American imperialism, rather than serve as a universal condition (Watters, 2010). The narrative and use of the PTSD diagnosis have been altered over time and repurposed for different socio-political and economic objectives. Catherine Liu (2023 interview) notes that trauma studies originated in academia and has always been deeply individualistic, engaging in what she calls “radical decontextualization” (i.e. depoliticization). This trauma narrative has become so deeply embedded in popular culture and our daily lives that we don’t dare to question this discourse, let alone its function.
In addition, the notion that trauma has a “post” phase arises from a particular type of experience. Dr. Samah Jabr, Head of the Mental Health Unit at the Palestinian Ministry of Health, pointedly argues in reference to the experience of Gazans: “There is no ‘post’ because the trauma is repetitive and ongoing and continuous” (Goldhill, 2019). Her statement highlights the lack of universality in mental health discourse and the error of imposing concepts like "post-trauma" onto those whose experiences of trauma (i.e. violations of power) are ongoing.
In this context, the "post” trauma narrative perpetuates a linear and overly simplistic understanding of the human experience and constructs of history, rooted in modern capitalist ideologies of progress. Whereas the past is framed as a historical site of suffering, the present becomes a place for labor, effort, and working towards progress, making healing and recovery “safe places” to arrive at in the future. This narrative is oddly reminiscent of the “American Dream” and the core notion of pulling oneself up by the bootstraps to take personal responsibility for trauma recovery. It also fails to capture the complex, non-linear, and political nature of trauma, safety, and recovery, which are complexities important to understand for clinicians working in treatment settings.
As demonstrated in the popular psychological discourse on social media, or on clinicians’ websites, many woke therapists reinforce reductionist linear narratives, idealizing a pre-colonial past. This often includes fetishizing Indigenous practices and spirituality (especially throughout the Americas). A pre-colonial “Indigenous” past is often portrayed as a “pure” and untainted state to which we should psychologically and socially return. This narrative contributes to erasing contemporary Indigenous peoples, in particular those seeking economic and/or political refuge in the United States from Mexico and Latin America, many of whom are not living in isolated "pre-colonial" ways but are navigating modern political, social, and economic realities. By idealizing a “pre-colonial past,” this mental health discourse inadvertently fosters nostalgia and a detachment from actionable social and political change.
In the context of Indigenous politics, Nick Estes (as quoted by Olúfẹ́mi O. Táíwò’s) argues: “The cunning of trauma politics is that it turns actual people and struggles, whether racial or Indigenous citizenship and belonging, into matters of injury. It defines an entire people mostly on their trauma and not by their aspirations or sheer humanity. This performance is not for the benefit of Indigenous people, but ‘for white audiences or institutions of power’” (2022). The trauma narrative is used by the Professional-Managerial Class to legitimize our roles as experts or mediators within institutions of power. Given that the PMC’s role is to engage in social control and reproduce ideology, as defined by Ehrenreich and Ehrenreich (1977), the PMC positions itself as an authority in addressing harm (trauma), turning us into (neoliberal) gatekeepers for resources, recognition (for the humanization of certain individuals, groups, communities, etc.), or institutional change.
For the wretched of the earth, true “trauma healing” (recovery or a sense of safety) requires real structural socio-political and economic change. No amount of Eye Movement and Desensitization and Reprocessing (EMDR) nor “liberatory/ radical therapy” is going to do the trick. Maria Helbich and Samah Jabr (2020) state:
A mere trauma approach is not able to adequately answer to the injustices of human rights violations. It also bears the danger of labeling people that are reacting to unbearable situations as ‘disordered,’ thus masking political violence by converting it into an individual experience (Becker, 1995) and into an individual incapability of adjusting. It also obscures the fact that human rights violations are seldom isolated individual abuses, but rather the response of a specific system (Lira 1988 in Kornfeld,1995). For this reason, and to bridge the dichotomy between individual psychological and socio-political approaches, a broader focus on human rights violations and on policy changes is needed (Italics added, p. 11).
Psychotherapists must take up the challenge of articulating and deepening the role of the political within our scope of practice. One way is to rethink trauma narratives. Articulating politics and political action as integrated with psychotherapy is not a niche concern, but rather a fundamental responsibility for all of us committed to the ethical practice of psychotherapy. Recognizing psychotherapy as a technology of power allows us to confront the ways our profession has been misused and also to reimagine it in ways that truly integrate the socio-political sphere with clinical theory and practice.
The Making of a “Leftist Self”
Phillip Cushman (1995) importantly referred to psychotherapy as a “healing technology,” which has shaped “the configuration of the American self [...] over time, with various healing professions employing different healing technologies to create, shape, and maintain specific historical selves, all of which have served significant political and economic functions within their respective eras” (Italics added, p. 35). By considering his argument, the rise of woke culture in the psychotherapy profession is not without economic or socio-political context or purpose. Psychotherapy is a healing technology that not only assists in constructing the American self according to modes of production in the United States, but it is also doing so globally as noted by Watters (2010). Beyond the American or global self, given all that was mentioned regarding the marriage of psychology and woke “left” culture, might psychotherapy (and the mental health discourse) be playing a part in the construction of a “leftist self” for economic and political purposes as well?
This “leftist self” or persona adopts the aesthetics of supposed “radicalism” (in hyperreality and in daily life), while ultimately upholding the status quo. When we say there is no “left,” might it mean that the modern “leftist” self is actually a corporate or a compatible left? This “leftist self” projects a "scary radical” agenda, advocating for often abstract goals (i.e. abolition and defunding the police, etc.), while showcasing revolutionary imagery for countercultural cred on social media; more often than not, comfortably distanced from the working class and poor. That is, unless they're contributing to the gentrification of a neighborhood.
That’s the case in Brooklyn, New York which has experienced significant gentrification. In a borough where 19% of residents live below the federal poverty line (Census Reporter, n.d.), it’s common to see white and non-white (the Diverse Professional Managerial class) gentrifiers embrace woke “left” culture, yet as they inhabit neighborhoods their very presence inflates home prices beyond affordability for longtime residents. Woke culture is strangely related to urban gentrification processes and this is barely spoken about. Shaming one another in an attempt to expose one’s lack of “political hygiene” is harmful and divisive and that is not my attempt here. Instead, I hope to encourage us to honestly confront the reality of our social conditions to develop class consciousness, rather than avoid uncomfortable truths about ourselves to maintain a sense of moral “goodness.”
Towards the Reality Principle
As I write this, the Trump administration has begun to utilize an attack against wokeness to enact an assault against democracy. Those who are not directly impacted by these policy changes at this juncture can choose to remain distracted, terrified, or shocked by the ensuing endless cycle of culture (and etiquette) wars. As responses to each new crisis that will inevitably occur, we can seek solace in familiar woke frameworks, mental health discourses, hyperreality activism, and speak poorly of the ignorant “deplorables.” Or we can take a step back for a moment to see the larger historical, economic, and socio-political picture and figure out our next steps. As Antonio Gramsci reminds us: “We need to create sober, patient people, who do not despair in the face of the worst horror and who do not get excited about every little thing” (Selections from the Prison Notebooks, published 1971).
We want so deeply to believe in something that can change the reality of the oppressive systems to which we belong. “Psychology” along with diagnostic language is a good medium for deceiving ourselves into thinking we have a sense of power and agency. Since widespread intersectional class-based social movements that evoke the possibility of real social change are not within our reach (yet), we might not know what else to do. “If I cannot change the world, I will change myself,” is the thinking! But we cannot strive to be individually “good” or “clean” within the sadistic systems we belong to, as this mindset reduces “politics [to] etiquette” and depoliticizes action. Instead, we must embrace the dialectic of our inevitable harm-doing with the desire for a fairer, more equitable world. Only then can we consciously redefine our work as psychotherapists committed to political and social change.
To this end, I encourage us to apply Freud’s reality principle: to critically engage with and confront reality. Only by doing so can we recognize that even our visions and practices for social change are tainted by fantasy-driven, id-like desires – desires that fuel our consumerism, narcissism, careers, class-based interests, and co-opted narratives. Embracing the reality principle is, therefore, a profoundly political act, an act of disillusionment. This act requires us to dismantle both the social and individual distortions to which we cling.
As mental health professionals we are members of a class and the narratives we promote have ideological and economic functions. However, this dilemma does not necessitate abandoning our professional roles. As Liu (2021) asserts, “Professionalism is not the enemy of solidarity” (p. 76). On the contrary, to paraphrase her (2021, p. 76), our professional knowledge and power are essential for advancing a broader project of economic redistribution in this country, which may be vital for the survival of the environment and democracy.
If we can heed the advice to be sober, patient, and unshaken by setbacks, I believe there is hope. One source of hope lies in building a movement rooted in universal healthcare, which includes mental health. After all, public health is mental health and inherently intersectional. Public health offers a shared, material concern that transcends divides across various identities and social classes, making it a powerful entry point for large-scale organizing. Fostering collective unity through a shared goal strengthens the solidarity required to build powerful coalitions. Doing this necessitates building an anti-liberal left movement (Liu, 2021). Mental health professionals, along with other members of the Professional-Managerial class, have a crucial role to play in this effort. As we move forward, may we embody Gramsci's call for “Pessimism of the intellect, optimism of the will.”
Darragh Sheehan is a clinical social worker, psychotherapist, and adjunct lecturer at Silberman School of Social Work (City University of New York) from New York City. She has been in direct practice for over 15 years in community mental health. Her primary post-graduate training is in a neo-Reichian somatically oriented psychodynamic psychotherapy (one of the earlier clinical attempts to integrate the political, the body, and subjectivity). She hopes to share her thoughts and experiences on the frontlines of direct social work practice, in order to promote substantive approaches to merging the socio-political with psychotherapy. She is a co-director of the Center for Critical and Clinical Analysis. To find out more visit cccacommunity.com
Footnotes
The idea that diagnoses were “typically viewed as tools of social control ‘on the left’” oversimplifies the complex and nuanced nature of the topic, as it fails to fully capture the diversity of opinions “on the left” regarding mental health and diagnostic systems. There are notably various interpretations and ways of interpreting these concepts. However, for the purposes of this essay, I have condensed this to a single perspective due to space limitations. A more thorough exploration of the topic would require an essay of its own.
A note on language use in this essay: while I do not necessarily agree with terms like “mental illness,” I will use commonly accepted language to describe distress and various altered states of self for the sake of clarity and accessibility.
For example, 44% of individuals held in jails and 37% in prison are estimated to have some type of mental illness, while 63% of individuals in jail and 58% in prison are estimated to struggle with addictive substances (SAMSHA, n.d.). Furthermore, 27% of police shootings involved a mental health crisis in 2015 (The Prison Policy Initiative, n.d.).
In woke discourse, marginalized groups are often portrayed through the lens of deference politics: the practice of prioritizing the perspectives of marginalized individuals in social justice spaces (activism, academic, cultural spaces, etc.). In Olúfẹ́mi O. Táíwò’s (2022) book Elite Capture: How the Powerful Took over Identity Politics (and Everything Else), he critiques deference politics by arguing that it leads to symbolic acknowledgment over structural change.
This paragraph is my interpretation and elaboration of ideas regarding the contemporary role of the Professional Managerial Class (PML) and class division by Catherine Liu. See her interview in Doom Scroll (2024) and the book Virtue Hoarders: The Case Against the Professional Managerial Class (2021).
If interested in this topic I would explore the following texts: The Protest Psychosis: How Schizophrenia Became a Black Disease by Metzl (2009); The Selling of the DSM: The Rhetoric of Science in Psychiatry by Kirk & Kutchins (1992); and Homosexuality and American Psychiatry: The Politics of Diagnosis by Bayer (1981).
When I use the term “woke therapist,” it's important to note that I’m not suggesting there’s a homogeneous category of therapist that fits neatly under this label. Wokeness has influenced psychotherapy in a variety of ways, and therapists interpret it differently in their practice. However, I’ve noticed some common threads in the integration of various influences (consciously or not). There seems to be a blending of several historical and cultural movements, including the human potential movement of the 70s, the radical chic aesthetic of the 60s, the 80s yuppie wellness movement, decolonial and gender/queer theory (which originally emerged from academia but has since been decontextualized as such), and the fetishization of Indigenous spirituality and practices. Additionally, there’s often the use of psychiatric diagnoses, a focus on identity that draws from identity politics (especially Black Feminism and the Black Power Movement), an emphasis on (intergenerational) trauma, and an “add on” awareness of “systemic harm,” informed by the person-in-environment (PIE) framework (a basic component of mainstream social work), framed as “radical awareness.” These concepts, terms, and movements are often repurposed through “glittering generalities”—vague language—that helps market “anti-oppressive” psychotherapy as part of a lifestyle product. The appropriation and decontextualization of these elements contribute to a kind of contemporary lifestyle capitalism in the mental health field. See my essay Glittering Generalities & Pop-leftist “Psychotherapy Speak” – Sublation Media
For example, there are also non-hegemonic models of diagnosis that need to be explored: the diathesis model of stress as an integrated biopsychosocial framework for understanding mental health reactions; the power threat meaning framework; psychodynamic theories; a transdiagnostic approach; a mad studies view; critical views that outright disagree with diagnostic concepts; culturally specific explanations for suffering or aberrations of behavior; or the mind in non-dominant or indigenous cultures. In short, the DSM is not the only way to explain these phenomena and this needs to be brought to light to counter its hegemony.
Contemporary research and perspectives on global mental health highlight ongoing efforts by (often well-intended) Western researchers and clinicians to translate suffering in non-dominant cultures into the American psychiatric framework. For examples of this see essays with studies: Culture and Mental Health by Eshun, S., & Gurng, H (eds). 2018.
These mental health discourses proliferate globally through books, social media, international health campaigns, international not-for-profits, films, TV shows, etc.
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