The Medicalization Of All Human Experience

tl;dr: Both talking and listening can be beneficial to others. When we assume that listeners are always sacrificing for speakers, this causes problems. ~and~ The definitions of "care work", "self-care", and "emotional labor" have drifted to transform replenishing experiences into depleting "labor".

 1. The Medicalization Framework

 

I recently spent some time with a therapist friend. She told of a tendency for many in her life to unload their woundedness onto her, presumably because she gets paid for that in her job, doing care work. She had reached the limit of her toleration for this. She wanted to be listened to, and spend time with someone who would not talk very much and would mostly listen and make her feel heard.

 

I told her I share her frustrations, and I was willing to mostly agree to her request, up to a point. The times when I did most of the talking, I experienced it as her making me carry the whole conversation. I offered to try to coax more out of her. But I brought my own proposed solution, if she is willing to listen and possibly agree to a compromise.

 

You see, her proposed solution preserves the reference frame which contributes to the problem.

 

I've noticed our social circles have an increasingly common tendency to re-frame every human interaction into the reference frame of care work. Emotional labor. If every interaction is interpreted as labor, it's no wonder there's so much exhaustion. Care work is useful, important, and often under-valued, but there are entire social spheres in which it drowns out all other values. I suggested that is what has befallen both of us in our social circles.

 

A medicalization framework habitually assumes that anyone who is speaking is benefiting from feeling heard, and that anyone listening is burdened and paying a cost. All replenishing activities are intepreted as self-care, care work, or emotional labor. When this interpretation is a reflexive habit, it transforms every positive experience, or every positive interaction, into the following spiral:

 

1. taking turns burdening each other
2. depletion
3. counting nickels and dimes of who spent more time speaking or listening
4. resentment
5. broken relationships

 

If (and this is a big "if") active listening is leaned on as the only or main source of regenerative fuel, to the neglect of other sources, I suspect it depletes faster than it replenishes. It's not a wrong form of fuel, it's just lacking something else. I suggested that she flip the script: ask others to provide value to her by speaking, and to be open to her own benefit as a listener. I suggested that when she speaks to others, to look to provide benefits other than feeling heard. Benefits such as:

 

1. wonderment or "sensawunda"
2. curiosity
3. humor
4. playfulness
5. enjoyment
6. creativity, which loops back to wonderment and kicks off the cycle again.

 

There are two main ways for others to be interested in you. One way is if they practice active listening, as my therapist friend wanted. The other way is to take the initiative to be interesting. That requires that you sometimes think of talking as providing benefit and listening as receiving benefit, not always the other way around. So we agreed to use both frameworks, and the rest of the evening was great.

 

2. How the Medical "ization" Framework Sets In

 

Some of your traits are not in your control. They are neurologically wired, or involve the production of chemicals which are untreatable. This is the area of things that are medical, not medical "ized".

 

You also have other traits which are your mental and emotional habits. These habits serve as a perceptual filter with which you interpret what you see according to your expectations, from the script of your past experiences. Keep yourself open to the idea that some of your traits might fall into the latter category.

 

Suppose you start from the flat fact that you have some conditions that are medical. And suppose from there you begin to perceive all (not some) of your own traits as permanent and unchangeable. Or view the constant undesired changes to your personality as only and always outside of your control.

In the final stage of the medicalization process, you view your changelessness as a fixed identity for which you desire validation.

At each step, you become less and less alive to the possibility of personal growth. You have become medicalized, but in a more important sense, medicalization has become you. If the medicalization framework of explanation and prediction sets in hard enough, it becomes hermetically-sealed, and you can reinterpret any disconfirming evidence to fit the schema.

 

3. The Replenishment Framework

 

I recently started a meetup in Detroit for readers of Scott Alexander's Substack blog, Astral Codex Ten (formerly the blog Slate Star Codex). We had a debate coach, two college philosophy majors, and three software developers who discussed our obscure hobbies. There was abundant wonderment, curiosity, humor, playfulness, enjoyment, and creativity. There was an eagerness to contribute by talking when appropriate. Those who are in that framework tend to interrupt each other constantly. Within the medicalized framework of labor, that sounds exhausting and selfish. It's true that it would be good to get a balance between these two frameworks, but we didn't experience it as work. We had a great time, and repeat attendance is high so far.

 

I'm grateful that such an environment was easy for me to find from about 2003 to about 2014 or 2015.

 

We seemed to share an internal locus of control. Instead of waiting to first feel welcomed by others, we did and said things that others would welcome. Then, if need be, I could have reminded myself of the external referent of my welcome, outside of my own head: I had done something to be welcomed for.

 

The real locus of control is always both inside and outside to some degree, although it differs for each person. When the locus of control is fully external, you will believe you are unwelcome and unheard, as a default condition, unless others try to drag your participation out of you. If you frame it as labor that others need to first do to solicit you to participate, that makes it harder and less likely that you'll get it. I look forward to spending time with you! Unless your medicalization makes it into labor.

 

4. The Concept-Drift Of Emotional Labor

 

Emotional labor has multiple common definitions. Arlie Hochschild, who coined the term, meant it to mean an employer pays you, in part, for emotions you do or don't express.

 

From the early 2000's until about 2014, the online Geek Feminism movement brought fresh attention to unreasonable expectations on women. They used "emotional labor" to mean work that is not paid, and is done for reasons of emotional bonds. Most of the examples typically given involve spending time and effort to work with one's hands regardless of the expression of emotion in one's voice and face. This inverts the original definition, but the critique was important and needed a name.

 

In the past decade, during the rise of medicalization, emotional labor came to be commonly used to mean "having to feel my own feelings", or even just, "if I listen to other people speak about something other than me, they are forcing me to labor for them." I commonly encounter the view, "a speaker must ask permission before raising any conversational topic other than the listener's woundedness, or it is a consent violation."

This is called critique drift.

 

There are already plenty of reasons to feel exhausted, without also discounting every richness and intimacy which constitutes the warp and woof of life, re-framing it as a form of depleting "labor".

 

A paradox: The weaker we are, the less capable we are of showing up for others; but the weaker we become, the more social clout we receive from sympathy, with which to justify our demands for others to show up for us. And yet, others have the same perverse incentive to present their self as too weak to show up for us. As a result, I often see my acquaintances get into winner-takes-all sympathy competitions.

 

5. The Medicalization Of All Experiences

 

In a culture of extreme medicalization, every person is assumed to need, and benefit from, therapy (see the memes about "men will literally do X instead of going to therapy"). And so every interaction is assumed to be an expenditure of emotional labor. A burden. Every human experience is medicalized, both positive and negative. All positive experiences are medicalized as self-care, or care work.

 

When there is any negative interaction, the community will diagnose both the harmed and the harm-doer with a pathology. Terms like "narcissist", "sociopath", "ADHD", "autism", and "trauma" have clear professional definitions. But medicalization re-defines most dissatisfactions with others with the terms narcissist, sociopath, psychopath, Dark Triad, (as we see in an infinite number of questions about them on Quora). And it re-defines any and all dissatisfactions with one's self with the terms trauma, ADHD, and autism.

All of those are real and important things. Medicalization mis-appropriates them as umbrella terms with vagueness of specifics but vastness of implication. If you don't do that, then I'm not talking about you.

 

The harm-doer (a term of art commonly used in the medicalization culture) is reframed as a victim: their misconduct is reframed as a medicalized disease which victimizes them. This feels good as another opportunity to express sympathy. It is a way to avoid falling back on blame and shame, but brings even more under medicalization's purview.

 

Under this framing, both the harm-doer and the harmed person are seen as not needing to change, because their dissatisfactions with themselves are done to them, passively, by an emotional disease before which they are helpless, lacking agency over their own stances, words, and actions. Self-improvement is increasingly seen as impossible, and the social context would not reward it with sympathy. It is very emotionally-rewarding to accomplish things we like, and prevent the things we don't like. But disempowerment trains the brain to get rewards from failing and sympathizing with one's self.

That works like a poverty trap. This trap is insidious because it's telling you something that is often true: much of the time, it really is too hard, and it really is someone else's fault. That's why the trap works so well.

 

Medicalization, when it becomes a worldview, crowds out the openness to experience which would expose the limits of the worldview. When you want nothing to happen to you, watch out. You just might get it. And then nothing will happen to you.

6. Further Materials Toward A Theory Of The Trauma Queen

In "The Coddling Of The American Mind", Greg Lukianoff and Jonathan Haidt name this "safetyism". Lukianoff and Haidt describe the effects of safetyism on formal institutions which we all depend on. What I have said here is the spearhead in informal or less-formal groups, such as hacker spaces, druid groves, science fiction conventions, local Burning Man events, open source software projects, Mastodon or Discord servers, board game and role playing groups ("We are not therapists: gaming and trauma.").

And, to a certain extent, the disastrous polyamory meetup group whose downfall I chronicled in detail in my last post shared some assumptions and norms of medicalization. It devolved into a... it doesn't rise to the level of a "cult"... let's say "high-control group".

 

I've been surrounded by an unusually high degree of medicalization in my social environment. I wrote a thousand words on why that is happening in the world, involving code, laws, markets, and social norms. But I'll save that to a file and leave it for another day. For now, I'm going to look harder at whether my own life decisions have filtered those who are around me-- my life centers on informal groups such as those I listed above. It's probably not a coincidence that I see this happen so often.

Two decades ago, I rejected an ideology, and left behind almost everyone I knew and started over, resulting in tremendous wonderment, curiosity, humor, play, enjoyment, and creativity. I think then I got complacent and tried to make my social surrounds into something that would last. Something that would not change out from under me. The old societal undertow has reemerged in a fresh form, an inevitable ebb and flow described in The Stifling Air Of Rigid Radicalism, an excerpt from "Joyful Militancy".

if you are part of my ennervated and self-infantilized social environments and projects, I'm not saying it's up to you to change that. It could be that there are emerging new social waves to surf, and it's up to me to catch them again.

 

I may not have control over society, but I do have control over which social environments I create, join, and maintain, and the replenishing energy of aliveness that I bring to them, and with it, all the unsafety of living life.