Via media: power and ideology in tele-therapy

The Distance Cure and The Doctor Who Wasn’t There are political books about medical media. Zeavin offers illuminating analyses of a range of distant psychotherapies: epistolary analysis, telephonic church services, suicide crisis telephone hotlines, computer-based therapies, and e-therapy (what Zeavin calls “therapeutic written speech”). For her, the media involved in these therapies are “active metaphors in their power to translate old psychical experiences onto new forms, into teletherapeutic encounters” (225), and as such can be invested with a good deal of political hope. We all have a “medium inside” that “identifies or rhymes with” (217) the forms of telecommunication or teletherapy we use—depending on our experiences and mental make-up, we might prefer e-mail over a phone conversation, zoom over text messaging. The introduction of new media thus offers opportunities to break from the dominating white, male, and heteronormative ideals, and the false ethical value of “empathy,” which too often dominate traditional therapy. Greene also explores the promises and limitations, past and present, of a range of telemedical devices, in his case, the telephone, radio-based technologies, cable television, and the mainframe computer. Whether they were able to reach new populations and thereby reduce health disparities or instead created new barriers (of connectivity, for instance), Greene argues, depended not on the technologies themselves, but on the political will, public investment, and economic support that made them work and maintained them. That is why, all too often, the promises of equality that accompanied these technologies when they were first devised were lost as these technologies aged.

Media aren’t always obvious. Loosely relying on Marshall McLuhan, Greene asserts: “We learn not to see the media of care that we are suspended within” (253). Devices such as the x-ray, the radio pager, or the telephone have become so thoroughly integrated into medical practice that their presence as technology is no longer noticed. And yet, even if the media are made invisible, they can still shape our social relations. As the sociologist Erving Goffman remarked about televised medicine: it rebuilt codes of relations between doctor and patient, encouraging new forms of interaction. When the doctor was transported behind a TV screen and out of the examination room, the asymmetry of the doctor-patient relationship—where the doctor could touch the patient but not vice versa (130)—was flattened. Conversely, as the physician and telemedicine advocate Kenneth Bird noted approvingly in 1968, medical TV “amplified” the doctor, expanding the influence and reach of the physician and thereby his authority.

Similarly, Zeavin reminds us that media are at work even if they seem to be absent from the therapeutic situation. Zeavin opens her set of teletherapeutic case studies with the beginnings of psychoanalysis. Sigmund Freud’s talk therapy, despite appearances did not occur in direct and simple ways, with two persons communicating with each other in the same room. Rather, from the beginning mediation played a role: Freud’s famous “self-analysis” was really a conventional analysis conducted by letter with Freud’s friend and mentor Wilhelm Fliess; and some of Freud’s cases, such as Herbert Graf a.k.a. Little Hans, Schreber, or his retrospective psychoanalysis of Leonardo Da Vinci, were mediated by written text or works of art. Freud, ever entranced by the immediacy of the telepathic séance then en vogue (even though he publicly distanced himself from it), nevertheless relied heavily on metaphors of mediation: therapeutic listening as telephone exchange, memory as a mystic writing page, and dreaming censored like the mail. As Zeavin suggests, it was precisely the distance introduced by epistolary writing that made intimacy possible. “The communication is a response to a felt absence that aims to mitigate that absence and thereby close the gap in affirming it” (39). The same process was at work during in-person psychoanalytic therapy where a form of “fantastical relating” allowed a process of “mutual transference” and thus for “unconscious work to occur on both sides of a communication” (40).

One thing we learn from the books, then, is that even the most basic and simple acts are complexly constituted. Such acts both have to be learned and shift according to the changing media landscape. Take the attentive listening that plays a major role in contemporary therapy. It owes much to the work of humanistic psychologist Carl Rogers, who used phonographic recordings to teach counselors and their students to listen productively, by playing back to them and thus allowing them to judge how well they listened. Not very well it turned out. In a study conducted by his student E.H. Porter, many counselors spoke four times as much as their patients in a typical session, and hearing themselves in the recordings encouraged them to take a less directive approach.[1] Like the forms of tele-intervention discussed in Zeavin and Greene’s books, therapeutic listening was never innocent but engaged with the media at its disposal, shaping it in ways that weren’t possible beforehand.

Given the reach of media into all forms of medical interaction, even the seemingly immediate, we might want to revisit the claims that they are inherently ideological. Might we not rather, via Greene, think about those forms of proximate therapy in terms of mediatic possibilities—possibilities that have been channeled and perhaps restricted by forms of power? Such an approach would allow us to use Zeavin’s insights, not only to welcome the possibilities of new forms of distance therapy, but perhaps also to revisit older forms of face-to-face treatments and recuperate possibilities that, though shut down in the past, might point towards new and better futures.

[1] E.H. Porter, “The Development and Evaluation of a Measure of Counseling Interview Procedures,” Part II, Education and Psychological Measurement 3, no. 2 (1943): 215-238, on 234.

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