Mr Rogers’ Unquenchable Unconditional Love Machine
The most pervasive ideas in mental healthcare, the ones that most consistently influence how mental healthcare professionals think, behave and treat people, don’t come from scientific evidence and they don’t derive from any of the grand psychological theories, they are just a part of a consensus which has evolved around how mental healthcare should be done, what it looks and sounds like and the values that should be attached.[1]
And the closest thing to a source for much of this consensus is the person-centred approach to psychotherapy pioneered by Carl Rogers. One of the key ideas of the person-centred approach is that people have a kind of self-righting mechanism (a ‘self-actualizing capacity’) that will allow them to reach their personal, individual potential if provided with the right environment. And the essential element of that environment is a complete absence of threats to the self ('conditions of worth’) so in therapy people should only ever experience ‘unconditional positive regard’.
Examples of values and themes in modern mental healthcare which can be traced back most directly to the person-centred approach include a powerful emphasis on subjectivity, personal authenticity, and self-acceptance, non-directional Socratic questioning and, perhaps, the current shift towards the active recruitment of people with lived experience into mental healthcare.
Some of these ideas had, and have, a place in other schools or approaches in mental health but person-centred therapy is where they really majored and came together. And the basic premise underlying this approach is that people are innately good and they will grow towards the light if they can just be provided with the right conditions: understanding, congruence and unconditional positive regard. The immediate objective is about people receiving understanding rather than gaining it. All you need is love.
There had never really been a point in history when enough people had been prepared to believe this idea for it to gain currency (most previous successful ideas about people had focussed on fallibility and capacity for sin). But, somehow North America and Western Europe in the decades after the 2nd World War supplied the opportunity (that’s what they took from the Rape of Nanking, the premature deaths of 85 million people, the industrialised extermination of 8 million for their ethnicity, disability, religion or sexual orientation and the detonation of two atom bombs on civilian populations?). And psychology proved the perfect breeding ground, probably because it maximised its exposure to the people most susceptible to it, the ones struggling most to find effective ways to manage their self-esteem.[2]
It is intuitive that if people suffer too much, it will be bad for them, and if people don’t get enough of what’s needed for humans to thrive, it will affect their mental health. But it’s a very great leap from there to say that all people need is understanding and unconditional positive regard. Or that there is a (one) potential in everyone that will find its way out in a beautiful, unique flowering if it can just be allowed to emerge.
And there isn’t a shred of evidence to support this as a (more) effective therapeutic technique. Research on the effectiveness of different types of therapy is incoherent and inconclusive but indicates that success rates for person-centred therapy are about the same as all the other forms of therapy.[3] Which is to say, not very good at all: NHS figures show that three quarters of the time people who have a diagnoseable mental disorder don’t recover as a result of receiving therapy.[4]
Yet these ideas are pervasive in mental healthcare, and they have become central to how people outside mental healthcare think about mental health. People just like them.
Here's a description of therapy approvingly cited by a professor of mental health: ‘The art of therapeutic care is: “to listen carefully, to be genuinely interested in the other person, to react in an accepting and non-shaming way to his or her disclosures, and to make no demands that the other party meet one’s emotional needs”’.[5] Here's a recent response from a psychotherapist to a reader in an ask-the-expert column in a national newspaper: 'But the best thing we can do for our children is to accept them where they are right now, which is more likely to give them the idea that they are good enough as they are and there’s nothing like believing in your own adequacy to give you confidence.'[6] Here's Gwyneth from the Goop website “my most lasting mistakes and the mess that comes with them have all stemmed from me not standing fully in my truth and speaking from it, come what may”.[7]
‘Learn to love yourself’, ‘you are enough’, ‘live your truth’: Rogers can’t have been a stupid person, and there’s more nuance in his approach than the slogans allow, but the slogans he gave birth to have a life far beyond the nuance. Here’s an article reporting concern that children might be being influenced to transition their gender in order to try to protect themselves from bullying – that is, young kids who are worried about being bullied may think transitioning could be a way out.[8] And this year the NHS’ Gender and Identity Development Service is being shut down and broken up following a series of controversies including complaints from patients that they were allowed to pursue gender reassignment when they were too young.[9] Whatever the rights and wrongs of the GIDS controversies maybe the best thing we can do for our children isn’t always simply to ‘accept them where they are right now’?
That idea above of not having to have regard for the emotional needs of others is regularly cited as one of the principal virtues of therapy.[10] That does what it says on the tin really, the clue is in the name: - who’s the ‘person’ in ‘person-centred therapy’? It’s the self. And it’s really not very clear why that experience would be expected to be a particularly effective way of helping people to deal with a real world in which it generally is actually quite important to be able to have enough regard to other people’s emotional needs.
The desire to be endlessly understood and to have unconditional relationships is understandable and forgivable (up to a point) but it’s also infantile. Self-actualisation is an adaptation of the developmental model. That is the idea of your lifespan as a journey of continuing personal growth, and that is another popular and very influential theme around mental health and well-being. But look at childhood, what it is. It's a process of becoming less self-centred, better able to cope with other people's separateness and independence, with not getting your own way, becoming more able to contain your own emotional life and manage the intensity of your own internal experience, developing more realistic expectations and negotiating a more robust accommodation with the external world. It’s about ‘getting’ other people.
Mental illness is about self-hatred. That’s its essence, with undertones of anxiety and top notes of aggression. In some people that results in a shut-down sense of hopelessness (depression), in others, acute states of anxiety, or attempts at self-aggrandisement, in some its alcohol abuse, in some it’s a school shooting.
Self-hatred, because you imagine you are worse than others, is a particular form of self-centredness. Not being able to come to terms enough with other people’s separateness and independence is another. And everyone struggles with that. And the reason we struggle with it is because it means recognising that we are more alone than we really want to be - that other people are separate and independent from us, with their own agenda in their life and they are just as single-mindedly focused on themselves as we are on ourselves.
So, everyone has to live with a built-in, miss-set expectation that other people, particularly the ones closest to them, they depend on most, will behave in certain ways, will behave in the ways they’d like them to, will do what they want. And this operates unconsciously, at an emotional level: people may be able to talk fluently and plausibly about relationships, and say just the right things, but if these ideas haven’t been tempered and grounded enough in reality, it means those expectations being disappointed. It means being doomed to a life of disappointment, frustration, anxiety, aggression, and self-hatred. And it means being more likely to develop mental health problems.
The idea that you can live any kind of life that isn't miserable without enough capacity to take account of other people’s emotional needs, even that you could have a very useful or meaningful interrogation of your own processes and values and leave other people’s emotional needs out if it (as if you lived in a bubble), is a really bad one.
Unrealistic perspectives and expectations of others, the contents of your own head being too vivid, an inability to meet the outside world halfway, that’s what the problem is. The neurotic emphasis on individualism in mental healthcare is itself a reflection of what it’s meant to be treating.
We are surrounded by ideas all the time. They are the water we swim in: we take them in without noticing. But they dictate how we see things, how we experience everything that happens to us, how it affects us and how we react and act in turn. And the ideas around us change without us noticing. The ideas we’ve been discussing have leached into the mainstream through multiple channels - mental health activism, awareness campaigns, schools, life-coaching, corporate well-being, parenting guides, journalism, the entertainment industry, celebrities, and influencers.
They’ve been helped to spread by the fact that they have credibility precisely because they come from mental healthcare. But since there isn’t actually any evidence for them, there isn’t much reason for the people whose job it is to treat mental health to believe them, other than that they want to. And since mental healthcare can’t offer a coherent account of what mental health is and can’t treat mental illness very successfully, it’s not really very clear that it deserves to be treated as a creditable source in the first place.
And it doesn’t hurt that these ideas sound great! You get to come across as wise and forbearing enough to just let things be, but still caring. Plus, you don’t actually have to do anything – just listen and understand and allow people to find their way, and (in your own mind at least) you’re always absolved of any responsibility for the outcomes.
So, these ideas have spread very effectively and that’s a problem. There is a lot of concern expressed about the medicalisation of normal human experience: the idea that the current epidemic levels of reported mental health issues may have been fuelled by the way we have come to think and talk about mental health.[11] That, in that sense, psychology and mental healthcare have actually been making things worse. And that’s very likely to be true, but this is about saying something different: this is suggesting that ideas emanating from psychology and mental healthcare have meant that people are actually more likely to become ill, not just to imagine that they are.
Unconditional love is the worst idea we have ever had. It’s never right and it’s responsible for a great deal of trouble in the real world. The last couple of decades have seen a particular manifestation of this fantasy transplanted from a niche technique in psychotherapy into the dominant idea behind how we think about mental health. And as mental health has moved into the mainstream, the chimera has emerged with a new veneer of authority and conviction to help it infiltrate any aspect of how we think about ourselves and other people – the Doctor says this is how things are, or should be.
But it’s still not true: mental health professionals are getting paid for unconditional positive regard. Even the love between parent and child is ultimately conditional. You have to be able to negotiate a workable, sustainable accommodation with the external world, you have to be able to meet other people halfway. The ideas people have assimilated from psychology and mental healthcare have made them less well equipped to do that than they have ever been.
Even though they can’t do much to cure them, mental healthcare professionals try to make things easier for people who are in immense suffering and often they do a very good job in extremely difficult circumstances. But, at the same time, the people meant to be looking after us have made things worse. Not just made people think they’re ill when they aren’t, not even just got in the way of people who are ill getting better, the solipsism at the heart of mental healthcare has leapt the gap and it’s actively making more people more likely to become ill.
[1] https://jonathancoppin.substack.com/p/the-lingua-franca-of-mental-healthcare
[2] https://jonathancoppin.substack.com/p/self-esteem-and-mental-health
[3] https://www.cambridge.org/core/journals/psychological-medicine/article/abs/effectiveness-of-cognitivebehavioural-personcentred-and-psychodynamic-therapies-as-practised-in-uk-national-health-service-settings/927D2179934AEEFFECBCA2BED3AE3369
[4] https://jonathancoppin.substack.com/p/the-drugs-dont-work-and-nor-does
https://twitter.com/JDaviesPhD/status/1571942241861509122
[6] https://www.theguardian.com/lifeandstyle/2023/mar/26/ask-philippa-perry-i-am-worried-my-introvert-teenage-son-is-missing-out?
[7] https://goop.com/wellness/mindfulness/gwyneth-paltrow-on-approaching-50/
[8] https://www.telegraph.co.uk/news/2023/04/14/sex-education-lessons-children-stop-bullying-claim/
[9] https://www.theguardian.com/society/2022/jul/28/nhs-closing-down-london-gender-identity-clinic-for-children?CMP=Share_AndroidApp_Other
[10] Not universally: Melanie Klein, for example, believed that it was by coming to care for your therapist (once you’d overcome your desire to kill them) that you got better. Relational therapists believe that it’s a mutually beneficial relationship between therapist and client that achieves the healing. But this idea of therapy as a responsibility free zone being somehow important for the process is the dominant one.
[11] For example, Lucy Foulkes: Losing Our Minds – What Mental Illness Really Is And What It Isn’t: The Bodley Head 2021
Thanks Daryl. Both kids shows, I guess?
wait... I read your article. Maybe I'm missing something here. initially, I thought you were referring to Fred Rogers (aka Mr Rogers), but you were talking about Carl Rogers.