‘Personal Responsibility Inc.’ Reimagines Mental Health and Its Care

The late mystic Jiddu Krishnamurti’s best-known, if somewhat apocryphal maxim is, “It is no measure of health to be well-adjusted to a profoundly sick society.” In other words, we shouldn’t gauge how well we’re doing by how well we’re able to conform to a flawed system. Without quoting this directly, licensed therapist and gender and cultural studies Ph.D Julie Tilsen applies this thesis to her field in her new book, Personal Responsibility, Inc., out now with OR Books. Confronting neoliberalism for blinkering psychotherapy, she urges practitioners and clients alike toward a more socially informed mental health care.

It’s conventional wisdom that everyone should be in therapy and stay in therapy, “a therapeutic life sentence,” Tilsen quips. Yet despite increasing levels of counseling and medication, surveys show our collective mental health has declined. This isn’t because we’ve gotten better at measuring and reporting mental illness; rather, our treatments have had trouble keeping up with our malaise. Tilsen alleges that “only about 20 percent of people treated for mental health concerns experience improvement (and often only temporarily).” Studies generally peg this number higher, between two-thirds and 75%, with meaningful, although reduced long-term benefits for responders. So proceed with caution: Tilsen’s therapy skepticism crops up throughout the book, in dubious claims that you can’t reliably diagnose mental illness or that regularly hearing voices isn’t symptomatic of a problem.

Personal Responsibility Inc.
By Julie Tilsen
OR Books, 220 pages

Still, the treatment-prevalence paradox remains: With more mental health interventions than ever, why are we so depressed? Tilsen points the finger at neoliberalism, which she accuses of harming us by reducing society to the economy and people to isolated consumers, then turning around and erecting a mental health–industrial complex to profit from our suffering. Neoliberalism is a famously squishy term. Free marketeers often disavow it, publications limit its use, and even economists debate what it means, if anything. But despite giving neoliberalism main-character status in her book, and the cutesy nickname “NL,” Tilsen devotes just three paragraphs to defining it in her introduction.

While Personal Responsibility Inc. isn’t about neoliberalism per se, it could use a concrete account of the subject, especially since Tilsen grounds her argument in the non-obvious connection between an economic theory and a cultural orientation. Absent conceptual bounds, iffy attributions creep in: Neoliberalism is blamed for a sprawling set of woes, from “increasing criminalization of civil protest” to our tendency to compare ourselves to one another and even fascism (which also isn’t defined).

To her credit, Tilsen touches on neoliberalism’s hallmark, economic privatization, and how that’s extended to the privatization of our problems. The market will solve all; no need for the state, or even each other. She quotes neoliberal poster child Margaret Thatcher, who decreed in a 1987 interview, “There is no such thing as society.” What Thatcher said next is equally instructive: “The quality of our lives will depend upon how much each of us is prepared to take responsibility for ourselves.” Enter individualism, Tilsen’s bête noire.

Applied to the realm of therapy, Tilsen contends this ethos has reduced collective mental health struggles to individual chemical imbalances in need of correction. But this is a bit of a straw man. While pharmaceutical companies have a vested interest in selling us psychiatric meds (Pfizer, the manufacturer of Zoloft, is behind a widely-used depression questionnaire) the field of psychology now largely rejects what Tilsen maligns as the “biopsychiatry” model of mental illness, instead nodding to a mix of individual, family, social, and even financial factors. That said, conventional therapy’s tools are limited to medication and counseling, which don’t always get the job done.

Tilsen is on firmer ground when arguing that many of our mental health stressors are structural. It isn’t simply that we need more serotonin or a better mindset; social media manipulations and the market logic of our world are driving us crazy. By valuing commodities over people, we’re led to consume more than we connect, deepening loneliness and social isolation. By fashioning the self as entrepreneur, we’re pressured to sell our identities as products, obsessing over how well we measure up to and compete with others. And by sanctifying the profit motive, we show we are prepared to sacrifice anything at its altar, from parental leave and affordable health care to living wages and a stable climate.

If the problems are systemic, Tilsen wagers, so are the solutions. Rather than medicate ourselves to better endure the harms of neoliberalism, we ought to be reaching out to friends and neighbors to resist them: “Instead of wanting to be less anxious or depressed or disorganized, commit to being a good community member.” It’s a sentiment as romantic as it is radical, and Tilsen is at her best when insisting that healing does not happen in private. Her “new relational ethic” offers us the dual virtues of connecting with others and getting out of our own heads. If you spend enough time alone, you’re bound to find some reason to be dissatisfied with yourself. On the contrary, spending time with others is the top predictor of longer, healthier, happier lives. What makes us feel good is a sense of meaning, purpose, and belonging. You can’t get those alone in your room.

Aiming to guide both the public and fellow practitioners, Tilsen outlines how to make therapy more relational, from group practices like The Tree of Life, where participants draw a tree and consider the symbolic meaning of each part, to writing letters to loved ones expressing struggles instead of bottling them in. Personal Responsibility Inc. is a practical manual of checklists, charts, exercises, case studies, and questionnaires, priming readers to think differently about therapy. Between these tools and strategies, presented in curious gray boxes with pithy subheadings, Tilsen employs jokes, curse words, and slang in a folksy tone squarely in the idiom of the identitarian Left. You get the sense that she wants — needs — you to know she’s on your level.

Sometimes, it’s humanizing, if a bit grating, like when she shares that her session recordings for training therapists “are as much to tell people what the fuck not to do.” Other times, it’s funny, if slightly performative, like when she declares “it’s OK to deadname Twitter,” or that “anger management really pisses me off.” Once in a while, though, it’s just flat out cringe, like when she instructs us to call out those who fat-shame the hoverchair people in Wall-E, or when she describes telling an AI therapy chatbot she’s “devasted [sic] by the genocide of Palestinians” while “drinking an iced latte” (she named her avatar after her beverage). The latter example speaks to the ideological hold of neoliberalism: Tilsen may disavow psychotherapy and consumerism, but she’s not giving up her license — or her latte. This isn’t unique to her, we’re all walking, talking contradictions.

My final objection concerns Tilsen’s personification of neoliberalism, which she treats as a bad actor in need of chastising: “You may be a stone-cold bitch, NL, but the grief and longing encoded in everyone’s responses to you are not hard to hear, if you have a heart.” Neoliberalism is a system, an economic framework that organizes everyday life through its incentive structure. It is amoral and quite literally heartless — it’s not human. Appealing to it is like shouting into the void. If we want to improve our collective mental health, we have to go out and make it happen.

This demands we start talking to each other again, and Tilsen deserves kudos for encouraging us, even if it risks conflict or “hurt feelings.” But herein lies the paradox of Personal Responsibility, Inc.: It’s only through our personal efforts that we can shift culture away from the personal responsibility paradigm. Sensitive to this, Tilson concludes her book with the open-ended question, “Just what is my responsibility if I take up the struggle against neoliberalism’s burden of personal responsibility?”