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Intimacy at a Distance: A New Book on Teletherapy Reviewed


By Hannah Zeavin

In 1991, Kenneth Colby, a psychiatrist at UCLA, released a software program that he hoped would relieve the burden on the nation’s overloaded psychiatric system. Overcoming Depression promised to make patients “experts in their own depression” through a program they could run on their new personal computers. It was a promising time for an initiative that aimed to cross-fertilize the desktop computing craze and the early-’90s rise in diagnoses of depression—encompassing 25 percent of the nation’s adults, according to the National Institute of Mental Health (NIMH), a number that Colby considered an underestimate.

But for all its promise, Overcoming Depression landed with a thud, another failed dream of the 1990s. The challenge of moving from a prototype to a functioning software system that could plausibly replace a human clinician proved too daunting for the NIMH, which cut the project’s funding after only a few years. Griping at what he considered the institute’s conservative vision, Colby remarked, “I think the ultimate funding will come from the private sector when it realizes how much money can be made from conversing computers.”

Colby was right. In 2020, mental health start-ups garnered $1.5 billion in investments, with companies like Cerebral leading the pack on a wave of VC cash. Many of these new companies specialize in fast-tracking prescriptions for controlled substances like amphetamines, capitalizing on the Covid-era relaxation of in-person prescribing rules. The legal gray areas surrounding these apps and how they should be regulated is a predictable result of the way every facet of our lives was clambering shambolically online during lockdown. But data about the extent to which these new forms of digitized psychiatry have changed the field—much less whether or not they work—remains alarmingly scant. Like QR codes, teletherapy and Web psychiatric consultations now seem less like a temporary emergency measure and more like part of an indefinite new normal. Sure, the much-touted increased access to psychiatric care comes laden with questions about treatment standards—but in the tyranny of the permanent ad hoc, who has the energy to ask whether the thing to which there are no alternatives is any good?

Hannah Zeavin’s The Distance Cure takes on the question of telepsychiatry’s therapeutic validity by examining the many ways that psychiatry and psychoanalysis have historically been practiced without an in-person session—from Sigmund Freud’s analyses conducted via written correspondence to call-in radio shows and suicide hotlines. As a history that looks into present trends, the book aims not only to contextualize teletherapy by assembling a larger genealogy of psychotherapy at a distance but to use it as a way into the problem that defined the quarantines: how to transact intimacy at a distance.

Psychotherapy that happens without both parties in the same room is not just a niche within the larger genre of “communication,” Zeavin argues. Instead, distance therapy reveals something that is true of human communication in general: that all intimacy relies on a fantasy of togetherness, even when the parties are physically present with each other. There is, she asserts, no way to be “really” together with someone else that doesn’t rely on a third thing traversing the space between “me” and “you.” This third thing, per Zeavin, is “media,” a vertiginously broad concept encompassing any means of communication, from a chat over lunch to a transatlantic telecom line. Rather than understanding teletherapy as “more distanced” than in-person therapy, then, Zeavin contends that different types of media facilitate different types of fantasies of togetherness that are, in the end, variations of the same psychic process. Whether we are FaceTiming or writing letters or in the room together, no experience of intimacy is more “real” than any other—they are just mediated differently.

Read entire article at The Nation