How to Dismantle the Therapeutic State

And replace it with the Agentic Society

Iatrogenesis is a Greek term that refers to an illness that originates from the actions of a healer. In 1847, Ignaz Semmelweis provided an epochal example, although he was not lauded for it during his lifetime. The physician realized that his medical students were inadvertently killing pregnant women.

Semmelweis was working at the Vienna General Hospital and noticed that the First Obstetrical Clinic, where medical students and doctors worked, had a much higher maternal mortality rate from childbed fever (puerperal sepsis) compared to the Second Obstetrical Clinic, which midwives staffed. Semmelweis figured out that medical students would go directly from dissecting cadavers in anatomy lessons to examining patients in the maternity ward without washing their hands.

So in May 1847, he instituted mandatory hand washing with chlorinated lime water for anyone moving between the autopsy room and the maternity ward. The mortality rate dropped dramatically from around 18 percent to less than 2 percent.

The Iatrogenic State

In Bad Therapy,

Abigail Shrier

argues that so much of contemporary psychotherapy has become an industry that, far from helping people with their problems, exacerbates and lengthens their pathologies. This is especially true among young people who offer therapists a returning, dependent customer base. Psychotherapists have formed standards of practice that justify mixing social justice ideology with therapy that keeps clients dredging up traumas, reopening old wounds, and finding ways to blame external factors for everything under the sun. The result is a generation that is underdeveloped in terms of resilience and lacks an internal locus of control.

Now, I’ve never cared that much for the work of the psychiatrist Thomas Szasz. Still, there is enough to his critical analysis to borrow from, especially if we extrapolate from Shrier’s investigations in Bad Therapy. The *therapeutic state* is an established concept with a specific connotation in political and social theory. The term was popularized by Szasz in the 1960s and 1970s, particularly in his work, The Myth of Mental Illness, and later writings, including those in The Freeman (of which, full disclosure, I was the editor).

The Therapeutic State refers to a society where:

• Government and institutions increasingly use therapeutic/medical language and interventions to manage social problems and control behavior

• Individual problems are medicalized and treated as psychological issues rather than moral, political, or social ones

• The state expands its power by claiming to act in the service of people's mental health and wellbeing

• Traditional concepts of personal responsibility and moral agency are replaced with therapeutic frameworks

Szasz and others who use the term are generally critical of this development, arguing that it represents a form of social control disguised as benevolent care. The "therapeutic state" is seen as potentially undermining individual freedom and personal autonomy by pathologizing dissent, nonconformity, or personal struggles.

From the concept of the therapeutic state, we can derive the iatrogenic state. That means just as the former approach encourages clients, patients, or citizens to seek healing in the identification of external forces of trauma, their condition worsens. In other words, iatrogenesis has become a problem not only in therapeutic practice, but also in society, as agents of the state have unsuccessfully extended the therapeutic mentality as the solution to most social issues.

Devouring Mother, Tyrannical Father

It has become increasingly clear that the Democrats have evolved into the Mommy Party and the Republicans the Daddy Party. And as each party pushes into unhealthy extremes, more of their followers become unhealthy extremists. The two unhealthy archetypes for the Ds and the Rs, therefore, are: the Devouring Mother and the Tyrannical Father.

The Devouring Mother archetype represents an overprotective, controlling maternal figure who psychologically *consumes* her children by preventing their individuation and independence. Characteristics include:

• Excessive emotional enmeshment with children

• Inability to allow children to separate and develop autonomy

• Using guilt, manipulation, or emotional dependency to maintain control

• Difficulty accepting children as separate individuals with responsibilities

The Tyrannical Father archetype includes the following characteristics:

• Overly rigid, controlling, and punitive

• Rules through fear rather than respect

• Crushes children's autonomy and self-expression

• Creates rebellion or excessive compliance

As the partisans struggle and the proverbial pendulum swings, citizens (replace children) experience a kind of unstable vacillation between these two unhealthy approaches to governance.

And this becomes expressed as follows…

The Devouring Mommy Party infantilizes great swathes of the American people and treats them as perpetual victims. They use guilt, manipulation, and hyperbolic shame campaigns as a means of keeping or regaining control. They prefer carrots to sticks, but wield both. And they tend to resist any effort to implement policies that would restore personal responsibility and agency to those they see as under their care. (Their mantra is Send in the social workers.)

The Tyrannical Daddy Party tends to overshoot in applying strength and protection by becoming excessively controlling or meting out punishments without reflecting on whether such applications are appropriate. They prefer sticks to carrots, but wield both. Instead of stripping people of their autonomy through collective pity or mollycoddling, they crush personal responsibility by instilling fear and demanding order. (Their mantra is Send in the cops.)

While the therapeutic state is primarily the domain of the Mommy Party, it can be commandeered by the Daddy Party, even though the latter generally prefers enforcers to counselors. Likewise, the Mommy Party uses its legions of social workers and civil servants as a kind of moralistic veneer as it surreptitiously sends police or military to do its dirty work—as with the FBI entrapment agents of J6, or the roundup of political enemies between 2020 and 2024.

While I admit to thinking we need more muscular and masculine approaches to governance in the near term to correct for the unhealthy excesses and shortcomings of the last four years, not all such approaches can originate with the Executive. I worry that too many of these particular approaches will do little to fundamentally restore the constitutional order, much less restore strong community and personal responsibility among the people. Instead, Tyrannical Daddies will leave too many outsized levers of unhealthy paternalist authority behind for Devouring Mommies who have become Deranged Nurse Ratcheds, currently nurturing a retributive rage. Foolish Tyrants will set precedents and leave authoritarian tools for their enemies to pick up. The necessary evil of muscular government must be directed at permanent institutional reform, not a sugar high or aimless payback.

The pendulum swings back, after all. And tit meets tat.

Politicos, Heal Thyselves

So, we must find ways to dismantle the iatrogenic state, and few such ways can come from the president's desk. Unfortunately, that means Congress needs to be reformed utterly (good luck with that; they’re a bunch of sociopaths) or we need to devise a thousand bottom-up measures that counter all of the iatrogenesis. Whether it comes from the Mommy or Daddy party, we must overcome the notion that concentrated government power and policymaking are the best treatments.

We must replace the Iatrogenic State with the Agentic Society.

Some readers will wistfully imagine a political leader who will perfectly embody a healthy balance of masculine and feminine statesmanship. Perhaps this person will shed the strongman vulgarity of Trump and the doddering flaccidity of Biden, allowing us to feel pride again whenever we see them speak on television. Alas, we’ve had an experience with leaders of soaring oratory who turned out to be snakes and servants of the managerial regime.

The presidency is a mirage.

There is no lasting salvation if we continue to rely on political leaders. We must learn to depend on ourselves. And that will take walking past the therapists, right up to the mirror, where we can recommit to practicing the virtues. Then, we must dispel the Myth of the President and the Presidency to stake out a powerful gravitational *center*—decentralization—that slows the wild swings of the national political pendulum. That means self-organizing in community and mutual aid, as well as finding ways to evade the worst excesses of the partisans and their power structures.

Like a healing person restores her internal locus of control, we must restore the local dynamics of neighbors helping neighbors. The new archetypes will become the Samaritan and the Steward, the Caregiver and the Mentor, the Educator and the Entrepreneur. (If you see mom and dad in these, so be it.)

We replace government by imposition with governance by agreement. Although the sociopaths in Washington will sap our resources through debt spending and taxation—creating incentives for us to continue outsourcing our time, attention, and responsibilities to them—there’s still time to rediscover what Tocqueville saw in us as Americans.

To many, the very idea of insourcing responsibilities away from distant capitals will seem curious or quaint—especially as we have lived too long in a society where politics has replaced civil society and TikTok has replaced critical thinking. But enough of us can take the lead, recruit the many, mentor the young, and grow the ranks.

We need only start replacing minutes and money wasted on politics with minutes and money spent on building the civilization of tomorrow.