Source: Marks, S. (2017) "Psychotherapy in Historical Perspective," History of the Human Sciences, 30(2), 3–16.
Tags: Foucault, Nikolas Rose, Ian Hacking, Szasz, moral treatment, looping effect, human kinds, technologies of the self, ontology-making, anti-psychiatry, Stoicism, psychoanalysis historiography
Difficulty: Intermediate to Advanced | Prerequisites: Part 1 of these notes (Introduction and Definitions). Some familiarity with Foucault's general approach to power and institutions is helpful but not essential.
This section covers how the history of psychotherapy has been written, and by whom. Clinicians, critics, and social theorists have all made use of history for different purposes: to legitimise their profession, to trace its roots, or to expose it as a tool of social control. The key insight is that psychotherapy does not just treat people; it creates new ways of understanding the self, new categories of personhood, and new vocabularies for suffering. The thinkers covered here (Foucault, Rose, Hacking, Szasz, Shamdasani) each offer a distinct lens for understanding the relationship between therapy and society. This is essential material for anyone studying the philosophy of psychology, the sociology of mental health, or the ethics of clinical practice.
Clinicians have used history to validate their profession, often tracing roots back to ancient Greece. Critics like Szasz and Foucault have used history to argue that therapy is a form of social control. Sociologists like Rose see therapy as a "technology of the self" that sustains liberal democracies. Hacking's "looping effect" shows how therapeutic categories change the people they classify. Together, these perspectives reveal that psychotherapy is an ontology-making practice: it does not just describe the mind, it shapes what the mind can be.
Moral treatment
A late-18th-century approach to the care of the mentally ill, associated with the Tuke family at the York Retreat (England) and Philippe Pinel at La Salpêtrière and Bicêtre (Paris). It moved away from physical restraint towards a "benevolent" environment that sought to restore the patient's reason, partly by simulating a family setting within the asylum.
Think of it as: the historical moment when "kindness" replaced "chains" in asylums, though Foucault argued this kindness was itself a form of power.
Technologies of the self
A concept developed by Nikolas Rose (drawing on Foucault). Psychotherapy functions as a technique through which individuals learn to regulate themselves, monitor their emotions, and become "competent autonomous" citizens. Liberal democracies depend on citizens who can govern themselves, and therapy is one of the tools that makes this possible.
In simple terms, this means: therapy does not just fix problems; it trains people to manage themselves in ways that serve the wider political order.
Looping effect of human kinds (Hacking)
Ian Hacking's concept describing how the categories created by the human sciences (e.g. "trauma," "multiple personality disorder," "child abuse") change the people who are classified by them. Once a new category exists, people begin to understand themselves through it, which in turn changes their behaviour and experience, which in turn changes the category itself.
Think of it as: a feedback loop between expert labels and lived experience. The label changes the person, and the changed person changes the label.
Human kinds vs natural kinds
Hacking's distinction. "Natural kinds" (e.g. elements on the periodic table) do not change when scientists classify them. "Human kinds" (e.g. "trauma survivor," "person with multiple personality disorder") do change, because the people classified become aware of the classification and respond to it.
In simple terms, this means: calling someone "depressed" is not like calling a rock "granite." The person hears the label and it alters how they see themselves.
Ontology-making practice
Sonu Shamdasani's description of psychotherapy. In the 20th century, therapy became a site where people did not just get treated; they learned new ways of articulating suffering, adopted new narrative templates for their lives, and took on new conceptions of the mind. The result has been a "plethora of optional ontologies," different frameworks for what it means to be a person.
Think of it as: therapy does not just heal; it offers you a new story about who you are and how your mind works, and you may adopt that story as your reality.
Anti-psychiatry
A movement (associated with Thomas Szasz, R.D. Laing, and others) that challenged the legitimacy of psychiatric diagnosis and treatment. Szasz argued that "mental illness" is a myth and that psychotherapy is really a medicalised form of rhetoric and religion. His 1978 book The Myth of Psychotherapy extended this critique specifically to therapy.
In simple terms, this means: a group of thinkers who argued that psychiatry and psychotherapy are not real medicine but systems of social control dressed up in medical language.
Clinicians have been the most enthusiastic writers of psychotherapy's history, but their accounts often serve to legitimise and celebrate their own profession.
A common strategy is to trace therapy's roots back to ancient Greece, bypassing the modern coinage of the term altogether. This creates a sense of timelessness and universal validity.
Jungian analyst Carl Meier drew parallels between analytic psychology and the healing traditions of the temple of Asclepius (dream incubation, isolation, the "wounded healer" archetype of Chiron).
CBT founders Albert Ellis and Aaron Beck traced their intellectual lineage to Stoic philosophy, particularly Epictetus' maxim: "Men are disturbed not by things, but by the views which they take of things."
Ellis's Rational Emotive Behaviour Therapy (REBT) was not merely analogous to Stoicism but actively drew on Stoic texts as an alternative to psychoanalysis.
While tracing classical roots risks anachronism, it points to something real: foundational texts of many therapies do appropriate classical motifs.
Laurence Spurling compared the way therapists cite their intellectual lineage to Talmudic scholarship, noting a culture of deference to founding figures (Freud, Jung) that can foster conservatism alongside creativity.
Thomas Szasz argued that psychotherapy conceals its true roots in rhetoric and religion. The medicalised language of "treatment" disguises what is really coercion and conversation. He traced therapy back to pre-Hellenic healing practices and pastoral care of the soul.
Michel Foucault identified a pivotal shift at the end of the 18th century with the establishment of moral treatment (York Retreat, La Salpêtrière/Bicêtre). The move from physical restraint to "benevolent" care looked like progress, but Foucault argued that:
The new asylum environment simulated a family setting, and the power dynamics within it involved judgement and punishment just as much as physical restraint had.
The "familial metaphor" masked coercion behind a veneer of kindness.
From this point, the "discourses of unreason became inextricably linked to the half-real, half-imaginary dialectic of the family."
Foucault's critique does not deny that moral treatment was different from what came before. It questions whether "benevolence" and "power" are as separate as reformers claimed.
Rose built on Foucault to argue that the psy-disciplines became crucial to liberal democratic governance in the 20th century.
Psychotherapy enables "competent autonomous selfhood" at the individual level. Citizens who can regulate their own emotions and behaviour sustain a political order that depends on free, self-governing individuals.
This is not a conspiracy theory. Rose's point is structural: therapy produces the kind of subjects that liberal societies need, whether or not anyone designs it that way.
Hacking's "looping effect" describes how therapeutic and diagnostic categories change the people they classify.
Example: the category "trauma" names a relatively new kind of human experience. Once the word exists, people can come to see themselves as trauma survivors, which changes their lives and relationships.
Example: multiple personality disorder became almost inextricably linked to child abuse. The causal link between category and aetiology was itself constructed through clinical practice and classification.
These categories are "human kinds," not "natural kinds." They are interactive: the classified person is aware of the classification and responds to it.
By dealing in human kinds, the psy-professions engage in what Hacking calls "making up people," creating new categories of personhood that did not previously exist.
This has direct implications for therapy: if the task of treatment is framed around locating a particular traumatic event, the therapy itself shapes the client's self-understanding.
Historian Sonu Shamdasani describes psychotherapy as an "ontology-making practice." In the therapeutic encounter, people learn to:
Articulate their suffering in new vocabularies
Reconceive their lives according to particular narrative templates
Adopt conceptions about the nature of the mind and reality
The result is a "plethora of optional ontologies": many different frameworks for understanding what it means to be a person, each generated by a different therapeutic tradition.
This creates a "moebius strip of circulating feedback loops": therapeutic concepts enter popular culture, people begin presenting themselves to therapists in those terms, and the clinical encounter is altered in turn.
Crucially, these ontologies are optional. Clients can resist. Individuals and groups sometimes reject the categories offered by psy-professions and generate their own alternatives.
The neurodiversity movement is a live example of Hacking's looping effect and Shamdasani's optional ontologies in action. Autistic self-advocates have rejected the "optional ontology" of behaviourism (which frames autism as a set of behaviours to be modified) and instead adopted a language drawn from neuroscience and cognitive psychology that frames autism as an indissoluble aspect of identity.
Students often read Foucault as claiming moral treatment was "bad" and physical restraint was "better." That is not the argument. Foucault's point is that moral treatment involved a different form of power, not the absence of power.
It is common to treat the looping effect as though it applies only to controversial diagnoses. Hacking's argument applies broadly: any human-science category that people become aware of has the potential to loop.
Students sometimes assume "ontology-making" means therapy is fraudulent. Shamdasani's point is descriptive, not dismissive. Therapy creates new ways of being; whether that is good or bad depends on the case.
The phrase "making up people" does not mean the people or their suffering are fictional. It means the categories through which they understand themselves are historically constructed.
⚠️ Hacking's "looping effect" and the distinction between human kinds and natural kinds are high-frequency exam concepts. Be able to give a concrete example (e.g. "trauma," "multiple personality disorder").
⚠️ Know the key figures and their positions: Foucault (moral treatment as coercion), Rose (technologies of the self), Szasz (therapy as medicalised rhetoric/religion), Hacking (looping effect), Shamdasani (ontology-making).
⚠️ Be prepared to explain what "optional ontologies" means and give an example of resistance (e.g. the neurodiversity movement rejecting behavioural frameworks).
⚠️ The Stoic roots of CBT (Epictetus, Ellis, Beck) are a frequently tested connection between the history of philosophy and modern clinical practice.
True or false: Foucault argued that moral treatment eliminated power dynamics in the treatment of the mentally ill.
Fill in the blank: According to Nikolas Rose, psychotherapy functions as a "technology of the ______."
True or false: Hacking's "looping effect" applies only to psychiatric diagnoses, not to therapeutic categories more broadly.
Fill in the blank: Shamdasani describes psychotherapy as an "______-making practice."
True or false: Albert Ellis drew on Stoic philosophy when developing Rational Emotive Behaviour Therapy.
Q: What is Ian Hacking's "looping effect of human kinds," and how does it apply to psychotherapy?
A: The looping effect describes how categories created by the human sciences change the people who are classified by them. In psychotherapy, diagnostic and therapeutic categories (such as "trauma" or "multiple personality disorder") give people new ways to understand themselves. Once someone adopts a category, their behaviour and self-understanding change, which in turn prompts changes in the classification itself. This means therapy does not passively describe pre-existing conditions; it actively shapes the experience of those it classifies.
Q: How does Foucault's critique of moral treatment challenge the standard narrative of progressive reform in mental health care?
A: The standard narrative holds that moral treatment (late 18th century) represented a humanitarian advance: kindness and family-like environments replaced chains and confinement. Foucault argued that this shift did not eliminate power but transformed it. The familial metaphor masked judgement and punishment behind a veneer of benevolence. The patient was still controlled, but now through guilt, moral expectation, and the simulation of family dynamics rather than physical restraint.
Q: Explain what Shamdasani means by "optional ontologies" in psychotherapy, and give one example of resistance to a therapeutic ontology.
A: Shamdasani argues that different therapeutic traditions generate different frameworks for understanding the self, the mind, and reality. These are "optional" because clients can adopt or reject them. An example of resistance is the neurodiversity movement: autistic self-advocates have rejected the behavioural ontology (which treats autism as a collection of modifiable behaviours) and instead mobilised a neuroscience-based framework that treats autism as an intrinsic aspect of identity deserving societal recognition, not correction.
Q: What role does Nikolas Rose assign to psychotherapy in liberal democratic societies?
A: Rose argues that psychotherapy functions as a "technology of the self" essential to liberal democracies. These societies require citizens who can regulate their own emotions and behaviour autonomously. Psychotherapy enables "competent autonomous selfhood" at the individual level, which in turn sustains the functioning of the wider political order. Therapy, in this view, is not just a clinical tool; it is a structural feature of how liberal societies govern.
This material links closely to the sociology of mental health and to debates about the social construction of psychiatric diagnosis (compare with critiques of the DSM). It also connects to epistemology and the philosophy of science: questions about what counts as "evidence" in psychology echo broader debates about scientific method. If you are studying political philosophy or social theory, Rose's argument about technologies of the self is directly relevant to discussions of governmentality and neo-liberalism.
Related Terms / Search Tags: Foucault moral treatment, Nikolas Rose technologies of the self, Ian Hacking looping effect, human kinds, making up people, Thomas Szasz myth of psychotherapy, anti-psychiatry, Shamdasani ontology-making, optional ontologies, Stoicism and CBT, Epictetus, Albert Ellis REBT, Aaron Beck, neurodiversity, history of psychology critique, psy-disciplines, governmentality