This essay argues that psychotherapy is not a neutral medium. From its invention in the laboratories and salons of late nineteenth century Europe, to its consolidation as a credentialed service with diagnostic codes and productivity quotas, therapy has been a social technology for manufacturing legible people. The promise is relief and clarity. The risk is alignment and conformity. When financial incentives, accreditation rubrics, and digital metrics surround the clinical hour, the therapeutic frame becomes a mold.
I flew to Mexico recently. In the local market, I wandered into a small local restaurant where almost no one spoke English. At the far table sat a French woman, also alone, also reading the room the way travelers do. I sensed an invitation and walked over. We talked.
She was on a short break from her role at a well known multinational based in France. She was the Director of Ethics in that company. Smart, dry sense of humor, opinions that landed clean. We spent the next day orbiting the neighborhood together, tasting things, naming what we liked about the city. It all moved easily.
On my last evening I asked if she wanted to watch the sunset at the beach. She did. We sat where the sand turns firm and talked about the deep stuff. Families. Work. Relationships. The talk carried a warm charge. Nothing indecent. Not cold either.
In the middle of a light tease she said, Why do men lie so much. I heard the door she was opening and asked, Who has been lying to you. She smiled the way people do when the truth is about to cost them. Then she mentioned about her boyfriend back home.
I felt at dis-ease. I have a personal line about private time with partnered people. It formed after some years of watching how minds load caches without noticing and how boundaries are important. That is a longer piece for another day. In that moment I asked the obvious question. Why did you not tell me before. She looked puzzled. As if the omission was unimportant. Perhaps cultural. Perhaps convenience.
I said goodnight and walked back to the hotel thinking about her job title. Ethics. A senior role in a company that publishes codes, holds trainings, and writes reports. In her private life the boundary was elastic enough with no clear boundaries.
When a partnered person does this, it was proximity & validation seeking outside the dyad. It was a boundary test with her own self. In ordinary language it is infidelity.
But the point is not to indict her. It is to notice the gap between role and life.
When ethics becomes a profession it often functions as concentration rather than transformation. Under the spotlight the language is precise & ethical. Off stage the line is thin. That gap is the personal version of institutional drift.
Now scale the pattern. Companies perform ethics in panels, policies, and attestation dashboards. The public sees care. Inside the building the bonus plan and the calendar keep running the show. Nothing criminal at face. Yet when the people who author the codes are comfortable sliding their own boundaries in private, it becomes easy to overlook the way a firm slides its stated values in practice. Not from malice. From a cultivated habit of compartmentalization. Role morality at work. Personal exceptions off stage.
Ethics as industry, and the disturbed moralist
When ethics becomes a career track, a budget line, and a communications asset, it often functions as a reputational veil for power rather than a brake on it. The most fervent people gravitating toward professionalized ethics frequently show a psychology that seeks control of outer narratives in order to quiet inner chaos. Ethics then works only inside a narrow cone of attention, what you called concentration, and dissolves when real incentives take the stage.
1) Why many who gravitate to ethics appear disturbed: a clinical sketch
This is not a universal claim, it is a pattern.
- Inner volatility seeking outer order: high baseline anxiety, high conscientiousness coupled with high neuroticism, strong disgust sensitivity, low tolerance for ambiguity. These people search for rules in order to quiet noise. Ethics offers rules that feel noble rather than compulsive.
- Overactive error watching and shame vigilance: a life history of punitive evaluation produces a chronic sense of wrongness. Ethical language provides a socially admired channel for constant fault finding, now cast as courage.
- Identity through moral talk: if personal identity feels unstable, moral certainty gives a spine. Grandstanding, purity tests, and escalating demands for alignment supply intermittent reinforcement. The person is soothed by clarity and by applause.
- Projection and displacement: unowned aggression and envy are relocated into public crusades. The enemy carries the shadow. The stage becomes a confessional that looks like a tribunal.
- Control by catechism: scripts, checklists, compliance rituals. These tools create the sensation of moral progress while keeping the underlying conflicts untouched. Private lives remain chaotic, public lives look exact.
2) Why the ethics industry behaves like a front: a brainstorm of mechanisms
Think of these as levers that convert ethics into optics.
- Budget as shield: when a firm funds an ethics office, it purchases plausible deniability. The existence of a function is treated as evidence of virtue, regardless of outcomes.
- Metrics as theatre: codes of conduct, training completions, attestation rates. Numbers are displayed to boards and regulators. The numbers say we care. They rarely measure externalities or harm.
- Language laundering: difficult acts are renamed with soft terms. Extraction becomes engagement, surveillance becomes safety, lock in becomes loyalty. Ethical talk becomes a solvent that removes friction from the same practices.
- Rotating door of legitimacy: ethicists consult for the same entities they later critique, then they return again. Everyone is both advisor and auditor. Conflict of interest becomes culture.
- Risk transfer to the user: consent boxes, policy pages, and choice architectures move responsibility to the individual. The system is declared ethical because the user clicked agree.
- Narrative capture: panels, white papers, and summits set the frame. The questions allowed on stage do more work than the answers. Out of frame harms vanish.
3) Why ethics often does not matter once you see how the world operates
Ethics without constraint and counterpower is a costume. Several regularities explain the failure.
- Incentives outrun ideals: what is rewarded repeats. Bonus plans, market share goals, election cycles, and venture timelines create gravity. Ethical language floats unless tied to pay, promotion, and permission.
- Goodhart and gaming: once a moral value is measured, the measure is gamed. The dashboard improves while reality worsens. This is how compliance rates rise while culture rots.
- Principal and agent drift: those who speak for the public are paid by private budgets. Without hard separation of powers, ethics becomes PR in academic dress.
- Selection effects: people who remain inside institutions are those who can metabolize the gap between stated values and operational reality. Those who cannot leave. The observable population will therefore skew toward comfortable rationalizers.
- Power writes the epilogue: after any scandal the winner writes the lessons learned deck. The same structure survives with a new pledge.
4) The paradox case: if ethics mattered, the ethicists would be ethical
The personal lives of professional moralists are frequently turbulent. Rather than disqualify the work, this exposes its psychic function.
Status addiction: public righteousness becomes a source of self worth. Any retreat from that posture feels like death. Thus the professional must keep producing moral performances, even while the life behind the curtain frays.
Ethics is steady only where character and constraint meet. Without constraint, ethics becomes a mood light that casts a clean color on the same machinery. Without character, even those charged with guarding the line step over it when the room feels private.
Ethics as self medication: moralizing gives relief from inner conflict. It is concentration, not transformation. The person can perform clarity for an hour on stage while their private boundaries remain porous.
Compartmentalization as skill: one learns to place ethical attention in a spotlight. Wherever the light falls, rules apply. Outside the beam, appetite rules. Institutions reward this spotlight talent because it keeps the show going.
Transfer failure: ethical talk does not generalize across contexts because the talk was never integrated with desire and shame. It was bolt on, not rebuild. The person can write a code of conduct and break commitments at home without a felt contradiction.
Now, Let’s extend this past Ethics…
Similar departments are built the same way, especially Therapy. Commercial therapy is for the Boardrooms. The machine purrs, Board-members are happy.
Relief is often rented from institutions that need you legible first and free second. If a method makes you easier to manage, the market will love it. If a method makes you harder to exploit, the market will call it unrealistic.
That is the ground we are standing on. The writers of codes are flawed in familiar ways. The industries that sell self improvement or self discipline mostly sell smoother gears. The rest of this chapter is a map of why and how.
1. A short prehistory of therapy
Therapy begins as a change in who we confess to and what we think a confession does. In an earlier Europe you confessed to God through a priest in order to reconcile with a cosmic order. In a later Europe you confessed to a doctor or a doctor like figure in order to reconcile with your own mind and with the demands of a modern city. The room changed, the furniture changed, the expected outcomes changed. What did not change was the basic promise. Place your life inside a narrative prepared for you and you will be allowed to return to the world with your edges sanded down.
Sigmund Freud and Josef Breuer turned spectacle into method. The spectacle was Parisian hypnosis and the public theatre of hysteria. The method was the talking cure. It said that symptoms are stories told by a body that cannot speak plainly. If you speak the right way to the right listener, the symptom can retire. This was a revolution and a translation. The revolution was the relocation of salvation from the altar to the couch. The translation was the act of taking nonverbal anguish and recoding it into professional language that could be discussed, billed, and taught.
From the beginning therapy did two things at once. It offered private relief and it produced public order. It persuaded individuals that their despair had reasons inside them that could be addressed inside them. This did not make culture irrelevant, it only made culture a background texture instead of a live participant in the room.
2. From secular confession to standardized treatment
The twentieth century taught therapy to speak the language of institutions. Manuals, randomized trials, and billing codes came first to improve reliability and predictability. The unintended result was a durable habit of treating the person as a unit of throughput.
Three great standardizers altered the room.
• Diagnostic codes turned descriptions into passports. A person became billable or not billable. The counsellor became reimbursable or not reimbursable. The label was no longer a tentative hypothesis. It was a key.
• Manuals promised to replace mystique with method. Session by session packages multiplied. Therapists learned to show fidelity to a sequence and to document it as proof of competence.
• Measurement followed. The clinical hour became a space that produced numbers at entry and numbers at exit. Numbers enabled quality reports, supervision dashboards, and cost benefit memoranda. Numbers also trained the eye to prefer what could be counted, and therefore what could be controlled.
Standardization was not sinister. It delivered real goods. It also delivered a script. The script said that progress is a scale movement, insight is a checklist item, and success is a return to baseline function. With this script in hand, schools, employers, and courts could coordinate their expectations about what a good outcome looks like.
3. Why the institution was flawed before tech money arrived
Several structural tensions were present long before platforms and venture capital entered the clinic. These tensions are useful to name because they define what money and software later magnify.
• Pathologizing as a default pressure. The intake process asks for a code. Insurance asks for a code. Grants and public health programs ask for codes. The code tends to come even when the person would be better served by a narrative without a disease name. The code is an admission ticket that gradually becomes a self description.
• Protocol versus person. A large portion of benefit in therapy can be attributed to alliance, expectations, and the bond. This is a humbling finding for every school that wants to believe the magic is in its technique. The finding does not negate technique. It simply says that outcomes lean heavily on common factors. A school that forgets this begins to fit the person to its favoured tool.
• Harm that is real but rarely counted. A non trivial minority of patients worsen in treatment. Some fashionable early interventions turned out to be not helpful at all and in some settings were associated with worse outcomes. The field has been slow to study adverse events with the same zeal it studies positive deltas.
• Dropout that is large and persistent. Many patients leave early. The reasons are diverse, but one recurring reason is mismatch. When the frame does not fit, a young or voice poor person often leaves without ever naming the rupture.
An institution that must code, must show fidelity, and must hit numbers is an institution that has difficulty honouring idiosyncratic lives. This difficulty predates tech. Tech only gives it a dashboard and a growth plan.
4. How tech money and digitization amplify the flaws
When care becomes legible to software, it becomes steerable by money. Three shifts matter.
• Measurement becomes a governor. Measurement based care is a double edged tool. It can catch deterioration early and it can hold lazy practice to account. It can also replace meaning with movement on a scale. The danger emerges when the metric becomes the master. The person learns to perform the score.
• Platformization invites extraction. Once symptoms and moods live inside phone applications, the commercial incentive to repurpose that data does not disappear simply because a privacy policy exists. The recent history of digital health platforms includes high profile cases where very sensitive data was shared in ways that violated the spirit and sometimes the letter of care.
• Funding capture sets the agenda. Public money for controversial sciences is scarce. Private money arrives faster and arrives with interests. When philanthropists and investors seed centres, fellowships, and trials, they also set priorities. The bias can be benevolent, but even a benevolent bias is still a bias.
Digitization makes therapy more transportable. It also makes it easier to audit, to benchmark, and to scale. This is a triumph for people who want wider access. It is also a triumph for people who want the clinic to serve the goals of other institutions.
5. How therapists are taught today, and why it sometimes harms
Therapist training is a mix of content knowledge, ethical formation, supervised practice, and institutional indoctrination. The last element is rarely acknowledged in public because it sounds accusatory. Indoctrination here does not mean sinister conspiracy. It means that a set of tacit assumptions is taught as if it were neutral and natural.
• Fidelity as virtue. Trainees are graded on adherence to protocols. This is understandable in research placements. It becomes less defensible when fidelity trumps fit in ordinary care. The young clinician learns to privilege the package over the particular.
• Diagnosis as a gate. Students gain fluency in checklists. They become quicker and more confident in applying labels. This helps with access to services. It also helps the label to become the story.
• Numbers or it did not happen. Scales administered every visit are meant to guide care. They can become the point of care. When a supervisor, a payer, or a platform asks for numbers first and understanding second, the trainee will learn the habit of producing numbers first.
• Risk management theatre. Every clinician knows that careful notes and careful boundaries protect patients and protect the therapist. Every clinician also knows that you can spend a significant portion of the hour documenting a life you have not had time to hear.
• Productivity quotas. Many training sites require brief protocols, short waits, and constant flows. The trainee learns to move the line. The patients who cannot keep up with that line are often the ones who most need time.
• Under education in harm. Few programs require deep study of deterioration and adverse effects in psychotherapy. Fewer still teach rupture repair as a core clinical art rather than as a side module. This leaves trainees both confident and fragile.
Every one of the above has a rational defence. Taken together they tilt the room toward throughput and away from deep attention.
6. A psychoanalysis of the therapy bound client
The institution searching person is not a stereotype. They are a cluster. They are often very open and easily moved by ideas and by images. They have strong capacities for absorption, which is the trait that measures how fully a person can be taken by a sunset, a painting, a theme from a film, a sentence in a book, or a voice that finally seems steady. Absorption and suggestibility are cousins. A person who can be carried by a vision is also a person who can be carried by a framework.
Many of these people were told repeatedly that their own readings of their life were unreliable or messy or too much. They learned to distrust their native idiom. They long for an interpreter, a credible adult, someone who can pin the tail on the donkey of their despair. They are often young or relatively new to the adult institutions that allocate permission and money and status. They do not yet have a bureaucracy proof voice.
In a clinic staffed by older adults with fluent frameworks, the young open person will often get relief and a new script at the same time. Relief is the experience that something finally holds. The script is the map of what counts as progress. If the map is too narrow, the person will return again and again to stay inside its borders. If the map is generous, the person will be coached to write their own legend. The hazard here is not malice. It is the quiet fact that a hungry imagination tends to eat whatever it is fed by the most confident adult in the room.
When such a person meets psychedelics, all dials turn up. Their absorbent mind becomes a porous mind. Their private metaphors become more vivid and more available to edit. If the guide has a strong worldview, the worldview can enter like a dye in clear water.
7. Kitchens on psychedelics, from healing to molding
Travis Kitchens describes a cultural fusion that presents itself as an innovation in care. The fusion is between therapy, spirituality, and elite sponsorship. The message says that a new sacrament has been found that can heal trauma, rescue meaning, and restore communities. The delivery device is a clinical protocol. The setting is part hospital, part chapel. The integration work after the dose uses a language that is partly cognitive and partly liturgical. The philanthropists and the venture capitalists provide the stonework and the stage lighting. The studies are conducted, the press releases are issued, the clergy are invited to pilot programs. The story is simple. The modern heart is broken. Here is a medicine that makes people whole and useful again.
Kitchens does not deny that people suffer or that medicines can help. His worry is sculptural. He says that psychedelic therapy is a particularly powerful mold, because it operates when minds are especially suggestible and especially plastic, and because it comes bundled with a narrative that says all religions share a hidden core and all good lives share a familiar set of virtues. He says that this narrative is not a discovery. It is an agenda. He notes the way donor networks, universities, media, and start ups amplify one another and present this agenda as a scientific deliverable. He calls attention to clergy experiments, spiritualized branding, and the ease with which unproven claims about ancient sacramental history are repeated as orientation material for modern patients.
You do not have to share every one of his suspicions to feel the force of his central point. If suggestibility is high and plasticity is high, then whoever sets the stage and tells the story has unusual power over what will be learned during that short window. If the story is the sponsor’s story, then the person will exit the room more compatible with the sponsor’s ideal of a healed citizen.
8. The science that makes molding feasible
The strength of the warning depends on three pillars.
• Set and setting are not decoration. They determine what kind of experience is likely to occur. Modern protocols turn set and setting into a script with chosen music, chosen symbols, chosen pre session priming, and chosen post session activities. These choices are never neutral.
• Suggestibility increases under classic psychedelics. This is a measured effect. It does not mean that a person becomes a puppet. It does mean that verbal and narrative cues have more influence on how the acute experience is shaped and on how it will be encoded in memory.
• Plasticity increases. Changes at the level of dendritic spines and synapses follow psychedelic dosing in animal models and are supported by early evidence in humans. Some drugs appear to reopen critical periods for social learning. A critical period is a time when the brain is unusually ready to learn certain patterns. To reopen such a period is to unlock an unusual learning window.
Put these together and you get an instrument that can do a lot of good in the hands of a careful team that knows how to bracket its own metaphysics and centre the patient’s language. You also get an instrument that can be used to write a preferred alignment into a person who arrived porous and hopeful.
9. The corporate history of molding people at scale
Institutions adopt whatever works to shape attention, emotion, and belief. There is a long record of using therapeutic looking practices to accomplish non therapeutic goals.
• Corporate mindfulness. There is mindfulness that is contemplative and community building and there is mindfulness that is human resources friendly. The latter teaches workers to manage stress without asking if the structure that produces the stress ought to be questioned. It trains attention and acceptance. It does not train organised refusal. Its vocabulary is inner. It is easy to admire because it reduces immediate suffering. It is easy to adopt because it reduces friction at work.
• Wellness dashboards and employer programs. Large employers bought programs that promised lower medical costs and higher productivity. Many of these programs produced thin changes if any. The dashboards however produced a spectacle of measurement and a channel for collecting more sensitive data. The optics were good. The returns were unclear. The data was valuable.
• Dark pattern interfaces and emotional experiments. Social platforms discovered that they could move user feeling by arranging feeds. They discovered that they could increase or decrease the probability of actions by changing the colour or the location of a button. They discovered that default choices will be accepted by a large majority of people, who will describe their acceptance as a free decision.
• Psychographic targeting. After a season of denial, a season of contrition and litigation arrived. The short lesson is that data sets of traits can be used to serve messages to micro groups with a precision that feels like intimacy and is in fact a simulation of intimacy. The simulation is efficient for persuasion.
• Pharmaceutical marketing through key opinion leaders. Education becomes marketing when incentives are misaligned. Entire epidemics can be worsened by the production of glowing narratives about safety and the minimisation of warnings. The system learns how to recruit curiosity and authority into pipelines that sell while educating.
• Digital mental health as an advertising pipeline. The very platforms that promised care were caught treating the sorrow of their users as fuel for targeted advertising. The surprise this produced was a measure of how strongly people want to believe that therapy is exempt from the logics of the attention economy.
The value of this history is that it kills naiveté. The point is not that every corporation is a cartoon villain. The point is that once a method for shaping people works, it is placed in service of commercial and political interests as surely as water runs downhill.
Closing remarks
A culture that wants free people must be suspicious of every method that promises improvement without asking improvement toward what. Therapy is one such method. It has real power to relieve suffering. It also has real power to domesticate souls. The more the method becomes legible to institutions, the more those institutions will recruit it to their projects. The arrival of psychedelics does not change that logic. It intensifies it. If a medicine heightens suggestibility and opens plastic windows, a person can heal more quickly and a person can be molded more quickly. Which one happens depends on the ethics of the room, the humility of the guides, the clarity of the consent, and the ability of the seeker to keep their own language alive when everyone else in the room has a nicer vocabulary.
My argument is not a negation of care. It is a request that we attend to the political economy of care. Who funds the room. Who writes the script. Whose myths are given the microphone. If you will keep those questions alive, you can ask for help without handing over your voice. That is the spirit of the third stage in your previous essay. Accept your raw nature. Accept the mess. Make the world accommodate you at least as often as you accommodate the world.
Footnote Observations:
People are not Statues. We are weather. Place the same person beside three different observers and you get three different readings of the sky. A mother sees duty and fatigue. A lover sees voltage and doubt. A manager sees throughput or drag. None of these views is false and none is complete. The self is an interference pattern made by temperament, history, and the eyes that fall upon it. Change the eyes and the pattern shifts. In that sense personality is not a single object but a moving border between inner impulses and social mirrors.
Now set that variable self inside a fixed frame. Psychology and psychotherapy are not neutral lenses. They are grammars decided by committees and taught by schools and enforced by payers. A grammar does two things. It lets you speak and it dictates what can be said. The DSM is a grammar. Manualized treatments are grammars. Measurement based care is a grammar. These grammars do not simply describe the person. They require the person to show up in forms they can process. If you want help, you must adopt the grammar. If you want to be reimbursed, you must adopt the grammar. In time the grammar adopts you.
Once a grammar is installed, variability turns into compliance. What was once a wide emotional topography is redrawn into lanes that the clinic can count and improve. A young man arrives with restlessness, ambition, shame, tenderness, and a private myth about becoming someone worth his father’s time. The grammar will translate this mix into anxiety, cognitive distortions, exposure tasks, and a score to be moved two points by week eight. This is not malevolent. It is administrative. And administration is a strong solvent of difference.
Notice the sleight of hand. The field markets itself as the study of human variability while its operational core is the production of legible people. It promises you will be understood as you are and then teaches you to become the kind of person it can understand efficiently. The movement is from mess to method. The price of admission is a narrowing of possible selves to those that the manual can handle.
A small example makes this plain. In a first session a person uses homemade language. They say their heart feels like a room with the furniture nailed to the ceiling. The therapist nods, writes, and later speaks about catastrophizing and safety behaviors. A second session arrives. The person repeats the therapist’s words back. The third session arrives. The person begins to experience their heart in the therapist’s vocabulary. The original image fades. It was too odd for the chart. The chart wins.
It is worse in institutions that value speed. When a clinic must demonstrate movement on scales every fortnight, complexity becomes an enemy. The therapist learns to chase metrics and the patient learns to produce the correct answers. Both can be sincere. Both can be relieved. Both can be misled. The variable self has been converted into a predictable product that satisfies the group’s definition of progress.
The integration frame becomes the grammar into which the experience will harden. If the frame belongs to a perennialist lab, you will exit with perennialist conclusions. If the frame belongs to a productivity church, you will exit with a renewed willingness to bear the load. Underneath the beauty of the experience is a mundane fact. In the hour when a person is most impressionable, the group’s story is the loudest sound in the room. The variable self learns the tune and hums it for months.
Some will say this is simply how all learning works. We cannot live without shared grammars. True. The question is who gets to write them and how tightly they are bound to enforcement. A grammar that helps you speak your own life is a tool. A grammar that makes you legible to systems at the cost of your private oddness is a mold.
Most of all it means recognizing that the group behind the grammar is never just a group of scientists. It is a circle of power with budgets and calendars and reputations to protect. When such a circle decides what counts as mind, the result will mirror the needs of the circle. The field will call this progress. The person will experience it as an invitation to become easier to manage.
You can test this quickly. Ask a therapist to sit for an hour without importing any of their favored terms. Ask them to work only with the patient’s images and verbs. If they cannot or will not, you have found the line where individualized care yields to group doctrine. If you then add a drug that makes doctrines glide more easily into memory, you have found the moment when psychology becomes not a study of difference but a method for domestication.
This is the practical definition we are circling. Psychology as institution is a medium for changing variables into constants that suit the committees who define what a constant should be. The work can relieve pain. It can also erase the very strangeness that makes a life worth saving. A free culture would design rooms that hold variability without forcing it into costumes. A captured culture designs rooms that sculpt variability into workforce harmony and reputational peace. We already know which rooms dominate. The task is not to abolish them. The task is to enter them with your own grammar intact and to refuse any treatment plan that cannot repeat your sentences back to you without translation.