Book Review
Book Review | The Distance Cure: A History of Teletherapy, by Hannah Zeavin (MIT Press, 2021)
University of Virginia
eae2f@virginia.edu
We are surrounded by remote or “virtual” therapy. During the COVID-19 pandemic, remote therapy services have been increasingly promoted by insurance companies, podcast advertisements, Reddit forums, and corporate wellness offices as a plausible solution to the rising rates of depression and other mental health concerns exacerbated by death, unemployment, and endless uncertainty. But remote therapy has a history before Zoom. As Hannah Zeavin argues in The Distance Cure: A History of Teletherapy, media have always been core to therapeutic relationships and practices, bridging physical and emotional distances.
Zeavin’s book is a deeply researched and compellingly articulated history of therapy as a technologically mediated socio-medical practice fundamentally based in communication. Covering over one hundred years, this book situates its subject within and in opposition to existing histories of media and psychology. Therapeutic broadcasting and crisis telephone lines are rarely part of (conventional) media histories, which have focused on other genres and audiences. Zeavin demonstrates that what we know about media history is echoed and enriched by these new objects of analysis. Similarly, Zeavin notes the structuring absence of mediation from received histories of psychotherapy. To tell these linked stories across a capacious variety of time frames and examples, Zeavin maintains a tight focus on mediation and its relationships to the forms of therapy in question.
Mediation is a framing that encourages us to focus not only on media technologies or institutions but on the contexts, relationships, and processes by which meaning is made. Mediation suffuses social life and shapes our understandings of reality and each other. As media theorists Sarah Kember and Joanna Zyliska propose, mediation can be understood as an entanglement of bodies and technologies, “an intrinsic condition of being-in, and becoming-with, the technological world” (2014, 1). Such an interrelationship of media, bodies, situation, and practice guides The Distance Cure, allowing Zeavin to challenge taken-for-granted ideas about how media “replace” or “dilute” in-person forms of communication (and therapy).
The core of this book is the argument that mediation is not a disruptor of the patient-therapist dyad but has always been a “third party” in the therapeutic relationship; ritualized communication and its (often mediated) forms of exchange are central to the very functions of therapy. As Zeavin writes, “media, far from getting in the way of treatment, first facilitate it and then are put out of mind” (58). Whether via letters, broadcasts, or computer interfaces, mediation enables people to step outside of their everyday in order to adopt and accept therapeutic modes of interaction and self-knowledge.
Individual chapters of The Distance Cure break down the details of various therapeutic media, attending to their differences in style, goals, and address. Fittingly, the first chapter considers Freud’s own use of letters to analyze himself and Little Hans, demonstrating that written communication could produce the same quality of unselfconscious disclosure associated with the “talking cure.” In these cases, Zeavin argues that the asynchronicity of letters allowed an intimacy and talking “as if” with another that fostered therapeutic interactions.
Later chapters consider radio broadcasts, suicide hotlines, automated computer programs, and online chats as various successors to Freud’s distanced therapies. These deeply researched chapters tell important and little-known histories, making them compelling reading for many historians of media and technology more broadly. The histories of World War II–era radio therapy and San Francisco’s first queer suicide hotline, conceived of as emergency responses, are particularly riveting and resonant in the present, as we watch the forms of remote access that proliferated as emergency responses to COVID-19 be discontinued in a push toward “normalcy” (Accessible Campus Action Alliance 2020).
For people with interest or experience using telehealth or app-based mental health services, the last two chapters offer analyses of computer-driven and self-directed therapies. These chapters are particularly interesting due to Zeavin’s discussions of how automated therapy and written forms (such as cognitive behavioral therapy apps) remove the therapist from the encounter, creating an autotherapeutic experience in which mediation produces necessary distance and direction. Paradoxically, in some cases, this seems to produce more pleasurable and even more successful interventions as these experiences enable a fantasy of true anonymity and self-focus. Such outcomes come with a warning, of course: Zeavin’s autoethnographic exploration of the app Talkspace indicates that prioritizing the patient as consumer may maximize fun and interactivity but does so with risks that treatment can be interrupted or partial (Talkspace refers out any patients who reference suicidal thoughts, domestic violence, or sexual assault) (213).
Throughout the monograph, Zeavin deftly develops intimacy as an overarching theme. After all, “distance is not the opposite of presence; absence is” (18), and mediated presence enables therapeutic connection. In distance, there can be a particular intimacy born of configurations of people and technologies and enabling forms of connection, care, and help. Zeavin describes this as “distanced intimacy,” which operates dialectically, as a distance that must be crossed to foster intimacy even as distance serves as a shield from becoming too close, enabling disclosure. Zeavin also discusses the “intimate strangers” of hotlines, who listen without adding their own information, holding space for callers’ disclosures (111), and the “auto-intimacy” of written and automated systems, in which a media object enables a “closed circuit of self-communication” (133). The choice to highlight intimacy—over and instead of the implied value of physical proximity—reflects the care with which Zeavin approaches this topic (also evident in methodological discussions about privacy and disclosure). Rather than taking for granted the ways in which therapy has talked about itself in authoritative and institutional sources, Zeavin’s turn to mediated therapy reveals some of what has been core to the therapeutic experience all along.
Furthermore, Zeavin demonstrates that distance enables access financially, physically, and otherwise. She is not overly optimistic about such access, noting that therapy is shaped by yet another medium—money (Swartz 2020)—and is too often too expensive. Efforts to broader access to therapy have often relied upon increased mediation to reduce costs and simultaneously reduce the availability of dedicated professional attention. Yet Zeavin cautions that beyond the technological possibilities of tele-, mediated, or automated therapies ought to lie a concern about exactly what help is offered and what limitations enforced. When remote therapy is treated as a cost-saving measure (for industries or patients), it often results in different standards of care; there can be good remote therapy, but not all forms of remote therapy are necessarily so.
Like any thematic history, the work of this book is partial. It is limited in geographic and linguistic scope, focused on Western English-speaking contexts. In places, important historical and geographical differences are collapsed, as in the chapter on radio therapy, which glides between significant national and political economic differences in radio as technology and industry. Furthermore, there is a history of therapy itself—the rise and decline of psychoanalysis, the dominance of cognitive behavioral therapy, and the institutional contexts of education, licensing, and insurance companies—that shines through Zeavin’s work, but is not covered in detail. These gaps are not faults of the monograph but are areas in which the reader’s knowledge may be taken for granted (or, potentially, their interest piqued).
Ultimately, in The Distance Cure, Zeavin produces a historical account that speaks to the present and the future. Not a book about invention or introduction, Zeavin’s historical facility draws attention to how these mediations of therapy are “adopted, exploited, and made part of everyday life” (22). Should visions of virtual reality come to dominate available therapeutic offerings, Zeavin’s book will still enable us to make sense of how these technological mediations work for or against the establishment of intimacy and the possibilities of therapeutic treatment.
References
Accessible Campus Action Alliance. 2020. “Beyond ‘High Risk’: Statement on Disability and Campus Re-openings.” https://bit.ly/accesscampusalliance.
Kember, Sarah, and Joanna Zylinska. 2014. Life after New Media: Mediation as a Vital Process. Reprint edition. Cambridge, MA: MIT Press.
Swartz, Lana. 2020. New Money: How Payment Became Social Media. Illustrated edition. New Haven, CT: Yale University Press.
Author Bio
Elizabeth Ellcessor is associate professor in media studies at the University of Virginia. She is the author of In Case of Emergency: How Technologies Mediate Crisis and Normalize Inequality (New York University Press, 2022) and Restricted Access: Media, Disability, and the Politics of Participation (New York University Press, 2016).