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Ts 100 Tz 0 Tr 6.8671 0 0 6.8671 18 601.7887 Tm (Hoover Institution - Policy Review - The Rise of the Caring Industry)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC Q /CS0 cs /P0 scn 27.468 559.595 764.532 34.405 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 1 1 1 rg 27.468 18 744.694 576 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 29.757 18 611.931 576 re f 0.8 0.8 0.8 rg 28.994 594 m 28.994 18 l 29.757 18 l 29.757 594 l h f 642.451 594 m 642.451 18 l 641.688 18 l 641.688 594 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.8 1 rg 30.52 436.271 610.405 51.808 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.922 0.922 0.922 rg 644.74 18 125.133 576 re f 0.8 0.8 0.8 rg 643.977 594 m 643.977 18 l 644.74 18 l 644.74 594 l h f 770.636 594 m 770.636 18 l 769.873 18 l 769.873 594 l h f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 10.6821 0 0 10.6821 30.5202 584.858 Tm (nurse psychotherapists and life coaches didn\222t even exist. We\222ve e\ xperienced a more than 100)Tj /TT1 1 Tf (-fold increase)Tj /TT0 1 Tf ( in the number of )Tj 0 -1.201 TD (professional caregivers over the last 60 years, although the general pop\ ulation has only doubled.)Tj 0 -2.557 TD (What accounts for this great change? True, professional caregivers aggre\ ssively promote themselves, but that fails to explain )Tj 0 -1.2 TD (why their services are in such high demand. For example, restrictions on\ who can \223care\224 creates a shortage that credentialed )Tj T* (caregivers eagerly fill. Yet life coaches, who lack licenses and a state\ -awarded monopoly, have increased at the same rate as )Tj T* (licensed caregivers.)Tj /TT1 1 Tf 16.0231 0 0 16.0231 37.1965 467.7134 Tm (People want to be able to go about their daily lives with the knowledge \ that )Tj 0 -1.2 TD (someone is there for them. )Tj /TT0 1 Tf 10.6821 0 0 10.6821 30.5202 412.6319 Tm (The answer lies in the people themselves \227 in the general culture. Th\ e American people want professional caregivers. And yet )Tj T* (the conventional cultural explanation for their desire is equally flawed\ . Many conservatives view psychotherapy with suspicion; )Tj T* (they think it encourages self-absorption, which leads to more emotional \ trouble that can only be treated with more therapy. )Tj 0 -1.2 TD (Hence, the growth in the number of therapists. This view predates Christ\ opher Lasch\222s )Tj /TT1 1 Tf (The Culture of Narcissism)Tj /TT0 1 Tf ( \(1979\), but it\222s )Tj 0 -1.201 TD (a view that Lasch, although not a conservative, popularized. Many conser\ vatives have accepted this narrative, most recently )Tj 0 -1.2 TD (Sally Satel and Christina Hoff Sommers in )Tj /TT1 1 Tf (One Nation Under Therapy)Tj /TT0 1 Tf ( and Joyce Milton in )Tj /TT1 1 Tf (The Road to Malpsychia)Tj /TT0 1 Tf (.)Tj 0 -2.559 TD (Yet this narrative is only half true. Many people who go to counselors s\ hare nothing with the stereotypical self-absorbed )Tj 0 -1.2 TD (neurotic. On the contrary, they are average people with conventional val\ ues who face real-life problems but have no one to talk )Tj T* (to. Fully a third of the American population has undergone some form of \ psychotherapy. It strains the imagination to think that )Tj T* (the majority of them are narcissists.)Tj 0 -2.557 TD (Moreover, psychotherapy has undergone enormous change over the years, wi\ th most of its narcissistic tendencies having been )Tj 0 -1.2 TD (stripped away. Traditional long-term psychoanalysis, where a therapist s\ pends years poring over the most insignificant details o)Tj (f )Tj 0 -1.2 TD (patient\222s life, has given way to what is called \223short-term therap\ y\224 \227 therapy conducted over a period of 20 sessions and )Tj 0 -1.2 TD (typically lasting no more than six sessions. Traditional psychotherapy s\ eeks to explain a person\222s problem in depth; short-term )Tj T* (therapy seeks only to solve that problem, whether or not an explanation \ for the problem can be found, and so requires less time.)Tj ( )Tj T* (Most psychologists, social workers, counselors, and life coaches operate\ these days within the short-term therapy framework. )Tj T* (By focusing on a person\222s problem, short-term therapy mimics the expe\ rience of real friendship. People don\222t expect a real frien)Tj (d )Tj T* (to psychoanalyze them when they have a life problem; they expect a frien\ d to suggest a course of action, or to at least raise th)Tj (eir )Tj T* (spirits. They expect a friend to advise them or help them feel better.)Tj 0 -2.557 TD (In fact, this new therapeutic style is key to understanding the growth i\ n the number of caring professionals and, indeed, the ri)Tj (se )Tj 0 -1.2 TD (of an entire \223caring industry.\224 Today\222s caring professionals of\ fer the same service to lonely, unhappy people that friends and )Tj T* (relatives once did. They do so because so many Americans are lonely and \ unhappy.)Tj 0 -2.557 TD (Recent scholarship confirms the sad state of affairs. In 1985, 10)Tj ( percent of Americans had no discussion partner of any kind; by )Tj 0 -1.2 TD (2004, that number had increased to 25 percent. In 1985, 15 percent of Am\ ericans had only one person to talk to about a life )Tj T* (problem, which even optimists call inadequate social support, since it m\ akes a person very vulnerable to losing that lone )Tj T* (relationship. By 2004, that number had increased to 20 percent.)Tj ET EMC /Article <>BDC Q q 0 18 792 576 re W* n q 61.0404663 0 0 104.5317993 678.693634 489.4682007 cm /Im0 Do Q 0 0 0 rg BT /TT0 1 Tf 10.6821 0 0 10.6821 739.7341 489.4682 Tm ( )Tj 0.2 0.2 0.6 rg 5.341 0 0 5.341 693.3323 482.2889 Tm (On the Cover )Tj 0 0 0 rg /TT2 1 Tf 10.6821 0 0 10.6821 649.3179 445.8041 Tm (TOOLS: )Tj ET q 64.855484 0 0 13.7341003 650.8439331 425.5142212 cm /Im1 Do Q BT /TT2 1 Tf 10.6821 0 0 10.6821 717.2254 423.9882 Tm ( )Tj ET q 62.5664673 0 0 13.7341003 650.8439331 408.7280884 cm /Im2 Do Q BT /TT2 1 Tf 10.6821 0 0 10.6821 714.9364 407.2021 Tm ( )Tj ET q 61.0404663 0 0 13.7341003 650.8439331 391.9419708 cm /Im3 Do Q BT /TT2 1 Tf 10.6821 0 0 10.6821 713.4104 390.416 Tm ( )Tj ET q 83.1676331 0 0 13.7341003 650.8439331 375.155838 cm /Im4 Do Q BT /TT2 1 Tf 10.6821 0 0 10.6821 735.5376 373.6298 Tm ( )Tj -8.071 -2.951 Td (FOLLOW THE )Tj 0 -1.2 TD (HOOVER )Tj T* (INSTITUTION:)Tj /TT0 1 Tf ( )Tj ET q 73.6300507 0 0 24.4161835 649.3179169 273.8848267 cm /Im5 Do Q BT /TT0 1 Tf 10.6821 0 0 10.6821 722.948 286.0929 Tm ( )Tj ET q 79.2572327 0 0 18.3121338 649.3179169 247.9426422 cm /Im6 Do Q BT /TT0 1 Tf 10.6821 0 0 10.6821 728.5751 257.0987 Tm ( )Tj ET q 50.3583832 0 0 18.3121338 649.3179169 222.0004425 cm /Im7 Do Q BT /TT0 1 Tf 10.6821 0 0 10.6821 699.6763 231.1565 Tm ( )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 6.8671 0 0 6.8671 18 8.7887 Tm (http://www.hoover.org/publications/policyreview/94880989.html \(2 of 12\)\ 6/2/2010 12:43:19 PM)Tj ET EMC EMC endstream endobj 205 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 6.8671 0 0 6.8671 18 601.7887 Tm (Hoover Institution - Policy Review - The Rise of the Caring Industry)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC EMC /Artifact <>BDC Q 1 1 1 rg 27.468 18 744.694 576 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 29.757 18 611.931 576 re f 0.8 0.8 0.8 rg 28.994 594 m 28.994 18 l 29.757 18 l 29.757 594 l h f 642.451 594 m 642.451 18 l 641.688 18 l 641.688 594 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.8 1 rg 30.52 233.095 610.405 51.808 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.922 0.922 0.922 rg 644.74 18 125.133 576 re f 0.8 0.8 0.8 rg 643.977 594 m 643.977 18 l 644.74 18 l 644.74 594 l h f 770.636 594 m 770.636 18 l 769.873 18 l 769.873 594 l h f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 10.6821 0 0 10.6821 30.5202 582.8338 Tm (Half of all Americans today are lonely. Not only lonely but also unhappy\ . An estimated 20 percent of the population exhibits )Tj 0 -1.2 TD (symptoms of anxiety and depression, and in some states the prevalence of\ symptoms is closer to 30 percent. An estimated 95 )Tj T* (percent of Americans have low self-esteem. Consistent with these trends,\ at least 15 percent of Americans are now on a )Tj 0 -1.561 TD (psychoactive drug at any given moment.)Tj 0.2 0.2 0.6 rg 8.5457 0 0 8.5457 221.6974 545.9931 Tm (1)Tj 0 0 0 rg 10.6821 0 0 10.6821 30.5202 513.2083 Tm (People want to be able to go about their daily lives with the knowledge \ that someone is there for them. This basic truth led to )Tj (the )Tj 0 -1.2 TD (rise of the caring industry. Millions of unhappy people use professional\ counselors to compensate for having no one to talk to )Tj T* (about their everyday problems. Separated and divorced women use psychoth\ erapy most of all. Because the caring industry )Tj 0 -1.2 TD (arose so swiftly, and because the caring relationship approximates the e\ xperience of real friendship, and because the \223caring )Tj 0 -1.2 TD (solution\224 to mass loneliness and mass unhappiness seems to work, it d\ oesn\222t bother people very much.)Tj 0 -2.557 TD (Nevertheless, the caring industry is an artificial creation without hist\ orical precedent. The wheels of life keep rolling around)Tj ( with )Tj 0 -1.2 TD (an alluring smoothness in America \227 people still build businesses and\ go to work \227 but the wheels do not roll of themselves. )Tj T* (The skill and care of trained professionals are needed to keep them goin\ g, and the task is no light one. Under our very noses a )Tj T* (revolution has occurred in the personal dimension of life such that mill\ ions of Americans must now pay professionals to listen t)Tj (o )Tj T* (their everyday life problems.)Tj /TT1 1 Tf 0 -2.58 TD (Back to the 1950s)Tj /TT0 1 Tf 0 -2.534 TD (Students of american)Tj ( culture have felt the necessity of going back to the origins of today\222\ s sensibilities, but none of them has )Tj 0 -1.2 TD (ever arrived there. They consistently stop at the turbulent 1960)Tj (s, but to understand the rise of the caring industry they must go )Tj T* (back another decade, to the seemingly placid 1950s, when mass happiness \ and mass loneliness began.)Tj /TT2 1 Tf 16.0231 0 0 16.0231 37.1965 264.5372 Tm (The peer groups described by the sociologists of the 1950s were typicall\ y composed )Tj 0 -1.2 TD (of authority figures, relatives, and friends. )Tj /TT0 1 Tf 10.6821 0 0 10.6821 30.5202 209.4557 Tm (So great was people\222s unhappiness during the 1950s, and so suddenly d\ id it emerge, that both the political and medical )Tj T* (authorities called it a \223mental health crisis.\224 Rates of alcoholis\ m and juvenile delinquency skyrocketed during the decade, whic)Tj (h )Tj T* (popular magazines dubbed the \223Age of Anxiety.\224 The signs and sympt\ oms of mental illness were rampant. In Manhattan alone, )Tj 0 -1.2 TD (82 percent of the population showed evidence of anxiety or depression. O\ f the 1.4 million Americans in hospitals on any given )Tj 0 -1.2 TD (day in the 1950s, 730,000 of them were in mental hospitals, with half of\ these inpatients new each year. It was estimated that )Tj T* (one out of three American families would have to admit a family member t\ o a mental hospital at some point during the decade. )Tj T* (Another 300,000 people sought help annually in outpatient psychiatric cl\ inics. Thousands more were turned away for lack of )Tj T* (mental health personnel. The afflicted were not just military veterans b\ ut people from all walks of life; they included anxious )Tj 0 -1.2 TD (housewives, frustrated businessmen, and rebellious teenagers, many of th\ em following a course of life repugnant to their minds. )Tj T* (Even if they did succeed in stifling the reproaches of their consciences\ , they still were unable to conquer their anxiety and fe)Tj (ars.)Tj 0 -2.557 TD (This mental health crisis has never ended. The Age of Anxiety in the 195\ 0s became the Age of Depression in the 1970s, 80s, )Tj 0 -1.2 TD (and 90s. Although the media have shifted emphasis, it remains the same c\ risis.)Tj 0 -2.557 TD (Mass loneliness emerged shortly afterward. During the postwar period, Am\ ericans became more mobile than ever before, such )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 6.8671 0 0 6.8671 18 8.7887 Tm (http://www.hoover.org/publications/policyreview/94880989.html \(3 of 12\)\ 6/2/2010 12:43:19 PM)Tj ET EMC EMC endstream endobj 206 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 6.8671 0 0 6.8671 18 601.7887 Tm (Hoover Institution - Policy Review - The Rise of the Caring Industry)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC EMC /Artifact <>BDC Q 1 1 1 rg 27.468 18 744.694 576 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 29.757 18 611.931 576 re f 0.8 0.8 0.8 rg 28.994 594 m 28.994 18 l 29.757 18 l 29.757 594 l h f 642.451 594 m 642.451 18 l 641.688 18 l 641.688 594 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.8 1 rg 30.52 308.102 610.405 51.808 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.922 0.922 0.922 rg 644.74 18 125.133 576 re f 0.8 0.8 0.8 rg 643.977 594 m 643.977 18 l 644.74 18 l 644.74 594 l h f 770.636 594 m 770.636 18 l 769.873 18 l 769.873 594 l h f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 10.6821 0 0 10.6821 30.5202 584.858 Tm (that by 1970)Tj ( a fifth of all Americans lived somewhere other than their hometowns. Al\ so, the nature of that mobility had changed: )Tj 0 -1.2 TD (Rather than trek in a group, Americans typically moved to new towns by t\ hemselves, and they knew no one when they arrived. )Tj T* (The 1960s also witnessed urban renewal projects that tore down impoveris\ hed but vibrant inner-city neighborhoods composed )Tj 0 -1.2 TD (of extended immigrant families and friends and replaced them with public\ housing or luxury high-rise apartments. The former )Tj 0 -1.2 TD (inhabitants of these neighborhoods moved to the suburbs, where sprawling\ distances rendered tight-knit \223urban villages\224 )Tj T* (impossible. As a third example, the number of Americans attending church\ or synagogue weekly dropped by almost 40 percent )Tj T* (from the previous decade, leaving many Americans without the peer group \ sustained by organized religion.)Tj 0 -2.557 TD (A revolution in interpersonal dynamics further compromised people\222s s\ ocial lives. The peer groups described by the sociologists )Tj 0 -1.2 TD (of the 1950s were typically composed of authority figures, relatives, an\ d friends. During the 1960s and 70)Tj (s, resentment against )Tj T* (authority figures reached intense levels of collective fury. Policemen w\ ere \223pigs,\224 soldiers were \223baby killers,\224 clergymen were)Tj ( )Tj T* (scorned, and professors were shouted down in the classroom. That some of\ these authority figures seemed infected with self-)Tj T* (doubt only worsened their impotence. Family breakdown also increased dur\ ing this period, whether because of the rising divorce )Tj T* (rate or the \223generation gap\224 causing relatives to drift apart. Fin\ ally, the new economy drew large numbers of women into the )Tj 0 -1.2 TD (workforce, while Americans in general began working longer hours. Life g\ rew hectic. Already isolated by suburban life, many )Tj 0 -1.2 TD (people found themselves with neither the time nor the energy to listen s\ ympathetically to a friend\222s problems. With the waning o)Tj (f )Tj T* (traditional authority figures and the added stresses on families and fri\ endship, peer groups collapsed.)Tj /TT1 1 Tf 16.0231 0 0 16.0231 37.1965 339.5442 Tm (With the waning of traditional authority figures and the added stresses \ on families )Tj 0 -1.2 TD (and friendship, peer groups collapsed. )Tj /TT0 1 Tf 10.6821 0 0 10.6821 30.5202 284.4627 Tm (Yet even mass loneliness has its roots in the 1950s, just as today\222s \ mass unhappiness does. The mass loneliness that began in )Tj T* (the 1960s and 70)Tj (s, and that continues on through this day, is an exterior loneliness. Bu\ t an interior loneliness had already begun )Tj T* (in the 1950)Tj (s. This fact is often ignored, since groupthink and conformism were thou\ ght to dominate that decade so thoroughly. In )Tj 0 -1.2 TD (a society like 1950s America, where peer groups at home and work policed\ virtually every aspect of life, loneliness would seem )Tj 0 -1.2 TD (to have been impossible. Even sociologists of the 1950s barely wrote on \ the subject, focusing instead on conformism. Much of )Tj T* (the sociology written during the 1950s ceased to be read after the end o\ f that decade because the aggressive individualism of )Tj T* (the 1960s and 70s made conformism the least of society\222s problems. Be\ cause this aggressive individualism led to exterior )Tj T* (loneliness, a serious problem in its own right, the problem of mass lone\ liness was naturally dated back to the 1960s and 70s, )Tj 0 -1.2 TD (and the more subtle interior loneliness of the 1950s was forgotten.)Tj 0 -2.557 TD (Yet the title of the most famous sociology book of the 1950s is )Tj /TT1 1 Tf (The Lonely Crowd)Tj /TT0 1 Tf (. Although its authors actually mention )Tj 0 -1.201 TD (loneliness only five times in the book, devoting most of their analysis \ to the opposite of loneliness \227 for example, people\222s )Tj 0 -1.2 TD (obsession with being popular, or the oppressiveness of the peer group \227\ they do discuss loneliness on the book\222s very first )Tj T* (page, noting how the new American character paradoxically \223remains a \ lonely member of the crowd because he never comes )Tj T* (really close to the others [his peers] or to himself.\224 This is interi\ or loneliness. It captures the paradox of a friendship with)Tj (out any )Tj T* (real connection between people.)Tj 0 -2.557 TD (Mass unhappiness and mass loneliness triggered the rise of the caring in\ dustry. Indeed, it is why the caring industry began its )Tj 0 -1.2 TD (exponential growth during the conservative 1950s rather than in the libe\ ral 1960s. It was in the 1950s, not in the 1960s, that )Tj T* (psychotherapy became wildly popular in the U.S. Therapy\222s novelty alo\ ne cannot explain its sudden popularity in the 1950s. )Tj T* (Freud introduced psychoanalytic ideas to America during his visit to the\ country in 1909)Tj (. For the next four decades, journalists, )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 6.8671 0 0 6.8671 18 8.7887 Tm (http://www.hoover.org/publications/policyreview/94880989.html \(4 of 12\)\ 6/2/2010 12:43:19 PM)Tj ET EMC EMC endstream endobj 207 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 6.8671 0 0 6.8671 18 601.7887 Tm (Hoover Institution - Policy Review - The Rise of the Caring Industry)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC EMC /Artifact <>BDC Q 1 1 1 rg 27.468 18 744.694 576 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 29.757 18 611.931 576 re f 0.8 0.8 0.8 rg 28.994 594 m 28.994 18 l 29.757 18 l 29.757 594 l h f 642.451 594 m 642.451 18 l 641.688 18 l 641.688 594 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.8 1 rg 30.52 18 610.405 51.463 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.922 0.922 0.922 rg 644.74 18 125.133 576 re f 0.8 0.8 0.8 rg 643.977 594 m 643.977 18 l 644.74 18 l 644.74 594 l h f 770.636 594 m 770.636 18 l 769.873 18 l 769.873 594 l h f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 10.6821 0 0 10.6821 30.5202 584.858 Tm (artists, and intellectuals hotly debated his ideas in the public space. \ Yet it was not until the 1950)Tj (s that those ideas penetrated )Tj 0 -1.2 TD (the popular culture.)Tj 0 -2.557 TD (To some degree the caring industry had no choice but to intervene. The m\ ental health crisis and mass loneliness were )Tj 0 -1.2 TD (revolutionary events that spawned real turmoil. People found themselves \ with more emotional problems than ever, and no one )Tj T* (to talk to. It was an intolerable situation. Thus, the creation of the c\ aring ethos, the caring industry, and the thousands of c)Tj (aring )Tj T* (professionals who define it.)Tj 0 -2.557 TD (Forty years ago, in his now-classic book )Tj /TT1 1 Tf (The Triumph of the Therapeutic)Tj /TT0 1 Tf (, sociologist Philip Rieff sensed that a great change had )Tj 0 -1.201 TD (come over the West. A \223therapeutic culture\224 grounded in psychother\ apy, he wrote, had replaced the \223ethos\224 of traditional society)Tj (. )Tj 0 -1.2 TD (Rieff did not know what this change signified. Nor did he know whether s\ uch a society would long endure. He could not know, for )Tj T* (he published his book in 1965, when mass unhappiness and mass loneliness\ had just taken hold. But now we know. What Rieff )Tj T* (had observed were the first stirrings of a new social order, one that wo\ uld rest on a nation-spanning network of caring )Tj T* (professionals. Today, countless institutions and millions of people are \ dependent to one degree or another on the caring )Tj 0 -1.2 TD (industry. Therapy is no longer just a \223culture.\224 In the form of pr\ ofessional caring, it has become our way of life.)Tj /TT2 1 Tf 0 -2.58 TD (The caring industry in daily life)Tj /TT0 1 Tf 0 -2.534 TD (The caring industry now stands in alter ego fashion alongside virtually \ every organized unit of state and society in the U.S. )Tj 0 -1.2 TD (Wherever there is a corporation, school, church, prison, nursing home, o\ r military installation, there is also a unit of the car)Tj (ing )Tj T* (industry. This is irrespective of whether the institution falls in the \223\ liberal\224 or \223conservative\224 camp. Sometimes a caring unit)Tj ( is an )Tj T* (official part of the institution \227 for example, a company\222s depart\ ment of human resources. More typically, it works on a )Tj T* (consultant basis, to be invited in as problems arise. I describe here ju\ st two examples: the military and the schools.)Tj /TT1 1 Tf 0 -2.557 TD (The military)Tj /TT0 1 Tf (. The caring industry\222s growing role inside the military \227 a relat\ ively conservative institution \227 is a case in point. )Tj 0 -1.201 TD (Psychologists have been associated with the military ever since they tes\ ted soldiers for combat readiness during World War I. )Tj 0 -1.2 TD (Yet well into the Vietnam War-era most military psychologists worked on \ military-related projects such as officer selection or )Tj 0 -1.2 TD (special operations. Psychiatrists and psychologists played an important \ clinical role during and after the Second World War, )Tj T* (helping soldiers cope with the psychological effects of battle and, late\ r, with readjustment to civilian life. However, it was n)Tj (ot until )Tj T* (the 1970s, after the Vietnam War, when demobilized soldiers again showed\ problems readjusting to civilian life, that )Tj T* (psychiatrists and clinical psychologists awarded these disabled veterans\ their own mental illness, called post-traumatic stress )Tj T* (disorder \(ptsd\), leading to a new and enduring kind of intervention by\ the caring industry.)Tj 0 -2.557 TD (Conservative critics of psychotherapy have called ptsd)Tj (, in part, a political artifact of the antiwar movement, a way to portra\ y )Tj 0 -1.2 TD (Vietnam veterans as psychiatric victims of an unjust war. At the very le\ ast, the diagnosis had political ramifications. The )Tj T* (women\222s movement, for example, enthusiastically supports the concept \ because it creates a diagnostic niche for victims of rape, )Tj T* (domestic violence, and child abuse. Indeed, the rate of ptsd in the )Tj /TT1 1 Tf (civilian)Tj /TT0 1 Tf ( population is now almost four percent. Yet ptsd is also )Tj 0 -1.201 TD (very real, as evidenced most recently by a direct correlation between th\ e incidence of ptsd)Tj ( during the Iraq war and the number of )Tj 0 -1.2 TD (firefights a soldier has been involved in.)Tj /TT1 1 Tf 16.0231 0 0 16.0231 37.1965 49.0969 Tm (Today, countless institutions and millions of people are dependent to on\ e degree or )Tj 0 -1.2 TD (another on the caring industry. )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 6.8671 0 0 6.8671 18 8.7887 Tm (http://www.hoover.org/publications/policyreview/94880989.html \(5 of 12\)\ 6/2/2010 12:43:19 PM)Tj ET EMC EMC endstream endobj 208 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 6.8671 0 0 6.8671 18 601.7887 Tm (Hoover Institution - Policy Review - The Rise of the Caring Industry)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC EMC /Artifact <>BDC Q 1 1 1 rg 27.468 18 744.694 576 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 29.757 18 611.931 576 re f 0.8 0.8 0.8 rg 28.994 594 m 28.994 18 l 29.757 18 l 29.757 594 l h f 642.451 594 m 642.451 18 l 641.688 18 l 641.688 594 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.8 1 rg 30.52 593.654 610.405 0.346 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 30.52 161.701 610.405 51.808 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.922 0.922 0.922 rg 644.74 18 125.133 576 re f 0.8 0.8 0.8 rg 643.977 594 m 643.977 18 l 644.74 18 l 644.74 594 l h f 770.636 594 m 770.636 18 l 769.873 18 l 769.873 594 l h f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 10.6821 0 0 10.6821 30.5202 570.0153 Tm (The problem is not with ptsd, but with the cover that ptsd)Tj ( has given the caring industry to penetrate the military for the purpose\ of )Tj 0 -1.2 TD (managing general life problems. Family-related crises and issues of well\ -being originate less in battle trauma, and more in )Tj T* (today\222s epidemic of mass loneliness and unhappiness, which explains w\ hy these crises affect everyone and not just soldiers.)Tj 0 -2.557 TD (Mental health data collected during the 1990s, before the wars in Iraq a\ nd Afghanistan, show what is happening. In \223Mental )Tj 0 -1.2 TD (Disorders Among U.S. Military Personnel in the 1990s,\224 published in t\ he )Tj /TT1 1 Tf (American Journal of Psychiatry)Tj /TT0 1 Tf (, the authors examined )Tj 0 -1.201 TD (the rates of hospital and outpatient mental health treatment among all m\ ilitary personnel, which at the time represented one )Tj 0 -1.2 TD (percent of the entire working adult population between the ages of 18 an\ d 45. Hospitalizations do not concern us here, as our )Tj 0 -1.2 TD (focus is on everyday life problems, and not true mental illness. Outpati\ ent psychotherapy for major depression can also be )Tj T* (ignored, as major depression is a serious medical problem, and not an ev\ eryday life problem. More relevant is the frequency of )Tj T* (outpatient visits for ptsd)Tj ( and minor mental health problems. The latter includes \223depression no\ t otherwise specified,\224 a catchall )Tj T* (term that includes everyday unhappiness; dysthymia, which is chronic dep\ ression less intense than major depression; stress; )Tj T* (and substance abuse. )Tj 0 -2.557 TD (From 1996 to 1999, ptsd was responsible for only 18,000 outpatient visit\ s, a small number compared with 28,000 visits for )Tj 0 -1.2 TD (dysthymia, 60,000 visits for depression \223not otherwise specified,\224\ and 350,000 visits for alcohol and drug abuse. Acute stress )Tj T* (resulted in 5,000 visits, \223unspecified stress\224 in 16,000 visits, a\ nd generalized anxiety disorder in 6,000)Tj ( visits. These numbers )Tj T* (don\222t even include the 106,000)Tj ( visits for the indefinable category of \223all other mental disorders,\224\ of which everyday unhappiness )Tj T* (is certainly a part.)Tj 0 -2.557 TD (In sum, far more soldiers sought help for minor mental health diagnoses \ than for ptsd)Tj ( during this period. Taken together, these )Tj 0 -1.2 TD (non-ptsd, nonmajor depression, and nonbipolar disorder diagnoses account\ for more than half of all outpatient visits among )Tj T* (soldiers in the 1990s. Moreover, the authors conclude that the incidence\ of minor mental health problems among soldiers )Tj T* (roughly tracks their incidence among the general population. Thus, the n\ otion that caring professionals have attached )Tj T* (themselves to the military to manage ptsd and other mental illnesses uni\ que to combat, such as the psychological effects of )Tj T* (traumatic brain injury, is simply wrong. They are dealing with the same \ everyday life troubles affecting people\222s performance in)Tj ( )Tj T* (other walks of life in America.)Tj /TT1 1 Tf 16.0231 0 0 16.0231 37.1965 193.1436 Tm (The caring industry has used the wars in Iraq and Afghanistan to justify\ an )Tj 0 -1.2 TD (expanded role for caring professionals in the military. )Tj /TT0 1 Tf 10.6821 0 0 10.6821 30.5202 138.062 Tm (If anything, the wars in Iraq and Afghanistan have clouded the caring in\ dustry\222s true role in the military. In 2008, the rand )Tj T* (corporation published \223The Invisible Wounds of War\224 to demonstrate\ the psychological toll the wars have exacted on soldiers. )Tj T* (Reportedly one third of military members returning home from a combat zo\ ne have mental health problems. Another study )Tj 0 -1.2 TD (published in the )Tj /TT1 1 Tf (New England Journal of Medicine)Tj /TT0 1 Tf ( confirms this figure, noting that roughly 27 percent of returning comba\ t troops )Tj 0 -1.201 TD (report mental health symptoms.)Tj 0 -2.557 TD (Yet this same study reports that )Tj /TT1 1 Tf (before deployment)Tj /TT0 1 Tf (, almost 21 percent of soldiers had mental symptoms. A significant porti\ on of )Tj 0 -1.201 TD (the post-deployment increase was due to ptsd, especially in Iraq, where \ roughly 90 percent of soldiers report having been shot )Tj 0 -1.2 TD (at, as compared to only 30 percent in Afghanistan. This increase in ptsd\ is to be expected, and demands a therapeutic )Tj T* (response. Yet much of the caring industry\222s new interventions will be\ for the prewar 21 percent baseline \227 for those mental )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 6.8671 0 0 6.8671 18 8.7887 Tm (http://www.hoover.org/publications/policyreview/94880989.html \(6 of 12\)\ 6/2/2010 12:43:19 PM)Tj ET EMC EMC endstream endobj 209 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 6.8671 0 0 6.8671 18 601.7887 Tm (Hoover Institution - Policy Review - The Rise of the Caring Industry)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC EMC /Artifact <>BDC Q 1 1 1 rg 27.468 18 744.694 576 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 29.757 18 611.931 576 re f 0.8 0.8 0.8 rg 28.994 594 m 28.994 18 l 29.757 18 l 29.757 594 l h f 642.451 594 m 642.451 18 l 641.688 18 l 641.688 594 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.8 1 rg 30.52 241.624 610.405 51.808 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.922 0.922 0.922 rg 644.74 18 125.133 576 re f 0.8 0.8 0.8 rg 643.977 594 m 643.977 18 l 644.74 18 l 644.74 594 l h f 770.636 594 m 770.636 18 l 769.873 18 l 769.873 594 l h f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 10.6821 0 0 10.6821 30.5202 584.1669 Tm (health symptoms equally prevalent in the civilian population. In other w\ ords, for the same symptoms that compelled the industry )Tj 0 -1.2 TD (to intervene during the halcyon 1990s.)Tj 0 -2.557 TD (The caring industry has used the wars in Iraq and Afghanistan to justify\ an expanded role for caring professionals in the milita)Tj (ry, )Tj 0 -1.2 TD (which already employs more psychologists than any other company or organ\ ization in the world. New policies include more )Tj T* (training of clinical psychologists within the military, as well as the h\ iring of psychologists, social workers, and counselors a)Tj (s )Tj T* (civilian contractors. A Center for Deployment Psychology has recently be\ en established within the military to step up contacts )Tj T* (between caring professionals both inside and outside the military, the w\ ord \223Deployment\224 implying that it was the wars and not )Tj 0 -1.2 TD (any problem in civil society that led to the sudden urgent need for ment\ al health services. In fact, these professionals will sp)Tj (end )Tj T* (most of their time caring for the same everyday problems that have gripp\ ed both soldiers and civilians since the 1970)Tj (s, and that )Tj T* (beg for resolution in an age of mass loneliness and mass unhappiness.)Tj /TT1 1 Tf 0 -2.557 TD (The schools)Tj /TT0 1 Tf (. A similar change has occurred in education. Professional psychology\222\ s earliest link to education was called \223school )Tj 0 -1.201 TD (psychology.\224 Trained mostly as educators, school psychologists during\ the first half of the 20th century focused more on )Tj 0 -1.2 TD (vocational guidance and aptitude testing rather than on psychotherapy. W\ hen professional psychology reorganized itself in )Tj T* (1945, school psychology became a recognized division within psychology; \ yet, because they lacked doctorate degrees, most )Tj T* (school psychologists were permitted to join only as associate members. S\ chool psychologists were almost an embarrassment to )Tj T* (the American Psychological Association \(apa\), given the way clinical p\ sychologists at the time preached how vital a doctorate )Tj T* (was to the practice of psychology. The apa tolerated them simply because\ theirs was an uninteresting, barren terrain, full of )Tj T* (testing children for this and that, without any real mental health respo\ nsibilities. Resentful of their second-class status, sch)Tj (ool )Tj T* (psychologists broke from the apa in 1969 to form their own independent o\ rganization called the National Association of School )Tj T* (Psychologists \(nasp\).)Tj /TT1 1 Tf 16.0231 0 0 16.0231 37.1965 273.0662 Tm (In the early 1980s, American schools began to feel the effects of mass l\ oneliness )Tj 0 -1.2 TD (and mass unhappiness. )Tj /TT0 1 Tf 10.6821 0 0 10.6821 30.5202 217.9846 Tm (The year 1975 brought change in the form of the Education for All Handic\ apped Children Act, which declared all disabled )Tj T* (children entitled to a free and appropriate public education. School psy\ chology prospered, as these children needed help )Tj T* (entering the mainstream. However, clinical psychologists made no effort \ to retake the rebel field. So long as school psychology )Tj 0 -1.2 TD (involved special education and not psychotherapy, the stakes seemed too \ low to merit a confrontation.)Tj 0 -2.557 TD (Change came again in the early 1980s, when American schools began to fee\ l the effects of mass loneliness and mass )Tj 0 -1.2 TD (unhappiness. This time clinical psychologists took notice. In the 1940)Tj (s, the top three discipline problems in schools were talking, )Tj T* (chewing gum, and making noise; in the 1980s, they were drug and alcohol \ abuse, teen pregnancy, and suicide. In 1999, the )Tj 0 -1.2 TD (surgeon general reported that one in five American children would experi\ ence a significant mental health problem during their )Tj T* (educations. Another report estimated that three to six million children \ suffered from clinical depression. A third study showed )Tj (that )Tj T* (ten percent of all children between the ages of six and 12 had experienc\ ed depression severe enough to interfere with daily )Tj T* (functioning. Educators blamed much of this new mental illness on the dec\ lining family, with divorced parents or two-income )Tj T* (couples forcing children to be raised in comparatively unsupervised circ\ umstances. Even physical mobility, with families )Tj T* (constantly uprooting and moving around, thereby cutting people off from \ extended family support, played a role in increasing )Tj 0 -1.2 TD (stress, educators argued.)Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 6.8671 0 0 6.8671 18 8.7887 Tm (http://www.hoover.org/publications/policyreview/94880989.html \(7 of 12\)\ 6/2/2010 12:43:19 PM)Tj ET EMC EMC endstream endobj 210 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 6.8671 0 0 6.8671 18 601.7887 Tm (Hoover Institution - Policy Review - The Rise of the Caring Industry)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC EMC /Artifact <>BDC Q 1 1 1 rg 27.468 18 744.694 576 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 29.757 18 611.931 576 re f 0.8 0.8 0.8 rg 28.994 594 m 28.994 18 l 29.757 18 l 29.757 594 l h f 642.451 594 m 642.451 18 l 641.688 18 l 641.688 594 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.922 0.922 0.922 rg 644.74 18 125.133 576 re f 0.8 0.8 0.8 rg 643.977 594 m 643.977 18 l 644.74 18 l 644.74 594 l h f 770.636 594 m 770.636 18 l 769.873 18 l 769.873 594 l h f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 10.6821 0 0 10.6821 30.5202 584.858 Tm (As the focus in school psychology shifted from special education to chil\ dren \223at risk\224 for mental illness, clinical and counseli)Tj (ng )Tj 0 -1.2 TD (psychologists \227 an important part of the caring industry \227 schemed\ to take school psychology back, arguing that they were )Tj T* (better trained to provide the new service. There was some merit to their\ claim. Like industrial psychologists, school psychologi)Tj (sts )Tj 0 -1.2 TD (had been caught unprepared by a mental health crisis now compounded by a\ social crisis. Even as late as 1984, school )Tj 0 -1.2 TD (psychologists spent 70)Tj ( percent of their time in assessment activities, and only ten percent in\ direct intervention with children; )Tj T* (71)Tj ( percent of their time was still spent with disabled children. Without p\ roper training, how could school psychologists practice )Tj T* (crisis intervention or short-term psychotherapy? the caring industry ask\ ed. One caring professional ranked school psychologists )Tj T* (on the same level as school bus drivers and secretaries, pejoratively de\ scribing their treatments as \223homespun.\224)Tj 0 -2.557 TD (School psychologists fought back, working through state legislatures to \ secure their independence. However, as the tide shifted )Tj 0 -1.2 TD (in favor of the apa, a truce was reached, with school psychologists agre\ eing to earn doctorates and master\222s degrees, and to )Tj T* (refrain from setting up office practices. The result was an enormous ext\ ension of the caring industry\222s clout in America\222s schoo)Tj (ls. )Tj T* (Today, 38,000 school psychologists work in tandem with the official cari\ ng industry to manage the everyday psychological )Tj T* (problems of children and adolescents. In 1988, the ratio of school psych\ ologists to students was 1:2000; in 2004 it was 1:1653 )Tj T* (and today, the industry\222s goal is 1:1000)Tj ( \227 and that doesn\222t even include the thousands of clinical and cou\ nseling psychologists, )Tj T* (social workers, and mental health counselors who already intervene in ch\ ildren\222s psychological problems.)Tj /TT1 1 Tf 0 -2.58 TD (The problem with the caring industry)Tj /TT0 1 Tf 0 -2.534 TD (Although well-intentioned,)Tj ( the caring industry poses serious potential problems. First, the caring\ industry may signify the death )Tj 0 -1.2 TD (knell for the traditional family. Almost all social conservative issues \ have something to do with preserving the traditional fam)Tj (ily. )Tj T* (And while most liberals are more elastic in their definition of what con\ stitutes a family, many of them nonetheless defend the )Tj T* (concept of the family as an institution. The caring industry weakens and\ may destroy the family by making it superfluous. If )Tj T* (people have caring professionals to talk to about their personal problem\ s, they don\222t need relatives. They don\222t even need )Tj T* (authentic friends. Caring professionals may form the peer group of the f\ uture.)Tj 0 -2.557 TD (Second, by pushing lay volunteers aside, the caring industry is leading \ ineluctably to a coarsening of everyday life in America.)Tj ( )Tj 0 -1.2 TD (As professional caregivers expand their presence in society, lay volunte\ ers inevitably disappear. To make matters worse, some )Tj T* (laypeople no longer see it as their role to volunteer, or to even help p\ eople in their own circle, thinking instead: \223That\222s wha)Tj (t the )Tj T* (professionals are there for.\224)Tj 0 -2.557 TD (Third, the caring industry continues the trend toward speech codes that \ curtail speech on the grounds that some of it is \223hurtfu)Tj (l\224 )Tj 0 -1.2 TD (and can injure another person\222s self-esteem. Many conservatives blame\ liberalism for such restrictions on speech, but they are )Tj T* (wrong to do so, as evidenced by the fact that many liberals also dislike\ speech codes. As historian Elisabeth Lash-Quinn has )Tj T* (shown in her book )Tj /TT2 1 Tf (Race Experts)Tj /TT0 1 Tf (, speech codes originated not in liberalism, but in the psychotherapy mo\ vement that allied itself )Tj 0 -1.201 TD (with liberalism in the 1960)Tj (s. By coalescing within the caring industry, these psychotherapeutic mod\ es of thought are increasingly )Tj 0 -1.2 TD (now woven into the fabric of American culture, and the speech codes they\ spawn will likely strengthen their hold on that culture)Tj (.)Tj 0 -2.557 TD (Fourth, the caring industry is changing the dynamic in the struggle betw\ een the state and the individual. During the 20)Tj (th century, )Tj 0 -1.2 TD (the major political debate was over the correct degree of state power. O\ ne argument against strong state power was that it )Tj T* (destroyed social and civic institutions that grew up naturally, includin\ g traditional peer groups, leaving individuals weak, )Tj T* (powerless, and atomized. Yet through the state-subsidized caring industr\ y, state power has shown that it can also be )Tj /TT2 1 Tf (caring)Tj /TT0 1 Tf (, on )Tj 0 -1.201 TD (the most personal level; that it can provide a kind of substitute for th\ e traditional peer group. State power carries with it th)Tj (e risk of )Tj 0 -1.2 TD (an alienated and isolated citizenry that might revolt, while the caring \ industry it sponsors annuls that risk. Caring profession)Tj (als )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 6.8671 0 0 6.8671 18 8.7887 Tm (http://www.hoover.org/publications/policyreview/94880989.html \(8 of 12\)\ 6/2/2010 12:43:19 PM)Tj ET EMC EMC endstream endobj 211 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 6.8671 0 0 6.8671 18 601.7887 Tm (Hoover Institution - Policy Review - The Rise of the Caring Industry)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC EMC /Artifact <>BDC Q 1 1 1 rg 27.468 18 744.694 576 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 29.757 18 611.931 576 re f 0.8 0.8 0.8 rg 28.994 594 m 28.994 18 l 29.757 18 l 29.757 594 l h f 642.451 594 m 642.451 18 l 641.688 18 l 641.688 594 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.8 1 rg 30.52 200.518 610.405 51.808 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.922 0.922 0.922 rg 644.74 18 125.133 576 re f 0.8 0.8 0.8 rg 643.977 594 m 643.977 18 l 644.74 18 l 644.74 594 l h f 770.636 594 m 770.636 18 l 769.873 18 l 769.873 594 l h f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 10.6821 0 0 10.6821 30.5202 584.858 Tm (touch individual lives in ways that government bureaucrats cannot, and i\ n a way that social and civic institutions, including th)Tj (e )Tj 0 -1.2 TD (old 1950)Tj (s peer group, once did. What they provide is not true friendship, but a \ credible substitute, one that meets the needs of )Tj T* (lonely and unhappy people, and rids them of anxiety. Thus, the caring in\ dustry shores up the argument for aggressive state )Tj 0 -1.2 TD (power at its weakest point.)Tj 0 -2.557 TD (Yet the most important consequence of the caring industry is the epoch s\ hift it signals in Western society, one that has nothing)Tj ( )Tj 0 -1.2 TD (to do with the old ideological divide between liberals and conservatives\ , one that has elevated Western society onto a new and )Tj T* (strange summit. A world based on \223caring\224 is emerging, replacing a\ world based on love. This shift in the West\222s cultural life i)Tj (s no )Tj 0 -1.2 TD (less momentous than the decline of the nation-state now evident in forei\ gn affairs. From a narrow policy perspective the caring )Tj T* (industry arose to combat mass loneliness and mass unhappiness. But it al\ so arose because of a change in Western civilization )Tj T* (itself.)Tj /TT1 1 Tf 0 -2.58 TD (The end of love)Tj /TT0 1 Tf 0 -2.534 TD (For centuries in)Tj ( the West, and until only recently, love has been the underlying essence\ in which the pulsations of existence had )Tj 0 -1.2 TD (their being. People were encouraged to indulge in the daydreams of love,\ to love their lover, their family, their sect, their na)Tj (tion, )Tj T* (and ultimately all mankind. When this civilization came crashing down in\ the first half of the 20)Tj (th century after two world wars, )Tj T* (the West had a vital interest in replacing a civilization based on love \ with something else. And it found that substitute in the)Tj ( new )Tj T* (ethos of caring, of which the caring industry is the leading exponent.)Tj 0 -2.557 TD (The ideology of love began nine centuries ago in the era of courtly love\ . It seems natural to us that people should always have )Tj 0 -1.2 TD (been obsessed with love, but this is not the case. Our code of etiquette\ that gives precedence to women seems natural, but it is)Tj ( )Tj T* (a legacy of courtly love, and to this day is considered to be far from n\ atural in Japan, say, or India. Prior to courtly love, t)Tj (he idea )Tj T* (of marrying for love would have been unthinkable. Marriage was a union o\ f property, a social calculation, and still is in many )Tj T* (countries. In the West, marrying for any reason other than love seems cr\ azy.)Tj /TT2 1 Tf 16.0231 0 0 16.0231 37.1965 231.9604 Tm (It seems natural to us that people should always have been obsessed with\ love, but )Tj 0 -1.2 TD (this is not the case. )Tj /TT0 1 Tf 10.6821 0 0 10.6821 30.5202 176.8788 Tm (Rather than remain confined to the personal dimension of life, the love \ obsession quickly spread, first to art. An unmistakable )Tj T* (continuity connects the troubadours of the Middle Ages with the great 19\ )Tj (th-century novelists and even today\222s authors of trashy )Tj T* (harlequin romances. It seems natural to us that love should be the commo\ nest theme of literature, but it was not always that )Tj 0 -1.2 TD (way. Ancient Greek literature mentions love, but the notion of happiness\ grounded on successful romantic love is absent. Love )Tj 0 -1.2 TD (in the classical period is portrayed as either a superficial sensuality \ or a kind of tragic madness.)Tj 0 -2.557 TD (Love ideology then infected organized religion. Previously, Christianity\ had viewed sensual love as a kind of sickness. In the )Tj 0 -1.2 TD (12th century, love ideology began to penetrate Christianity, causing sen\ sual love to lose its sinful quality. Over time, many )Tj T* (clergymen envisioned a new alliance between religious love and sensual l\ ove, one that would let people enjoy the happiness of )Tj T* (a private passion while, at the same time, forever coaxing them to widen\ their circle of romantic love to include all mankind, )Tj T* (thereby spreading romantic love ever wider and wider, thus moving them c\ loser to God\222s perfection. )Tj 0 -2.557 TD (This was the plan: Every man loves himself, which is natural and require\ s no incentive. Then he loves his lover, which brings )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 6.8671 0 0 6.8671 18 8.7887 Tm (http://www.hoover.org/publications/policyreview/94880989.html \(9 of 12\)\ 6/2/2010 12:43:19 PM)Tj ET EMC EMC endstream endobj 212 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 6.8671 0 0 6.8671 18 601.7887 Tm (Hoover Institution - Policy Review - The Rise of the Caring Industry)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC EMC /Artifact <>BDC Q 1 1 1 rg 27.468 18 744.694 576 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 29.757 18 611.931 576 re f 0.8 0.8 0.8 rg 28.994 594 m 28.994 18 l 29.757 18 l 29.757 594 l h f 642.451 594 m 642.451 18 l 641.688 18 l 641.688 594 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.8 1 rg 30.52 395.854 610.405 51.808 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.922 0.922 0.922 rg 644.74 18 125.133 576 re f 0.8 0.8 0.8 rg 643.977 594 m 643.977 18 l 644.74 18 l 644.74 594 l h f 770.636 594 m 770.636 18 l 769.873 18 l 769.873 594 l h f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 10.6821 0 0 10.6821 30.5202 582.8811 Tm (him comfort. Then he loves his children, who are his future hope; his pa\ rents, who reared him; and his tribe, which supports and)Tj ( )Tj 0 -1.2 TD (protects him. Then he loves his race, which may not be so instinctive, b\ ut is also common.)Tj 0 -2.557 TD (From here, the love impulse faces a steeper climb. A man is encouraged t\ o love his fellow countrymen, who speak his language )Tj 0 -1.2 TD (and profess his traditions. Yet love for one\222s country is more of a f\ ictitious semblance of real love, since, unlike a lover or )Tj (a child, )Tj T* (a nation is less concrete and involves loving strangers. At this aggrega\ te of humanity, the man\222s power to love begins to wane; )Tj T* (and yet, despite this deficiency, the man is coaxed to take one final st\ ep and expand his love to include all mankind, the )Tj T* (universal entity. Man, having expanded his love from the individual to t\ he family, and from the family to the race and nation, i)Tj (s )Tj 0 -1.2 TD (encouraged to do so one more time, and to love all humanity, as God does\ , thereby escaping the hatred and strife that arises )Tj T* (from the division of humanity into tribes, races, and nations.)Tj /TT1 1 Tf 16.0231 0 0 16.0231 37.1965 427.2968 Tm (But it is impossible to know humanity in the concrete; humanity is a fic\ tion, it cannot )Tj 0 -1.2 TD (be loved. )Tj /TT0 1 Tf 10.6821 0 0 10.6821 30.5202 372.2153 Tm (By the 18th and 19th centuries, secular thinkers had adopted organized r\ eligion\222s plan. Humanitarians, nationalists, and )Tj T* (socialists alike saw in the new policy of an indefinite expansion of the\ kingdom of love an opportunity to build a new community)Tj ( )Tj T* (of man where people lived for each other in peace. True, secular thinker\ s saw in religion\222s emphasis on God something )Tj 0 -1.2 TD (superstitious and arbitrary; nevertheless, they accepted the basic frame\ work of extending an individual\222s love ever outward unti)Tj (l )Tj 0 -1.2 TD (it included all of humanity. Their contribution was simply to rest the d\ octrine of love for humanity on a firmer basis than reli)Tj (gion.)Tj 0 -2.557 TD (However, so long as people fell short of loving all humanity, the intens\ ification of all these parochial loves, each supposedly )Tj (a )Tj 0 -1.2 TD (necessary step along the path to loving all humanity, destabilized socie\ ty. People who selfishly loved their families were )Tj T* (troubling, but even more troubling were the racists, the nationalists, t\ he fascists, and the communists, all of whom built new )Tj T* (political ideologies based on their respective idealized communities, ea\ ch envisioning total strangers coming together and lovin)Tj (g )Tj T* (one another. The movement of contemporary life grew profoundly violent. \ During the First World War, Westerners pierced with )Tj T* (the most intense pangs of devotion to strangers whom they had never met \ \227 their countrymen \227 shot at other strangers across )Tj T* (deep trenches. Hundreds of thousands of soldiers died in the name of lov\ e of one\222s country.)Tj 0 -2.557 TD (Love ideology had revealed its fatal flaw. Clergymen, philosophers, arti\ sts, and politicians had encouraged people to intensify )Tj 0 -1.2 TD (their passion for others, to join in consciousness with an ever-expandin\ g number of individuals, with loving all humanity the fi)Tj (nal )Tj T* (goal. But it is impossible to know humanity in the concrete; humanity is\ a fiction, it cannot be loved. Love ideology applied to)Tj ( )Tj T* (politics had tried to build on the passion people felt for others in the\ ir personal life, but that love lost its efficiency as t)Tj (he objects )Tj T* (of love grew more distant, and in the nation or the class reached its fi\ nal limit, and could go no further. The concept of human)Tj (ity )Tj T* (evoked no feeling in man.)Tj 0 -2.557 TD (A disastrous situation quickly arose, with love ideology precipitating a\ nd intensifying the inevitable conflagration. With the r)Tj (ise of )Tj 0 -1.2 TD (racism, nationalism, and classism, it became all the more essential to w\ iden the sphere of love to include all mankind to )Tj T* (preserve the peace. And yet the very attempt to satisfy this requirement\ , by calling on people to look beyond their personal liv)Tj (es )Tj T* (toward some ideal community, only made matters worse, as the goal of lov\ ing all humanity could not be reached.)Tj 0 -2.557 TD (The disaster played itself out in the Second World War. Afterwards and t\ hroughout the West, family, sect, tribe, and country \227 )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 6.8671 0 0 6.8671 18 8.7887 Tm (http://www.hoover.org/publications/policyreview/94880989.html \(10 of 12\ \)6/2/2010 12:43:19 PM)Tj ET EMC EMC endstream endobj 213 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 6.8671 0 0 6.8671 18 601.7887 Tm (Hoover Institution - Policy Review - The Rise of the Caring Industry)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC EMC /Artifact <>BDC Q 1 1 1 rg 27.468 18 744.694 576 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 29.757 18 611.931 576 re f 0.8 0.8 0.8 rg 28.994 594 m 28.994 18 l 29.757 18 l 29.757 594 l h f 642.451 594 m 642.451 18 l 641.688 18 l 641.688 594 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.6 0.8 1 rg 30.52 476.421 610.405 51.808 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.922 0.922 0.922 rg 644.74 18 125.133 576 re f 0.8 0.8 0.8 rg 643.977 594 m 643.977 18 l 644.74 18 l 644.74 594 l h f 770.636 594 m 770.636 18 l 769.873 18 l 769.873 594 l h f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 10.6821 0 0 10.6821 30.5202 584.858 Tm (the bedrock allegiances in people\222s lives \227 were called into quest\ ion. All of these institutions had been complicit in the West\222)Tj (s )Tj 0 -1.2 TD (failure. Their prestige had rested on faulty reasoning. In response, peo\ ple grew anxious and cynical and lived in fear and self-)Tj T* (doubt. Whom to love and what to love and why to love suddenly became que\ stions without clear answers. They remain )Tj 0 -1.2 TD (questions to this day.)Tj /TT1 1 Tf 16.0231 0 0 16.0231 37.1965 507.8633 Tm (In romantic life people still want to fall in love as much as ever, and \ love ideology )Tj 0 -1.2 TD (remains as strong as ever. )Tj /TT0 1 Tf 10.6821 0 0 10.6821 30.5202 452.7817 Tm (In this unstable environment the caring ethos emerged as the preeminent \ solution. Love ideology had encouraged Westerners to )Tj T* (keep enlarging their circle of love so that it included more and more pe\ ople, with the dream of loving all mankind beckoning in )Tj T* (the distance. It aroused a generous fervor and a massive piety that our \ cynical age can barely comprehend. Yet the price of )Tj 0 -1.2 TD (falling short of the ideal was not just disappointment but disaster, for\ while the ideal of loving all mankind is an unselfish o)Tj (ne, a )Tj 0 -1.2 TD (love-obsessed civilization exacerbates the ordinary forms of personal se\ lfishness so long as that ideal remains unfulfilled.)Tj 0 -2.557 TD (Rather than encourage people to love greater and greater numbers of peop\ le, the caring ethos helps people fulfill their deepest )Tj 0 -1.2 TD (psychological needs without love \227 without friends, without families,\ without communities. The age of fraternities, brotherhoods)Tj (, )Tj T* (and fatherlands is waning; the days of strangers transmitting deep feeli\ ngs to one another is over. We are witnessing the dawn )Tj T* (of the lonely age.)Tj 0 -2.557 TD (In romantic life people still want to fall in love as much as ever, and \ love ideology remains as strong as ever, encouraged by t)Tj (he )Tj 0 -1.2 TD (entertainment industry, but outside this sphere the caring relationship \ has displaced love as the framework of existence, outsid)Tj (e )Tj T* (of which no issue, however compelling, no passion, however profound, and\ no belief, however soaring, is of much account. )Tj 0 -1.2 TD (Many people today meet their basic psychological needs, including self-e\ steem, fulfillment, and identity, not through a social )Tj 0 -1.2 TD (system of friends, intimates, and communities, as people did in the age \ of love, but by working directly with a caring )Tj T* (professional. Although lonely, they are psychologically stable, and soci\ ety is spared the tumult of an earlier era when people )Tj T* (satisfied these needs through loving communities.)Tj 0 -2.557 TD (In this way the caring industry exercises a double fascination \227 on t\ he one hand as a sounding board for lonely, unhappy )Tj 0 -1.2 TD (individuals, and on the other as emblematic of a new ethos of civilizati\ on. The age of caring is a more skeptical age, but also )Tj (a )Tj T* (more tolerant one, expressing a distrust of authority and an antipathy t\ o old enthusiasms that wavers between laughter and )Tj T* (disgust. It would be wrong to say that people today deny the world; they\ simply prefer to ignore it, presenting a blank wall of )Tj T* (indifference to how people live and what they believe. They prefer meeti\ ng their psychological needs through a therapy session )Tj T* (rather than through a community of blood brothers.)Tj 0 -2.557 TD (True, the caring experience lacks the intimate gusto and genuineness of \ feeling that marked life in a social system. Gone are th)Tj (e )Tj 0 -1.2 TD (hysterics and absurdities, the waving of bullet-pierced banners and the \ singing of militant songs. Gone is the special pride tha)Tj (t )Tj T* (one religious sect felt against another. But society is more stable. Alt\ hough many Americans still cleave to love, dream of love)Tj (, )Tj T* (and hope for love in their romantic lives, the other dimensions of life \ have been spared the tumult and violence that once )Tj T* (haunted life when the love ideal reigned supreme and people bonded intim\ ately with strangers.)Tj 0 -2.557 TD (But how can inequality and hardship, which will always be, be compensate\ d for without the pleasure of some attachment? In the )Tj 0 -1.2 TD (past, allegiance to a nation, a tribe, a city, a family, or even just a \ group of friends distorted reality such that people put )Tj (up with )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 6.8671 0 0 6.8671 18 8.7887 Tm (http://www.hoover.org/publications/policyreview/94880989.html \(11 of 12\ \)6/2/2010 12:43:19 PM)Tj ET EMC EMC endstream endobj 214 0 obj<>stream /WebCaptureCN <>BDC /Artifact <>BDC 0 0 0 rg 0 i BT /T1_0 1 Tf 0 Tc 0 Tw 0 Ts 100 Tz 0 Tr 6.8671 0 0 6.8671 18 601.7887 Tm (Hoover Institution - Policy Review - The Rise of the Caring Industry)Tj ET EMC /WebCaptureBG BMC /WebCaptureFN <>BDC q 0 18 792 576 re W* n /Artifact <>BDC EMC /Artifact <>BDC Q 1 1 1 rg 27.468 209.044 744.694 384.956 re f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 29.757 211.333 611.931 382.667 re f 0.8 0.8 0.8 rg 28.994 594 m 28.994 210.57 l 29.757 211.333 l 29.757 594 l h f 642.451 594 m 642.451 210.57 l 641.688 211.333 l 641.688 594 l h f 28.994 210.57 m 642.451 210.57 l 641.688 211.333 l 29.757 211.333 l h f EMC q 0 18 792 576 re W* n /Artifact <>BDC Q 0.922 0.922 0.922 rg 644.74 211.333 125.133 382.667 re f 0.8 0.8 0.8 rg 643.977 594 m 643.977 210.57 l 644.74 211.333 l 644.74 594 l h f 770.636 594 m 770.636 210.57 l 769.873 211.333 l 769.873 594 l h f 643.977 210.57 m 770.636 210.57 l 769.873 211.333 l 644.74 211.333 l h f EMC EMC EMC /Article <>BDC q 0 18 792 576 re W* n 0 0 0 rg BT /TT0 1 Tf 10.6821 0 0 10.6821 30.5202 584.5598 Tm (these burdens. A group provided the framework of one\222s whole being, w\ ithin which was to be found all that life had to offer. It )Tj 0 -1.2 TD (charmed reality; it made hard life easier to endure. Without this charmi\ ng of reality, people will see life in all its horrible )Tj T* (unfairness, fueling their anger and resentment. Winning romantic love in\ private life, already a matter of luck to begin with, w)Tj (ill )Tj 0 -1.2 TD (become an even more high-stakes game, since in a world governed by the c\ aring ethos private life will become love\222s last )Tj 0 -1.2 TD (bastion, and the only place in which to build a strong attachment. Witho\ ut romantic love, and with the unfairness and injustice )Tj (in )Tj T* (life laid bare for all to see, people may grow violent. And because grou\ ps built around love will continue to decline, people wi)Tj (ll )Tj T* (have fewer groups on which to focus their anger; instead, other unattach\ ed individuals will become the focus of anger. The )Tj T* (Virginia Tech massacre is just one example.)Tj 0 -2.557 TD (In the middle of the last century a gulf was fixed \227 a narrow gulf, b\ ut a deep one. Since then that gulf has widened, and the )Tj 0 -1.2 TD (vision we have of that earlier era is increasingly one of a strange and \ dead antiquity. Even the institutions that live on from )Tj (that )Tj T* (era have changed in spirit, reflecting the new sensibility. It will be h\ ard to reverse this trend, but without a true understand)Tj (ing of )Tj T* (how mass loneliness and the caring industry are related, it will be virt\ ually impossible.)Tj ET 0.5 0.5 0.5 rg 106.821 404.782 457.803 0.763 re f 0 0 0 rg BT /TT0 1 Tf 10.6821 0 0 10.6821 30.5202 390.2985 Tm (Ronald W. Dworkin, M.D., Ph.D., is the author of )Tj /TT1 1 Tf (Artificial Happiness: The Dark Side of the New Happy Class)Tj /TT0 1 Tf ( \(Basic Books, )Tj 0 -1.201 TD (2006\). )Tj ET 0.5 0.5 0.5 rg 106.821 367.684 457.803 0.763 re f 0.2 0.2 0.6 rg BT /TT0 1 Tf 8.5457 0 0 8.5457 30.5202 340.3183 Tm (1)Tj 0 0 0 rg 10.6821 0 0 10.6821 35.2716 334.8491 Tm ( For statistics on loneliness, see Miller McPherson, et al., \223Social \ Isolation in America: Changes in Core Discussion Networks )Tj -0.445 -1.2 Td (Over Two Decades,\224 )Tj /TT1 1 Tf (American Sociological Review)Tj /TT0 1 Tf ( 71 \(June 2006\). For statistics on the prevalence of mental health sym\ ptoms, )Tj T* (see Tara W. Strine, et al., \223Depression and Anxiety in the United Sta\ tes,\224 )Tj /TT1 1 Tf (Psychiatric Services)Tj /TT0 1 Tf ( 59 \(December 2008\). For data on )Tj 0 -1.201 TD (antidepressant drug use, which estimates over 10 percent of the U.S. pop\ ulation is on antidepressants, see Mark Olfson and )Tj 0 -1.2 TD (Steven Marcus, \223National Patterns in Antidepressant Medical Treatment\ ,\224 )Tj /TT1 1 Tf (Archives of General Psychiatry)Tj /TT0 1 Tf ( \(August 2009\); for the )Tj 0 -1.201 TD (prevalence of anti-anxiety drug use \(roughly five percent of the popula\ tion\) see Federal Census data from 2003.)Tj 0 -2.457 TD ( )Tj ET 0.5 0.5 0.5 rg 106.821 235.749 457.803 0.763 re f 0 0 0 rg BT /TT0 1 Tf 7.6301 0 0 7.6301 201.6548 223.8785 Tm (Copyright \251 2010 by the Board of Trustees of Leland Stanford Junior U\ niversity )Tj 12.735 -1.2 Td (Phone: 650-723-1754 )Tj ET EMC /Artifact <>BDC Q 0 0 0 rg BT /T1_0 1 Tf 6.8671 0 0 6.8671 18 8.7887 Tm (http://www.hoover.org/publications/policyreview/94880989.html \(12 of 12\ \)6/2/2010 12:43:19 PM)Tj ET EMC EMC endstream endobj 215 0 obj(Hoover Institution - Policy Review - The Rise of the Caring Industry) endobj 216 0 obj<> endobj 217 0 obj<> endobj 218 0 obj<> endobj 219 0 obj<> endobj 220 0 obj[217 0 R] endobj 221 0 obj(http://www.hoover.org/publications/policyreview/94880989.html) endobj 222 0 obj(V?c#8QH) endobj 223 0 obj<> endobj 224 0 obj<> endobj 225 0 obj('WIAJI0=p) endobj 226 0 obj 1 endobj 227 0 obj 1 endobj 229 0 obj 2 endobj 230 0 obj 1 endobj 231 0 obj 1 endobj 232 0 obj 1 endobj 233 0 obj 1 endobj 234 0 obj 1 endobj 235 0 obj 1 endobj 236 0 obj 1 endobj 237 0 obj<> endobj 238 0 obj<> endobj 239 0 obj<>stream 2010-06-02T12:43:19-04:00 2010-06-02T12:43:15-04:00 2010-06-02T12:43:19-04:00 application/pdf Hoover Institution - 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