Wendy Lotterman reviews The Distance Cure

Hannah Zeavin. The Distance Cure: A History of Teletherapy. Cambridge, Mass.: MIT Press, 2021. 328 pp.

27 October 2021

Psychoanalysis is a riddle for the humanities. If used as a reliable tool for interpreting art and literature, its premises become fact. If its theses are revised through interventions by art and literary objects, psychoanalysis becomes a thought experiment, detatched from its clinical origin. This is not to say that the entire body of work has no place in the humanities but that its perceived authority at times obstructs access to new ways of thinking about its range and limits.

The adjacent world of clinical discourse is also in gridlock: classical Freudian psychoanalysis has resisted radical alterations to form, a muted third within the classic dyadic scene. And yet, the very attachment to a traditional form—or frame, as it is called by practitioners—is proof of a medium. This is where Hannah Zeavin begins her lucid study in The Distance Cure: A History of Teletherapy. Through carefully demonstrating that mediated therapy is as old as the talking cure itself, Zeavin allows for a more expansive (and less threatened) history of what she calls “the distance cure.”

Before the pandemic forced a mass migration to virtual care, psychodynamic clinicians saw dislocated therapy as an inferior treatment. This preference presumes a higher index of presence in person—but, as Zeavin crucially points out, “distance is not the opposite of presence; absence is” (p. 18). Zeavin begins the study with Sigmund Freud’s letters, arguing that the hallmark processes of transference and interpretation make use of the same deferred presence that defines the epistolary form. Not only did Freud indirectly treat “Little Hans” through handwritten interpretations sent to his father but, Zeavin argues, Freud explored his own psychic processes in letters to friend and eventual enemy, Wilhelm Fliess. Looking at Freud’s correspondence as both clinical record and diary, Zeavin rereads the letter as a form whose irreducible mediation provides the space for intimate communication. Zeavin replaces our idea of Freud as an orthodox Freudian with a profile that includes his disavowed forays into the occult, telephonic metaphors, and flirtations with broadcast therapy as a solution to the socioeconomic exclusivity of psychoanalysis. Wilfred Bion, Frantz Fanon, and Donald Winnicott pick up on the utility of radio as a tool for therapeutic dissemination. Zeavin fills out the compassionate paradigm of the good enough mother with scenes of the fatherless domestic settings that Winnicott entered with radiotherapy during wartime. Such experiments with public intimacy pave the way for the contemporary therapeutic ears of call in counselors like Esther Perel who swaps the parent child dyad for the couple form, remaining no less triangulated by listeners.

Zeavin’s historically rooted study of intimacy via mass communication is matched by an equally archival study of the suicide hotline and its specifically Protestant origins, up to its vital role in anonymous LGBTQ support. While the whole book sustains a focus on the often-ignored economics of the frame, Zeavin posits an especially compelling relationship between the temporality of crisis and the cost of care. A chapter on automated therapies and chatbots reveals the more disposable element in the mediated therapeutic triad to be the therapist—a clue to the defensive position taken by practitioners. Another on “written speech” suggests that messaging apps do not suffer from the absence of nonverbal signs—which are increasingly rendered orthographically—but, if anything, from being structured as a tech start-up with ambitions to monetize (see pp. 177–216).

The book’s incisive and timely coda offers an etiology of Zoom fatigue that is not, as so many claim, a mere distaste for the virtual but rather a confrontation with talk therapy’s inability to solve the social ills that follow the individual into the session. Psychotherapy may not be able to solve poverty or racism or COVID-19, but, as Zeavin shows, adaptations of mediated treatment are not only verifiably effective approaches to care in periods of widespread upheaval but as old as the talking cure itself.