Clinton's tome marks a thoroughly therapeutic age

An abusive stepfather, poor self-esteem, a drive to excel, a tendency to self-destruct. An affair that rocked a marriage - with America watching his every move. And, finally, therapy that, in his eyes, brought new insight, vitality, and peace.

With his new memoir, "My Life," former President Bill Clinton has sprinkled his 900 pages with revelations from religious, marital, and family counseling - and brought America's gaze, once again, to the growing role of psychotherapy in private lives and popular culture.

Unthinkable a few decades ago, Mr. Clinton's talk of counseling, his "private [struggle] to hold the old demons at bay," and the ways in which his unconscious shaped his life and presidency, is a barometer of just how widespread and acceptable therapy has become.

In some ways, Clinton is the ultimate emblem of an Age of Therapy - an era in which the rich and powerful, as well as the lost and lowly, seek, and even embrace, psychological help. The phenomenon has been lionized in popular culture, from "The Sopranos" to Dr. Phil, and is giving rise to a whole new lexicon. Just think "closure."

"It's certainly a sign of where we've come by the end of the 20th century, that these kinds of psychological variables are part of ... a politician's self-disclosure," says Stephen Hinshaw, chair of the psychology department at the University of California, Berkeley. "It's revealing of just how psychology-minded we have become as a culture."

To many, it's a positive movement - a more honest reckoning with oneself and a more genuine approach to others. But not all of America is on board. To some, all those hours in an easy chair create problems where none exist - hence the pejorative term, "Woody Allen syndrome," for the wealthy and neurotic who dash to psychologists over a lost toothbrush or a bad date.

There are vast cultural differences, too: Some immigrant groups have far more negative perspectives on digging through the past, warts, wounds, and all. Even therapy advocates worry that cultural forces popularizing it can "both present a reality and also trivialize and distort some of what we know about the mind's workings," according to Professor Hinshaw.

In politics, as in society at large, it wasn't so long ago that any discussion of mental illness or depression was strictly taboo - or worse, a death knell for careers. Former President Nixon carefully hid the fact that he underwent psychoanalysis after his impeachment. In 1972, Sen. Thomas Eagleton saw his spot as the vice-presidential candidate on George McGovern's ticket demolished by revelations that he'd had electric shock therapy. Even in 1988, Democratic presidential contender Michael Dukakis fought rumors that his wife had been hospitalized for mental illness.

"What's changed is that people who are high up, presidents, corporate officials, and others, now feel they can talk openly about their psychological difficulties and their willingness to go into therapy," says Richard Lachmann, a professor of sociology at the State University of New York, Albany. "Until recently, it was seen as a sign of weakness.... Now, if anything, it's seen as a sign of strength."

Yes, detractors have criticized Clinton for minimizing personal failings, blaming them on his childhood, or portraying them as factors beyond his control. But the fact remains that Americans use therapy - and talk about it - more than ever.

According to a Harris Interactive survey released in May, some 27 percent of Americans - or 59 million people - have received mental-health treatment in the past two years. Although about half of them were treated solely with drugs, some 15 million went into therapy each year.

"A cynic would say the nation is becoming more screwy," says Jo Colman, publisher of Pychology Today, which cosponsored the survey. "An optimist would say we've always had these issues, but now more people are getting help." Online, too, the therapy culture is booming. Mr. Colman points to the popularity of an Internet directory of some 2,500 therapists. Launched a year and a half ago, the site gets 100,000 hits each month.

Experts trace the shift to several factors: the introduction of more effective antidepressants, which are often used in conjunction with counseling; the availability of more therapists, especially in urban areas; the willingness of many insurance companies to pay for certain types of counseling; and a growing population of satisfied clients who talk about therapy's benefits, thereby lessening its stigma and encouraging more people to go.

There are more subtle reasons, too, beyond the reach of drugs, HMOs, or water-cooler conversations. As American culture has grown more secular, Hinshaw says, the notion of mental illness as a sign of the devil's grip has all but vanished. As neuroscience has advanced, a focus on flawed parenting has given way to discoveries of faulty genes - a movement, he cautions, that invokes its own stigmas, branding the sufferer with "bad wiring" and qualitative flaws.

Perhaps most pervasively, media depictions of therapy and mental illness have transformed in the past decades. Though often lacking the nuance of real-life illness and treatment, they've come a long way from the days of "Nightmare on Elm Street" to portrayals of depression and schizophrenia in "A Beautiful Mind," the omnipresent Dr. Phil, or therapy sessions on "The Sopranos."

That makes therapy not only more accessible, but acceptable to a far broader crowd. "If you see someone like [fictional mob boss] Tony Soprano being treated effectively, it carries the message that even tough guys can benefit," says Danny Wedding, a clinical psychologist and director of the Missouri Institute of Mental Health.

Perhaps it was to be expected as the baby boomers aged and the angst-ridden generation of the 1980s drama "Thirtysomething" hit their midlife crises, had their own kids, and sent them to therapy, too. It's a generational shift that features prominently in recent cultural criticism: Michael Barone's new book, for example, "Hard America, Soft America," posits a "hard" world of competition and accountability, and a "soft" world that leans toward (or on) social safety nets. In the hard/soft scale, Clinton - who spent a year's worth of weekly sessions with his wife following the revelations of his affair - may epitomize the soft baby boomer, while the first President Bush, straight from a generation of World War II veterans, emphasized the harder virtues of self-sufficiency and steely resilience.

But if that divide has changed and grown, and if attitudes toward therapy have shifted, so has therapy itself. The old emphasis on Freudian analysis and long-term treatment has faded: Now, for many, the approach is far more focused on behavioral strategies, sometimes eight sessions' worth, rather than eight years.

The shift is partly driven by insurance companies demanding accountability and looking to lower their bills. But to many, it's the pragmatism of a peculiarly American brand of therapy. "You go for a short period of time, you're helped, and that's it," says Professor Lachmann.

Still, for all the change in attitudes, more serious mental illnesses often retain their stigma. Schizophrenia, for example, is hardly "in vogue," Hinshaw points out. When attitudinal surveys ask people how close they'd like to be to various groups, he adds, they put those with mental illness at the very bottom, comparable to rankings for people with leprosy a few generations ago.

"People who are stars or politicians or in the news are willing to talk about getting help," he says. "The next step would be for such people to admit having schizophrenia or a bipolar disorder.... We're still a long way away from that."

• Staff writer Christina McCarroll contributed to this report.