“Just Use the Telephone, Please”: Hannah Zeavin on the Power of Teletherapy

“You can have really intense intimacy over distance, sometimes only because distance is there.”

Hannah Zeavin is a polymath. A writer, professor, historian, poet, editor, scholar of science and technology studies, and true public thinker, she has published across a wide range of forums, from academic presses to culture/literary stalwarts like Harper’s, Slate, n+1, LARB, and on. She also recently cofounded a magazine, Parapraxis, that brings together psychoanalysts and those holding the psycho and social together. When not writing, she teaches history and science and technology studies, until recently at the University of California, Berkeley, and starting this summer at Indiana University. When not teaching or writing, she’s leading the charge to blur the lines between a public-facing and an ivory-tower identity. Her most recent book and the prompt for this interview is The Distance Cure: A History of Teletherapy (MIT Press, 2021). It is already winning awards and has placed Zeavin as a leading voice on technology and the mind sciences. We spoke about all of the above earlier this year over Zoom.

B. R. Cohen (BRC): You have a new book about the history of teletherapy, which some people read too quickly as telepathy.


Hannah Zeavin (HZ): It’s not about mind reading, or not only! It’s about the ways different technologies have mediated our interactions with therapists over the past century. Telepathy does come up again and again as the dream of an unmediated intersubjective relating.


BRC: You begin with written correspondence as the technology, but there’s also radio, telephone hotlines, websites, chat bots, Zoom screens, and on. We’ll get back to that, but you mentioned off mic that you’re the child of psychoanalysts, and I have to ask first: Is that how you got to this research?


HZ: The pandemic hit right when the book was accepted for publication, and my parents were suddenly doing teletherapy and just couldn’t bear to read about it too. They finally read the book after they started seeing patients in person again.

But, yes, of course, the book in some preconscious and not even very preconscious way was an attempt to better understand what my parents do all day.


BRC: At least it gets you into studying psychoanalysis as not a psychoanalyst.


HZ: That has been a constant question in my life; when I applied for the PhD, I nearly ended up doing infant observation at the Tavistock in London. But so far, I’ve stayed firmly on the side of being a historian and writer, not a practitioner. Though I have definitely been a patient.


BRC: I’m new to therapy myself. One day my therapist called and said, “My kids are sick so we have to switch to Zoom this week,” and I thought, I’ve barely even done this “normally,” I don’t want to do it virtually. Where would I set up? I don’t want to go home, I don’t want to sit in my office. It’s a whole thing. And that was before reading your book.


HZ: It is a sudden frame shift. Almost all of the case studies in my book deal with moments of crisis. A lot of psychological treatments start as tele- because they have to, and remain tele- because they have to. Indeed, with the pandemic we just had to, and now lots of people’s treatments are hybrid. Typically it is the patient who says, oh, I can’t make it to the office, can we switch to Zoom just once? But, therapists too.


BRC: I’m mostly outside the world of psychoanalysis, so the technology studies part was my entry into your work. For the psychoanalytical side, I hesitate to admit I have these media stereotypes of 1980s TV or movies where anytime you say something, I want to respond, How does that make you feel?


HZ: That’s something my colleague, Orna Guralnik, would call negative transference. She was the star of Showtime’s Couples Therapy, which is maybe the best version of representing actual therapeutic experiences in recent media. Those stereotypes definitely remain with us culturally, even as therapy itself has become less taboo overall.


BRC: Was that part of your motivation for the book too? That readers don’t have many healthy images of what therapeutic relationships are or how they come about?


HZ: Yes, but more specifically, almost no one knew what a teletherapeutic relationship might look like now, no less since 1890. When I began writing, the little clinical work on teletherapy posited that teletherapy is less or horrible, metallic—not “true” therapy.


BRC: And you didn’t buy that?


HZ: I just didn’t. I wasn’t sure it was wrong, but it was so flat as a description of a technique, it made it sound like, Well, who would ever want that? And if they didn’t want it, what was its utility?

I started working on the project in 2013. Talkspace ads were just starting to blanket the New York City subway. And I didn’t only want to write a book about our recent history. In fact, it was the reverse. I knew I needed to write about computational therapy and e-therapy, and, in part, that was to excuse the fact that I would have been very happy to talk about 1890 Vienna and Berlin and letters for hundreds of pages.


BRC: How did you get to the present as a writer and researcher?


HZ: I went backward to come forward. I tried to find how long teletherapy had existed as a practice, irrespective of tele-analysis or tele-CBT [cognitive behavioral therapy]. And I ended back with Freud. Then I went forward through time to re-land us at our present moment, having no idea that I would be landing in a pandemic.

Freud didn’t have a Zoom room, obviously, but he did do the work that we associate with teletherapy.

BRC: One through line of the book is that whatever the technological conditions at the time, the cultural context gave shape to the psychoanalytical conditions of the patient-analyst relationship.


HZ: There was certainly a history-of-technology component to my work, but not only. Take recent teletherapy in the pandemic: I was stunned by the ferocity with which the kind of technology itself was attacked—Skype before the pandemic, Zoom now—rather than by something like that question you asked before: Well, where would I take that call? How can I feel like I have privacy? How can I feel like I have containment? How can I feel settled?


BRC: That must be something so many telepatients have navigated.


HZ: They have, yes, and then conversely too, I am invested in the history of the mind sciences or the psy-ences, which generally, as scholars like Martin Summers have shown us, hold a very normative picture (a white picture) of what a “good” treatment is and who can benefit from it.


BRC: “And how does that make you feel?”


HZ: Ha, well. As in, psychoanalysis across its long history abandons so many kinds of patients who might otherwise quite like to make use of some alternative form of care. What I discovered, which you find in the first half of the book, is that teletherapy can have a democratizing if not revolutionary impulse. Not just because you add technology to the water and then everything is accessible. No. It’s because there are many kinds of patients who don’t want to interface with expertise because, say, in the case of the midcentury suicide hotline I studied, “homosexuality” is in the DSM as a personality disorder, or, in World War II, maybe you can’t safely leave your house, there might be bombs dropping, you’re in unsafe conditions, etc. Then in the second half of the book, things become quite digital, starting in the 1960s, where that democratizing impulse is bent back towards profit.


BRC: How do you mean?


HZ: That we have lived for over a century without enough mental healthcare, and technology has not been the answer, but it has been posed as such.

BRC: You write that “distance is not the opposite of presence; absence is.” I just keep walking around thinking about that line. Did you come to it or was it something that you found?


HZ: No, I came to it. I write best when I really feel like I’m talking to someone. Like someone maybe specifically or a group of people. I do my best work as speech first, usually with my partner, who tolerates listening to me, and then I translate it back into writing afterward, and I really felt that we have made a conflation between distance and absence. The equation, or non-equation, was a reminder that we needed connection before the pandemic, significantly before the pandemic.


BRC: It’s one of those things: once you see it, it seems clear; but I hadn’t thought about it beforehand.


HZ: I used to get asked this question a lot in conference presentations as a grad student: Where is absence? And sometimes I would say, I’m not really talking about absence, I’m talking about presence and more presence, different kinds and qualities because of distance.

There is absence in the book, of course. Dislocation can create absence. The entire book is about a response to the absence of care, which then is broached and starts to be redressed by distance. But also it became really important in pandemic life for those who were privileged enough to live at a distance to remember that that wasn’t an absence from life, though it—for me at least, who was able to stay home—really felt like one. To re-answer a question from before, the book overall, I’d say, is about what we do when we relate over distance.

BRC: When you are at the end of a work of history, people always ask you to prognosticate what comes next. It’s like, “Dr. Zeavin, can you tell us what 2040 will bring us?” If you’re like me, you don’t actually have an answer for that, but I’m wondering if you field that question a lot, given the immediacy of the issues that you’re writing about.


HZ: Exactly. I’ve done a lot of events for the book with clinicians. What they’re anxious about has been metaverse and Web3 stuff. Should I buy a consulting room on Facebook (I can’t really bear to call it Meta)? No, no, you shouldn’t. It is all the problems of corporate teletherapy and none of the solutions to the access problem. Just use the telephone, please.


BRC: They must feel so much pressure.


HZ: Yes, my guess is that we’ll also see a big push with VR therapies, which I didn’t write about, though others have brilliantly, like Marissa Brandt and Amit Pinchevski.


BRC: That reminds me, the idea of what topics are well covered and which are not. To that end, I really appreciated your first chapter on Freud, though I wondered how you went about it. We’re in 2022, and we’re still writing chapters on Freud, like, don’t we have it down yet?


HZ: It’s funny, I’ve thought a lot about this. I’m looking at the standard edition on my shelf as we speak; all the volumes, five literal feet of Freud. But it feels like we never talked about Freud’s use of media to do treatment.


BRC: Why did that matter to you?


HZ: Two reasons. One is just the correction to the historiography. Freud not only treated himself in conjunction with his best friend (maybe lover, later enemy) Wilhelm Fliess via mail correspondence, he also treated the child of his friend by letter, and picked up many correspondences with patients either before they could come to the consulting room or after they had to leave it. People traveled the world to be in treatment with him, but could only leave, say, New York City for a few weeks to go to Vienna. And then lo and behold, the rest was executed by letter. So there is much more work to be done here on the medium of treatment in Freud’s own consulting room, and, crucially, beyond it.

The other reason is for practicing psychoanalysts. I didn’t know this when I wrote that early chapter almost ten years ago, but in the pandemic one of the greatest refrains of people in the psychological weeds with teletherapy has been that you can’t imagine Freud’s Zoom room. And again, Freud didn’t have a Zoom room, obviously, but he did do much of the work that we would associate with teletherapy via the post.

I thought, Okay, psychoanalysts, maybe it isn’t so bad—look, the founding father did it and did it well enough to found psychoanalysis.


BRC: Is that where the wonderfully named Smiley Blanton comes in?


HZ: Smiley was a patient of Freud’s, yes. I try and say “Smiley Blanton” in literally every talk I do about this book. Blanton is the guy I was referring to when I just alluded to “lives in New York, goes to Vienna” and later to London. Smiley Blanton was a patient of Freud’s. He was probably one of the last patients Freud saw before his death.


BRC: He has something to do with Peale, the Power of Positive Thinking guy, I learned.


HZ: Yes, Norman Vincent Peale started working with Smiley Blanton in response to the Great Depression. Suicidal activity increased in New York City (you can imagine why). They cofounded the psycho-religious clinic in New York City, which is still in operation, and still provides training. Blanton was a Freudian psychiatrist. He was a good Christian from the South. Alongside Peale, he pioneered a new form of pastoral counseling. In the United States, their methodologies shape the ministries that end up hosting suicide hotlines. As it turns out, the suicide hotline is religious, not secular in its origins. The first suicide hotline in the United States is often attributed to the Los Angeles Suicide Prevention Center (LASPC), the same people who diagnosed Marilyn Monroe after her death with suicide.

But in reality, LASPC had tried to shut down the actual first US suicide hotline, in San Francisco, because they found it outrageous.


BRC: Why?


HZ: A few reasons: it used peers, it used the phone, it was anti-psychiatry, and it was anti-cop. And that hotline was growing out of the Anglican psycho-religious tradition, but with a twist. It was helmed by Bernard Mayes, a self-described closeted queer priest, working in San Francisco’s Tenderloin, taking care of the queer population who are increasingly being raided by the police and subject to dangerous 1950s and ’60s psychiatric conversion therapies.

In parallel, Blanton and Peale start training all of these different ministries to do that work, where, across the ’50s and ’60s and into the ’70s, the hotline becomes a very normative technique with lots of difference depending on the line and whom it’s trying to reach.


BRC: The telephone hotline as a therapeutic intermediary.


HZ: That’s it. Teletherapy.

BRC: You say therapy is not “the talking cure,” it is the communication cure. I was thinking of that through different interrelationships with people you don’t know, like, when you try to write them virtually instead of an in-person meeting. Sometimes you email someone and there’s an instant ease of communication, you click right away, whereas the next email interaction with someone else is stilted and uncomfortable, and obviously so.

I don’t even know what my question is … Am I just asking, why is communication hard?


HZ: Because it’s impossible. It all depends on how good the person on the other end of the line is at what we might call “telepresence,” or fostering distant intimacy. We make up a lot of stuff about other people in our minds, whether we are embodied with them or not. It’s why analysts preserved the couch across their 130-year history. (That and Freud hated patients looking at him. It’s intense to be stared at all day long.)

We know this from decades of people falling in love online, or having developing friendships online with people they never met before. This has been true since Usenet and bulletin-board services. You can have really intense intimacy over distance, sometimes only because distance is there. Navigating between the two is the tricky spot, when the distant relationship crashes into a proximate relationship and vice versa.


BRC: In the middle of our semester, we changed the mask requirement in class so it was mask optional. It was like, look at all these faces I’ve never seen! I don’t know who this person is walking into my class. I had to remeet my students because now I could see three more inches of their face.

That felt like a point about distance not having to be physical. You can feel far from someone right beside you.


HZ: I would love to see the neural work on what we do to make up what we think the person looks like underneath the mask. I have a really dear friend in the Bay Area, Jane, and recently my husband and I were out to dinner, and we were convinced she was at this same outdoor parklet and ignoring us. It never occurred to us that it wasn’t Jane. (Hi, Jane!) Eventually the woman took her mask off to sip her cocktail and she looked nothing like Jane. There must be some scientist who can tell me what was happening there.

BRC: You are a prolific writer for a number of forums. Is that the result of a natural inclination?


HZ: Perhaps embarrassingly, at five years old I decided I was going to be a poet. And when I was around 18, a book of my poetry was published. And what you should never do is publish a high school poet’s juvenilia as poems. It was too much too fast, and even worse, they weren’t very good. But then I didn’t know quite how to grow up out of them.

What finally helped was taking Dr. Laura Wexler’s seminar at Yale. It was a class on photography and memory and the family. It changed my life, got me to rethink what it meant to want to write and publish. Laura is a professor of American studies and gender and sexuality studies, and she got to bring us to all of Yale’s archives and art museums. So, one day we are reading Freud’s “Mourning and Melancholia” for class. I was reading the essay for the first time. Yes, my parents are analysts, but no, I hadn’t really sat down to read their foundational texts. And I had never wanted to understand something so badly, so urgently! The idea of trying to understand “Mourning and Melancholia” felt much more urgent than writing a poem about whatever.

And so I just got to work. I hadn’t been a very invested student, but overnight that changed. I wanted to understand critical theory. I wanted to understand the theory of photography, and eventually media theory. I moved away some from the visual, but that is where I started, and from that I have been invested in moving my research beyond the boundaries and limits imposed by the academy, while also really respecting some of the conventions of our field.

It is a both/and for me.


BRC: Are there leading lights for you who do this really well?


HZ: Oh my goodness, so many. We’re in a boom for para-academic criticism and also extra-academic education, and not for happy reasons, although being in these groups has, for me, been deeply generative for thinking. I just started a new magazine project with some very brilliant people, and codirect an extra-academic foundation with Alex Colston, who is someone I respect and admire.


BRC: What is your magazine called?


HZ: Parapraxis.

I think there’s a fantasy that the public work is rewarded institutionally, although I think it’s more complicated than it is or it isn’t; I think it’s rewarded for some, typically those with tenure.


BRC: It is a constant conversation at my school. I have to explain how much more difficult it often is to write not for the academy. Working across different editorial oversights and demands is tricky, understanding and catering to varying audiences is difficult.


HZ: Right, and that’s true for peer-reviewed work too, sure, but the difference between the two isn’t that one is easy and one is hard.


BRC: Oh shit, I almost said the same thing. I often feel like peers say, Oh that’s nice, you published something at a website, as if it’s a 1997 Geocities website or something. As if you cut and paste something onto your blog.


HZ: Sometimes what feels more gracious to me about writing for the public is also that you can be in the role of the editor there. I have learned so much from being well edited, especially in the last few years. My partner reads everything I write, but if someone sends me a piece of criticism or a peer-reviewed essay, it is top of the inbox. It is what I’m going to do that day. It is the most pleasurable part of “the job” probably, but it is also about friendship. But when you have that editorial experience within peer review, it is like the best of both worlds, you’ve gotten this anonymous feedback (and hopefully no one has been cruel). And you actually have subject-area editors who are taking the time to really help the thing be as well seated as it can be. I’ve had that experience twice at differences, and it has been joyous.

I wish we paid and respected and cared for our editors at academic journals, and I could say the same for editors who work for the popular press and small literary magazines and so on.


BRC: Is that what you are doing more with Parapraxis?


HZ: Parapraxis is going to be a popular magazine of psychoanalysis and for psychoanalysis. We have just the most amazing crew at work on this. We are editing and commissioning for our first issue, which will come out in November, we hope. It is being hosted by what is called the Psychosocial Foundation—


BRC: Is that yours too?


HZ: Yes, with Alex. But we are running seminars and conversation series around key words in the psychosocial. Our first issue this fall is on the theme of the family, and it has been incredible, because every time one of the editors speaks to people about it, to find contributors, they are just so excited, even thrilled. But also they can’t believe something like this has never existed before. So we are trying to be a medium for this new project, to facilitate it. It takes a lot of time! And we’re fundraising so that we can pay everyone, and are paying our writers, designers. People are being so generous. And we want to provide a space for people who are just getting started as well as featuring work by those already established.


BR: People aren’t able to get jobs in academia in the way that they would have in the ’70s. What do you think the relationship is between the rising precariat and the proliferation of these new forums? The proliferation of para-academic spaces?


HZ: Those were the not-so-happy reasons I was alluding to before. For four years, I was an adjunct, a contingent faculty member, pretty much semester to semester. By the end of it, before I got my job that starts this summer, I was lucky in that I was full-time for two of those years. Which is a lot of work. I taught five courses in the regular school year, both to undergrads and to graduate students. I also taught in the summer to be able to send my kid to preschool.


BRC: Your Rate My Professor reviews are so much better than mine.


HZ: Thank you! I think I have two of them; I do have good teaching evaluations—my job literally depended on it. Though teaching evals should be disbanded. One thing that I know about Parapraxis and the Psychosocial Foundation is that I wanted a place where we could think together, like truly think. It is a very difficult thing to do, let alone alongside precarious labor. And it requires having the space be open economically, so all of our activities through the foundation are sliding scale—all the way to free.


BRC: Does this connect with your next book, Mother’s Little Helpers?


HZ: In some ways, thinking-wise, if not publisher-wise. It’s called Mother’s Little Helpers: Technology in the American Family. It’s about how “mother” became conceptualized as a medium in the 20th century. As parenting gets more labor-intensive across the century, parents call in adjunctive technologies to help them assist in their parenting, not just the iPad, but the much-longer intensive history of this; I start with the crib (but also with the aftermath of enslavement, the professionalization of the nanny). The book looks at how at the same moment this becomes a necessity to accommodate a certain parenting, the psy fields—psychoanalysis, psychology, psychiatry—begin to punish parents for making use of these adjunctive sites of care by turning “mother” into a medium herself.


BRC: This is underway?


HZ: Yes, I have a contract for it with MIT Press, and am finishing it now. You might see the common ground between our first issue of Parapraxis and the family focus.


BRC: I wanted to say something about synergy but I hate that word too much, so instead I’ll say what a great image that is, of how public-facing and traditional academic work can be of a piece.


HZ: Aw, thank you, yeah—we certainly have much to do.


This article was commissioned by B. R. Cohenicon

Featured Image: Courtesy of Hannah Zeavin.