If you’re not having fun in life, is that because of something inside you, or something in the world outside? This is a discussion I and my therapist have had in various forms on numerous occasions. With an activist perspective I am prone to putting the blame for my distress on the outside world and saying it needs to be changed. The therapeutic approach emphasises doing internal work in order to overcome your distress.

This is a debate that can never be resolved because there’s no way to draw a line around what the best approach is in a given situation. Unfortunately in the world of therapy one voice – that of the importance of internal work – speaks massively louder. This makes me interested in David Smail, who in ‘The Origins of Unhappiness’ argued that therapists are fooling themselves as well as others in thinking that we can locate our distress in the relationships and situations close to us, and then change the nature of those relationships. Much of our distress, he argues, is caused by forces acting at a much greater distance, economic and social forces that pervade the world and which we cannot just decide to change. Therapists ignore power relations, he says, and so can’t really understand their clients’ minds.

I think Smail goes too far. He doesn’t take trauma seriously, and where internal work can be useful is undoing some of the work of trauma. But he is probably right in some regards – when it comes to some forms of depression for example. I suspect it is often the social and economic worlds that strip our lives of meaning. The problem is not you. It is that the world is alienating and depersonalising and has no interest in supporting you.

The answer to the title then is clearly ‘both’, but that’s only the beginnings of an answer. For any given incidence of distress, should we focus on the external world or internal? We have to re-answer this constantly, and because social phenomena are so complex, we can’t easily test whether our answers are right or not. The question, however, is a good one to always have in mind.