The Social Pathologies of Contemporary Civilization 9781409445050, 9781409445067, 9781409472865, 2012030840

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The Social Pathologies of Contemporary Civilization

Edited by Kieran Keohane and Anders Petersen

The Social Pathologies of Contemporary Civilization

Classical and Contemporary Social Theory Series Editor: Stjepan G. Mestrovic, Texas A&M University, USA Classical and Contemporary Social Theory publishes rigorous scholarly work that re-discovers the relevance of social theory for contemporary times, demonstrating the enduring importance of theory for modern social issues. The series covers social theory in a broad sense, inviting contributions on both ‘classical’ and modern theory, thus encompassing sociology, without being confined to a single discipline. As such, work from across the social sciences is welcome, provided that volumes address the social context of particular issues, subjects, or figures and offer new understandings of social reality and the contribution of a theorist or school to our understanding of it. The series considers significant new appraisals of established thinkers or schools, comparative works or contributions that discuss a particular social issue or phenomenon in relation to the work of specific theorists or theoretical approaches. Contributions are welcome that assess broad strands of thought within certain schools or across the work of a number of thinkers, but always with an eye toward contributing to contemporary understandings of social issues and contexts. Also in the series Utopia: Social Theory and the Future Edited by Michael Hviid Jacobsen and Keith Tester ISBN 978-1-4094-0699-0 Fallgirls: Gender and the Framing of Torture at Abu Ghraib Ryan Ashley Caldwell ISBN 978-1-4094-2969-2

The Social Pathologies of Contemporary Civilization

Edited by Kieran Keohane University College Cork, Ireland Anders Petersen Aalborg University, Denmark

© Kieran Keohane and Anders Petersen 2013 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise without the prior permission of the publisher. Kieran Keohane and Anders Petersen have asserted their right under the Copyright, Designs and Patents Act, 1988, to be identified as the editors of this work. Published by Ashgate Publishing Limited Ashgate Publishing Company 110 Cherry Street Wey Court East Union Road Suite 3-1 Farnham Burlington, VT 05401-3818 Surrey, GU9 7PT USA England www.ashgate.com British Library Cataloguing in Publication Data The social pathologies of contemporary civilization. -(Classical and contemporary social theory) 1. Civilization, Modern--21st century--Health aspects. 2. Sociology of disability. I. Series II. Keohane, Kieran. III. Petersen, Anders. 306.4'61-dc23 The Library of Congress has cataloged the printed edition as follows The social pathologies of contemporary civilization / [edited] by Kieran Keohane and Anders Petersen. p. cm. -- (Classical and contemporary social theory) Includes bibliographical references and index. ISBN 978-1-4094-4505-0 (hbk) -- ISBN 978-1-4094-4506-7 (ebook) 1. Sociology--Philosophy. 2. Sociology--Psychological aspects. 3. Pathology--Social aspects. 4. Diseases--Social aspects. 5. Civilization, Modern. I. Keohane, Kieran. II. Petersen, Anders, 1973HM585.S566 2013 301--dc23 ISBN 9781409445050 (hbk) ISBN 9781409445067 (ebk – PDF) ISBN 9781409472865 (ebk – ePUB) V

Printed and bound in Great Britain by the MPG Books Group, UK.

2012030840

Contents Notes on Contributors   Introduction   Kieran Keohane and Anders Petersen

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Part I Social Pathologies: Addressing the Question 1 2 3

The Notion of Social Pathology: A Case Study of Narcissus in American Society   Alain Ehrenberg The Social Pathologies of Contemporary Civilization: Meaning-giving Experiences and Pathological Expectations Concerning Health and Suffering   Arpad Szakolczai Modernity as Spiritual Disorder: Searching for a Vocabulary of Social Pathologies in the Work of Eric Voegelin   Bjørn Thomassen

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Part II Social Pathologies: Contemporary Malaises 4

The Value of Houses in the Libidinal Economy: Financialization as Social Pathogenesis   Kieran Keohane

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Depression: Resisting Ultra-liberalism?   Bert van den Bergh

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The Pathologization of Morality   Svend Brinkmann

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The Multiple Self: A Social Pathology?   Annalisa Porfilio

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Possible Explanations for Increasing Antidepressant Treatment in Modern Society   Margrethe Nielsen and Gunnar Scott Reinbacher

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Part III Social Pathologies: Biopower, Subjectification and Civilization 9

Does Society Still Matter? Mental Health and Illness and the Social Sciences in the Twenty-first Century   Pia Ringø

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Evaluations as a Process of Disenfranchisement   Anders Petersen and Rasmus Willig

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Schismogenesis, Liminality and Public Health   Agnes Horvath

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Index  

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Notes on Contributors Bert van den Bergh is Senior Lecturer at The Hague University and is completing his PhD at Erasmus University Rotterdam, the Netherlands. Svend Brinkmann is Professor of General Psychology and Qualitative Methods at Aalborg University, Denmark. His recent books include Psychology as a Moral Science: Perspectives on Normativity and Qualitative Inquiry in Everyday Life: Working with Everyday Life Materials. Alain Ehrenberg is Senior Research Scientist at the CNRS (Centre National de la Recherche Scientifique). He is author of La Société du Malaise and The Weariness of the Self: Diagnosis the History of Depression in the Contemporary Age. Agnes Horvath is a sociologist and political scientist with interests in anthropological aspects of modern society. An affiliated scholar at Cambridge University and co-founder of the journal International Political Anthropology, she is co-author of Senkifoldjén (On the No Man’s Land) and The Dissolution of Communist Power, and co-editor of Reclaiming Beauty: Collected Essays in Political Anthropology. Kieran Keohane is Senior Lecturer in Sociology at the School of Sociology and Philosophy, University College Cork, Ireland. He is the author of Symptoms of Canada and co-author of Cosmopolitan Ireland: Globalisation and Quality of Life and Collision Culture: Transformations in Everyday Life in Ireland. Margrethe Nielsen is Lecturer in Midwifery at Metropolitan University College, Denmark, where she is currently completing her doctoral dissertation. Anders Petersen is Associate Professor of Sociology at Aalborg University, Denmark and President of the Danish Sociological Association. He is editor of Selvet: Sociologiske Perspektiver (The Self: Sociological Perspectives). Annalisa Porfilio is Associate Lecturer in Sociology at the National Distance Education Centre of Dublin City University, Ireland. She is currently completing her doctoral dissertation at the School of Sociology and Philosophy at University College Cork, where she has been investigating the question of ‘theory’ with the financial support of the Irish Research Council for the Humanities and the Social Sciences.

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Gunnar Scott Reinbacher is an associate professor in the Department of Culture and Global Studies at Aalborg University, Denmark. He is Chair of Research Network 16 at the European Sociological Association on The Sociology of Health and Illness and co-editor of Research Design: Validation in the Social Sciences. Pia Ringø is completing her PhD at the Department of Sociology and Social Work, Aalborg University, Denmark, focusing on the connection between political, managerial and regulative forms of governance and the scientific character, transformation, understanding and practice of psychiatry. Arpad Szakolczai is Professor of Sociology at University College Cork, Ireland. He is the author of Max Weber and Michel Foucault: Parallel Life-Works; Reflexive Historical Sociology; The Genesis of Modernity; Sociology, Religion and Grace; and Comedy and the Public Sphere. Bjørn Thomassen is Associate Professor of Sociology at the Department of Society and Globalisation, Roskilde University, Denmark and co-founder of the journal International Political Anthropology. Rasmus Willig is Associate Professor of Sociology at the Department of Society and Globalisation, Roskilde University, Denmark and author of Disenfranchisement: An Essay on the Infrastructure of Critique.

Introduction Kieran Keohane and Anders Petersen

The Social Pathologies of Contemporary Civilization seeks to understand the ways in which contemporary malaises, diseases, illnesses and psychosomatic syndromes are related to cultural pathologies of the social body and disorders of the collective esprit de corps of contemporary society. We argue that many contemporary problems of health and well-being are to be understood in the light of radical changes of social structures and institutions, extending to deep crises in our civilization as a whole. Problems of health and well-being have hitherto been considered in isolation; both in isolation from one another, and in isolation from broader contexts. We argue, however, that health and well-being are not just located at the level of the individual body, the integral human person, or even collective social bodies, particular communities, entire societies, or even whole civilizations, but encompass the health of humanity as a whole and our relationship with Nature. Depression, addiction, stress, identity crises and other contemporary diseases and disorders are usually addressed discretely as though they were entirely unrelated to one another. This book, by contrast, draws out the commonalities these conditions share as social pathologies. This does not mean, however, that the contributions in this book address these problems from a uniform perspective. On the contrary they address these problems from a multidisciplinary perspective, in ways that are different, though complimentary. Different in the several disciplinary perspectives – philosophy, sociology, social psychology and anthropology, and diverging and disagreeing but unified in their rejection of a reductive biomedical and individualistic diagnosis of these conditions. Social pathology was once a mainstream concern of the social sciences, but over the years it has become associated with conventional, ‘old fashioned’, or normatively conservative standpoints. For instance, the social science focus on social pathologies of the early and mid century was on specific topics, such as alcoholism, crime and delinquency and (what was seen at that time as) sexual deviance. More recently, professional clinicians and medical doctors have provided a great number of books in a ‘self-help’ genre oriented to both a specialist readership and to a wide audience. There is a wide variance of quality in the genre. Some are ‘best-sellers’ because their authors hold positions of authority and their readers are looking for authoritative guidance. However, the weakness of most books in this genre is that they concern themselves with one discrete problem – depression, or eating disorders, or stress – and/or that they are focused at the level of the individual subject.

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Conscious of this problematic antecedence and its narrowly ideological and moralistic legacy, this book breaks decisively from this anachronistic context in several ways. First, this book is concerned with contemporary epidemic social pathologies. These illnesses – depression, stress-related illnesses, eating disorders, suicide and deliberate self-harm, to name just a few – are the subject of much discussion today, and they are the problems recognized and targeted by mental health professionals and in public health campaigns promoting mindfulness and well-being. While sympathetic to these problems and while aware of these developments in public mental health promotion and appreciative of them insofar as they are well-intentioned, our book is concerned with understanding more widespread social pathologies than fall within the conventional remit of mental health and well-being. We understand social pathologies not only in terms of their being constructions in psychiatric discourse, but we see reductive psychologization and biomedical psychiatricization as itself a symptom of a problem that requires diagnosis and analysis, and we locate ‘mental’ illness and their conventional formulations in psychological and psychiatric discourses in terms of wider social transformations and civilizational crises. This book treats pathologies as multiple and as being related to one another, and as not merely problems to be understood and addressed at the level of the individual sufferer but rather as to be understood in social and historical terms. Instead of addressing these conditions as though they were discrete pathologies, specific diseases suffered by private individuals as ‘cases’, our starting point is always that the sources of these problems are social, that they arise from collectively experienced conditions of social transformations and shifts in our civilization. Reductive psychological-individualistic and psychiatriac-biomedical perspectives dominate the contemporary literature. The earlier, conventional social science literature on social pathologies is reductive in another sense. Not only are social pathologies considered primarily in the conventional and dated meaning of ‘social problems’, but the scope of their analysis has been typically restricted to particular societies: drug addiction in the USA, for instance, or juvenile delinquency in the UK, taking the modern nation state as their compass. By contrast, the contributors to this volume take it that social pathologies cannot be understood within the confines of particular societies but need to be understood within the society-transcending contexts of globalization. Furthermore, the authors share the premise that the genesis and etiology of contemporary social pathologies cannot be understood within Euro-centric or Moderno-centric terms of modern western society, but rather they need to be interpreted within the perspective of an historical longue durée and in comparative civilizational contexts. This book, based on the proceedings of an international conference on The Social Pathologies of Contemporary Civilization, held at Aalborg University, Denmark, 28–29 October 2010, poses the following questions: Are we able to understand contemporary epidemics such as depression, stress, addictions, anxiety and emotional disorders etc., as social pathologies; as symptoms of disorders of the collective esprit de corps of contemporary civilization manifest at the level

Introduction

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of individual patients’ bodies? Are the sources of these contemporary epidemics (social pathologies) to be found in understanding their historical socio-genesis, and do health policy responses to them need to be formulated in terms of the broader civic health of society? How has the development of a powerful health industry, a pharmaceuticals industry especially, paved the way for a widespread medicalization of the new social pathologies, and hence for society as such? How do social, cultural, political, normative and economic transformations of society effect health and well-being? How is the experience of social change related to the emergence and proliferation of new mental illnesses? Does contemporary civilization as such make people ill? Is illness – particularly mental illness – merely a response to societal change? Is every societal epoch characterized by different illnesses? The central hypothesis uniting the contributions in the book is that the various health-related symptoms are part of a radical change of our civilization. A particular focus of the book is thus the role of humanities and social sciences, particularly sociology, philosophy, psychology and anthropology, in helping to understand the connection between social transformations and health and well-being. In reviewing the contributions for the book, we discovered that they touched upon different aspects and levels of the overall theme. We have therefore decided to divide the book into three parts in order to present the topics addressed in a wellarranged manner. These are: Part I Social Pathologies: Addressing the Question; Part II Social Pathologies: Contemporary Malaises; Part III Social Pathologies: Biopower, Subjectification and Civilization. Part I Social Pathologies: Addressing the Question Alain Ehrenberg begins the book by elaborating the notion of social pathology. The idea underlying the adjunction of the adjective ‘social’ to the substantive ‘pathology’, Ehrenberg says, is that mental pathologies are the product of our social relationships, that they reveal something about our mores and our lifestyles, and that there is a moral, social and political lesson to be drawn from this type of pathology. This theme is explored through a case study of narcissism in American society, from Tocqueville through to contemporary classics of Reisman, Sennett and Lasch, identifying both the general relations between modern individualism and social pathologies of narcissism and what is particular and peculiar to contemporary American and French manifestations of the relation between self and society. Arpad Szakolczai’s chapter expands the concern with social pathologies to address Pathologies of Contemporary Civilization, for the book is not about ‘The Social Pathologies in Contemporary Civilization’, but ‘The Social Pathologies of Contemporary Civilization’. This enables one not simply to address the pathological character of certain aspects of the civilization in which we are living – and here it is important to note the importance of the word ‘civilization’, in contrast

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to ‘society’ or ‘culture’, much more frequently used in sociology, or the social sciences in general – but might pose the question of how an entire civilization may show pathological features. Such an idea is ‘disturbing’; undermining the easy, comforting certainties of a deep belief in the progressive nature of our societies, of ‘us moderns’ as Latour states. Yet, this is a question that needs to be raised, and at this level, if we are to transcend the Euro-centric and Moderno-centric limitations of perspective that are very much part of the problematic. Bjørn Thomassen develops this project in another trajectory, seeking to recover and to refine a language with which to grasp and articulate the social pathologies of contemporary civilization. The term pathology is loaded. Any invoking of the concept risks being attacked: the moment we say ‘pathology’, we somehow signal a strong normative position on what is ‘normal’, what is ‘good’ and what is ‘healthy’. Such a reference to the good, healthy or even beautiful contrasting to the pathological will immediately be accused of essentialism and ideologically-based normativism. One feels compelled to positively establish principles or foundations from where the pathological can be defined. This is hardly acceptable within the reigning positivism of the social sciences or within its alternative paradigm, social constructivism. In this chapter Thomassen wants to pose two very basic questions: Is there a way in which we can justify such a language? And what would such a language sound like – i.e. into what kind of conceptual, methodological or theoretical frame does it become justifiable? Thomassen argues that Eric Voegelin has provided some crucial elements for us to at least pose these questions in a meaningful way. Part II Social Pathologies: Contemporary Malaises The chapters comprising Part II take the general paradigm of social pathologies of contemporary civilization, the parameters and contours of which have been mapped out in the first part, and apply the perspective to develop diagnoses of the prevailing zeitgeist through analyses of particular contemporary malaises. Kieran Keohane’s Chapter 4, ‘The Value of Houses in the Libidinal Economy: Financialization as Social Pathogenesis’, draws from Simmel’s classic Philosophy of Money as a diagnostic of the pathogenic effects of financialization. Money dissolves and reduces all unique and particular values to a lowest common denominator and modern civilization becomes characterized by cynicism, nihilism and greed. These pathogenic tendencies of money economy become amplified in the more recent context of the globalization of financial markets. Liquescence and limitlessness become collective stimuli on the one hand, and on the other hand a source of deep insecurity as people search for points of unconditional mooring in a world of flux and contingency. It is in this specifically contemporary context of liminality and existential insecurity that real estate attains an exaggerated value on which derivative financial instruments were leveraged, constituting insecurity at the foundations of globalization that was the epicentre of the global financial crash.

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Bert van den Bergh’s Chapter 5, tackles the most pervasive and most characteristic social pathology of contemporary civilization, namely depression, which he formulates in terms of the contours and contexts of ultraliberalism. Systematically reviewing the most penetrating philosophical and sociological analyses of the human predicament under conditions of late capitalism/postmodernism, from Charles Taylor’s paradoxes of the quest for authenticity and Alain Ehrenberg’s identification of the tiredness of having to become, within the exigencies of what has been called ‘the new spirit of capitalism’, van den Bergh takes us to the cutting edge of the most recent literature by Dany-Robert Dufour and others, drawing our attention to a mutation taking place at the level of political anthropology and the emergence of the ideal-type subject that is formed by the neo-liberal revolution: no longer the critical-neurotic modern subject, but an a-critical, isolist subject with psychotic tendencies. In Chapter 6, ‘The Pathologization of Morality’, Svend Brinkmann investigates how a number of moral and existential forms of suffering have become pathologized and transformed into psychiatric issues; how, in other words, we witness a pathologization of morality. The argument navigates between the Scylla of global medicalization (according to which any kind of human suffering can – and must – be seen in the light of psychiatry) and the Charybdis of anti-psychiatry (according to which psychiatric diagnoses per se represent an unwarranted medicalization of morality). On the one hand, it has undeniably been a major humanist breakthrough that we no longer hold people responsible for things that they cannot control and in this sense replace a moral understanding with a psychiatric one, but, on the other hand, a widespread medicalization today threatens to eradicate our sense of moral responsibility and meaningfulness altogether. The challenge, however, is how to distinguish warranted from unwarranted pathologization. Annalisa Porfilio’s Chapter 7 addresses the phenomenon of ‘Multiple Personalities’ as a symptom of social pathogenesis, and also as an index of the changing status of the self in contemporary civilization. The chapter traces a genealogy of the formulation of the phenomenon of multiple personality in the psychological literature, from multiple personality having been understood as ways in which a rational individual coterminous with a physical body would cope with deep traumatic experiences through dissociated mental processes. During the last decades, however, these ideas seem to have lost popularity and mental health professionals have been confronted with the new phenomenon of the inherently multiple self a volitional subject actively engaged in the construction of plural identities in response to the existential demands a globalized, pluralized world. Thus in the literature persons claiming to possess multiple identities healthily coexisting in a single body have gradually replaced narratives of pathology, though this normalization in itself may be read as symptomatic of pathogenic society. In Chapter 8 Gunnar Scott Reinbacher and Margrethe Nielsen outline possible explanations of increasing usage of newer antidepressants. Since the late 1980s sales and prescribing of newer antidepressants have increased dramatically in most European countries and internationally. However, the prevalence of depression

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amongst a population should be expected to be constant, so the sharp increase in the use of antidepressants indicates the important role of social and cultural factors rather than biomedical explanations for the increase. The ‘epidemic(s)’ – of depression as disease and the ‘epidemic’ of diagnosis and prescribing – are discussed, showing the role of the pharmaceutical industry and other stakeholders in influencing the utilization of health care services and the increased use of antidepressants. Part III Social Pathologies: Biopower, Subjectification and Civilization The chapters in the final section of the book move us back again from the particular towards the general level of sociological analysis and diagnosis by building bridges linking the subtle and diffuse ways in which micro-processes and molecular biopower map onto processes at the most general level of social transformation and civilizational change. Pia Ringø’s Chapter 9, ‘Does Society Still Matter? Mental Health and Illness and the Social Sciences in the Twenty-first Century’, examines the ways in which the scientific character of psychiatry and the managerial-technological principle that scientific methods that identify truth with certain ways of acquiring knowledge can produce more effective treatment measures, tends to abandon the fundamental problems of psychiatry. The complexities of emotional life and the existential and moral problems of what it means to be a healthy human being are increasingly set aside and bypassed, instead trusting in the ability of science to determine ‘what works’ in psychiatric practice, reducing consideration of the healthy mind to primary individualistic biomedical and cognitive approaches. In Chapter 10, ‘Evaluations as a Process of Disenfranchisement’, Anders Petersen and Rasmus Willig analyse one of the ubiquitous, seemingly innocuous, light, and even progressive aspects of governmentality and the audit culture, selfevaluation. The case in point is self-administered evaluation by Danish kindergarten workers, an exercise that seems beguilingly easy and ’helpful’, being oriented to improving services to children by enabling greater self-reflexivity amongst staff, but that turns out to be much more an exercise in subjectification; self-criticism fostered by the evaluation questionnaires being a subtle but powerful regulatory discourse and disciplinary mechanism, and one that clearly has the discernible effects of demotivating staff and decreasing and dis-improving the time, attention, and the quality of care for children. The closing chapter, Agnes Horvath’s ‘Schismogenesis, Liminality and Public Health’, returns us again to the broad and deep contexts and framing questions at the heart of this collection. Health, especially public health, Horvath says, cannot be reduced to the absence of illness and measured by indicators collected in a number of disjointed areas. It rather refers to the harmonious manner in which various aspects are combined together. Eating, drinking, mental health, and so on, all add – or should add – to a harmonious whole for everyone, and for society as a whole. This perspective on health frames our concern with the loss of public

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health toward degenerative social pathologies, exemplified in this analysis by the case of communism as a diffuse, paralyzing political disease of stagnation for much of the past century; a pathological condition that suddenly, and almost bloodlessly, seems to have collapsed, though its dissolution does not simply mean its complete end, rather only its contaminating dilution of palsy continuing to have an even more schismatic, widespread effect, and not only in the areas that were formerly under its control. This chapter turns attention to the meaning of the term social pathologies, by arguing that they are not the opposite but the replacement of wholesome conditions.

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Part I Social Pathologies: Addressing the Question

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Chapter 1

The Notion of Social Pathology: A Case Study of Narcissus in American Society1 Alain Ehrenberg

The aim of this chapter is to elaborate the notion of social pathology. The idea underlying the adjunction of the adjective “social” to the substantive “pathology” is that mental pathologies are the product of our social relationships, that they reveal something about our mores and our lifestyles, and that there is a moral, social, and political lesson to be drawn from this type of pathology. At the end of the nineteenth century, neurasthenia inaugurated the tradition of social pathology: it was the first illness of modern life. Today, this topic is related to the widespread—and very confusing—idea in the social sciences and philosophy that there is a double process of psychologization resulting from a weakening of social links, and of a decline of public man in favor of private man. Partisans of this idea mainly claim that genuine society is what used to be. Sociology, in my opinion, has to go beyond this causal explanation. This notion raises the tricky issue of the relationships between changes in symptoms and personality, and changes in social norms and values. To try to clarify the notion, I’ll focus on the basis on which this widespread idea has been elaborated since the 1970s. This basis is made up with pathologies coming from British and American psychoanalysis: narcissistic and borderline pathologies. They belong to the category of “character neurosis.” These neuroses are characterized by a disorganization of the personality, and notably self-esteem problems, which didn’t exist in “traditional” neurosis, the so-called transference neurosis, that is hysteria, phobia, and obsession, and by anxieties of loss rather than of conflict. In transference neurosis, it is both the superego and the conflict between what is allowed and what is forbidden which are at stake; in character neurosis, it is both the ideal ego and loss which are the problem. Today, psychoanalysts deem that most contemporary patients belong to the second category. They tend to think that they address less a therapy of the repressed, the one of transference neurosis, than one of the ideal, the one of character neurosis. In this shift from transference to character, depression has played a major role, but I want to address a parallel issue. 1  This chapter is based on Ehrenberg (2010).

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On the basis of this class of neurosis, two American sociologists, Richard Sennett in 1974 with The Fall of Public Man and Christopher Lasch in 1979 with The Culture of Narcissism, successfully launched the idea that the individual has become narcissistic. This psychoanalytic notion has been successfully accepted as a sociological concept: a wide moral, social, and political consensus has been shaped to claim that Narcissus has replaced Œdipus. Sennett and Lasch raised a question on the basis of these pathologies: are we facing a transformation of individualism, which is turning against both society and the individual himself? I will approach this sociological transfiguration of the psychoanalytic notion of narcissism in the American context at two levels, sociological and epistemological. At the sociological level, I consider it as a narrative, which shows tensions specific to American individualism. The issue is less the truth or mistake of this narrative than its success. It seems to me that its success in America lies in its anchoring into a style of rhetoric that the historian of American literature Sacvan Bercovitch called “The American Jeremiad ” in a book published with this title in 1978. The term is descriptive: it designates the political sermons by Puritan ministers of New England in the seventeenth century which “joined lament and celebration in reaffirming America’s mission.” The Jeremiad is characterized as follows: a recall of ideal norms of the past; a condemnation of the current state of the community; and a prophetic view announcing that the gap between past and present will be filled in by a punishment sent by God, which is a correction. They made up an American ritual “designed to join social criticism to spiritual renewal, public to private identity.” On the other hand, at the epistemological level, as a tool for sociological analysis, I’ll criticize this narrative because it is an individualistic sociology, that is a sociology which is trapped in the opposition between the individual and society, and obsessed by a feeling of decline and of social dissolution, and not a sociology of individualism, which goes beyond this opposition. To summarize my point: the fear of social dissolution is a common idea in our society, it is a social idea; the sociologist has to describe and analyze this fear, as a feature of our society, and has to go beyond it, as a sociology of individualism. Elements on American Individualism Its specificity lies in a category that symbolizes the American way: the self. Before being a philosophical or psychological concept, the self is a specifically American anthropological category, at least if one compares the US and France where there no such thing as a self, a category whose origins are social. It is a collective representation, a common idea in American society. This concept is of the greatest social value. It is an expression of a way of living in common through which is represented the automotivated individual who is a fundamental common value of the American society. It harks back to the Puritan origins of America, continues on to the Revolution of the end of the eighteenth century, and nineteenth-century

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Romanticism, notably with its major figurehead, Ralph Waldo Emerson. The American individual’s first duty is toward society, as it was previously toward his God, whereas in France, it is society, through the state, which has obligations of protection toward the individual—the state being the expression of solidarity of society to any individual. Of course, the self is not considered alone, as an isolated entity; it is intertwined in a cluster of related concepts: self-reliance, which means trust in oneself and independence; self-government, which designates the interdependent pairing of individual and community; it also refers to another pair of key values: achievement, which has its source in Puritanism, and equality, which results from the democratic nature of society, and which is conceived of in terms of opportunity. We French people value an equality conceived of in terms of protection. Opportunity is not highly valued; it is in the same situation as protection is in the US: a secondary value. America and France are like reversed mirror images. The self, then, is not something inside the individual, but the interface between impersonal and personal (Bercovitch 1975); it is the common, what is shared between us. The self is the motor of this restless activity noticed by Tocqueville, and the crisis of the self is a permanent feature of American history. This goes back to the Puritan foundation in which the strain on the self is a permanent ordeal faced with the double predestination: elected or doomed? To soothe this strain, believers found in the “exemplary biographies” a scene for their dilemma and of their resolution. In Auto-Machia (1607), a popular piece of poetry of Puritan literature, George Goodwin wrote: “I sing my SELF; my Civil Wars [sic] within” (Bercovitch 1978: 13). This “narcissistic liebestod,” as Bercovitch put it, is a swaying between fall and redemption. We will later again find this swaying in the tensions between “individualism” and “community,” or between private and public happiness. In the eighteenth century, doctrine evolved thanks to Methodism which added an affective and cheerful element to Puritanism: the authentic convert could take advantage of his life on earth, and this gave rise to what Max Weber called “a culture of affectivity” (Weber 2003: 241). In the nineteenth century, American Romantics used the tradition of the exemplary biographies in a new literary genre: the American autobiography. They celebrated their own self as a representative of America. Ralph Waldo Emerson, the most famous of them, merged romantic naturalism with Puritan hermeneutics in an idea of the American self in which the personal and the common are intertwined. The relationship between the individual and America is as direct as the relationship between the believer and his God. I didn’t refer to the mortal narcissism of the Puritans by chance, because Sennett and Lasch have inherited this topic.

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The Encounter between Psychoanalysis and Sociology The transformation of narcissism into a sociological concept results from the encounter between the main trend of American psychoanalysis, the Ego– Psychology school, and the exploration of the American character, the brand name of American social sciences since David Riesman’s The Lonely Crowd, published in 1950. Two recurrent topics used to criticize transformations of individualism until today first appear in this seminal book: “personalization” and “privatization.” This encounter appears in a social context which I will specify further. In the US, contrary to France, psychoanalysis has been introduced in the context of a global interest in psychology, a psychology that has been invested with hopes of enhancement of personal ability to connect with others successfully. For instance, Freud raised so much interest among American scholars that The American Journal of Sociology devoted a whole issue to his work in 1939, the year of his death. Another feature of American psychoanalysis and of the relationships between psychoanalysis and sociology in the US is the role played by the Frankfurt chool, the Culture and Personality School, and, more generally, by Culturalism. The issue of “personality” is a major topic of American social sciences. This was not the case in France, where the French sociological school considered the notion of “personality” and collective psychology suspiciously. In a speech given before the French Society of Psychology in 1924, Marcel Mauss considered that collective psychology described the group spirit without the description of the group itself. He called it “the contentious discipline” (Mauss 1968: 296). The key moment unfolded between the 1930s, with the work of Eric Fromm and Karen Horney, and 1950, the year The Lonely Crowd was published. It has been the biggest commercial success of American sociology until today, and Riesman was the first social scientist to be on the cover page of Time Magazine after the paperback publication in 1953. His book was explicitly founded on a hypothesis formulated by Fromm. The Frankfurt School, The Culture and Personality School, etc. are contributions, among many others, to the American way of representing common life on the basis of the self-motivated individual. The concept of collective personality has opened a space of exchange between psychoanalysis and sociology, actually a space that is a sort of a division of labor: psychoanalysis being about individual psychology and sociology about collective psychology. Following the publication of The Lonely Crowd, numerous studies on the American Character and its changes were published. At the same time, several books by psychoanalysts popularized the idea that the character or the personality of the patient had changed. Childhood and Society, by Erik Erikson (1950) or The Quest for Identity, by Allen Wheelis (1958) described new patients that were no longer subject to the same type of neurotic disorder than those of Freud’s time. They suffer from identity disorders, from disorders of self-image, that is, pathologies where social and moral ideals of the individual are core symptoms. Often, these patients don’t show clear symptoms, but rather a vague and permanent malaise.

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Here, I have to emphasize the social role played by character neurosis: this notion rendered psychoanalysis less strange, because everybody could recognize common social types through it. With this sort of neurosis, as Karl Abraham wrote in 1925: Psychoanalysts henceforth could not only speak of conflicts related to sexuality, but also of character psychology easily recognizable in daily life in striking descriptive terms. Organized around character and identity, psychoanalysis could enter in public space more easily. (Abraham 1965: 253)

The evolution of ideas in psychoanalysis, on individual personality, and in sociology, on collective personality, lead to an epistemological and moral alliance between the two disciplines. The consequence is that both issues of changes in the normal and the pathological individual are elaborated interdependently. This shaped the “American Jeremiad” narrative of the last third of the twentieth century. The changes in psychopathology that appeared in borderline and narcissistic patients were the staple on which a moral, social, and political criticism has been built about certain trends in American society. Psychoanalysis has been used as a means of information on what is going on in individual reality. It has been utilized in that way because it runs deep into the self-conscious self, into this personality which is valued from the outside, but which is collapsed, psychologically speaking. It shows the disintegration of the self when the pursuit of private happiness and the pursuit of public happiness follow different or opposite paths, betraying the American ideals. In 2000, an American political scientist from Harvard, Robert Putnam, gathered an abundant corpus of quantitative studies allowing the synthesis of trends in terms of strengths and weaknesses of social links. Bowling Alone, a worldwide success, empirically showed the following: For the first two-thirds of the century, a powerful tide bore Americans into ever deeper engagement in the life of their communities, but a few decades ago – silently, without warning – that tide reversed and we were overtaken by a treacherous rip current. Without at first noticing, we have been pulled apart from one another and from our communities over the last third of the century. (Putnam 2000: 27)

During the 1960s and the 1970s, American individualism entered into a crisis which expresses itself in a split between private and public happiness. This has given rise to abundant literature and huge media buzz through two topics: psychotherapy considered as a worldview, and a new character of social life, the narcissistic individual. This encounter between psychoanalysis and sociology happened in a context that I will characterize by two features: the first is what can be termed as the end of a liberal cycle, which had started with Roosevelt with the development of public

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policies aimed to protect individuals and struggle against inequalities; the second feature is the change in mores represented both by the tide of sexual liberation, of valorization of self-ownership, the search for true self (authenticity), and by the movements of emancipation of minorities. These two features are intertwined because policies that aimed to protect the weaker categories of people contributed to the claim of the “personal.” The American paradox is that a new individualism has developed thanks to state protection—as if America were like France—but this has led to a crisis of liberalism which at the same time is a crisis of the core value of self-reliance. Changes in mores were characterized by a new value first noticed by American sociologists at the beginning of the 1960s. Edward Shills formulated it as follows in 1962: To a greater extent than in the past, the experience of the ordinary person, at least in youth, is admitted to consciousness and comes to form part of the core of the individual’s outlook. There has come about a greater openness to experience, an efflorescence and intensification of sensibility. […] In a crude, often grotesque way, the mass society has seen the growth, over wide areas of society, of an appreciation of the value of the experience of personal relationships. (Shills 1976: 1006)

The meaning and the value of what is defined by “personal” is not an issue of private happiness or unhappiness, but a public problem of justice and rights. Social movements of the sixties related claims of justice and rights to one of a recognition of the personal value of the individual. “Personal,” “recognition,” and “experience”: with these three notions it is not only rights which are to be acknowledged, but also lifestyles, lifestyles aiming both to explore and develop the proper personality of every individual. Narcissus, or the Crisis of American Self-reliance It is in this context that the sociologist Philip Rieff (1966) published The Triumph of the Therapeutics. By “triumph,” he means that therapy is not only a tool to treat people, but a worldview which has transformed social man into a psychological man, this new personality which signifies the “failing of ascetic culture” and a “response to the absent God.” “The therapeutic is the symbolic truth of the present age,” and this truth is “the end of the vertical in authority.” Psychological man, concerns about privatization, subjection to impulse and the loosening of community bonds: here are all the topics and the concepts which soon will be the stereotypical concepts of the criticism of individualism in the US, in France and elsewhere. One is missing. According to Rieff, “The strange new lesson we have begun to learn in our times is how not to pay the high personal costs of social organization.”

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On the contrary, Sennett and Lasch describe these “new personal costs” and they underpin their arguments on psychoanalysis. These costs consist of the idea that every individual’s self has become his main burden. Psychoanalysis has taught them that narcissism is a tragedy—and not simple egoism—the tragedy of being locked up inside oneself, which makes the individual waver between a miserable and a grandiose self. Psychoanalysis allowed them to escape from moralism, in which Rieff remains trapped, because he doesn’t perceive the tragedy of the individual. Narcissus performs the Puritan civil war of the self in which selfclaim and self-denial are interwoven in a relentless fight. If narcissism is “a refusal of the self that centers everything on the self,” according to Sennett (1974: 270), it clearly stems from the dilemma of the Puritan who doesn’t know if he is doomed or elected. The dilemma is reproduced in the oscillation between a miserable and a grandiose self, which is the hallmark of the lack of self-reliance. The issue of affectivity is similar in Puritanism and in narcissism, according to Sennett: “The question: ‘What do I feel?’ becomes a genuine obsession.” By the way, Rieff talked of “permissive” psychotherapy as “a permanent fixture of modern culture – a kind of secular Methodism for those who remain obstinately uncomfortable in their pleasures” (Rieff 1966: 238–9). Narcissus is the secularized descendant of the man who lacks faith, who John Cotton portrayed in his Christian Calling: with Narcissus oscillating between the anxiety of emptiness and the joy of all-mightiness, “It is the same act of unbelief that makes a man murmur in crosses which puffs him up in prosperity” (Cotton 1956: 179). The narcissistic individual then symbolizes a crisis of the self, undermining both faith in America and faith in oneself. Though these books are sociological, they are structured on the model of the symbolic analysis of the Jeremiad: social criticism is connected with a call to moral renewal. Both are organized around strong oppositions: between past and present, between the individualism of the past, the “rugged individualism” and today’s individualism, etc. In lieu of the divine correction heralded by Puritan sermons, it is a psychological correction which manifests itself in the painful narcissism of the self which is disembedded from community, the self which only holds up thanks to therapy—25 years later, Prozac was granted an analogous social status. These books are full of nostalgia for an American past, which united the rugged individualism of the pioneers and the good neighborliness of the community (the French wouldn’t say good neighborliness, but solidarity). Their criticism is a ritual of celebration of America and its lost ideals of pursuit of both private and public ideals. They praise America by opposing the genuine individualism of the past to the current and artificial individualism of emotions, impulses, etc. Narcissism brings to light unexpected tensions coming from the emancipation of mores, and a crisis of self-reliance that traditional individualism symbolized with its balanced alliance between competitive sturdiness, cooperation with others, and personal independence. Through therapy and narcissism, these authors gave both a form and a name to specific tensions of American individualism. Which ones? During the 1970s, the

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politics of progress, which developed under the supervision of the federal state from the 1930s to the 1960s, were called into question. As early as the end of the 1960s, this policy was strongly criticized, including by Democrats: it was wasteful and inefficient, increased bureaucracy and encouraged assistance, hence dependence. “Affirmative Action,” designed to give advantages to minorities considered as groups and not as individuals, triggered strong opposition, because it called into question the moral individualism of personal responsibility. In my opinion, the success encountered by Narcissus is related to an association between a critique of federal intervention and the division of American society (culture wars, Vietnam war, etc.). Narcissus represented the end of a cycle of big government: becoming the operator of progress, the federal state appeared as a nanny state for individuals having given up healthy competition. The crisis of liberalism is a crisis of selfreliance. The strength and popularity of the arguments of Sennett and Lasch are due to the fact that they interweave two levels of analysis. First, they show the crisis of self-reliance in strongly linking personal unhappiness and disturbed social relationships in a figure that is symbolic because it unifies the individual and common evil in a very recognizable fashion for any American. Second, they blur the traditional intellectual coordinates of the opposition between liberals and conservatives with a new synthesis that borrows from the latter a moral critique of assistance, and from the former the will to build a better society through social progress. They play on a variety of topics highly valued in American democracy and which represents America and its dilemmas: one clearly perceives the group rhetoric of the Americans, its main common representations. These narratives tell the fate of the ability to seize opportunities when the covenant between the quest for personal prosperity and the building of the good society is broken. In this context, therapy is formulated as a stand-in for the lost community and community itself is perceived as therapeutic. Narcissistic and borderline personalities are variations on the difficulties of self-government, self-direction, and on the shaking of self-reliance. Narcissus is the tragic icon of this crisis of self-reliance. Individualistic Anxiety: From Individualistic Sociology to Sociology of Individualism The unhappiness of Narcissus is a narrative about the loss of the substance of life in common which undermines both the individual and society. However, considering the narcissistic individual only is to focus on the dissolution of social links resulting from the loss of verticality only; this leads to being trapped in the romanticism of the Fall (The Fall of Public Man). The Jeremiad is unable to go a bit further than the democratic skepticism of social dissolution, it is powerless to escape from the idea of a loss of substance of the individual and society—that the world is disenchanted, that everyone tends to abandon the company of men, either by imposing oneself on it or in lamenting its disappearance. But there is a

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reason for this powerlessness: narratives that make up the American Jeremiad are fostered by skepticism to which they give form: they constitute a language game with which one can formulate the difficulty of making up society. The American Jeremiad is part and parcel of what I referred to as the individualistic sociology at the beginning of this paper. How do we go beyond this impasse? And more, how to do this without canceling the part of truth of this sort of narrative, truth which lies in the idea that this difficulty is a necessity in an individualistic society? The problem with individualism is that we always need to go back to basics, because one pronounces the word “individualism” as if it were something “individual,” whereas individualism is a common spirit. Let’s go back to the opposition of the individual and society. In 1898, Émile Durkheim wrote than one must stop confounding individualism with egotism: “Individualism […] is not glorification of the ego, but of the individual in general. It is founded not on egotism, but on sympathy”; and he adds: A verbal similarity could have given the impression that “individualism necessarily resulted from individual feelings, then egotistical. But in fact, the religion of the individual is made up of the social institution” (Durkheim 1970: 24). This means that behind the substantive, the noun “individualism,” one is looking for the “individual” substance. Now this is exactly what, more than 30 years later, Ludwig Wittgenstein has defined as “one of the great sources of philosophical bewilderment: a substantive makes us look for a thing that corresponds to it” (Wittgenstein 1958: 1). Individualism means that every individual has equal value, because equality renders every man similar to another—contrary to a caste society, for instance, where there is no such thing as sympathy for any individual. However, one has to do justice, to recognize the value of the belief, and not reject it, because it tells us something true by highlighting the destructive aspect of individualism. Difficulty making up society is part and parcel of individualistic society. What does it mean? In claiming a loss of substance of common life, the American Jeremiad expresses a type of skepticism that one can term individualistic or democratic. There must be a place for such a language game, because it gives shape to individualistic anxiety; but simultaneously, it must be struggled against constantly, because it prevents us from understanding in what sense we make up society. Critics of American individualism continually repeat that one must struggle against individualism because it has become destructive—it weakens social links and creates new pathologies, like narcissism, depression, and so on. However, Americans have always struggled against individualism. One of the main references of these critics is Tocqueville’s Democracy in America, the first volume of which was published in France in 1835, and the second in 1840. What we learn from Tocqueville in this book is that Americans were already struggling against individualism at that time. He gave a framework to the issue of the difficulty of making up society, he gave it a locus from which it can be both recognized and struggled against. Let’s follow his reasoning. Individualism is created by equality, which gives the same value to any human being, regardless of his social origin—that’s why sympathy is a primary moral

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feeling in our society. In one of his most famous chapters, he carefully distinguishes individualism from egoism: “Individualism is a recent expression which a new idea has contributed to giving birth to. Our fathers only knew egoism.” Why is individualism a creation of democracy? “Men who lived in aristocratic centuries […] are closely bound together by something which is situated outside them […]. The general notion of fellow creature [of peer] is vague and […] nobody thinks of dedicating oneself to the cause of humanity, but one often sacrifices himself for certain men. In democratic centuries, conversely, where the duties of the individual toward the human species are much clearer, dedication toward a man becomes rarer: the bond of human affection slackens and comes loose.” And he adds that individualism constitutes “a natural […] illness of the social body [that is, society] in democratic centuries.” By using the adjective “natural,” Tocqueville means that there is nothing abnormal in this situation, on the contrary: “Feelings and ideas renew only by a reciprocal action of men on each other. I have shown that this action is quasi nil in democratic countries. So it must be created artificially” (de Tocqueville 1993: 125, 126, 127, 132). The opposition between natural and artificial is a rhetorical way of saying that what we first see is the independent individual, and second interdependence between men. Consequently, in a democratic society, it is natural to remind individuals that they live in a web of interdependent social relationships because they are independent beings from the vantage point of our supreme values. Because democracy renders the individual free in breaking the great chain that closely binds human beings to something situated outside themselves, it has to struggle against individualism. With his idea of natural illness, Tocqueville has opened a path to considering that the slackening of social links is a natural feature of democratic society and not an evil that destroys it inexorably. Why? Because we cannot have a democratic society, that is, a society where men are presupposed to be free and equal, if links of dependency are not dissolved, for instance the link between a slave and his master; but we cannot have a society in general if people are separated from each other by the abyss of their freedom. This is the natural tension of individualistic and democratic society that Tocqueville has brought to light, and that I call “individualistic anxiety.” It is this tension that is formulated in the opposition between individual and society. But to understand this truth comprehensively, we have to posit the issue of individualism in terms other than the opposition between the individual and society. The American Jeremiad underlines the destructive dimension of individualism, which is a partial truth. It is blind to a central aspect of democracy that French anthropologist Louis Dumont has brought to light that enables us to complete Tocqueville: hierarchy. For us, who are educated in the religion of liberty and equality, the concept of hierarchy is difficult to understand because it resembles the concept of inequality. Values of interdependence, that he calls holistic, are hierarchically subordinated to values of independence, the proper individualistic values. Interdependence doesn’t disappear: it is embedded in independence. Embedded means it is part of it; it is not either independence or interdependence, because interdependence is

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included in independence, but at a subordinated level. Without the holistic value, no society could exist. Thus, interdependence between human beings is as present as it is in “traditional” society. Dumont writes: “Relationships between men must be subordinated so that the individual subject [or self] can be autonomous and ‘equal’” (Dumont 1983: 254). It is a necessity that individualism contains holism. This is why critiques of individualism are inherent to individualism: by reminding men that they depend on each other, they foreground the subordinated value of interdependence, without affecting the supreme value of independence. That is what the American Jeremiad does. It is a narrative that stages some dilemma of American individualism. Now, considered not as a narrative, but as a sociology, it is an individualistic sociology because it doesn’t integrate the hierarchical dimension: it doesn’t distinguish between the containing individualistic value and the contained holistic value. Conclusion: From American to French Individualistic Anxiety Narcissus has given form to a style of individualistic anxiety noticed by Tocqueville very early on. To end this chapter with a comparative perspective, I would say that this anxiety is formulated differently in the US and in France. Traditionally, in France we have no such thing as a self, if I may say. Rather, it is a secondary value. The equivalent social concept of self, the concept to which we give the same value, is the “institution.” As Robert Bellah and his team pointed out in The Good Society published in 1991, Americans have difficulties understanding the notion of institution. They write: We Americans tend to think that all we need are energetic individuals and a few impersonal rules to guarantee fairness. […] It is hard for us to think of institutions as affording the necessary context within which we become individuals; of institutions as not restraining but enabling us. (Bellah et al. 1991: 6)2

We French people understand very well what Bellah and his colleagues mean. In France, it is the state which incarnates the notion of institution. The best summary of French individualism was given by Émile Durkheim in 1899: The state […] has been the liberator of the individual. It is the state which, when it became more and more powerful, freed the individual from his local and particular groups that aimed to absorb him – family, community, corporations, etc. In history, individualism has walked at the same pace than the state. (Durkheim 1976: 171)

2  This book was the sequel of Habits of the Heart. Individualism and Commitment in American Life, Berkeley, Los Angeles, University of California Press, 1985, by the same authors. This book clearly belongs to the tradition of the American Jeremiad.

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This sentence certainly sounds very strange to an American. In the US, narcissism appears as a lack of responsibility of the self, a decline of individual autonomy; in France it appears as a deinstitutionalization process, which means a receding of the state, whose consequence, the exact opposite of the American way, has been conceived of as an excess of responsibility on the self, an excess of autonomy. Here, the anxiety is the fear of an abandonment of society by the state, a fear that competition will then be unfettered.3 This is another form of the individualistic anxiety. But it is possible that we are attending the very difficult and painful birth of a French self, a self à la française. References Abraham, K. 1965 [1925]. “Étude psychanalytique de la formation du caractère”, in K. Abraham Œuvres Complètes, tome II. Paris: Payot. Translation by the author. Bellah, R.N., Madsen, R., Sullivan W.M., et al. 1991. The Good Society. New York: Knopf. Bercovitch, S. 1978. The American Jeremiad. Madison: The University of Winconsin Press. Cotton, J. 1956. “Christian calling”, in P. Miller (ed.), The American Puritans. Their Prose and their Poetry. New York: Columbia University Press. de Tocqueville, A. 1993 [1835–1840]. De la Démocratie en Amérique. Paris: Garnier-Flammarion. Dumont, L. 1983. Essais sur l’Individualisme. Une Perspective Anthropologique sur l’Idéologie Moderne. Paris: Seuil. Durkheim, É. 1970 [1898]. “L’individualisme et les intellectuels”, in J.-C. Filloux (ed.) La Science Sociale et l’Action. Paris: PUF. Durkheim, É. 1976 [1899]. “Une révision de l’idée socialiste”, in Textes, 3, Fonctions Sociales et Institutions. Paris: Minuit. Ehrenberg, A. 2010. La Société du Malaise. Paris: Odile Jacob. Erikson, E.H. 1950. Childhood and Society. New York: Norton. Lasch, C. 1979. The Culture of Narcissism. New York: Norton. Mauss, M. 1968 [1924]. “Rapports réels et pratiques de la psychologie et de la sociologie”, in C. Lévi-Strauss (ed.), Sociologie et Anthropologie, Introduction à l’œuvre de Marcel Mauss. Paris: PUF. Putnam, R. 2000. Bowling Alone. The Collapse and Revival of American Community. New York: Simon and Schuster. Rieff, P. 1966. The Triumph of Therapeutic. Uses of Faith after Freud. Chicago: University of Chicago Press. 3  In La Société du Malaise, I compare the notion of autonomy in the US with that of France because that notion unifies the Americans and divides the French.

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Riesman, D. 1950. The Lonely Crowd: A Study of the Changing American Character. New Haven and London: Yale University Press. Sennett, R. 1974. The Fall of Public Man. New York: Norton. Shills, E. 1976 [1962]. The Theory of Mass Society, originally in Diogene, n. 39. Here quoted from R.H. Turner, “The Real Self: From Institution to Impulse”, in The American Journal of Sociology, vol. 81, n. 5, pp. 989–1016. Weber, M. 2003 [1904]. L’Éthique Protestante et l’Esprit du Capitalisme, Suivi d’Autres Essais, edited, translated and presented by J.-P. Grossein. Paris: Gallimard. Wheelis, A. 1958. The Quest for Identity. New York: Norton. Wittgenstein, L. 1958. The Blue and Brown Books. New York: Harper Torchbooks.

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Chapter 2

The Social Pathologies of Contemporary Civilization: Meaning-giving Experiences and Pathological Expectations Concerning Health and Suffering Arpad Szakolczai I know that suffering is the sole nobility Which earth and hell shall never mar, And that to weave my mystic crown, You must tax every age and every universe. C. Baudelaire, The Flowers of Evil, ‘Benediction’ What does not kill one, makes one stronger. F. Nietzsche, Ecce Homo, ‘Why I Am So Wise’ Is there, could there be, any miraculous suspension of the wearily historic, the dingily geographic, the dully drearily sensible beyond her faith, her charm, her love, to command? Yes, there could be, yes, alas, indeed yes, O there is, right here, right now before us, the situation present. W.H. Auden, The Sea and the Mirror: A Commentary on Shakespeare’s The Tempest, ‘Caliban to the Audience’ A passionate tumultuous age will overthrow everything, pull everything down; but a revolutionary age, that is at the same time reflective and passionless, transforms that expression of strength into a feat of dialectics: it leaves everything standing but cunningly empties it of significance. S. Kierkegaard, The Present Age

This chapter will address the theme of the conference from a particular angle, rendered possible by its title. Notice that the title is not about ‘The Social Pathologies in Contemporary Civilization’, but ‘The Social Pathologies of Contemporary Civilization’. This enables one not simply to address the pathological character of certain aspects of the civilization in which we are living

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– and here I also want to note the importance of the word ‘civilization’,1 in contrast to ‘society’ or ‘culture’, much more frequently used in sociology, or the social sciences in general – but might pose the question of how an entire civilization may show pathological features. Such a way of approaching the problem might seem a sophistic play with words for some and almost indecently broad for others. I am painfully aware that such an idea is ‘disturbing’; undermining the easy, comforting certainties of a deep belief in the progressive nature of our societies, of ‘us moderns’ (Latour 1991). Yet, this is a question that does not cease to preoccupy – even haunt – me since quite a long time, in fact the moment I started to work in the Centre for Value Sociology at the Institute of Sociology, Hungarian Academy of Sciences, guided by Elemér Hankiss, almost 30 years ago. Hankiss had an interest in the question of ‘social pathology’, and the term ‘diagnosis’ was even used as the title of a book of his that outright became a best-seller in Hungary,2 so in a way I’m still only following him. A similar terminology was developed by main contemporary social and political thinkers like Michel Foucault and Eric Voegelin.3 Being concerned with the problem of a ‘pathological civilization’ for me – just as for them – was not merely an intellectual endeavour, but part of my daily existence. Growing up on the other side of the Iron Curtain was an experience that literally everyday made one face the situation that something is wrong in the world in which one happens to live. I was living in a world where everything that was not rooted in very local and very old traditions was simply turned upside down. At the same time, and also since my university years, I increasingly gained the conviction that not only am I living in a deeply pathological environment, but I am not being given the intellectual instruments that would enable me to understand the nature of the situation. The official Marxist ideology was evidently bankrupt, but I increasingly realized that the ‘alternative’ approaches, starting with ‘critical’ versions of Marxism, but including socialism, liberalism or nationalism, thus the entire set of socio-political ideologies bequeathed to us by the French Revolution, were just as unacceptable as starting points. I had to keep searching. Over the years, I managed to complement my more experiential than academic education in Hungary with a PhD in Austin, Texas, in the 1980s; a visiting fellowship in London in 1989/90; and teaching positions in Italy and Ireland since then. However, and in spite of all the many differences, I found that two basic aspects of the experiences I gained during communism in Hungary were strangely generalizable: the pathological aspects of the civilization to which we belong cannot be restricted to the countries under the sway of 1  For the recent interest in civilization analysis, see Arjomand and Tiryakian (2004), Arnason (2003), Arnason, Eisenstadt and Wittrock (2005). 2  The book came out first in 1982, and already by 1983 a third edition was published. 3  Foucault frequently used the word ‘diagnosis’ in the interviews he gave in the 1970s (see Foucault 1980); while Voegelin coined the expression ‘pneumapathology’ in order to characterize certain aspects of modern life and thought (see Voegelin 1978).

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communism – it is an upside down turned world that is being globalized; and the dominant intellectual discourses, strangely enough, far from addressing this problem, rather share a complicity in this pathology. I am quite aware that at this point it would be easy to charge my position either with excessive gloom or rash overgeneralization. At this moment I can only say that, far from following a gloomy, dualistic, Gnostic vision of the world as a realm of irresistible evil, my basic outlook is rather close to Plato’s mature work, as expressed with particular clarity in the Timaeus; or, in a different terminology, it is inspired by the idea of the harmonia mundi. The problem, as the Auden motto indicates, rather lies with the (modern) world in which we live, and in particular with the radical corruptness of the intellectual language which we came to inherit, and which – instead of helping us to retrieve harmony – manages to push us further away from the very possibility of leading a decent, meaningful, shared life, reconfirming and further leading us astray in the dark Dantesque forest of pathologies that have become, in the language of Max Weber, our fate. Over the years I also encountered the work of a number of important thinkers who found themselves in similar positions. They were either historically-oriented social theorists, who realized that they have to find their own path, outside the intellectual environment which surrounded them, trying to develop their own intellectual tools in order to escape the dominant intellectual currents of neoKantianism, positivism, Marxism and psychoanalysis. Such figures include, most prominently, Max Weber, Norbert Elias, Eric Voegelin and Michel Foucault, much influenced by the philosophies of Kierkegaard and Nietzsche. Alternatively, they were anthropologists who also and similarly discovered, at the field, that the tools they were given by the Durkheim- or Marx-inspired teachers were deeply defective; these include Paul Radin, Gregory Bateson and Victor Turner, all of whom developed a number of crucial tools necessary to diagnose, clinically, the pathological features of contemporary civilization, like liminality, the trickster and schismogenesis. One could also add here Marcel Mauss with his discovery of gift relations as being the foundations of social order, and the work of Tarde, Girard and Latour on the role of imitation. In this chapter, through historical and conceptual clarification related to health, pathology and illness, I’ll investigate the question of the extent to which the pathological character of contemporary civilization is related to the way these concerns are approached in our times; revealing an ever deeper, and even more troubling, suspicion concerning human experience itself – a deep mistrust in the capacities of human beings, even a hostility to life, which Nietzsche diagnosed as being at the heart of nihilism. Meanings of Health and Pathology Let me start with some clarifications of meaning, related to the terms ‘health’ and ‘pathology’. Concerning ‘health’, an idea that seems difficult enough, the

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linguistic results will be simple, almost trivial; while concerning ‘pathology’, which on a first instance looks a quite straightforward technical word, the results will be rather the opposite. Such conceptual clarification is necessary in order to distinguish my approach from the kind of functionalist–organic analysis that was used by sociologists in the 1950s and 1960s. From this perspective, social life represents a functioning whole, comparable to a watch (using the famous metaphor of Steuart which would be taken over by Adam Smith, among others), or to an organic body.4 This metaphor clearly has very limited value, and became attacked from the 1960s onwards, though almost exclusively from the perspective that it fails to explain the presence of conflict in social life, and even the positive – meaning revolutionary – role it might play there. Far from taking up one or other of the sides in this controversy, I consider this entire thematization, or ‘problematization’, in the sense of Foucault, as fundamentally mistaken; part of the problem, and not the solution. In the language of Bateson, it is the result of schismogenic developments within modern thought, that merely mimic schismogenic social processes, instead of explaining them and helping to move beyond. The reason is that social life cannot and should not be analysed through merely mechanical or organic analogies, as – following the perspective of classical political philosophy – the aim of social life in not simply ‘order’ or ‘function’, but meaningful social order, or the ‘good society’, informed by ideas of harmony or the overall beauty of the world. The idea of a ‘good society’ does not mean the realization of some kind of abstract, lifeless utopia, but simply maintaining the searching and striving for the joint realization of inseparable ethical and aesthetical values. In this sense, the problems with European social and political thought started not with modernity, or even the Enlightenment, but much earlier, of which the thinking of Hobbes and even Machiavelli were crucial symptoms: with the idea that the aim of politics is simply to establish a stable order, without any concern with meaning (Voegelin 1999: 153–5). This identifies the period of the collapse of the Renaissance as the crucial moment in which European civilization took a pathological turn.5 A ‘pathological civilization’ is one which gives up the pursuit of a meaningful life and of the realization of beauty at the level of the community, which parallels the overriding beauty that characterizes the world of nature, the plants and animals, 4  About this, see in particular the ideas of Saint-Simon and Cabanis (Procacci and Szakolczai 2003). 5  I try to reconstruct this dynamics in two book projects, one published about the Renaissance (Szakolczai 2007a), and an ongoing project about the genealogy of comedy, which – taking another guiding idea from Nietzsche, which follows the motto used in this paper, stating that ‘Not by wrath does one kill, but by laughter’ (Nietzsche, Thus Spoke Zarathustra, Part I, ‘On Reading and Writing’) – will argue that the European Renaissance was literally killed off by low-level comedy, in the form of Commedia dell’Arte, which was brought into Europe through Venice after the sack of Constantinople in 1453; just as something similar happened with classical Athens and Rome.

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seas, rivers and mountains that surround us, and which was the aim of human existence at least since the Upper Palaeolithic period. Terms related to health in most languages have a singular etymological origin, which in English ‘health’ is still full visible: they are related to a state of wholeness, or integrity. Further examples include Italian salute, rooted – together with words related to ‘salvation’ – in a Sanskrit term capturing integrity (sarva); German Gesundheit, rooted similarly in integrity or soundness; the term ‘sanity’, going back to terms signifying a certainty of oneself, and even the force to resist (see Sanskrit sakami, even connected to the root of ‘salvation’); or even Hungarian egészség, which literally means ‘whole-ness’, and ép (a very basic and short root), which means something not broken, or possessing integrity. We must also add that these terms usually also imply aesthetic qualities. Pathology seems a simple technical term, but its linguistic analysis opens up a new horizon. The word shares etymology with a number of terms in modern languages that altogether map a very distinct and even striking semantic field. It includes words like ‘pathetic’ and ‘pathos’, but also ‘passion’ and ‘passive’. The etymological source of all these terms is the Greek verb paskho, which means ‘to suffer’, but at the same time also ‘to experience’. This brings into our analysis the quite stunning fact that for the Greeks experience was a passive event, which human beings had to undergo or ‘suffer’, and which in this manner exerted a formative impact on their personality.6 It was therefore not considered as something humans should be actively searching for; something very close to the way in which in some of his last writings Foucault thematized the connection between ‘subject’ and ‘experience’. It also implies something further – and here we arrive, from a seemingly minor technical point, into the heart of our analysis. Such an intimate connection between suffering and experience implies not only that an exclusively positive, activist and subjective conception of experience is untenable, but that similar kind of considerations apply to suffering as well. Eliminating suffering from the world is impossible, at least in so far as one does not eliminate at the same time the possibility of genuine human experience. This renders evident the pathological character of modern ideologies, and of the civilization that is producing them, because promoting happiness through the elimination of all suffering from human life is perhaps the most important legitimating ideology of modernity. If the ideal is impossible, we need to make a further step and realize that this ideal then must be mistaken. Here one must tread carefully, striking the right tone and make the right kind of circles in the right direction in the argument, as otherwise it can easily be misconstrued. It is evident that in order to become a healthy adult, a child must go through a number of unpleasant experiences and disappointments; but this does not mean that a well-wishing parent must actively procure suffering and disappointments for his child. The reason why eliminating suffering as the 6  See also Hungarian, with the close similaritities between ‘suffering’ (szenvedés) and ‘passion’ (szenvedély).

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central aim of ‘social politics’ is wrong is that it pursues an Aristotelian logic of double negation, without realizing that so far as the meaning of human and social life is concerned, two negations do not easily add up to something positive. By ‘eliminating suffering’, we do not directly and ‘logically’ gain something positive; if we promote physical health and longevity as aims on their own, this does not necessarily mean that people live a better life, in a ‘good society’. It might simply procure boredom, ennui, melancholy and spleen; which can be explained through the etymology of ‘pathology’. The statistical logic of ‘proxy variables’ ignores the problem of meaning, and is therefore of extremely limited value in human life. To give an example, ‘consumption’ is supposed to be a ‘proxy variable’ to measure happiness, in a Benthamite perspective, though by now it is evident that a ‘consumer society’ does not bring about overall happiness. The meaning of the term could have been taken as a good indicator even here, as ‘consumption’ originally had a medical and pathological sense, meaning ‘wasting of the body by disease; wasting disease’. The radically problematic nature of the way in which modern ideologies, both liberal and socialist, systematically confuse positive aims and meanings with the mere elimination of negative experiences can be demonstrated through the ideas of John Rawls – widely considered as one of the most influential political philosophers of the twentieth century. I would like to claim that the central argument of his most famous work, A Theory of Justice, is simply wrong – though it ‘seems’ or ‘sounds’ right, being most ‘attractive’, just as the voice of the Sirens. Rawls argues that the basic standard by which any public policy should be measured is the benefit it brings to the well-being of the ‘least advantaged’ member of society. The idea ‘sounds’ plainly right, in conformity with our basic values of justice, charity and pity. Certainly politics must do something not just for the majority, but also for those who are emarginated. Yet, something with it clearly is not right – and actually helps us understand why Nietzsche, the greatest thinker of the modern age, placed such an emphasis in his critique of Christianity on the problematic nature of ‘pity’ or ‘compassion’ (Mitleid). If we accept that politics is ‘basically’ about helping the least well-off members of society, then politics becomes – as it indeed has become, with frightening consequences, in the modern world – deprived of any positive value, thus of any meaning. There is no common good, no community, no pursuit of beauty at the level of the whole, except the promotion of the ‘interests’ of individuals. Quite strikingly, through the ideas of Rawls, liberalism became all but identical with radical Marxism: once everybody will be equal with everybody else, there will be no ‘least well-off’ members of society, politics will cease to exist, just as the state, classes, philosophy, economics and everything else, and we’ll enter a universal state of bliss. Starting by trying to understand the meaning of pathology, beyond the functionalist–organic paradigm, and taking some cues from etymology, we arrived at a first diagnosis of the pathology of modernity. The problem of modernity lies not at the level of means – the scarcity of resources, the impossibility of satisfying

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the inspiration of everybody – but at the level of ends. This is where the meaning of health must be analysed in more detail. Canguilhem on Health and the Pathological In order to gain a more in-depth conceptual and historical understanding of ‘health’ and ‘pathology’, I now turn to the French historian and philosopher of science Georges Canguilhem, in particular his classic book Le Normal et le Pathologique (1966). Michel Foucault repeatedly stated that – together with Georges Dumézil – Canguilhem was the most important thinker having an impact on his work (and not Lévi-Strauss, Lacan, or Sartre); and he wrote the Introduction to the 1978 English edition of the book. In this piece Foucault argues that the central value of the particularly French interest in the history of science – an approach to which Gaston Bachelard also belongs, another thinker held in the highest esteem by Foucault, and Bruno Latour, one of the most important contemporary social theorists – is that it represents a self-overcoming of French Cartesian rationalism, which implies the recognition that rationalism ‘has its own history of dogmatisms and despotisms’, and that therefore it can ‘only have a liberating effect [effet d’affranchissement] if it manages to free itself of itself [se libérer d’elle-même]’ (Foucault 1994, III: 433). For Canguilhem pathology, just as health, is a function of the whole organism, and it cannot be broken down into pieces (Canguilhem 1978: 7). The ‘normal’ state is being healthy exactly in the sense of living according to certain norms. The crucial question concerns the exact status of the organism with respect to these norms – which goes to the heart of the meaning of ‘life’, or living. Health, for Canguilhem, is not identical to the absence of disease and the ensuing suffering – just as life, in extremis, cannot be defined as the opposite of death; it cannot even be reduced to the ‘meeting of needs’ or the ‘satisfaction of desires’, other standard terms from the dictionary of the social sciences. Life is rather a quantum of energy at the disposal of an organism, which is always in excess of its needs (Canguilhem 1966: 177); in fact, Canguilhem defines a healthy human being as a living organism that is exceeding its needs; who is literally insatiable (Canguilhem 1966: 109; Canguilhem 1978: 95).7 It is exactly this basic feature of human nature which requires that some choices be made concerning the actions to be pursued; it is in order to curtail their excesses – necessary for health – that human beings need to give themselves norms which would delimit and structure their experiences (Canguilhem 1966: 177). The central question now concerns the nature of these norms, and the individuals’ relations to these norms. Here Canguilhem offers a radical critique of the nineteenth century positivist version of ‘objective’ and ‘scientific’ medicine, as championed by Comte, Claude Bernard and Virchow (Canguilhem 1978: 13, 125). According to Canguilhem, the norms 7  See also Kerényi’s ideas about indestructible life (Kerényi 1976).

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that render a healthy human life possible cannot be imposed from the outside, by following a type of thinking that combines a reduction of norms to positive laws, characteristic of Kelsenian legal theory, with a similar positivistic reductionism of medicine to technology (Canguilhem 1978: 13, 69–70).8 Health implies the capacity of an organism to establish or create norms (Canguilhem 1966: 115–17), which must be a spontaneous effort of the living being, not imposed from the outside. Quêtelet’s famous idea concerning the ‘average’ as normal views processes from the wrong end. Rather the opposite is true: the fact that there is an average should be considered as the sign that a norm exists (Canguilhem 1978: 86). In other terms, the norm has originality with respect to the statistical average (Canguilhem 1978: 103). It cannot be defined ‘objectively’, from the outside, rather life itself has a normative character (Canguilhem 1978: 104). The central issue therefore concerns not external evaluation, but the ability of an organism to establish norms, and live accordingly (Canguilhem 1978: 70). This, of course, does not mean that individual human beings are monads following their own purely internal motivations or norms; rather, living organisms establish such norms in reactions to the environment in which they live (Canguilhem 1978: 72). Healthy, normal – meaning norm-setting – life is therefore always reactive, or reacting. It is in this context that we can understand the meaning of illness, and the true nature of the challenge that it represents. Pathological organisms also live; and in so far as they live, they must follow certain norms. Disease does not mean the absence of norms, but the following of inferior norms: norms that do not tolerate a change in the external conditions, rendering the organism non-reacting (Canguilhem 1966: 106). A pathological organism simply becomes unable to respond to the external environment by the setting up of new norms, or by restoring the norms that it lost, due to illness (Canguilhem 1978: 8). For any healthy human being a disease can be considered as a testing, which it can win, and by this demonstrate its own health; while in the absence of such challenges it will be assailed by boredom and anxiety (Canguilhem 1966: 177; see also Csikszentmihályi 1975). This helps us understand the true significance of illness, and thus realize that a society where illness would be eradicated is not simply a utopian ideal in the sense that, unfortunately, it cannot be realized, but positively a nightmare. From this perspective disease is a bad response, or an error; though at the next cycle in the wonders of life, even a bad response, like a genetic mutation – which originally is a particularly bad response, a monstrosity – can end up producing a new type of organism, which can establish a new norm. Disease is thus fundamentally a question of biological value, and not of objective science.

8  About Kelsen and neo-Kantianism, see Szakolczai (2011).

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From Organic Health to Social Well-being Canguilhem’s work helps us to overcome jointly both sides of the schismogenic intellectual field of contemporary social thinking, with rationalism, exteriority, objectivism and positivism on the one hand, and utopian idealism, social critique and the cult of suffering on the other. The question now concerns the way in which his ideas could be transplanted at the level of social life. The first point to consider here is that in the social sense as well a human being can only be healthy if one is able to posit, or pose in front of oneself, one’s own positive goals.9 Apart from being irreducible to the mere absence of negative considerations, it is also different from the perspective of economic theory with its utility maximization principle. This theory assumes as a fact the highly peculiar norm that an individual must always exist on its limits, thus eliminating that cushion of excess which is a precondition of health, and actually pushes, in the manner of a performative speech act, all individuals within such an ‘economic society’ onto the limit. In contrast to this, and in plain language, a healthy life implies a meaningful life, as it is only those acts which a human being can accept as meaningful, in which he participates with his own being, instead of simply ‘going through the motions’, that can give the kind of satisfaction that is necessary for health and happiness. The second question concerns now the social aspect of a meaningful life. One might argue that while living organisms might be able to set their own norms, for human beings it is necessary that such norms be harmonized through external constraint. This is the very definition of a ‘social fact’ as offered by Durkheim in his – neo-Kantian, legalistic – social theory. The argument, however, is wrong again, as it is formulated from a presumed ‘external’ perspective, which also means from inside the rationalistic/utilitarian/individualist paradigm. This assumes that the life-goals of individuals only incorporate the goals of others as if from the outside, as external ‘conditions’ that must be taken into account. However, the social dimension was already incorporated in the term ‘meaning’, and in two different ways: first, because meaning assumes language, and language is already social; and second, because any aspect of life and activity can only become meaningful if it is recognized as such, in the sense of Pizzorno (1987, 1991, 2000), by those who matter for the individual human being, and who therefore constitute that ‘circle of recognition’ which defines one’s own identity.10 Without recognition, there is no identity, whether at the individual or social level. Whatever a human being thinks about oneself, which is not recognized by significant other persons, 9  Interestingly, etymology again guides us in the way, as the etymology of ‘positive’ is exactly to ‘pose’ or ‘posit’ something, in the sense of ‘placing’ or ‘putting’. 10  Pizzorno’s work is also fundamental both in its critique of the ‘rational choice’ perspective (Pizzorno 1986, 1991, 2006), and in its emphasis on the importance of a participating component in order to assess the question of the ‘rationality’ of a particular social phenomenon (Pizzorno 2007).

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is as meaningful, and effective, as if we declare ourselves the sovereign state of Freedonia. The norms of any decent human community were not the results of a deliberative legislation which was then imposed from above and the outside on everyone, but grew out – not ‘organically’ – of those aspects of social life that were considered as meaningful, and thus became as norms the conditions of possibility of meaningful human life. The argument can be further supported from a most surprising perspective, the question of pleasure. From the perspective of ‘rational choice’ or philosophical liberalism, any concern with meaningful life is usually brushed aside by claims that ‘rational’ human beings simply aim to satisfy their own interests; something which is connected – since the classical utilitarianism of Bentham – to the search for pleasure and the avoiding of pain. However, etymology, this central auxiliary science of social thinking, again helps us by offering a different perspective. The PIE root *ger means pleasure, source of the Greek word charis, which itself is at the origin of modern terms like grace or gratitude. This meaning has two main characteristics that are radically different from the Benthamite one: pleasure as charis is inherently social, as it presumes the company of others who are also pleased; and it is just as inherently aesthetic, as it assumes beauty, or aestheticallypleasing qualities. In the world of classical Greece, socio-political, ethical and aesthetic considerations could not be separated from each other in so far as a healthy social life was concerned; they were part of a whole. Thanks to Plato, we also know who were the figures of the ancient world who effectively, and successfully, worked on such a separation: the Sophists. Now we are in a better position to understand what is wrong with Rawls’s Theory of Justice, and the entire ‘politics of suffering’ of which it is a part. The theory represents a peculiar collusion between radical liberalism and radical democracy (or socialism), which concerns the ignoring of the positive and meaningful aims of human life. In spite of all differences, both philosophical positions assume that the aims of human life are trivial, and at any rate beyond the possibility of a rational discourse. For liberal economists, as formulated with particular, ruthless clarity in a famous piece by two Noble prize winners, ends are a matter of pure taste; they cannot be disputed (Becker and Stigler 1977). Human beings have so many different goals that all these certainly cannot be satisfied at the same time. Political or social questions can be reduced to the allocation of scarce resources that are at our disposal to satisfy various needs, aim, goals or desires, following the wellknown logic of the happiness of the greatest numbers, and the freedom to pursue one’s own ‘autonomous desires’. Radical democrats think in exactly the same manner concerning the ends, but they either consider that therefore – following the principle of equal rights and justice – all resources should be completely equally distributed; or, following a more ‘realistic’ perspective, they take up the plight of those who currently receive less, and thus suffer more, and try to alleviate this injustice. Both positions formulate extremely appealing and attractive arguments – in fact, it is safe to say that at the level of pure arguments neither radical liberalism, nor radical socialism can be defeated, as there are no totally convincing arguments

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against them (who could oppose freedom or fairness?). One might only point to the disasters to which they lead, whenever put into practice; though ideologues would always say that it was not tried well or hard enough. Yet, both simply fail to consider the question of how positive aims, norms or values can actually be formulated and put into practice in a community, which would produce jointly a much more pleasurable and meaningful life for everybody. In my view, this is the central question concerning health and pathology in contemporary civilization; and it is due to the failure of posing such questions that this our civilization not only contains pathological aspects, but is thoroughly pathological. But what is the way in which the discussion of ends is formulated in contemporary social theory? Let me refer here to the ideas of two of the most important social thinkers of the past century, who – though rarely discussed together – share a number of common features. Both of them are considered among the most famous figures in their respective fields, sociology and economics; in fact, it is easy to argue that they were the single most important sociologist and economist of the past century. Yet, both are not only widely and doggedly criticized, from the left as from the right, but arguably the mainstream perspective of their respective disciplines seriously misrepresented their ideas, and proclaimed this travesty as the ‘official’ canon. By now I guess everybody realized that I’m talking about Max Weber and John Maynard Keynes. Here I will focus on one aspect of their work, though easily a most important one: the social nature of a crucial aspect of individual ‘rational’ action, expectations. Max Weber Concerning Max Weber, I will restrict my attention to two of his best known passages from the start of Economy and Society that are – I very much hope – taught in every sociology course anywhere. These define sociology, social action and the rationality of a social action. First of all, Weber defines sociology as a science that deals with the meaning of social action (Weber 1978: 4). Though Weber uses the unfortunate neo-Kantian adjective ‘subjective’, I would argue that what Weber really has in mind, through Dilthey and Nietzsche, is something very close to Canguilhem’s definition of health: a ‘participatory’ and ‘energetic’ involvement of the human being, which therefore is not fully accessible from a purely ‘external’ and ‘objective’ perspective.11 Now the question, especially given the language of ‘subjective’, is how such an action can be social – and here Weber uses, at first only implicitly, and then explicitly and repeatedly, the term ‘expectation’ [Erwartung] (Weber 1972: 1, 8; 1978: 4, 24). An action is ‘social’ in the sense that it must take into account – in order to be meaningful – the action of the others, thus implying certain expectations about their behaviour, which therefore 11  On the dynamics of involvement and detachment, see also the basic work of Norbert Elias (1987).

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would orient one’s actions. In the definition of the types of social action, Weber explicitly uses the word ‘expectation’ in order to characterize ‘instrumentally rational’ [zweckrational] action, which means that the acts of others become pure ‘conditions’ or ‘means’ for attaining one’s own ‘rationally calculated’ ends. The question of the ‘rationality’ of ends, however, involves huge question marks, partly reflected in the well-known fact that zweckrational was translated as ‘instrumentally rational’, instead of ‘end-rational’, as this does not seem to have a meaning in English – a huge paradox in itself. It alludes to the fact that Weber was trying, as always, to incorporate the problem of the posing of ends into his sociology, as leaving it out would have made his work a new exercise in sophistry; yet, he was not able to fully leave behind the ‘rationalist’ neo-Kantian philosophical perspective into which he was trained, even though he knew it only too well that the problem of ends cannot be ‘rationally’ solved. The questions of expectations and rationality also return at the heart of the work of Keynes. John Maynard Keynes I will shortly resume here the main ideas of the General Theory (Keynes 1964), as related to the role of expectations, with the help of an article Keynes wrote shortly after the publication of his book in response to his critics. The similarities with Weber’s argument, and framework, are striking. First of all, Keynes starts his argument by alluding to a basic distinction between ordinary situations – which classical economic theory assumes always apply – and situations of crisis (Keynes 1937: 209), which was the current situation, then as now, recalling Weber’s fundamental distinction between the ‘ordinary’ and the ‘out-of-ordinary’ [außeralltägliche] (Weber 1972: 245–6; 1978: 400–401). A ‘general theory’ means nothing else for Keynes than a kind of theoretical framework that applies for both types of situations; in the analogy of non-linear programming, of which linear programming is just a special case.12 This distinction is especially important with respect to the possibility of foreseeing the future, concerning both the consequences of our acts (recalling Weber’s basic preoccupation about the unintended consequences of social actions); and expectations about what is going to happen, or how others will act (Keynes 1937: 213–4). As such uncertainties concerning the future constitute the very bases of our expectations, these expectations can change, and even quite violently, which might produce a situation of crisis (Keynes 1937: 204–5). According to Keynes, this constitutes the key issue in economic theory (Keynes 1937: 205). Going into some details, expectations concerning the future in economic terms mean the expected return of investment, which depend on general expectations 12  Or, as Keynes argues at the end of Chapter 3, ‘[i]t may well be that the classical theory represents the way in which we should like our Economy to behave. But to assume that it actually does so is to assume our difficulties away’ (Keynes 1964: 34).

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concerning the future (Keynes 1964: 136, 141). If such expectations change from confidence to precariousness (Keynes 1964: 148–53), relatively minor displacements could escalate into major changes, due to the impact on the market for investment goods (Keynes 1964: 156). Expectations about the future always contain a great deal of irrational components; but such uncertainty has increased in the then recent past, due to the separation of ownership and control, which led to increased speculation, thus provoking phenomena that can only be understood in terms of mass psychology (Keynes 1964: 154, 170). Ignorance and facing unexpected situations can lead to sudden and violent reactions (Keynes 1964: 154). Keynes makes particularly strong claims against speculation, so it is important to add here that ‘expectation’ (ex-spectare) and ‘speculation’ (speculatio) share the same etymological root, which is to visualize or envision, recalling also the term ‘spectator’, so fundamental both for Descartes and Adam Smith. This is important for two reasons: first, because it establishes a contrast between participation and merely external ‘observation’ or ‘watching’; and second, due to the implied emphasis on the visual as opposed to the verbal–rational component. Modern economics, and the modern economic system itself, boasts itself of being ‘rational’; yet, its description amply uses terms more applicable to crowd spectacles, like vulgar comedies or even fair-ground entertainment. From such a perspective, it is particularly striking that Keynes outright uses the metaphor of marriage as model for a proper attitude to investment: ‘The spectacle of modern investment markets has sometimes moved me towards the conclusions that to make the purchase of an investment permanent and indissoluble, like marriage, except by reason of death or other grave cause, might be a useful remedy for our contemporary evils’ (Keynes 1964: 160).13 Given such uncertainty about the future, the crucial question of economics concerns the manner in which the future is mediated, in monetary terms, towards the present. This is where the significance of the interest rate lies. The etymology of this word is again most important, as inter-esse means ‘being in between’, i.e. between the future and the present. The size of the interest rate calculates the size of the risk – the higher the risk concerning future earnings, the greater is the rate of interest. But it also has a mediating influence concerning the past. The results of past earnings are accumulated in wealth, including various assets and liquid money. It is this liquid money that can be invested with an eye towards future earnings – but which, in the case of worsening expectations, might simply be hoarded. In this sense, argues Keynes, the rate of interest rewards not so much not-spending (i.e. not-consuming), as not-hoarding (Keynes 1964: 174). Once speculation starts to play an excessive role in the markets, expectations concerning the future might 13  Notice here also the term ‘spectacle’, to round up the previous argument. I might also argue that our civilization turned in the exact opposite manner: instead of modelling economic investment on marriage, it is rather modelling marriage on economic investment – of course, in the name of individual freedom, autonomy, the right to escape suffering, and rational choice.

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shift violently, leading to an increased willingness to hoard, especially at the margins (Keynes 1937: 209, 217), which could have deleterious consequences for the economy. The role of the government is to maintain, at all costs, stability at the level of investments, assuring overall responsibility (Keynes 1964: 164). We can now see how tragically – or, if you like, comically – wrong ‘rational expectations theory’ is, both in its critique of Keynes and the role of the government or the state, and in its own self-contradictory central idea, which became a cornerstone of ‘rational choice theory’. Expectations simply are not ‘rational’ – just as strictly speaking ‘rational choice’ is an expression that makes no sense, confusing the inside and the outside perspectives, the question of ends and means, the origins of tastes and the power of reason to limit and shape desires – and are especially not rational in a state of crisis. The rule of ‘rational expectations theory’ over the past decades in economics represents not so much the ‘return of the repressed’, but the ‘return of the refuted’; just as the same applies true for the combination of evolutionist positivism and Marxist criticism that returned to rule sociology after Weber. Apart from misleading, and in a serious manner, economic policy, the economists of the ‘Chicago’ and ‘Minnesota’ schools created an oblivion about the fact – which even Weber and Keynes failed to emphasize sufficiently – that expectations in a society are fundamentally not about economic calculations and profits, but rather about the general structure of social conduct, at a level that is much more basic, and much more important, than the level of law. Most importantly, such expectations are related to the norms in vigour in a particular society, which – we have seen this – are the most important elements for healthy living. The central issue concerns the extent to which members of that society can be expected to behave according to such norms. Normality or normativity is thus not about rewards and punishments concerning certain acts, but about the conditions of possibility of meaningful life, thus the foundations of a community. It is in this sense that Georg Simmel considered sociability, and Marcel Mauss gift relations, as foundational for social life. In order to better investigate the social significance of expectations, I now turn to an essay by Reinhart Koselleck, a German political historian and theorist who – apart from Foucault – made the most important contribution to the historical analysis of systems of thinking – thus, a historization of Kantian categories – in recent decades.14 It will also help us return to our starting point and central question, the problem of health and experience. Koselleck on Experience and Expectations Koselleck’s essay studies jointly ‘experience’ and ‘expectations’ (Koselleck 1985). For Koselleck, these two concepts are fundamental for historical understanding, as 14  Note also the term ‘pathogenesis’ in the subtitle of Koselleck’s most famous work – which in its title, by the way, has ‘critique’ and ‘crisis’.

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they constitute a conceptual pair that captures, in its full asymmetry, the relationship between the past and the future, through the present. Experiences, as remains or memories of lived reality, are ‘present past’ (Koselleck 1985: 272), as they bring the past into presence; while expectations are ‘future made present’ (Koselleck 1985: 272.), thus bringing the future into the present through imagination.15 The asymmetry between the two is thus evident, as the two presences are distinct (Koselleck 1985: 273). Expectations can also be defined as ‘anticipated forms of experiences’ (Koselleck 1985: 272); and Koselleck even calls this asymmetry as a ‘fundamental anthropological supposition’ (Koselleck 1985: 288). It is perhaps best visible through the difference between ‘memory’ and ‘imagination’: memories are traces of what one has lived through, but what has now passed, and which implies a fair bit of hardship and suffering; while images are pure figments of fantasy, they have no weight, and so easily can carry one away. What the two share, however, and again, is the overwhelming importance of the visual element. Our lived memories are stored away in our mind in the forms of images, and so they can be easily interfered with by other kind of images, like mechanical reproductions (especially photographs), or attractive fantasies sketched about a supposedly bright future. This distinction has a crucial significance concerning the self-understanding of modernity as a distinctly new kind of historical moment, where – so it is argued – all past experiences suddenly lose their relevance and value. Given the imbalance between the presence of the past – lived and ‘suffered’ as an experience – and of the future – ‘imagined’ as expectation of a blissful state to come – in any contemporary/present moment, the shift of focus from the past to the future, following an ideology of a progress, can be identified as a par excellence Sophist trick: operating through ‘image-magic’ (Szakolczai 2007b), or the flipping of attractive visions of the future, through rhetorical discourse.16 The trick works perfectly, at least for a time, until the past is reduced to an ‘image’ of pure suffering, and in contrast the future can be presented as a flawless realm of utopian purity, where all the sufferers of the past will be redeemed for their sufferings. The problem is that, after a time, people start to get worried and demand the promised land of happiness, or at least a piece of the pie, right here and right now. This is when they will have to realize that they have been taken in for a ride in the name of progress, and that much of the life they could have lived is already gone. This is what happened in the ‘East’ by about the 1980s; and this is perhaps what is happening, mutatis mutandis, now in the ‘West’. 15  Interestingly enough, Koselleck does not use the word ‘image’, so I had to complement his analysis here with the results of the previous conceptual and etymological analysis of ‘expectation’. 16  Plato’s work, through its emphasis on the combination of images, theatrical devices, and rhetorical discourse by the Sophists is fundamental here. One should also add here that the title of what is considered as Dickens’s most perfect novel, comparable to Dostoevsky’s Demons, is Great Expectations.

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The question is, whether at that moment they will be searching for an even shrewder illusionist, believing in an even more thorough elimination of all sufferings from the world – in the future that is always receding at the horizon, as Koselleck reminds us of the old joke about Comrade Khrushchev (Koselleck 1985: 273); trading in their vision of progress for a supposedly necessary and ever accelerating spiral of change (Koselleck 1985: 184); or finally deciding to live a healthy and meaningful life. Concluding Remarks I can only offer here a few provisional concluding remarks. 1. There is no objective science of health; such an idea is itself pathological, and is very much part of the pathological nature of the civilization in which we live. 2. This fact is hidden through the mobilizing value of expectations about the future, the central technique of social image-magic both in liberal and socialist ideologies, whether in the form of individualized images about the future (the ‘American dream’), or through collective, socialist utopiavisions, which systematically devalue the past and community traditions, rendering individuals alienated from their own home-world. 3. Human beings can only be healthy in healthy societies, which implies a life focused on the concrete and personal, driven by inner energy and not the elimination of real or imagined negative situations, saturated with meaning that can only emerge through participation in communities, or ‘circles of recognition’, which are stable over time – stability being a function of experienced life, and not externally imposed ideologies or standards. References Arjomand, S. and Tiryakian, E. (eds). 2004. Rethinking Civilizational Analysis. London: Sage. Arnason, J. 2003. Civilizations in Dispute: Historical Questions and Theoretical Traditions. Leiden: Brill. Arnason, J., Eisenstadt S.N. and Wittrock, B. (eds). 2005. Axial Civilisations and World History. Leiden: Brill. Becker, G. and Stigler, G.J. 1977. De Gustibus Non Est Disputandum, in American Economic Review 67, 2: 76–90. Canguilhem, G. 1966. Le Normal et le Pathologique. Paris: PUF. Canguilhem, G. 1978. On the Normal and the Pathological. Dordrecht: Reidel. Csikszentmihályi, M. 1975. Beyond Boredom and Anxiety. Chicago: University of Chicago Press.

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Elias, N. 1987. Involvement and Detachment. Oxford: Blackwell. Foucault, M. 1980. Power/Knowledge: Selected Interviews and Other Writings by Michel Foucault, 1972–1977, Colin Gordon (ed.). Sussex: Harvester. Foucault, M. 1994. Dits et écrits, 4 vols, D. Defert and F. Ewald (eds). Paris: Gallimard. Hankiss, E. 1983. Társadalmi Csapdák/Diagnózisok (Social Traps/Diagnoses), third edn., Budapest: Magvetö. Kerényi, C. 1976. Dionysos: Archetypal Image of Indestructible Life. Princeton: Princeton University Press. Keynes, J.M. 1937. The General Theory of Employment, in Quarterly Journal of Economics 51(2),: 209–23. Keynes, J.M. 1964. The General Theory of Employment, Interest, and Money. New York: Harcourt Brace Jovanovich. Koselleck, R. 1985. ‘“Space of Experience” and “Horizon of Expectation”: Two Historical Categories’, in Futures Past: On the Semantics of Historical Time. Cambridge, MA: MIT Press, 255–77. Koselleck, R. 1988. Critique and Crisis: Enlightenment and the Pathogenesis of Modern Society. Oxford: Berg. Latour, B. 1991 Nous n’Avons Jamais Été Modernes: Essai d’Anthropologie Symmétrique. Paris: Découverte. Pizzorno, A. 1986. ‘Some Other Kinds of Otherness: A Critique of “Rational Choice” Theories’, in A. Foxley, M.S. McPherson and G. O’Donnell (eds), Development, Democracy and the Art of Trespassing: Essays in Honor of Albert O. Hirschman. Notre Dame: University of Notre Dame Press, 355–73 Pizzorno, A. 1987. ‘Politics Unbound’, in C.S. Maier (ed.), Changing Boundaries of the Political. Cambridge: Cambridge University Press, 27–62. Pizzorno, A. 1991. ‘On the Individualistic Theory of Social Order’, in P. Bourdieu and J.S. Coleman (eds), Social Theory for a Changing Society. Boulder and Oxford: Westview Press, 209–31. Pizzorno, A. 2000. ‘Risposte e Proposte’, in D.D. Porta, M. Greco and A. Szakolczai (eds), Identità, Riconoscimento e Scambio: Saggi in Onore di Alessandro Pizzorno. Bari: Laterza, 197–245. Pizzorno, A. 2006. ‘Rational Choice’, in S.P. Turner and M.W. Risjord (eds), Handbook of the Philosophy of Science: Philosophy of Anthropology and Sociology. New York: Elsevier, 373–95. Pizzorno, A. 2007. Il Velo Della Diversità: Studi su Razionalità e Riconoscimento. Milano: Feltrinelli. Procacci, G. and Szakolczai, A. 2003. La Scoperta della Società. Rome: Carocci. Szakolczai, A. 2007a. Sociology, Religion and Grace: A Quest for the Renaissance. London: Routledge. Szakolczai, A. 2007b. Image-Magic in A Midsummer Night’s Dream: Power and Modernity from Weber to Shakespeare, in History of the Human Sciences 20(4), 1–26.

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Szakolczai, A. 2011. ‘Eric Voegelin and neo-Kantianism: Early Formative Experience or Late Entrapment?’, in L. Trepanier and S. McGuire (eds), Eric Voegelin and the Continental Tradition: Explorations in Modern Political Thought. Columbia, MO: University of Missouri Press. Voegelin, E. 1978. Anamnesis. Notre Dame, Ill: University of Notre Dame Press. Voegelin, E. 1999. The New Order and Last Orientation, Vol. 7 of History of Political Ideas, in The Collected Works of Eric Voegelin. Columbia: University of Missouri Press. Weber, M. 1972 [1921–2]. Wirtschaft und Gesellschaft. Tübingen: Mohr. Weber, M. 1978 [1921–2]. Economy and Society. Berkeley: University of California Press.

Chapter 3

Modernity as Spiritual Disorder: Searching for a Vocabulary of Social Pathologies in the Work of Eric Voegelin Bjørn Thomassen It is not by confining one’s neighbour that one is convinced of one’s own sanity Dostoyevsky There is an order to be found, within things and between them, which binds and directs this world Saint Augustine

So Far Away Yet So Close When Gregory Bateson went to Papua New Guinea in the early 1930s to do his anthropological fieldwork, he did not know exactly what to expect. As he settled down among the Iatmul, he started to observe events and cultural patterns that disturbed him. Members of the Iatmul tribe were constantly engaged in mutual mockery and there was a sense of a lurking violence underneath people’s everyday lives and their communication. Some of the ritual acts that Bateson studied were outright humiliating and denigrating of the persons mocked; and more than often violence actually broke out. Bateson especially found the types of behaviour that demarcated the male and female genders exaggerated and obscene. But such behaviour was frequent and it took place in public. In his attempt to analyse the Iatmul, Bateson (1958) developed a new conceptual vocabulary, including the concept of schismogenesis, which points to the process whereby a schism develops and in some cases installs itself more permanently, leading to pathology. Bateson would later in his career apply schismogenesis to the study of pathological states in individuals and in relationships between individuals. Bateson was interested in two things: the emergence of a schism within a population, and the way in which a clearly pathological type of cultural behaviour could become fixed as a model, establishing itself as the ethos of a whole society; in other words, how a pathological state could turn into cultural norm.

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It would be convenient to remain among the Iatmul, a remote headhunting tribe studied nearly 80 years ago by a confused, young anthropologist: their bizarre pathologies seem to reinforce our own normality. After all, we don’t go headhunting just for the fun of it, and our public sphere is not dominated by absurd rituals of latent, violent mockery between genders or age cohorts. Let me then describe a daily, ordinary event far from the Iatmul in the airport lounge of Zurich, April 2011. The scene is characterized by order and cleanliness, and very little communication between people. Some people work, others chat in pairs, while others again are watching large television screens. What does the screen show? It shows a series of small candid camera clips. The scenes are deliberately made for an airport audience: a guy in an airport waiting lounge pretends to lose a coin into a woman’s bag, and promptly starts to empty her bag, while the camera zooms in on the woman’s facial expression shifting between wonder, irritation, confusion, anger. Some of the ‘victims’ of the gimmick laugh, others become angry, others again simply do not know how to react. In either case it is all very funny, and it makes people watching the joke laugh. And what is wrong with laughing to kill a bit of time in an airport lounge? A group of passengers catch a Swiss Air flight to Rome. As the plane takes off another series of gimmicks are shown on small screens in front of each seat. It is almost impossible not to watch: the screens are fixed in the ceiling above each passenger seat. Everyone looks up and enjoys the show while they are served a drink and a snack. What do they see? The first gimmick involves a clergyman who pretends to be in trouble with a heavy coffin, asking random passers-by to help him push the coffin into his car, parked on a public square. As they do so, a voice from the coffin suddenly starts to speak. The volunteer is scared, in shock, which is of course funny to watch. One woman covers the ears of her young child and makes the sign of the cross as the coffin starts to speak. Once the joke is revealed most of the victims laugh, with a bit of embarrassment. Some don’t laugh at all. Their embarrassment once they find out that they have been trapped provides the second laughter for the audience. The second scene involves a technician setting up a speed-camera along a roadside. He needs help to hold the camera while setting up the connecting machinery further down the road, so he stops a couple. He picks the man of the couple who kindly volunteers, tells him to put on an orange jacket, and to hold the camera. He then walks with the woman down the road to connect the camera to the speedmeasuring cable, which she has to hold. While the woman looks away, her husband is replaced by a human doll wearing an orange jacket. From a distance it is hard to see that it is not him. When the woman looks back towards her husband, a car runs down the human doll. The fun in this gimmick is to see the facial expression of the women as they see their husbands or boyfriends being run down. They are shocked. In one of the scenes the woman watching it bursts into tears and falls to the ground from the shock, which is of course very funny. The third scene involves children around the ages of five to eight dressing up for carnival. They are placed in front of a mirror inside a commercial centre where an adult woman starts to do their make-up. The kids are happy and excited. Suddenly, and with no

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warning, the child sees a monster inside the mirror, appearing behind their own image, and slowly replacing it. It is the devil. The little girl screams. The face of the devil is truly frightening. A boy hides under the chair, shivering from fear. The fun in these scenes consists in zooming in on the children’s facial expressions of disbelief, horror and fear as they see their own image turning into the face of the devil. I look around. People are smiling, it is all very funny, and sandwiches have already been served. Pathologies of the Contemporary This is an anecdote. But it is also true. And the very fact that such candid camera shows are increasingly used for display in public (airports, commercial centres, boutique windows in Europe’s most crowded shopping areas) makes it all doubly disturbing. What is going on? Is it just me not ‘getting it’, taking life too seriously? I do find it utterly disturbing that adults can poke fun at at small children, abuse their innocence, benefit from the trust they put into adults, and scare them with the figure of the devil replacing their image in a mirror as they believe they are being decorated for a children’s party. If someone did it to my seven-year-old daughter I would call the police – although for sure to no use, for it was all just a joke. I find it outright pathological that we are even supposed to laugh when we see a child screaming from fear of the devil, or a woman crying as she sees her husband being run down by a car. That is my reaction, and, some would say, just one kind of reaction – and therefore a normative position. The moment we say ‘pathology’ we somehow signal a strong normative position on what is ‘normal’, what is ‘good’ and what is ‘healthy’. Such a reference to the good, healthy or even beautiful contrasting with the pathological will immediately stand accused of essentialism and ideologically-based normativism. To defend principles or foundations from where the pathological can be defined is hardly acceptable within the reigning positivism of the social and political sciences or within its alternative paradigms of social constructivism and postmodern thought. In this chapter I want to pose two very basic questions: Is there a way in which we can justify such a language? And what would such a language sound like – i.e. into what kind of conceptual, methodological or theoretical frame does it become justifiable? I argue that one important thinker of the twentieth century, Eric Voegelin, provided some crucial elements for us to at least pose these questions in a meaningful way. He did so outside the still-hegemonic Durkhemian framework for thinking about pathologies. Rather than seeing pathologies as deviance from norms, he asked another question: is there a way for us to grasp, diagnose and render clear not how deviant behaviour produced by criminals or madmen can turn into a pathology, but how exactly ‘normality’ itself, the very standards that ordinary well-functioning persons take for granted, can be considered pathological? This question takes us into a far more uncomfortable region, and completely outside a functionalist perspective. What if an entire civilizational setting – the Western one –

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is suffering from pathologies, is pathological, however dynamic and productive it may also be? Voegelin argued that this is indeed so. This raises the stakes at hand almost beyond comprehension: how to think or even talk about such pathologies if one is living – as we are – inside this civilizational context, being brought up within it, and trained as thinkers and academics within its traditions, however ‘critical’ they may claim themselves to be. This cannot be done by staying within the frameworks of analysis that have developed within modernity. As has been argued by Szakolczai (2000) the particularities of the modern world should better be approached in a contrast to premodern or extra-modern contexts. This involves a twofold engagement that brings social theory into intimate contact with anthropology and historical sociology, opening up the study of the modern world in time and space. Gregory Bateson and Eric Voegelin belong to a group of thinkers who contributed to such an analysis. They are far from being the only ones, of course, but for the purposes of this chapter I privilege the contributions of Eric Voegelin. For a longer discussion of Bateson’s contribution to the analysis of the ‘fixing’ of pathological states within wider populations, I refer the reader to Horvath and Thomassen (2008). Eric Voegelin: Pneumapathological Consciousness and Modernity as Spiritual Disorder It would not be surprising if sooner or later psychologists and social scientists were to find out about the classic analysis of noetic existence as the proper theoretical basis for the psychopathology of the ‘age’ (Voegelin 1990: 8–9). Born in Germany in January 1901, and growing up in an Austrian academic environment, Eric Voegelin belongs to a group of thinkers who lived through both World Wars. His work can certainly be seen as a reflective attempt to understand the wars, and the related political ideologies and mass movements. The age in which Voegelin was living was an age where the ordering structures of society were collapsing. And this collapse of order – or rather, this experience of a collapse of order – became a leitmotif in his entire work (Szakolczai 2000: 153ff). Voegelin was particularly interested in two types of experience: experiences of dissolution and chaos, and the opposite experiences of order. It was these ‘experiences of order’ against a world of decay or chaos that Voegelin diagnosed as Gnostic, to the extent that human beings ‘artificially’ sought to create order out of disorder through their own ordering devices, departing from a sense of alienation or homelessness. Voegelin also argued that this amounted to an intellectual hubris that was deeply nihilistic in nature, hopelessly emptying the world of meaning exactly as it was searched for. Voegelin recognized this Gnostic tendency as underpinning both modern science and politics – indeed the modern world as such. To put it briefly: Gnosticism was to Voegelin the social pathology of modernity. The main aim of Voegelin’s early work was to find the roots of the modern political mass ideologies, which he considered pathological. Voegelin witnessed

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the rise of Nazism, and just barely escaped the Nazis before the Anschluss of Austria in 1938. He eventually settled in America, where he lived the rest of his life. Some of Voegelin’s early writings were about the roots of Nazism; however, for Voegelin the problem turned out to be much broader. He identified a ‘Gnostic tendency’ in modern political movements, but under the term ‘Gnosticism’ he very provocatively put other ‘isms’ that together define the modern episteme, such as scientism, Marxism, positivism, etc. In other words, for Voegelin it was somehow the very modern worldview and its search for ‘inner-worldly fulfilment’ which was problematic and, indeed, deeply pathological. Voegelin quickly realized that the end of Nazism was not the end of ‘the problem’. Voegelin’s analysis was historical, and his empirical work concentrated almost solely on political ideas. More precisely, Voegelin focused on political ideas as they related to events and sprang from human responses to experiences. This included human responses to transcendental experiences. In terms of terminology, Voegelin invoked the term ‘pathological’ with frequency and consistency. In a very direct way, Voegelin’s work concentrated on identifying the underlying pathologies of contemporary civilization. Voegelin used ‘pathology’ interchangeably with another series of terms which are possibly even more charged: ‘spiritual disorder’, ‘disease’, ‘derailment’, ‘disorientation’, ‘closed’ or ‘pneumapathological’ consciousness. In his essay on ‘Reason: the Classic Experience’ he talks outright about the ‘psychopathology’ that dominates the modern worldview (1990: 6ff). A longer list of Voegelian pathology-related terms would include ‘egophanic revolt’, ‘metastatic faith’, ‘demonic mendacity’, ‘Prometheanism’, ‘social Satanism’, and many others (see the excellent discussion by Franz 1999). Perhaps the term that covers Voegelin’s view best is that of ‘spiritual disorder’, as it contrasts to his view of ‘order’; an order which is a prerequisite for ‘social health’ (my word). Voegelin would also contrast ‘imbalanced’ against ‘balanced consciousness’ (Hughes 1999: 163ff.). Voegelin’s vocabulary, as his theoretical view, often derived from his reliance on the classical tradition. I have already indicated in a general way what Voegelin saw as pathological about contemporary civilization. Let me try and elaborate a bit further what he meant. The exercise is made difficult by the enormity of Voegelin’s work. Voegelin’s work runs into 39 volumes, and the term ‘pathology’ is used throughout his authorship: in his early work on Nazism; in his work on political religions and ‘modernity without restraint’ (Voegelin 2000); in his early statements about the Gnostic nature of science and politics (2004); and also in his later writings. The exercise is also complicated by the decisive shifts that took place in Voegelin’s theoretical orientation, up until the writing of the last volumes of Order and History – shifts that cannot be discussed here. I will therefore indicate how Voegelin came to see ‘pathologies’ mostly with reference to his mature work – for example to what he wrote as he embarked on the series, Order and History from the mid 1950s. And it goes without saying that given the space limits, and given the centrality of the term for Voegelin, no exhaustive analysis can be offered.

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Searching for a Language of Pathologies: Voegelin’s Political Science Part of the pathological character of modernity had to do for Voegelin with ideology. Voegelin located, conventionally, ideologies as formal systems of thought within modern times. Ideologies as thought systems were products of the nineteenth century. At the same time, one of Voegelin’s main points was always to show that the character and origins of modern ideologies must be traced back in time, back to at least Antiquity. Voegelin also argued that the ancients had indeed developed a diagnostic vocabulary to bespeak exactly such pathologies. Therefore, while ideologies as ‘closed systems’ are pathologies of the modern, the human tendencies that can drive towards such pathological patterns go back in time and arguably pertain to the human psyche. Indeed, the diagnosis of such pathologies lay at the heart of axial and post-axial thought: In fact, the Greek thinkers diagnosed it [the pathological consciousness] as a disease of the psyche from the time they had occasion to observe it in the embattled polis. Heraclitus and Aeschylus, and above all Plato, speak of the nosos or nosema of the psyche; and Thucydides speaks of the expansion of the disease into the disorders of the Peloponnesian War as a kinesis, a feverish movement of society … The Stoics, especially Chrysippus, were intrigued by the phenomenon, and Cicero, summarizing the findings of the preceding centuries, deals with the disease at length … He calls it the morbus animi, the disease of the mind, and characterizes its nature as an aspernatio rationis, as a rejection of reason. (Voegelin quoted in Franz 1999: 141)

Voegelin was not ‘constructing’ a theory of pathologies in order to diagnose the problems of his own age, he was searching for ways in which pathologies had been diagnosed and recognized throughout the ages. The point is that every healthy society is able to recognize pathologies and establish its remedies. In Reason: The Classic Experience (1990: 7) Voegelin offered another brief overview of diagnostic efforts in the Classical age, which is worth quoting in full as it evidences something very central about Voegelin’s own understanding of pathology as a closure or revolt against the divine ground, invariably leading to existential disorientation and alienation. Heraclitus had distinguished between the men who live in the one and common world (koinos kosmos) of the logos which is the common bond of humanity (homologia) and the men who live in the several private worlds (idios kosmos) of their passion and imagination, between the men who lead a waking life and the sleepwalkers who take their dreams for reality (Voegelin 1990: 89) and Aeschylus had diagnosed the Promethean revolt against the divine ground as a disease or madness (nosos, nosema). In the Republic then, Plato used both the Heraclitian and Aeschylean symbols to characterize the states of attunement and closure to the ground as states of existential order and disorder. Still, it took the shattering experiences of ecumenic imperialism and, in its wake, existential disorientation as

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a mass phenomenon, to let the bond between reason and existential order arrive at conceptual fixation. Only the Stoics created the terms oikeiosis and allotriosis, translated by the Latins as conciliation and alienation, to distinguish between the two states of existence which respectively make the life of reason possible or condition disorders of the psyche. Of course, one could focus on the outward manifest symptoms of the pathology. In fact, from the Stoic Tusculan Disputations Voegelin (Voegelin 1990: 8) collects ‘a list of syndromes that sounds quite modern: restless money-making, status-seeking, womanizing, overeating, addiction to delicacies and snacks, winetippling, irascibility, anxiety, desire for fame, stubbornness, rigidity of attitude, and such fears of contact with other human beings as misogyny and misanthropy’. However, analysis had to go beneath these historically contingent symptoms to the underlying worldview that produced them: that, to Voegelin, was the central task of a political thinker, then as now – as always. The very fact that we today are forced to search again for a meaningful language of pathology, and almost against the odds, having to be apologetic towards the very project, is in itself a serious indication of a deep-bound crisis in our values and an almost complete overtaking of the pathological view itself; it is a symptom that we have disabled ourselves from discerning, from seeing. A healthy civilization must possess a fully articulated vocabulary for pathologies of mind and soul. A society that does not have it has locked itself into the asylum. This relates to another point stressed by Voegelin: the diagnosis of pathological states, of ‘imbalanced consciousness’, cannot be made without accounts of a wellordered state or ‘balanced consciousness’. It is never just enough to establish what is ‘wrong’. We need a language of health as well. It is not possible here to engage Voegelin’s larger attempt to formulate a theory of consciousness. Suffice to say that here again Voegelin did not create such ideals or values ex novo but found them articulated in historical individuals, such as Plato or Saint Augustine, and their contemplative attitude and openness towards the divine ground; their seeking of attunement to the ordered world. As Eugene Webb argued in one of his essays on Voegelin (Webb 1997) Voegelin’s contribution to contemporary philosophy and social theory lies not only in his attempt to diagnose the pathological character of modernity but equally in his positive conception of human universality, deriving in part from his notion of ‘differentiated consciousness’. I shall return to this point below. Thucydides: Diagnosis of the Pathology To concretize what Voegelin meant here it is perhaps useful to consider one particular aspect of Voegelin’s position, namely his appreciation of both Thucydides and Plato. Thucydides (c. 460–c. 395 bc) is normally not considered a political theorist. Instead he is routinely claimed as the forefather of political realism in International Relations, where morals have lost their role in realpolitik

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and been replaced by sheer force. Together with Herodotus he is also considered a forefather of history writing with the supreme goal of descriptive objectivity and neutrality. It would seem almost impossible to draw normative lessons about pathologies from an objectivist Realist who cut off morals from the political. Voegelin saw it differently: Thucydides’ work was a concentrated effort to diagnose the pathologies of his age. ‘The two thinkers complement each other’ (1957: 357) in the sense that Thucydides concerned himself with the causes of the disorder while Plato (429–347 bc) was engaged in the major attempt at restoration. This quite simply means that what the Realist schools in International Relations still today claim as axiomatic for their worldview is in reality based on Thucydides’ description of a disease. To put it more strongly: Realism builds its theoretical construct upon every single problematic element of a diagnosed pathology, and hence can safely be catalogued as a mere symptom of that same disease, couched in objective scientism. But what is the disease? Pathology was indeed the main concern of Thucydides and it is worth pausing a bit at what he actually said, also because it resonates quite strongly with a Batesonian language of schismogenesis (see again Thomassen and Horvath 2008). I lean on here the analyses by Fliess (1959) and Price (2001) of Thucydides as a political theorist which in my view makes explicit what Voegelin recognized as important in Thucydides. Thucydides is mostly known for his analysis of interpolity relations, which true enough was the focus in many of his writings. Yet a great part of Thucydides’ narrative in The Peloponnesian Wars take place inside the city. Price convincingly argues that Thucydides’ most acute analysis ‘is applied to the internal workings and disruptions of individual men and cities’ (Price 2001: 274). Therefore, in order to understand how things could have gone so wrong at the interpolity level (military atrocities against civilians and the spread of warfare in the Hellenic world at the time of his writing), Thucydides engaged in a detailed analysis of what was happening within both the Athenian and Spartan societies. The atrocities that were being committed by the powerful against the less powerful were spreading; yet these atrocities were nothing more than symptoms of the moral decay behind them (Fliess 1959: 599). Thucydides here described the ‘character traits’ that had grown out of balance in Athens at the time of his writing. One was the drive towards over-extension of power. Pericles had with much foresight warned against the over-extension of Athenian power before the outbreak of war. The values of moderation and temperance had gotten lost: atrocities were justified as a defence of Athenian society. In actual fact, however, such justificatory arguments were signs of a system of terror devised to preserve over-extended and ruthless power (Fliess 1959: 599) the pathology had therefore become selfperpetuating. As Fliess states, ‘Athens had manoeuvred herself into the morally and politically untenable position of ruling over her empire in a tyrannical fashion (polis tyrannos)’ (Fliess 1959: 599). Thucydides also analysed how Sparta and Athens had developed within a perfectly Batesonian schismogenetic system: Sparta’s dexterity was matched

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by the meddlesome and ceaseless activity of Athens, preventing any form of relaxation within the entire Hellenic world. Athenian restlessness was as pathological as Spartan complacency. Both attitudes were endangering the survival of society: both attitudes contributed to the bipolar ‘balance’ making war inevitable. Thucydides was certainly aware of the difficulty of applying norms internal to society to interpolity relations; yet he does not exclude the possibility. The problem was that ‘the pathological convulsion that had gripped the entire Hellenic world forbade an insistence on norms applicable in periods of moral and social health’ (Fliess 1959: 599).Thucydides also called this ‘pathological activism’, which is bound up with domestic politics. The imbalance of the system is so marked that even a ‘small natural shock might easily precipitate a panic’ (Fliess 1959: 601), almost a short-hand definition of a schismogenetic society. International disorder stems from domestic disorder. What Athens had lost was moderation. The demos had become dominated by factions and party polemics, forcing leaders to ignore diplomatic solutions under the impact of domestic pressures. Athens was full of fearful Generals, who sought to find favour among the demos. However, to act out of fear is hardly going to produce anything positive. Just like Weber, Thucydides set up Pericles as a positive example of how to act in a liminal situation, channelling individual acts towards the common good and lifting up the collective; but he contrasts Pericles’ speech to the social consequences of the plague and pathology. To preserve the nobleness of Athenian society, including its democratic character erected by the principles of isonomia and isogeria, the development of certain character traits had to be encouraged in both rulers and ruled: legal and political stability was not possible without it. It was in this context that Foucault (2002) in his very last years realized the importance of parrhesia, ‘frank speech’, or truth-speaking, as a fundamental aspect or ‘third leg’ of the Greek democratic experiment; one that stands in contrast to rhetoric and the clever use of words for a purpose. The crisis of Athenian democracy had nothing to do with the institutional set-up; it had to do with a pathology of the soul that in turn affected the lifeconduct of its citizens. The ‘spirit’ of democracy had vanished long before the institutions collapsed. In the Pathology Thucydides elaborated in some detail the moral decay in post-Periclean Athens, spreading like a plague to the entire Hellenic world: ‘The pathological disturbance of the normal equilibrium of the forces of human nature had led to the emancipation of the base human drives of greed (pleonexia) and ambition (philotimia) from the civilizing restraints imposed by the rule of law. As a result patriotism had been abandoned to a malignant factionalism (stasis) a general evil’ (Fliess 1959: 606). As stressed also in the more recent analysis of Price (2001) Thucydides sees stasis as a pathology stemming from an internal disturbance in both individuals and states. Using a Platonic language, the human desires have lost the chords that tie them together in a balanced way; or in another Platonic expression, elaborated in Ion, human action and thought have become decoupled from the chain that connects the human to the divine (Thomassen 2007).

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Just as Athens and Sparta had developed into a schismogenetic system, so had Athens itself. Factional strife in the interpolity domain was propelled by corresponding schisms in the domestic sphere. The enmity of irreconcilable factions had almost entirely dissolved the unity of the citizenry into opposing ideological camps. Symptomatic of this pathological state was the total subordination of the common welfare to the satisfaction of the private aspirations of factional leaders ‘aiming at the seizure of power as good in itself without regard to any genuine political end’. Politics had become reduced to a question of means, and a central element of those ‘means’ involved a rivalry over the emotions of the masses. True patriotism was gone; it had been replaced by empty populist slogans. Politics and social life had dissolved into obtuse friend-enemy categories eliminating all possibility of toleration and mutual trust. The situation was marked by a devastating loss of values: ‘General indifference towards everything except money and power, rejection of higher values, and lack of concern with moral selfperfection had of necessity produced a loss of respect for law and religion’ (Fliess 1959: 607). As leaders were concentrated on seeking the emotional support of the masses, reason itself was vanishing. Anti-intellectualism was spreading; status was gained by entertaining the masses with easy slogans; lies were accepted as true; neither honesty nor wisdom were of any importance in the faction-ridden poleis; in this state of affairs, the intelligent citizens were excluded from political influence (Fliess 1959: 607). The social disintegration was even visible via a complete confusion of language and concepts: words and concepts were losing their meaning, preventing the communication of truth, ‘without which no order can endure’ (Fliess 1959: 608; see also Price 2001: 81–126; 190–206). This conceptual confusion relativized all standards. Basic distinctions between virtue and vice, good and bad, had become impossible to make. Hence the basic virtue of moderation could be cast off as cowardice while the boasting and irresponsible acts of the violent were acclaimed as manliness. The break-down of language and communication was therefore accompanied by the uncontrollable outbreak of cruelty and violence. The situation had degenerated to such a point ‘that honesty had to be sacrificed to shallow cleverness and plotting by anyone desiring to be esteemed by his fellow-citizens’ (Fliess 1959: 608). As we have seen above, the central diagnostic term that Voegelin took from Thucydidies was kinesis; which now starts to assume its full meaning. The term cannot be translated into a single modern word. Thucydides sees the Peloponnesian war as part of a kinesis hitting the Hellenic world. But kinesis is more than the war itself; it is a ‘movement’, a disturbance which affects all aspects of human life (Price 2001: 208). However, the point about kinesis is that it is not simply the suffering and break-down of order caused by warfare and external threats to the survival of society; the suffering is self-inflicted, and follows from the internal break-down of ‘morals’ in the body politic, as we would today call it. Put differently (Thomassen 2010: 330), kinesis refers to a sudden eruption of a spiralling and unsettling force, a feverish movement of disintegration and destruction, a constant breaking down

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of any boundary, a fracturing of existing wholes, the disappearance of limits to growth, and the loss of a centre of balance to moderate human desires. To stress how this virulent frenzy, this pathology, emanated from and had effects upon both the personal-psychological and societal-political levels, Voegelin also used the term ‘concupiscental expansion’ (1974: 313). Following Thucydides, Voegelin saw kinesis as a moving force of the entire ecumenic age, or what could also be considered the ‘first global age’ (Szakolczai 2008, Thomassen 2010). The parallels with the current global age are simply too important to be overlooked. In fact, in his article World-Empire and the Unity of Mankind, Voegelin was most explicit about this connection. In analysing the pathological background of the contemporary conception of world-empire he asserts that ‘the dangerous impasse on the ecumenic scale is the result of processes originating in the Western civilization’ (1962: 179). The various social processes connected to expansionism (geographical explorations, science and technology, transport, colonialism, new military potentials) and their concomitant ideologies (nationalism and democracy, liberal progressivism, positivism or Communism) are ‘meaningfully connected by their common origin in the Western revolutionary explosion since roughly the middle of the fifteenth century. The Western process has produced and engulfed the global ecumene’ (Voegelin 1962: 180). The Enlightenment was no new departure for Voegelin, quite the contrary: ‘Within this process there is a critical juncture, in the middle of the eighteenth century, when its pathological character becomes evident and the syndrome of the disease discernible’. Voegelin then proceeds to discern the pathology in the thought of Turgot, a central figure in the French Enlightenment. In Search of Order: Open Existence and Differentiation of Consciousness Voegelin was not interested in Antiquity for the sake of philology: he saw the parallels to the contemporary situation, and from here he engaged in an attempt of restoration, a search for order (Voegelin 1987). Also here Voegelin turned to the value of the classical traditions, and especially to Plato. Philosophy (and political science) was to Voegelin not about creating system in the world: our role is rather to interpret experiences of transcendence as such ‘differentiating experiences’ become symbolized in thought. As Voegelin had said in the ‘New Science of Politics’, ‘since the maximum of differentiation was achieved through Greek philosophy and Christianity, this means specifically that theory is bound to move within the historical horizon of classic and Christian experiences. To recede from the maximum of differentiation is a theoretical retrogression; it will result in various types of derailment which Plato has characterized as doxa’ (Voegelin 1987: 9). For a doxic thinker truth is an answer that settles the questioning and then concentrates on turning the truth into system. Voegelin contrasted this attitude with the Socratic notion of ‘living in truth’, or the ‘philosophical mind’, or ‘open

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existence’, where truth is not a formula, nor even a veridical relationship between words/propositions and the external world, but rather a mode of existence where the mystery of reality becomes luminous from within. Truth is personal; it is not something that can be pursued by collectivities. The philosophical mind realizes that there are truths that lie beyond the reach of finite human knowledge, and seek knowledge with and from that consciousness. We do not know where we come from, and we do not know where we will go. We think in that tension between absolute ignorance and absolute knowledge, in a ‘tension toward the ground’. And, as Plato kept telling the Sophists, that ground cannot be ourselves. Voegelin was well aware that while Plato’s philosophy can be considered one of the highest intellectual achievements of the Classical world, it must be remembered that his entire philosophy can be read as a meditation on the political crisis of Athens. In his main dialogues, Plato searches for the deeper reasons behind this crisis. It is in this wider context that the battle between philosophy and sophistry must be seen. This also helps to indicate what Voegelin meant by a ‘balanced consciousness’. Voegelin’s understanding must be placed in his analysis of the dangers accompanying the discovery of divine transcendence, itself a crucial aspect of the axial age revolutions. The human search for meaning now became placed in what Voegelin calls a tension between the finite world and transcendent reality. Human consciousness very fundamentally has to do with how we orient ourselves towards the transcendent. The fallacy for Voegelin is to misidentify one of the poles in this tension as reality and disregarding or declaring irrelevant or untrue the other pole of the tension. Consciousness becomes unbalanced when either immanence or transcendence is ignored or rejected. The balanced consciousness recognizes the tension of existence as a condition which sets the limits for human thought and action. The pathology involved in various types of modern worldviews or philosophies (see Hughes 1999 for more detail) has to do with what Voegelin called the temptation to ‘hypostasize’ the transcendent, turning ‘it’ into an ‘it’ or a thing. Voegelin saw the human being as ‘framed’ by a series of tensions between the ‘beyond and the below’, the finite and the infinite, time and eternity, the human and the divine, which is why Plato’s term of metaxy and existence in metaxy became so central to his thinking. The metaxy is Plato’s symbol for the in-between plane of human existence, the place of our participation in reality, developed in the Symposium and Philebus. To try to move outside the metaxy, attracted by the divine pole, or negating its existence altogether, equaled for Voegelin a loss of balance, a human hubris (duly signalled in Greek mythology as such), a ‘deformation’ of both thought and consciousness, with deadly consequences. For Voegelin the disorder of the day could only be contrasted to types of symbolic representation of the world that preserved a vision of the world as ordered and meaningful. Grounding his idea of political communities in representations of transcendental experiences, Voegelin insisted that truth cannot be directly represented: this must happen in myth and symbols. The question of a political theorist, for Voegelin, concerns the modes of symbolization. Voegelin’s call for a restoration of political science was likewise a recovery of classical philosophy.

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Voegelin sided with Plato that there must be a connection between order in the soul, order in the city and order in the cosmos. Yet this ‘order’ is not man-made, but something we as humans should recognize and tune in towards, and for Voegelin this was only possible via participation in what he called ‘the divine ground’. Man is not a self-created autonomous being and we do not carry the origin and meaning of our existence within ourselves. And on this point Gregory Bateson would have been in perfect agreement: we are but small parts of a larger whole, of a larger ‘mind’. Conclusion: On the Recovery of Reason and Sanity Let me end by summarizing why I believe Voegelin continues to speak to us today in our renewed efforts to understand the pathologies of the contemporary, but perhaps also in our attempts to overcome them. Voegelin analysed ‘derailment’, ‘deformation’, ‘loss of balance’ and ‘pneumopathologies’ in the history of political thought. The very charged wording was invoked to diagnose not only specific thinkers or historical periods, but the modern worldview as such. It was clear to Voegelin that to confront the pathological character of the modern, he had to reach deep down to the level of foundations. His ‘research area’ was not just political thought or symbolism: his research area was how we think and thereby how we relate to the world. Voegelin’s focus on Antiquity was therefore an inquiry into the ordering and disordering structures of the present. It was at this level that the underlying pathologies of contemporary civilization lay buried; it was here that the beginning of an answer could emerge. While this project was evidently ambitious and even grandiose, Voegelin always proceeded from the recognition that this searching was not simply his. He remained acutely aware of the highly problematic modern tendency to construct theories of the world, from where that world as defined and categorized becomes controllable. Such was not his project. Voegelin’s ‘New Science of Politics’ was in fact not new at all: it was a search into the classical traditions that he wanted to restore in the context of the present disorder. The view that Voegelin developed was therefore tied to a recognition of limits, and to a recognition of the boundaries within which the search for truth could or should take place. As said above, Voegelin expressed this view of limits partly via Plato’s notion of the metaxy. ‘Reason’ in the classic experience was tied to a recognition of groundedness and to a relational view of man in the world; the pathological nature of modernity was to be found in the violation of the metaxy, a departure from the in-betweenness of meaningful existence and thought. This can also be summarized with reference to ‘Voegelin’s rule’ (1990: 17): ‘All “eristic phantasies” which try to convert the limits of the metaxy, be it the noetic height or the apeirontic depth, into a phenomenon within the metaxy are to be excluded as false.’ While denouncing the pathological nature of objectivism and materialism, Voegelin was equally critical of ‘supernaturalism’. I state this with some emphasis,

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since one of the charges against Voegelin was exactly that he was a mystic, and that the ‘science’ he was proposing was itself nothing but a religion, followed by secluded groups of believers. Mainstream political and social scientists have little time for a theorist who based his political science on the notion of a ‘divine ground’. However, for Voegelin this divine ground is something very real (the unreal is to deny it) although here we have to be extremely careful concerning ‘reality’.1 Reality is tied to experience; the ‘poles’ that identify the tension of the metaxy indicate a kind of structural boundary to lived experience. ‘But if the poles of tension are hypostatized as independent entities – if the partners to the encounter are torn asunder and converted into subjects and objects of experience that exist apart from the experiential relation – then the true understanding of reality is lost and the vision of our humanity deformed’ (Morrisey 1999: 24). In other words, ‘reality’ is itself an existential tension, and is therefore not directly accessible and cannot (must not!) be objectified. ‘Unreality’ is the human error of detaching the poles of the tension from the experience of participation in reality, resulting, unavoidably, in spiritual disorder. Voegelin’s approach was anti-ideological. Voegelin saw ideologies as inherently unbalanced, schismatic or one-sided representations of the world. Only in a deeply pathological society where humans have been cut off from their experiential relation to the world can people so easily succumb to the lure of ideologies. Only in a spiritually weakened situation can people so easily be lifted away from the ground by these utopias of ‘second order realities’, as Voegelin would call them. The image that piles up in front of us starts to look rather bleak and hopeless: the world has become deeply pathological and at a very deep level. But that would not be a fair way to end this chapter. It is certainly true that Voegelin was keenly aware of the historical moment and the immensity of the pathology, which went beyond the more evident pathologies of mass totalitarian movements. Voegelin saw strong parallels between the ecumenic age and the disorder and confusion that characterized the present – and, as I have indicated, are just as evidently present in this age of globalization. The parallels are many, from the spread of sophistry to ecumenic expansion, but include at its heart a serious loss of meaning and a loss of an adequate language to speak about the world. The role of analysis, however, does not stop here. Something must be proposed, an alternative must be indicated. Rather than inventing a new language or proposing finished models, Voegelin would come to perceive his task as one of recovery of a meaning that had become lost. Voegelin attempted to formulate a theory of balanced consciousness, tied to a philosophy of history (see Webb 1981, 1997). Such a recovery, however, was not entirely out of reach. After all, not everything produced within the frame of ‘Western civilization’ is to be rejected (Szakolczai 2004). Pathological states, or pathological consciousness, are real enough: they can be readily reproduced and come to dominate entire epochs. Yet, this ‘deformation’ 1  See Thomassen 2012 for a discussion of how Voegelin’s position here differs radically from that of John Rawls.

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or ‘derailment’, Voegelin would agree, is not an in-born state, nor is it, like a virus, an externally-generated process that befalls a passive ‘victim’: the pathology is generated in the process of thinking and living in single individuals. Herein lies a hope, if not a promise. Voegelin started from the premise that human thought springs from an experiential encounter with a ‘beyond’. It springs from the recognition that ‘Man is not a self-created, autonomous being carrying the origin and meaning of his existence within himself … From this experience of his life in precarious existence within the limits of birth and death there rather arises the wondering question about the ultimate ground, the aitia or prote arche, of all reality and specifically his own’. And this experience could never become entirely extinguished in the human person; the question was how to treat the experience. The overcoming of the pathology therefore involved the searching subject, and the manner of searching (Bateson 2002: 81) an anamnesis (Voegelin 1978). We must seek clarity in ourselves, look for every sign of clarity in others, and reinforce whatever is sane. The recognition of something so clearly pathological about the world in which we live carries within itself a danger which, if unrecognized or not treated well, easily becomes tied to a reproduction of the pathological. Once the world is seen as pathological, several attitudes or worldviews may develop as a result of this experience, from world-rejecting attitudes, to cynicism (since the world is pathological, I might as well get the best out of it, and through whatever means available) and to various utopian fantasies about another world which we humans can construct anew, thus eradicating or purifying the pathological state in which we find ourselves. It is fair to say that Eric Voegelin recognized these dangers, without falling in to the various traps of escapism, cynicism or utopianism, and without falling prey to that self-flagellating attitude towards the world and everything created within it that to such an extent has characterized the academic landscape during the last decades, representing nothing but the opposite extreme of positivism and blind belief in progress. In fact, Voegelin to a large extent analysed exactly these traps via the human temptation to world-rejection in moments of transition where the taken for granted worldviews of people were no longer representing adequate frameworks for understanding the world. A return to Plato also means to return to a foundation of epistemology that rests in a recognition of the world as a meaningfully ordered cosmos. And, as Plato argued with such emphasis in his ‘genesis story’, Timaeus, here our reasoning must also flow from a recognition of beauty. As Voegelin (2004: 32) said, ‘Philosophy springs from the love of being: it is man’s endeavor to perceive the order of Being and attune himself to it’. The role of the human being living within an ordered cosmos is not to enforce the logic of our rational minds on an allegedly chaotic world, but to humbly recognize the beauty and intrinsic order of the world as it has been given to us. From here, reason and science becomes possible. Outside it, pathologies emerge. We need, more than ever, to recognize and diagnose the pathologies of our contemporary civilization; but we need to treat this recognition itself with great

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care, and with that due amount of humility that should accompany all human recognitions: that the world is imbued with rhythm, order and beauty, and that we have been given the means to become part of this beauty but also to destroy it. This world, the only one where our pneuma can breathe oxygen into life. And here, in our searching, in our recognition of the uncertainty of outcomes, our humility must remain firm. References Bateson, G. 1958 [1936]. Naven. Stanford: Stanford University Press. Bateson, G. 2002 [1979]. Mind and Nature: A Necessary Unity. Cresshill: Hampton Press. Fleiss, J.P. 1959. Political Disorder and Constitutional Form: Thucydides’ Critique of Contemporary Politics. The Journal of Politics, 21(4), 592–623. Foucault, M. 2002. Fearless Speech. Los Angeles: Semiotext(e). Franz, M. 1999. Brothers under the Skin: Voegelin on the Common Experiential Wellsprings of Spiritual Order and Disorder, in The Politics of the Soul. Eric Voegelin on Religious Experience, edited by G. Hughes. Lanham: Rowman and Littlefield, 139–61. Horvath, A. and Thomassen, B. 2008. Mimetic Errors in Liminal Schismogenesis: On the Political Anthropology of the Trickster. International Political Anthropology, 1(1), 3–24. Hughes, G. 1999. Balanced and Imbalanced Consciousness, in The Politics of the Soul. Eric Voegelin on Religious Experience, edited by G. Hughes. Lanham: Rowman and Littlefield, 163–83. Morrissey, M.P. 1999. Voegelin, Religious Experience, and Immortality, in The Politics of the Soul. Eric Voegelin on Religious Experience, edited by G. Hughes. Lanham: Rowman and Littlefield, 11–31. Price, J. 2001. Thucydides and Internal War. Cambridge: Cambridge University Press. Szakolczai, A. 2000. Reflexive Historical Sociology. London: Routledge. Szakolczai, A. 2004. Sources of Civilization, in Rethinking Civilizational Analysis, edited by S.E. Arjomand and E.E. Tiryakian. London: Sage, 87–102. Szakolczai, A. 2008. The Spirit of the Nation-State: Nation, Nationalism and InnerWorldly Eschatology in the Work of Eric Voegelin. International Political Anthropology, 2(1), 193–212. Thomassen, B. 2007. Platone e l’arte dell’imitazione: il problema della verità in un contesto storico liminare, in Gli Interpreti degli Interpreti. Lo Ione di Platone Oggi, edited by A. Horvath and A. Szakolczai. Firenze: Ficino Publications, 63–71. Thomassen, B. 2010. Anthropology, Multiple Modernities and the Axial Age Debate. Anthropological Theory, 10(4), 321–42.

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Thomassen, B. 2012. Reason and Religion in Rawls: Voegelin’s Challenge. Philosophia, 40(2), 237–52. Voegelin, E. 1957. The World of the Polis, volume two of Order and History. Baton Rouge: Lousisiana State University Press. Voegelin, E. 1962. World-Empire and the Unity of Mankind. International Affairs, 38(2), 170–88. Voegelin, E. 1974. The Eucumenic Age, volume four of Order and History. Baton Rouge: Louisiana State University Press. Voegelin, E. 1978. Anamnesis. Illinois: University of Notre Dame Press. Voegelin, E. 1987. In Search of Order, volume five of Order and History. Baton Rouge: Louisiana State University Press. Voegelin, E. 1990. Reason: The Classic Experience, in The Collected Works of Eric Voegelin, volume twelve, Published Essays, 1966–1985, edited by E. Sandoz. Baton Rouge: Louisiana State University Press, 265–92. Voegelin, E. 2000. The Political Religions, the New Science of Politics, and Science, Politics and Gnosticism, in The Collected Works of Eric Voegelin, volume five, Modernity without Restraint, edited by M. Henningsen. Columbia: University of Missouri Press. Voegelin, E. 2004. Science, Politics & Gnosticism. Wilmington: ISI Books. Webb, E. 1981. Eric Voegelin: Philosopher of History. Seattle: University of Washington Press. Webb, E. 1997. Eric Voegelin at the End of an Era. Differentiations of Consciousness and the Search for the Universal, in International and Interdisciplinary Perspectives on Eric Voegelin, edited by S. McKnight and G. Price. Columbia/ London: University of Missouri Press, 159–89

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Part II Social Pathologies: Contemporary Malaises

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Chapter 4

The Value of Houses in the Libidinal Economy: Financialization as Social Pathogenesis Kieran Keohane

The libidinal economy is Freud’s term for the currency of conflicted and ambivalent fears and desires that animate individuals’ lives and the collective life of a society at any given time so that the spirit of society, the esprit des corps of the body politic, the zeitgeist, civilization as a whole, is always more or less troubled and discontented. There is an economy to the discontents of civilization, by which Freud means that as we individually and collectively try to balance Eros and Thanatos (creative integrating and destructive disintegrating tendencies) there is a discernible system of patterned distribution of the symptoms of civilization’s discontents, and it is the art of cultural analysis to bring this economy into view by interpreting the signs of the times read as the symptoms of our discontented civilization, symptoms that are especially florid at times of crisis such as our present global financial crisis. In this chapter I will bring a cultural symptomology of libidinal economy to bear on the political economy of global financial crisis. I focus especially on that sector of the global markets where the crisis first emerged, the sub-prime mortgage derivatives market, and while Freud’s Civilization and its Discontents provides contours of a general interpretive framework my analysis is informed more particularly by Georg Simmel’s Philosophy of Money as a diagnostic of the pathogenic effects of financialization, specifically in terms of how financialization liquefies and erodes value and meaning in contemporary civilization. A central feature of globalization has been the expansion of limits and the dissolution of boundaries as financial markets and their informational infrastructure have extended beyond the fiscal regulatory frameworks of nation states. The indefiniteness, liquidity and boundlessness of the spatial frame of global markets, the opacity and complexity of their media and processes become a source of collective stimuli. Indistinctness of boundaries has a stimulating and seductive effect, Simmel says, like a meeting convened in darkness: the outer boundaries fade and the focus intensifies on the immediate as ‘fantasy expands darkness into exaggerated possibilities; one feels surrounded by fantastically indefinite and unlimited space’ (Simmel 1997a: 145–6). The intensified focus on the immediate due to spatial limitlessness is further amplified by temporal

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de-containment: global trade in financial markets takes place around the clock, Wall Street opening, London and Frankfurt trading, Tokyo closing; and an inner temporal expansion whereby margins on currency and interest rate fluctuations are traded instantaneously by automated systems. De-framing takes place too on the linguistic and cognitive level: the Classical modern narrative framing of political economy, from Adam Smith and Marx through Keynes and Friedman has been superseded since the 1970s so that economics in general and financial derivatives trade in particular takes place on the basis of mathematical models and algorithms that even financial services professionals themselves scarcely understand. The global financial market is ‘the most computationally intensive activity in the modern world’ (MacKenzie 2008: 25) a ‘streaming epistemic system … clearly defined in terms of prices, news, relevant economic indicators at any given moment’ but ‘ill defined with respect to the direction they will take at the next moment’; a processual reality, an infinite succession of non identical matter projecting itself forward as a changing screen, a reality that changes all the time ‘stable only long enough to enable transactions to occur’ (Knorr Cetina and Preda 2007: 117). Streaming flux, instability and permanent liminality is the economic form of global liquid modernity (Bauman 2000). In the context of this techno-financial sublime wherein liminality and liquescence are greatly intensified there is a corresponding increasing significance to spatial fixity as ‘every immobile asset around which economic transactions of any kind occur is [a] pivot point for unstable conditions and interactions’ (Simmel 1997a: 146). ‘The reason why mortgages tend to be connected almost exclusively to immovable assets’ Simmel says, ‘is a combination of the stationary character and the indestructibility of these assets … the mortgaged object can remain in the hands of the debtor and yet be completely secure for the creditor’. A relatively insignificant dimension of the money economy in Simmel’s time but which would play a central role in subsequent and especially in the most recent economic crisis was developed by Lloyds of London in the early modern finance industry, so that a ship and its cargo valued according to the risk of its safe arrival or its loss could become a security, is the prototype of contemporary financial investment vehicles; namely ‘the principle of insurance which has made those objects that are totally lacking in any fixed position in space eligible for mortgage lending’ (Simmel 1997a: 147). Insurance exponentially increases money’s character of abstraction, as each derivative insurance policy, a financial product whose value is derived from the risk of earlier insurances, abstracts financial transactions away from the original fixed, literal, ‘concrete’ asset on which it is leveraged. Credit Default Swaps (CDS) and Collateralized Debt Obligations (CDO) as insurance policies derived from Mortgage-Backed Securities (MBS) are the lynchpin of the 84-trillion dollar financial derivatives market, and the sub-prime section of that market was the epicentre of the crash (MacKenzie 2008). Why did the value of houses (and thereby mortgages) increase so much during the recent period of neo-liberal globalization? The value of a house can be understood in terms of what Simmel (1997b) formulates as ‘the hypertrophy

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of objective culture and the relative underdevelopment of subjective culture’ and the subject’s search for points of unconditional mooring in a world of flux and contingency. Money, the universal solvent, dissolves and reduces all values to the question of ‘how much?’ ‘Everything floats with the same specific gravity in the constantly moving stream of money’, and as all things come to have equal value, differentiated only by price, all particular values are eroded (Simmel 1964a: 414). Modern civilization becomes characterized by cynicism and nihilism, as in Oscar Wilde’s aphorism whereby people know the price of everything but the value of nothing! Through the universalization of money economy (financialization) the whole objective world becomes devalued, Simmel says, and the personality is dragged down into the same feeling of worthlessness. Money is an annihilating power: ‘the frightful leveller. … It hollows out the core of things, their individuality, their specific value and their incomparability in a way that is beyond repair’ (Simmel 1964a: 414–15). It is in this specifically modern context of liquefaction and flux, a devaluation of all values, that the house attains a very special value. The house, the residence, is the only rampart against the dread of nothingness, darkness and the obscurity of the past. Its walls contain all that mankind has patiently amassed over hundreds of centuries. It opposes escape, loss and absence by erecting an internal order, a civility, a passion of its own. Its liberty flourishes where there is stability and finitude, not openness and infinity. To be at home is to recognize life’s slow pace and the pleasures of sedentary meditation. … Man’s identity is thus residential, and that is why the revolutionary, who has neither hearth nor home, hence neither faith not law, epitomizes the anguish of errancy. … The man without a home is a potential criminal. (Kant, in Perrot 1990: 342)

Against the tendency of money economy towards cultural nihilism the house retains a value that cannot be so easily reduced to cash value because its use value is entwined with its concrete, material endurance as residence, as dwelling place. As recently as the nineteenth century, Simmel reminds us, even in cities, individual houses typically had proper names, as though houses were persons! ‘The house that is called by its own name [gives] its inhabitants a feeling of spatial individuality, of belonging to a qualitatively fixed point in space. Through the name associated with it, the house forms a much more autonomous, individually nuanced existence’ (Simmel 1997a: 149). Kant says that not everything has a monetary value: ‘Everything has either a price or a dignity. Whatever has a price can be replaced by something else as equivalent. Whatever by contrast is exalted above all price and so admits no equivalent has a dignity’ (2002: 36). But it is not so either/or as Kant asserts, for some things (and the house may be such a special type of thing) have both price and dignity. Through dwelling, whereby subjective culture is developed and institutionalized, the substantive value of house and home become intertwined in the collective biography, character and name of the household. Whereas the housing market (and Kant) splits them, in

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ordinary language usage ‘house and home’ are synonyms for a unified whole, ‘the household’, an entity constituted by a web of libidinal attachments and thereby imbued with character and dignity that resists financial liquefaction and commodification. From the perspective of the householder this is primarily how the house appears: substantive value as concrete actuality, as residence, dwelling place, as identity, as the end in an otherwise endless sequence of purposes that money can serve. The house and home is an enduring final object of enjoyment providing spatial and temporal boundaries to life, a mooring for meaningful lifeprojects of autonomous individual and familial self-realization. The Ideal Value of Real Estate Moreover, and in addition to the way in which its exchange value is inseparable from its use value as dwelling in the realm of subjective culture, the house as ‘real estate’ retains a moment of ‘ideal value’. What is ‘real’ about the value of real estate is that it contains a portion of an absolute, ideal value that is relatively indestructible, and thus ‘it grants a certain dignity which distinguishes it from all other types of possession’. This special value of real estate continues throughout history, because ‘whereas movable objects might be exchanged against one another, immobile property was – cum grano salis – something incomparable: it was value as such, the immovable ground above and beyond which real economic activity was carried on’ (Simmel 1990: 241). The ‘reality’ of real estate is that house and home stands in the place of what Lacan (1978) terms the Real: the abyss of nothingness and meaninglessness over which human existence is suspended. Herein lies the affinity between private home ownership and nihilism; the little piece of the Real that adheres to real estate. In our rational, though pathological– fetishistic attachment to our house as private property we express our existential anxiety at the meaningless thrownness of existence. In Weber’s (1978) formulation the oikos, the household, is that deep nexus of economy and society, the locus of wealth in its ur-form: ‘The size and inclusiveness of the house varies. But it is the most widespread economic group and involves continuous and intensive social action. It is the fundamental basis of loyalty and authority, which in turn is the basis of many other groups. … The principle of household communism, according to which everybody contributes what he can and takes what he needs (as far as the supply of goods suffices) constitutes even today the essential feature of our family household, but is limited in the main to household consumption’ (Weber 1978: 359). The oikos for Weber is an idealtype socio-economic institution, a primordial and transcendent form preserved and expressed by the etymology of economics as meaning ‘the care of the household’. Weber’s oikos corresponds in Simmel’s paradigm to an enduring social form, an institution with innumerable substantive anthropological and historical variations at the level of life’s contents while retaining all the while a coherence and cohesion of social form. Just as ‘the stranger’ is the social type in which ‘the tension between

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closeness and remoteness, involvement and detachment finds equilibrium’ (Simmel 1964b: 402) and just as ‘it is the function of the metropolis to provide an arena for the struggle between the individual and the super-individual contents of life and their reconciliation’ (Simmel 1964a: 423) the modern household can be formulated as the institution in which tensions in the libidinal–political economy, tensions between external objective culture and subjective internal culture are brought to terms with one another. In the genealogy of the spirit of capitalism, as the Calvinist throws himself into working in his vocation in order to avoid doubt of being amongst the elect while at the same time avoiding expenditure of accumulated wealth on pleasure, the household becomes the theatre in which this inner and outer conflict is played out. In Weber’s formulation, ‘the puritan outlook [that] stood at the cradle of modern economic man … set the clean and solid comfort of the middle-class home as an ideal’ (Weber 1958: 171). The provision and the maintenance of the household becomes for the husband and housewife an exterior manifestation of goodness, that, even though it cannot of itself assure one’s being amongst the elect, it represents nonetheless ‘the methodical development of one’s own state of grace to a higher and higher degree of certainty and perfection’ (Weber 1958: 133). Careful domestic economy restricts consumption and the irrational use of wealth, and, from the point of view of the inner world and the libidinal economy of the subject, ascetic domesticity opens up a world of work that is never finished, demanding ‘hard, continuous bodily or mental labour’ (Weber 1958: 158). Thus homemaking and housekeeping serves within the genealogy of the Protestant ethic and the spirit of capitalism as a worthy vocation and a means of avoiding doubt: ‘the home was the anvil on which adult manhood was forged’ (Vickery 2009: 52). In this formation the well-ordered household as an ideal and an end in itself within the symbolic order of the emerging spirit of capitalism that holds the place of the Real and saves the puritan ascetic proto-modern householder from the psychosis-inducing terror of not being amongst the elect. The modern household began as a part of the puritan’s vocation and like other dimensions of the Protestant ethic it gradually became secularized and massified in the broader objective culture of the iron cage of rationalized acquisitiveness, where compulsive economic activity ‘no longer related to the highest spiritual and cultural values … stripped of its religious and ethical meaning, tends to become associated with purely mundane passions … this nullity imagines that it has attained a level of civilization never before achieved’ (Weber 1958: 182). Herein lies the source of the deep ambivalence of the modern relationship of home ownership: its association with sedentary pleasure and the liberties of private life on the one hand, and, no less, with petty bourgeois conservatism, aggressive narcissistic defensiveness and a terrible entrapment in banal routine.1 1  As a consequence the house is the locus classicus of modern anxiety, from Edgar Allan Poe to the Amityville Horror. The undertone to the harmony of the modern bourgeois home has been the fugue and the affair: the man who dissociates from his household

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Love and Value: The Emotional Wealth of the Household The history of family life shows a progressive improvement of the status of women in respect to recognition of subjectivity and equality, and, especially the centrality of the emotions, specifically love, as the core of family life (Simmel 1964c: 128–30, 1964d: 326–9; Frisby 1998). A libidinal economy of reciprocal relations of erotic passion, care and affection, mutual loyalty and responsibility, love relations that are ‘more than life’ stands at the centre of the household. The idea of modern marriage and ‘marriage-like free love’ which is Simmel’s inclusive term for the multiplicity and variety of stabilized institutionalized contemporary postconventional intimate relations, ‘is the commonness of all life contents insofar as they determine the value and fate of the personality, immediately or through their effects’ (Simmel 1964d: 328). In a thriving union, Simmel says, individuals who ‘give themselves wholly to one another’ do not in fact ‘wholly’ give themselves away, ‘because their wealth consists in a continuous development in which every abandon is at once followed by new treasures … from an inexhaustible reservoir of latent psychological treasures and hence can no more reveal and give them away at a stroke than a tree can give away next year’s fruits with those of the season’ (1964d: 328). It is this inexhaustible wealth of a libidinal economy upon which the contemporary household is built. This is a constantly increasing emotional capital that in healthy modern intimate relations is perpetually replenished, constituting a miraculous libidinal–economic ‘surplus’ that sustains the integrity of the form the household and generates its added value. But of course this ideal modern form of marriage or marriage-like householdconstituting emotional commerce is by no means always realized, or neither is it easily sustained, and where it is it is very often at a high price of repression and resentment. The conditions of contemporary life, the complex web of political– economic and cultural relations within which modern intimate relations are negotiated, the always unstable equilibrium of individuals’ inner life played out against a constantly expanding outer horizon of alternative possibilities and the progressive loosening of the constraints of conventional morality threaten modern love, marriage and household, however configured, from both within and without, as Freud, Simmel (and indeed the Webers) knew very well, and it is in fact the presence of such a ‘third term’ that gives a dialectical dynamism to the household saving its members from the banality of intimacy.2 responsibilities into an alternate identity; the housewife who entertains a ‘gentleman caller’; a social form diversely represented by Dr Jekyll and Mr Hyde, the double entendres of Vermeer’s interiors, Ibsen’s A Doll’s House and the shenanigans of Wisteria Lane. 2  The standard account of Simmel’s private life is that ‘Simmel and his wife Gertrud, whom he had married in 1890, lived a comfortable and fairly sheltered bourgeois life. His wife was a philosopher in her own right who published, under the pseudonym MarieLuise Enckendorf, on such diverse topics as the philosophy of religion and of sexuality; she made his home a stage for cultivated gatherings where the sociability about which Simmel

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While the oikos diminishes in size and significance in terms of the material economy and becomes associated primarily with subjective culture, because of the richness of its libidinal economy the modern household assumes an increased value amid the flux and liquessence, indeterminacy and nihilism of the broader culture. Zelizer, developing a theme of Simmel’s, argues that children have become ‘economically worthless but emotionally priceless’ (1981: 1036). The same inversion takes place with respect to the household: the trace of ideal value that accrues to the household is its core nexus of priceless emotional relations, and in Simmel’s formulation this priceless nexus is increasing in value as it becomes more difficult to achieve and to maintain. The idealized value of the household increases in proportion as it recedes in reality from our grasp. In societies where the housing market boomed a high rate of divorce and household decomposition on the one hand is matched by remarriage and the recomposition of second and third new households on the other. Hence the enduring and amplified value of the idealized household as an end in an otherwise endless sequence of purposes, as a repository of value as such, and thus as mother lode, agalma:3 a source of primary collateral from which all other collateral is derived. It is the anthropologically deep-seated and, under conditions of modernity, progressively elaborated treasure trove, the elusive, idealized object of the household constituted through the reciprocal complex of libidinal and material economies as an irreducible core of value that has anchored the wider economic trade in financial derivatives.

wrote so perceptively found a perfect setting (Coser 1965: 195). Against this view, we also know that Simmel came from a household destabilized by his father’s death and difficult relations with his mother, and that Simmel’s own home life was unconventional. Simmel had a lover of many years, Gertrud Kantorowitcz. Gertrud Kantorowitcz and Simmel’s wife were close friends, and Gertrud Kantorowitcz was always amongst the select company of the Simmels’ salon. Both Gertruds were together by Simmel’s deathbed and he entrusted his last works to them. It was several years later that Gertrud Simmel discovered that Georg and Gertrud Kantorowitcz were much more than friends, and that they had a lovechild together. Gertrud Simmel turned furiously against her deceased husband and asked that Hans, their son, similarly radically reappraise his memory of his father’ (Weber 1988: xlii). Such was the complex libidinal economy both within and outside of the family home that gave a particular liveliness and richness to the Simmel household. 3  Agalma is an ancient Greek term for a gift to the gods, and thereby endowed with magical powers beyond its apparent face value. Over time, agalma has come to mean something beautiful, an object to be treasured. Lacan introduced the term in his Seminar VIII (1960–1961) writing on Symposium. The agalma is defined by love; it is the inestimable object of desire that ignites our desire: the agalma is the treasure which we seek in analysis, the unconscious truth we wish to know – which may of course be entirely lacking!

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Liquescence, Liminality and the Solidity of Household Value The value of real estate resonates with deep-seated needs of the household’s domestic economy of emotional and material asymmetrical reciprocal relations of interdependency. In times of insecurity and liminality the house assumes added and amplified value. The amplification of the value of the house as a bulwark against insecurity is ancient. For the Greeks to sell a family home or landed property was ‘an offence not only against the children, but also against the ancestors, because it disrupted the continuity of the family’ (Simmel 1990: 240). As Simmel notes, the Greek prohibition on the sale of real estate was instituted at the apex of Classical civilization, at the cusp of decline.4 The recent history of the real estate market reiterates this ancient lesson: while currency and stock market bubbles burst and crash, comparatively, until very recently, real estate prices, even when inflated, deflate gradually, fall back slightly and recover steadily. Owner-occupiers who dwell in their house as home, for whom their primary relation is their property’s ongoing and enduring use value rather than its exchange value, batten down the hatches and weather the economic storm. Within five years of the UK property crash of the early 1990s homeowners in south-east England who had experienced the highest levels of negative equity had fully recovered their lost value and within the following ten years saw their real estate increase in value by over 100 per cent (Boleat 1995). In the US while stock values crashed in the aftermath of the dot.com bubble, ENRON and other corporate scandals, the housing market saw extraordinary growth, in parts of the State of California by over 100 per cent within one year. The boom in housing prices, in the US, the UK and beyond can be understood primarily in terms of how modernity is increasingly characterized by liquescence (Bauman 2000) and permanent liminality (Szakolczai 2000) and neo-liberal globalization is an intensification and acceleration of these collective historical experiences. The heightened value of the house emerges against the insecurities of the risk society (Beck 1992), the destabilization of the fiscal and legal bases of national citizenship and the identity insecurities of the post-national constellation (Habermas 2001), the ephemerality of postmodern culture and accelerated social transformation (Baudrilliard 1988; Jameson 1991; Virilio 1995). Labour no longer 4  Similarly in Rome, where the architectural geometry of the Roman house was symptomatic of a fundamental insecurity as the Empire at its full expanse coincided with its decadence: Body, house, forum, city, empire: all are based on linear imagery. … This visual language expressed the need of an uneasy, unequal and unwieldy people seeking the reassurance of place; the forms sought to convey that a durable, essential Rome stood somehow outside the ruptures of history. And though Hadrian spoke this language masterfully, he may have known it was all a fiction. (Sennett 1996: 121)

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defines value according the theories of finance capitalism. Workers are no longer needed, only consumers. Surplus and redundant populations tend towards precarity and are discursively rearticulated in terms of their being ‘flawed consumers’ (Bauman 2005). The new poor, having no longer a role in production, attempt to become consumers, and so they focus on that commodity par excellence, the house, as primary asset, investment, and as theatre for the performance of the ethic of consumerism. The sub-prime mortgage borrower is an exemplary instance of Bauman’s flawed consumer, in whom we can see not only a defensive retreat to the interior but also the persistence of a deep need to articulate and to realize an idea of the good life. The care and attention given to interior décor, the work of continuous home improvement so characteristic of contemporary life, even amongst such flawed consumers, as a mask and as a compensation for their precarity, practices too readily disparaged as commodity fetishism can be more sympathetically understood as attempted elaborations of subjective culture and the search for meaningful life projects in the face of the hypertrophic growth of the objective culture of globalization. ‘Sub-prime’ Borrowers’ Desire for a Dream Home The sub-prime mortgage crisis arose because economic restructuring and flexibilization under conditions of globalization has amplified the desire for security amongst the economically least secure borrowers whose jobs are being outsourced and flexibilized and who suffer what Sennett (1998) has called the ‘corrosion of character’ under the economic conditions of global neo-liberalism. ‘Sub-prime’ precarious borrowers are Simmel’s subjects of modern culture whose life chances are unstable and incoherent, for whom self-realization through meaningful autonomous life projects are foreclosed. ‘The question as to what value really is, like the question as to what being really is, is unanswerable’ Simmel says, ‘value is never a quality of the objects, but a judgement upon them that remains inherent in the subject’ (Simmel 1990: 62–3). The value – werth [worth] – of an object, Simmel says, is determined by the dialectics of desire: The content of our desire becomes an object as soon as it is opposed to us, not only in the sense of being impervious to us, but also in terms of its distance as something not-yet-enjoyed, the subjective aspect of this condition being desire. … The object thus formed, which is characterized by its separation from the subject, who at the same time establishes it and seeks to overcome it by his desire, is for us a value. … Objects are not difficult to acquire because they are valuable, but we call those objects valuable that resist our desire to possess them. (Simmel 1990: 66–7)

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Desire and value are amplified by the desire that others have for the same objects. The presence of a third term, a competing desire that thwarts the dyadic economic relation, by creating opposition and distance raises the value of the object. This amplifying effect of a third term opens a spiral of competitive relations, constituting a libidinal economy underpinning the money economy. Simmel’s theory of the triangulation of desire in the libidinal economy that underpins political economy anticipates the explicit formulation of desire as mimetic by René Girard, and desire as desire for recognition to mask a constitutive lack in the subject by Jacques Lacan. In Girard’s formulation ‘the mediated nature of desire can be illustrated as a triangle, that is, as a relation between subject – model/mediator – object’ (1976: 15). In this relationship the object of desire, in this case the house, is not the goal. The subject actually desires to be the model (the other subject, a hypothesized, idealized subject) and only desires the object so as to imitate the model. As the subject and the model desire the same object competition and rivalry ensues, and when same the object is desired by many, its original value becomes inflated. This is exactly what happens in a ‘bubble’, such as land and property markets. Houses, and the particular sense of security that is bound up with home ownership, become more valuable as economic relations become globalized, flexibilized and insecure. Mimetic desire is not about the object but about the model that one desires to become, for what is lacking, and what is desired in the model is ‘being’. Projected into and beyond the ‘ideal home’ is a fantasy of the model homeowner, an idealtype subject: the secure, autonomous, proprietor of private property. The subject, lacking security of being, desires ‘to be’, to have the fullness of being that the model is imputed to have (though the model also lacks being, in fact being an elusive image deployed by the fashion, advertising and real estate industry, always evading the subject’s grasp and intensifying and accelerating the cycle of consumption). The more the model is an empty cipher, the more a model approaches a ‘size zero’ as it were, the more effective the model becomes at capturing the desire of the subject.5 As much as Marx’s proletarian producer, Lacan’s hysterical subject of consumer society is the pure and essential subject of capitalism. The desire of the subject of hegemonic neo-liberal political economics, the purportedly rational economic agent, is in fact entirely irrational and unconscious: desire for a fullness of being that is constitutively lacking in the subject, sublimated onto an object desired by a model idealized Other who is fantastically imagined to possess fullness of being, so that by attaining the object desired by the Other we partake of the model’s fullness of being, capturing the model’s recognition and the model’s desire only to find, in the heel of the hunt, that the model is also lacking in some way or other – flawed, incomplete, not quite what we had imagined it to be, so that the whole chase has to be taken up again to a higher level of intensity. Similarly, in Lacan’s idiom the elusive object sought in analysis 5  Ideal homes represented in magazines and property supplements are typically devoid of people for this reason.

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is agalma (lost treasure, buried in the unconscious) a kernel of truth that would fill the lack and make the subject whole again. Attaining wealth, attaining selfsufficient wholeness, fullness of being, is what all things are measured against, whether in political economy or libidinal economy; it is the very substance of social evaluation. One who has wealth is ‘worthy’ of recognition, of respect. The determination of wealth is thus the fundamental libidinal–political economic problem (Dumouchel 1988: 102). Simmel provides the sociological common ground for Girard and Lacan’s formulation of libidinal economy, in that as money is a coincidenta oppositorium that liquefies and substitutes for all values generating an endless sequence of purposes that money can serve, whereas, against flux and indeterminacy ‘real estate’ comes to resemble ultimate ‘ideal’ value. Real estate has historically been regarded as a form of wealth superior to any other as it serves as a place-holder for ‘being’; an objective measure of the truth of the subject, his substance and legacy, the bearer of the name of the subject as having substantial ‘worth’; a legacy that lives on and transcends the mortality of the merely affluent moneyed subject by ‘the Proprietor’. Property is ‘proper’ wealth. Economic Insecurity and Socially Unsecured Financial Derivatives The domestic economy is integrated with the wider ‘real’ economy and the dematerialized, financial derivatives markets of mortgage-backed securities through a libidinal and moral economy of the oikos, wherein there is a presumed contract between people with aspirations of becoming owners of a private home, with secured means of income, accumulated savings, and all of the sublimated libidinal energies and self-discipline, conscientious planning and mutual commitment to the personally shaped future vested in the family home and its dependents, an island of intimate sociality and solidarity within the broader sea of the so-called market society. It is not the house but the oikos (the household) and the homemaking project holistically combined as a meaningful and self-sufficient sustainable totality that together constitute the ‘asset-backed security’, the nexus of wealth wherein economy and society are ineluctably bound up with one another. The sub-prime mortgage market is a further refinement of the uncoupling of the relationship between the money economy of the market and the libidinal–moral– domestic economy of the oikos (Weber 1978: 375) and becomes increasingly based on relatively fictive households. Some 40 per cent of all US house purchases in 2006 were not ‘primary residences’ but speculative ‘investment properties’ and ‘holiday houses’. As well as this froth, which is a common historical feature of real estate booms, the problematic bubble was in the new territory of the subprime market which was opened up through the development of a plethora of new ‘sophisticated’ financial products: ‘adjustable rate mortgages’ (ARMs), with ‘teaser’ low entry rates that would later increase; 100 per cent mortgages with zero down payment; loans based on stated (rather than proven) resources, such as

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‘stated income, verified assets’ (SIVAs), ‘no income, verified assets’ (NIVAs) and eventually ‘no income, no job, no assets’ (NINJAs). Online mortgage companies, often branch enterprises of real estate and construction companies, developed ‘automated underwriting’ of loan applications for houses that they were selling or building, ensuring loan approval without any review of applicants’ assets, prospects, or ability to make repayments. Over 40 per cent of all sub-prime lending in the US was concentrated in the ‘dream states’ of Nevada, Florida and California, where immigrants pursue the American dream and Americans’ dream of retiring. At the height of the boom there were 45,000 mortgage sales agents working the California market (McDonald 2009). The rate of functional illiteracy in the State of California is over 30 per cent. A substantial proportion of sophisticated mortgage products were sold to clients who had difficulty reading the loan agreements. In this market not only is there an accelerated and intensified uncoupling of the economy from the oikos, but the oikos itself is increasingly fictive; it shrinks from the historical extended household to the nuclear, atomized and particulate household units of the contemporary postfamily striving to reconstitute itself; and it fades from the radiant ideal of the anthropological universal and transcendent form of the house and home to the mere simulacrum: the residual and vestigial image of the beautiful home flickering on the wall of the cave, which has a mesmerizing effect none the less for that as it now shines ever more brightly. Sub-prime lenders then ‘bundled’ mortgages, that is, in an idiom of the narcotics trade that found a new usage in financial markets, they ‘cut’ (combined sub-prime, insecure loans with traditional secure mortgages, as cocaine is cut with milk powder) into packages of ‘mortgage-backed securities’ (MBSs) containing several thousand mortgages, and sold MBSs on to larger banks, which bundled them again with other sub-prime mortgages and sold them to other financial institutions and investment banks as mortgage derivatives. Asset-backed securities (ABSs), MBSs and collateralized debt obligations (CDOs) which, based as they were on the traditionally secure value of real estate and the low default rate of households, enjoyed artificially high credit ratings, and risks were further displaced through credit default swaps (CDSs), insurance policies held by still other financial institutions extending throughout a globalized banking system. German and French banks bought American mortgage-backed derivatives, and on the purported secure profitability of these investments they lent for further investment to Greek, Spanish and Irish banks. Taken together this constituted a spiralling system of risk displacement and amplification, a housing pyramid scheme with foundations in acute insecurities at the level of subjective culture and the individual household.

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The Moral Grammar of Financial Sophistry6 The value of houses (real estate) has, from anthropological time immemorial, been a substantive – ‘real’ – value anchored in libidinal attachments, meaningful symbolic networks, morals and cultural ideals. The derivative value, abstracted away from the substantive, as it becomes distant from all contexts of meaningful morality, as the real economy becomes decoupled from the speculative financial economy, becomes a-moral; based on ‘nothing’. The collapse of the sub-prime mortgage derivatives market illustrates Plato’s indictment of the sophists as that fantastic class of the image-making craft who build on the nulla/nihil/ nothing so that the false assumes the appearance of the real (Hovarth 2009). Plato traces the various declensions and permutations of sophistry as the art of the trader as a money-making species. Simmel’s formulation of the stranger closely corresponds with Plato’s characterization of the sophist, as ‘throughout the history of economics the stranger everywhere appears as the trader, or the trader as stranger’. The stranger’s role in ‘intermediary trade, and often (as though sublimated from it) in pure finance, gives him the specific character of mobility’ (Simmel 1964a: 403). Plato’s sophist is a protean and slippery creature who assumes a variety of guises and appearances. He is ‘the paid hunter after wealth and youth, who baits his hooks with pleasure and flattery’ (Plato 1892: 223) [sophisticated sales techniques]; ‘the trader in the goods of the soul’ (1892: 224) [ideals of the beautiful household founded on a wealth of love]; ‘retailer and manufacturer of the same wares’ (1892: 224) [the developer/realtor/mortgage broker combined in the same company at the level of the housing market, and, at the level of banking and finance, the designer and trader in the dream-image of the household and sophisticated loans and financial investment products]; ‘the eristic disputator, combative and acquisitive’ (1892: 226) [the trader/broker/dealer on the trading floor fighting in the bonus culture of the finance industry]; the ‘purger, who separates and differentiates’ (1892: 231) [the market analyst who rates and apportions risk]. Plato systematically deconstructs the grammar of sophistry so that the quintessential hallmark of the species comes into view: The sophist, Plato says, is ‘a magician and imitator of true being … a mimic … a juggler [who] imitates creation by copying images, mixing being and nonbeing … haphazardly, thus proliferating falsity’ (1892: 235) by ‘the phantastic art of making appearances … appearances, since they appear only and are not really like’ (1892: 236). Making money, or more accurately, creating the appearance of money is the work of what Plato calls ‘the image making and phantastic art’ (1892: 261) … ‘the juggling part of productive activity’ (Szakolczai 2009). The semblance of true being created out of non-being is the ‘derivative’: the seeming value derived from the nullity of the ‘mortgage-backed security’ where 6  For the following discussion I am indebted to Agnese Horvarth who led a discussion on Plato’s Sophist, the nulla and metastasis at the Fourth Socrates Symposium, 7–9 November 2009, Firenze, Palazzo Guidi.

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there is in reality no oikos only a fictive household whose reality is undermined, flawed, non-existent. The sophisticated nullity then metastasizes. Metastasis is the quality of being able to change and to travel and to change the constitution of to where it travels. Cancer, for example, begins as a primary tumour, becomes mobile and invasive and metastasizes to distant locations in the body, destroying those organs too. Similarly, sophistic forms of contemporary economics not only separate and travel away from the oikos, but return and invade it so that the household begins to function as though it were a corporation. In the mortgage market of the ‘noughties’, households that had some substance, that had endured and prospered, were inveigled to ‘release some of the value locked up in the home’ by remortgaging to fund current expenditure. Thereby householders became the pillagers of their own commonwealth, undermining the security of their own foundations and tearing otherwise sustainable households asunder. In the wider economy as the MBS is bundled the nullity multiplies exponentially, proliferates, inflates; a bubble, containing nothing. The ‘bundled’ compound nothingness is masked by credit ratings agencies (CRAs), who are paid by the banks to rate their investment products, ‘bundles’ of securities in which secure investments are ‘cut’ with worthless ‘junk’ mortgages. Whether they are blinded by past historical performances of ‘real’ households’ historical record as reliable investments, or whether the ratings agencies were aware of the nullity and cynically engaged in masking, giving ‘triple A’ ratings to investments that bear only the vestigial after-image of household security that they knew were in truth worth ‘nothing’ (nihils, NINJAs) the effect is the same: the creation of the seeming ‘something’ – money – out of nothing, by the ‘unreal class of the image-making craft’ (Horvath 2009). As the nullity inflates it unleashes a spiral of mimetic desire: because others are seen to be making money everyone wants to ‘get into the game’: the ‘property game’ at the subjective cultural level of ‘househunting’; the ‘development game’ for land speculation and construction companies; the ‘hot mortgage market’ for the local and regional lending agencies; the ‘securities game’ at the objective cultural level of the economy, and so on. The localized consumer housing market all the way up to the global banking and financial system becomes a vast, spiralling mimetic game, ‘casino capitalism’ (Strange 1986) expanding and feeding on nothing. Money is ‘made’ in the sense of the mimetic spiral of desire for images in which real and unreal elements are mixed is set in motion, as set out above, when investors compete to buy into derivatives so that their ‘investment value’ escalates far beyond their current market value and is based instead on investors’ expectations of the price that other future investors may be prepared to pay for them. Beginning in 2006 sub-prime mortgage defaults began to rise steeply and for the first time in the history of economics lending agencies saw borrowers default on their very first mortgage repayment. The fictive households wherein coherent and enduring meaningful life projects were supposed to be being built were being at the same time undermined by broader social and cultural currents:

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would-be homemakers cannot constitute an oikos as they are beset by conditions of general liquescence in the wider objective culture that mitigate against the very possibility of the oikos: flexibilized short-term employment, precarious economic relations that have their correlate in the intimate sphere in the form of a corrosion of character (Sennett 1998) and temporary short-term-commitment social relationships wherein libidinal energies become de-sublimated and discharge themselves formlessly through the instant gratification of individual consumption and in the insecure, unstable and vulnerable configurations of postmodern family life. As these fictive households fail to materialize, dissolve and otherwise cannot meet their mortgage obligations, the rate of default and repossession increases sharply and the value of derivative investments leveraged on mortgage-backed securities collapses along with the fictive households themselves. Conclusion The fateful question of the human species seems to me to be whether and to what extent the cultural process developed in it will succeed in mastering the derangements of communal life caused by the human instinct of aggression and self-destruction. In this connection, perhaps the phase through which we are at this moment passing deserves special interest. … It may be expected that the other of the two heavenly forces, eternal Eros, will put forth his strength so as to maintain himself alongside of his equally immortal adversary. (Freud 1961: 40)

The phase to which Freud is referring, through which we were passing when Civilization and its Discontents was written and published7 was the immediate context of the Wall Street Crash, the Great Depression and the rise of Dictatorships; a phase that bears worrying resemblance to the present, when, as the crisis unfolds, democratic sovereignty is ceded to direct and indirect financial technocratic administration by the International Monetary Fund and the European Central Bank in Greece, Italy, Ireland, and more to follow, while citizens become bonded serfs paying tribute to the post-national global powers of J.P. Morgan and Goldman Sachs. In effect we are living through the rise of a dictatorship of banks in a market-totalitarian new world order. Against this depressing vista of generalized and diffuse social pathologies in contemporary civilization we might, as Freud did, invest some hope in a resurgence of the other heavenly power, eternal Eros. The power of modern love, Simmel says, is a specifically contemporary social form of intimate relationship; a relationship of progressively egalitarian reciprocity wherein individuals ‘give unreservedly to one another all of their being and having … [gifts of] hopes, idealizations, hidden beauties, attractions of which not even [the partners to the love relation] are conscious’ (Simmel 1964d: 329). These gifts are drawn from 7  Written during 1929, published in 1930.

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what Simmel calls ‘the inexhaustibility of their inner life and growth … the fertile depth of relations [that] suspects and honours something even more ultimate behind every ultimateness revealed’ (1964d: 329). This is an incremental and mutually enriching economy of gifting in which ‘there lies a beauty, a spontaneous devotion to the other, an opening up and flowering from the “virgin soil” of the soul’ (1964e: 393) that ‘overflows to the other being exclusively and entirely in colour, form and temperament’ (1964d: 329). Furthermore, the dyadic relationship is enriched by the introduction of a ‘third term’ which saves the parties to the dyad from losing their individuality and descending into a trivial identity, and draws them, individually and collectively, into a broader society in ways that simultaneously decompose ossifying social forms and reinvigorate creativity and subjective culture. Modern intimate relations are, for Simmel, an ideal form of sociation wherein a miraculous surplus value, ‘something super-personal that is valuable and sacred in itself’ (1964d: 129) is generated. Even in hyper-individualized conditions of contemporary life, and moreover accentuated by the very experience of individuation, a higher, third element, springs from modern love. This higher, third element is society intruding into the household and the household, reinvigorated, reciprocally extruding into society. The reciprocal dynamic between private household and social life is the delicate flower that, however vulnerable and endangered it is by the crushing weight of objective culture and the annihilating power of the market, continues to thrive on the wasteland of late capitalism’s money economy. References Baudrillard, J. 1988. The Ecstasy of Communication. New York: Semiotext(e). Bauman, Z. 2000. Liquid Modernity. Cambridge: Polity Press. Bauman, Z. 2005. Work, Consumerism and the New Poor. Cambridge: Polity Press. Beck, U. 1992. Risk Society: Towards a New Modernity. London: Sage. Boleat, M. 1995. The 1985–1993 Housing Market in the UK: An Overview. Housing Policy Debate 5(3), 253–74. Coser, L. 1965. Georg Simmel. New York: Prentice-Hall. Dumouchel, P. 1988. Violence and Truth: On the Work of René Girard. London: Athlone Press. Freud, S. 1961. Civilization and its Discontents. New York: Norton. Frisby, D. 1998. Introduction to Georg Simmel’s ‘On the Sociology of the Family’. Theory Culture & Society 15(3–4), 277–81. Girard, R. 1976. Desire, Deceit and the Novel: Self and Other in Literary Structure. Baltimore: Johns Hopkins University Press. Habermas, J. 2001. The Postnational Constellation. Cambridge: Polity Press. Horvarth, A. 2009. Ekstasis, or the Estranged Sophist in Plato. Paper to Fourth Socrates Symposium, Firenze, Palazzo Guidi, 7–9 November 2009.

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Jameson, F. 1991. The Cultural Logic of Late Capitalism, in Postmodernism, Or, the Cultural Logic of Late capitalism. Durham, NC: Duke University Press, 1–55. Kant, I. 2002 Groundwork for the Metaphysics of Morals. Translated by A. Zweig. Oxford: Oxford University Press. Knorr Cetina, K.D. and Preda, A.
2007. The Temporalization of Financial Markets: From Network Markets to Flow Markets. Theory, Culture and Society 24(7–8), 123–45. Lacan, J. 1978. The Four Fundamental Concepts of Psychoanalysis. New York: Norton. MacKenzine, D. 2008. Material Markets: How Economic Agents are Constructed. Oxford: Oxford University Press. McDonald, L.G. 2009. A Colossal Failure of Common Sense: The Inside Story of the Collapse of Lehman Brothers. New York: Ebury Publishing. Plato. 1892. The Dialogues of Plato translated into English with Analyses and Introductions by B. Jowett, M.A. in Five Volumes. 3rd edition revised and corrected. Oxford: Oxford University Press. Perrot, M. 1990. At Home, in A History of Private Life: From the Fires of Revolution to the Great War, edited by P. Aries and G. Duby, translated by A. Goldhammer. Cambridge, MA: Harvard University Press, 341–58. Sennett, R. 1996. Flesh and Stone: The Body and the City in Western Civilization. New York: Norton. Sennett, R. 1998. The Corrosion of Character: The Personal Consequences of Work in the New Capitalism. New York: Norton. Simmel, G. 1964a. The Metropolis and Mental Life, in The Sociology of Georg Simmel, edited by K.H. Wolff. New York: Free Press, 409–24. Simmel, G. 1964b. The Stranger, in The Sociology of Georg Simmel, edited by K.H. Wolff. New York: Free Press, 402–8. Simmel, G. 1964c. The Isolated Individual and the Dyad: Monogamous Marriage, in The Sociology of Georg Simmel, edited by K.H. Wolff. New York: Free Press, 118–44. Simmel, G. 1964d. Types of Social Relationships by Degrees of Reciprocal Knowledge of their Participants: Marriage, in The Sociology of Georg Simmel, edited by K.H. Wolff. New York: Free Press, 317–29. Simmel, G. 1964e. Faithfulness and Gratitude, in The Sociology of Georg Simmel, edited by K.H. Wolff. New York: Free Press, 379–401. Simmel, G. 1990. The Philosophy of Money, edited by D. Frisby. London: Routledge. Simmel, G. 1997a. The Sociology of Space, in Simmel on Culture: Selected Writings, edited by D. Frisby and M. Featherstone. London: Sage, 137–70. Simmel, G. 1997b. The Conflict of Modern Culture, in Simmel on Culture: Selected Writings, edited by D. Frisby and M. Featherstone. London: Sage, 75–90. Strange, S. 1986. Casino Capitalism. Oxford: Basil Blackwell. Szakolczai, A. 2000. Reflexive Historical Sociology. London: Routledge.

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Szakolczai, A. 2009. Sophists: Ancient and Modern. Paper to the Fourth Socrates Symposium, Firenze, Palazzo Guidi, 7–9 November 2009. Vickery, A. 2009. Behind Closed Doors: At Home in Georgian England. New Haven: Yale University Press. Virilio, P. 1995. The Art of the Motor. Minneapolis: University of Minnesota Press. Weber, M. 1958. The Protestant Ethic and the Spirit of Capitalism. New York: Charles Scribner’s Sons. Weber, M. 1978. Household, Enterprise and Oikos, in M. Weber, Economy and Society Vol. 1. Berkeley: University of California Press, 370–84. Weber, M. 1988. Max Weber: A Biography. New Jersey: Transaction Publishers. Zelizer, V. 1981. The Price and Value of Children: The Case of Children’s Insurance. American Journal of Sociology 86(5), 1036–56.

Chapter 5

Depression: Resisting Ultra-liberalism? Bert van den Bergh

Appreciate what rhythm holds men Archilochos

Which Individual? ‘Individualism’ is a term generally used with a certain casualness when it comes to typifying Western culture and its components. Focus on the individual is often contrasted with group orientation, individualist cultures are compared with collectivist ones. Although much can be said against those types of coarse indications, in business circles they are rather popular because they create the illusion of getting to grips with cultural differences and thus coming into a position to remedy problems and misunderstandings these differences entail. Anyone conducting business wants to be able to act and interact without being hampered by culturally determined misinterpretations and allergies. But how to lay one’s finger on them? The Dutch social scientist Geert Hofstede has answered this pressing practical question in such a way that his name has grown into a wellknown institution which is consulted by people all over the world eager to manage cultural differences. One of the five ‘dimensions’ Hofstede uses to distinguish cultures is that of individualism/collectivism: Individualism on the one side versus its opposite, collectivism, is the degree to which individuals are integrated into groups. On the individualist side we find societies in which the ties between individuals are loose: everyone is expected to look after her/himself and her/his immediate family. On the collectivist side, we find societies in which people from birth onwards are integrated into strong, cohesive in-groups, often extended families (with uncles, aunts and grandparents) which continue protecting them in exchange for unquestioning loyalty.1

These categorizations are questionable not only because of their extremely abstract character – though they are designed for specific everyday situations – but also because the key concepts that are at the bottom of them are taken for granted, for 1  http://www.geerthofstede.nl/dimensions-of-national-cultures [accessed: 30 March 2012]. Cf. Hofstede 1980, 2001.

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instance, regarding the dimension just mentioned: the concept of ‘the individual’. What kind of being precisely is aimed at here? Does it relate to a sort of archetype that is realized more completely as the members of the culture at issue manifest themselves as more individualist? Does ‘individualist’ within one cultural context mean the same as within another? Does the phenomenon ‘individual’ not have a history? Did ‘individualism’ 50 or 100 years ago signify the same as it does today? Charles Taylor’s Sources of the Self (1989) was a successful attempt to transcend such abstractions and give the concept of ‘individualism’ depth by unlocking its historicity. In this celebrated study the genesis of the modern Western individual is revealed in a finely tuned and highly detailed way. Subsequently, Taylor centred his thoughts on the seamy side of the outcome, in The Malaise of Modernity, a little book that is also known under the title of The Ethics of Authenticity (2003).2 It contains a stand against, among other things, the cultural relativism argument of Alan Bloom and the narcissism criticism of Christopher Lasch. Given this angle, the title could also have been The Alleged Malaise of Modernity, since Taylor chiefly draws attention to the acquired spiritual power of modern Western existence. Its history is that of the gradual development of the ideal of ‘authenticity’. ‘In articulating this ideal over the last two centuries’, Taylor writes, ‘Western culture has identified one of the important potentialities of human life’ (Taylor 2003: 74). Nowadays narcissism can be amply found – Taylor does not deny that – but according to him this derailment does not make up the core of our contemporary culture. This core – individualism, self-fulfilment, authenticity – is something we should bring to mind, reconsider, recollect, by taking a deep dive into the ‘sources of the self’, in order to (re)activate their moral power, partly as a weapon against narcissist aberrations that repudiate these sources, although in the end they draw on them as well. ‘What we need to understand here’, states Taylor, ‘is the moral force behind notions like self-fulfilment’ (Taylor 2003: 16). Late Modern Malaise Notable is that neither here, nor in Sources of the Self and The Secular Age (2007), Taylor is tempted to dwell on the phenomenon we know today as the ‘depression epidemic’. The ‘malaises of modernity’ – in the plural, and the title of the eighth chapter of The Secular Age – are brought up by Taylor only in the abstract. Sources of the Self is concluded with ‘The conflicts of modernity’ (Taylor 1989: 495ff) a chapter in which Taylor once again recapitulates the main tensions of 2  The Malaise of Modernity was the title of the radio lectures Taylor gave in 1991 for CBC. See http://www.cbc.ca/ideas/massey-archives/1991/11/11/massey-lectures-1991the-malaise-of-modernity/ [accessed: 20 March 2012]. The extended text of these lectures was first published under the very same title, later as The Ethics of Authenticity. This title change reveals the final focus of the text: not the malaise but the achievements of modern Western culture.

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modernity, tensions between the principal ‘sources of the self’: Christian theism, Enlightenment and Romanticism. Precisely the charged balance in this ‘struggle’ Taylor deems to be typical of our culture, and according to him this balance is not profoundly disturbed. In The Malaise of Modernity then, the attention is completely focused on the stand against Bloom, Lasch and company and their over-simplified cultural pessimism, thus in defence of cherished key achievements of modernity, namely the primary ideals of individualism, self-fulfilment and authenticity. Being on the defensive, Taylor presents only abstract indications of certain ‘dangers’ that are related to these ideals, for instance when he writes: ‘They tend to centre fulfillment on the individual, making his or her affiliations purely instrumental’ and ‘they tend to see fulfillment as just of the self, neglecting or delegitimating the demands that come from beyond our own desires or aspirations, be they from history, tradition, society, nature, or God’ (Taylor 2003: 58). In The Secular Age, finally, it is the orientation on the process of secularization that seems to keep Taylor from a concretization of the discontents in contemporary civilization. The modern malaises pass by as part of a ‘summary over-view’ of the controversy around ‘belief and unbelief’ (Taylor 2007: 299). In the chapter concerned Taylor for a brief moment considers melancholy as a ‘predecessor condition’ of the contemporary feeling of ‘a threatened loss of meaning’. This malaise, he continues, is that of the modern ‘buffered identity’, which, in contrast to the pre-modern ‘porous self’, is exposed to the danger of becoming insensitive to everything that is not part of its own circle and project. In that secluded condition of the self ‘nothing significant will stand out for it’ (Taylor 2007: 303).3 So, the crisis that is at stake here is a ‘malaise of immanence’, which Taylor chops into three pieces: fragility of meaning; unsuccessful attempts to solemnize crucial moments in our lives; and a flatness and emptiness of daily life. In the explanation of these sorrows he does not give more concrete indications than the following: ‘a kind of “nausée” before this meaningless world’; ‘some people sense a terrible flatness in the everyday, and this experience has been identified particularly with commercial, industrial, or consumer society’ (Taylor 2007: 308f). This way the present-day malaise remains nebulous, in spite of Taylor’s admirably wide-ranging and sharply focused outlook. Is there in the end really a problem, one might wonder after reading Taylor’s texts. According to the authors that are at the centre of this chapter the German sociologist Hartmut Rosa and the French philosopher Dany-Robert Dufour, plus in the background, Alain Ehrenberg4 – there most certainly is a problem, and it is at the heart of our current, late modern culture. What I intend to show in the following sections is how these 3  Cf. Taylor 2007: 37f, where melancholy also briefly appears on stage, but here again, in my view, with the wrong kind of lighting. 4  Since Alain Ehrenberg presents his view on social pathology in this very volume, I will refrain from paraphrasing his key thoughts on this subject. But as his works are a major source in my research project on melancholy and depression, he will pop up a couple of times in this chapter when it comes to the positioning of the views of Rosa and Dufour.

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authors, in sharp contrast to Taylor, radically problematize self-fulfilment, more or less following on Lasch, but without his conservatism, and in analyses that reach much further. The threat to the late modern individual is not the ‘buffered’ nature of his identity, but on the contrary his susceptibility, or, in Taylorian terms, precisely his ‘porosity’. Ehrenberg speaks of ‘the uncertain individual’, whose identity according to Rosa has become ‘situative’, which leads to a condition that Dufour calls ‘psychotisizing’. The thematization of the gradual growth of the modern ‘self’, as in Taylor, thus gives way to that of the rising corrosion of its late modern shape. In the work of the said authors a sharp distinction is made between classic modernity and late modernity. Today we live in post-neurotic times, in which no longer prohibition but incitement rules (Ehrenberg); it is an era of extreme social acceleration and mobilization, rendering the individual radically context-oriented (Rosa); this threatens to turn him into a plaything, from which he tends to protect himself by withdrawing into a depression (Dufour). Individualism, in sum, is not what it used to be, so runs the main thought of these three authors. They all spot a new type of subjectivity, of which they analyse the characteristics and consider the implications. This way the late modern subject is put on stage as a precarious and problematic creature, with the phenomenon of depression at the centre of the portrayal. However, what in these interpretations stays underexposed is depression as experience, by which also the possibility of depression as a form of defence or resistance remains hidden in the dark. Though Dufour touches upon this possibility when he writes that the rise of the phenomenon of depression might be ‘an obvious sign of resistance of the subject to the economy of the generalised market’ (Dufour 2007a: 325f)5 he leaves the option undiscussed. Rosa bestows upon the depressed person the status of ‘most sensitive seismograph of current and coming transformations’ (Rosa 2005: 390) without coming to an understanding of this sensibility. And Ehrenberg’s analyses, finally, are in the end always focused on ‘a certain tonality of our collective psychology’ (Ehrenberg 2010: 20) and not on the response of the concrete individual to it. Furthermore, it concerns a ‘tonality of loss’ (Ehrenberg 2010: 309) and so depression appears wholly as a token of deficiency, as ‘fatigue of being oneself’, ‘pathology of acting’, as ‘lack of project, lack of motivation, lack of communication’, in brief, as ‘lack of initiative’ (Ehrenberg 1998: 157, 251, 182). What is hidden behind this deficiency? What causes someone to fail? In what way is this incapacity to act still a way of acting? Is there any defence or resistance in it, or perhaps even something like a turn? In order to elucidate depression ‘from the inside’ the final part of this chapter will be devoted to two phenomenological interpretations of depression: that of the Swiss psychotherapist Alice Holzhey-Kunz and that of the Belgian psychiatrist Jacques Schotte. In the ‘Daseinsanalytical’ approach of the former as well as in the ‘pathoanalytical’ perspective of the latter, depression occupies a central place. Holzhey-Kunz speaks of a Sonderstatus, a special position (Längle 5  Cf. Dufour (2007b: 107); (Dufour 2011: 125, 279).

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and Holzhey-Kunz 2008: 304). Schotte calls the disorder ‘the most ubiquitously important one of the whole of psychiatry’ (Schotte 1989: 79). Anthropological Mutation First a brief further positioning of the work of the three authors named above, whose studies as already stated thematize the late modern transformation of subjectivity in different but related ways. In the 1990s Alain Ehrenberg published a trilogy in which the contours of the late modern subject are marked. The three volumes have telling titles: Le Culte de la Performance – The Cult of Performance (1991); L’Individu Incertain – The Uncertain Individual (1995); and La Fatigue d’Être Soi, Dépression et Société – The Fatigue of Being Oneself. Depression and Society (1998).6 Recently a follow-up study has been published, La Société du Malaise – The Malaise Society (2010) in which Ehrenberg contrasts the French malaise with the American one and makes an attempt to indicate the new course that should be taken in order to throw off the straitjacket of an ‘individualistic sociology’: growing individualism does not mean loss but change of social ties. To be able to respond adequately to this change we first need to understand it adequately, says Ehrenberg. This, however, also involves reflection on a dimension that is missing in Ehrenberg’s work: that of time. Hartmut Rosa’s solid study Beschleunigung – Acceleration (2005) can therefore be considered a complement to the work of Ehrenberg. Next to the ‘fatigue of being oneself’ we could then place Rosa’s interpretation of depression as ‘pathology of time’. Incidentally, at the moment of completing this chapter a new work by Rosa was published: Weltbeziehungen im Zeitalter der Beschleunigung – World Relations in the Age of Acceleration. In this new book Rosa raises the questions in what way the world experience and the world cultivation of late modern man have changed, and what are the consequences of these changes for a critical sociology which is oriented towards the determination of social conditions for a ‘successful individual and collective world appropriation’ (Rosa 2012: 2). The philosophical sources, finally, of the genesis of the late modern subject are explored extensively in the work of Dany-Robert Dufour. He has also written a trilogy, devoted to what he has termed ‘the liberal cultural revolution’. The titles of the three parts of this trilogy are revealing too: L’Art de Réduire les Têtes. Sur la Nouvelle Servitude de l’Homme Libéré à l’Ère du Capitalisme Total – The Art of Shrinking Heads. On the New 6  Recently the book was translated into English: The Weariness of the Self. Diagnosing the History of Depression in the Contemporary Age (Ehrenberg 2009). During a lecture in Denmark Ehrenberg explained that in the English translation of the French title something essential is lost, namely the emphasis on the self as an active state, a process or a task: the ‘becoming oneself’. A more suitable translation then would be ‘The Weariness of Selfrealization’ or ‘The Fatigue of Being Oneself’. See http://vimeo.com/16530794 [accessed: 12 March 2012].

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Servitude of the Liberated in the Age of Total Capitalism (2008); Le Divin Marché. La Révolution Culturelle Libérale – The Divine Market. The Liberal Cultural Revolution (2007); and La Cité Perverse. Libéralisme et Pornographie – The Perverse City. Liberalism and Pornography (2009). Dufour has published a follow-up study, L’Individu Qui Vient … Après le Libéralisme – The Individual That Arrives … After Liberalism (2011), in which he deepens his former analyses and presents an initial answer to the question Que faire? – What needs to be done? The title of the book already indicates that in the end Dufour is not a pessimist: a new start is possible, the true individual can still arrive. And thereby we are back at the start of this chapter what does ‘individualism’ involve today? Do we indeed live in the era of individualism? And has this individualism become intensified in the course of time? Neither of these two, writes Dufour on the first page of L’Individu Qui Vient: ‘That our epoch is that of egoism, is certain; but that of individualism, not at all. For a good and simple reason: the individual has never existed yet’ (Dufour 2011: 11). What modernity had in mind is not realized at all. What has become a reality is a sham individual,7 without true autonomy and without real commitment to the other; a being that is reduced to its passions by the global market. The individualism that is coming on the other hand, or could be coming – and the book concludes in an Annexe with 30 ‘emergency measures’ to stimulate this entry – is called a ‘sympathetic’ individualism, because it is open to the other and does not have the chilliness of the now dominant self-seeking or ‘isolist’ subjectivity. The background of this latter term, ‘isolist’, coming from the infamous Marquis de Sade, will be discussed presently, but in advance of that here is Dufour’s one-word typification of our late modern culture: ‘Sadean’. Sadean isolisme, which is an extremist pairing of egoism and hedonism, destines our present-day world. This ‘destiny’ obviously needs explanation. Before we turn to Dufour’s thoughts on that, I would like to return for a moment to Taylor and conclude that what in Dufour’s view is ‘coming’ – the ‘sympathetic individualism’ – is taken by Taylor as a reality. Here we have the common ground and the point of difference of the two philosophers. Dufour also deems dialogue and recognition essential for true self-fulfilment and genuine individualism. He, however, considers the denial of the latter – ‘narcissism’, ‘egoism’, ‘isolism’ – not to be an aberration but the main stream of contemporary culture. In the eyes of Taylor of course this means he is a cultural pessimist. Dufour probably would say that he is not a pessimist but an optimistic realist: on the basis of a keen eye for what is we can facilitate what might come. And seen from this angle Taylor could be called an optimistic idealist, whose optimism springs from a view that in the end is too broad, too abstract, too unrealistic.

7  On the second page of the Introduction of L’individu Qui Vient Dufour defines the true individual: a being that detached himself from the herd, thinks and acts free from his passions, can govern himself, has an interest in the other and is aware of his relative place in the universe (Dufour 2011: 12).

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In France Dufour’s analyses have already earned him the label ‘neoreactionary’, a label which he resolutely rejects. There is no nostalgia at stake whatsoever, he writes. The only possible choice nowadays seems to be between the old verticality and the new horizontality; one is classified either ‘alongside the worshippers of the strict Father or among the permissive liberals’ (Dufour 2011: 45). Dufour advocates a third way and makes a distinction – referring to Freud and Marcuse (Dufour 2011: 31, 148) – between necessary and unnecessary repression: the latter concerns the subjection of the other and needs to be contested, the former relates to the disciplining of the passions and is connected to a long tradition that we need to guard and recall.8 So no neo-reactionary or neo-conservative discourse, but a way of thinking that he terms neo-resistant and conservatoire, neo-resistant and conserving. For the only regime that is truly revolutionary, as the young Marx already expressed, is the capitalist system. The thing is to resist this perpetual turnover and take ‘conserving measures’ (Dufour 2011: 303ff).9 In this way the tradition that was demolished by ultra-liberalism can be recovered and regained. It was the capital mistake of ‘postmodern’ philosophers like Gilles Deleuze,10 says Dufour, to let themselves be seduced by the revolutionary machinations of capitalism and join enthusiastically, because blinded, in the demolition process, and more than that, aim at radicalizing it: ‘Deleuze, who thought he could pass the Market on the left, actually was taken over by the Market on the right. In sum, by believing he was challenging the Market, he was serving its cause’ (Dufour 2011: 236).11 The Sadean world is a Deleuzian one, but Deleuzian in a sense that probably would have baffled Deleuze himself. Total capitalism is much more total, that is absorbing and versatile, than Deleuze suspected (Dufour 2008: 93). An ‘anthropological mutation’ has taken place, Dufour states. (Dufour 2007b: 104, 2008: 5, 13) The late modern subject has revealed itself as a self-referential being, exhorted to create himself, without a real basis to take the plunge.

8  Cf. Holzhey-Kunz on the Urverdrängung (primal repression) in the section Twilight

state.

9  As ‘emergency measures’ Dufour mentions for example: halting the businesslike changes of schools, hospitals, cultural institutions etc.; rebalancing the contributions of ‘virtual’ economy, based on speculation, and ‘real’ economy; limiting the power of the cultural industries in the exploitation of individual passions (Dufour 2011: 361, 367, 369). 10  Foucault and Derrida are criticized by Dufour as well. The former is alleged to have neglected the transitions between épistèmès (Dufour 2011: 47, 81, 93, 112), the latter to have paid too little attention to the constructive part of the ‘deconstruction’ (Dufour 2011: 130). The point is, states Dufour, to get to the bottom of the transitional situation in which we are placed right now, in order to apply ourselves on the basis of this understanding to building a ‘sympathetic individualism’. Reconstructing the tradition, not out of a nostalgic craving for restoration, but for the sake of what has not yet existed. 11  Cf. Dufour 2011: 119, 128, 232, 311. See also Dufour 2008: 11, 65, 81, 147.

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This pliability, cloaked as self-fulfilment, makes us go adrift. The former modern subject, who had a critical and neurotic nature – two characteristics that complemented each other perfectly according to Dufour (Dufour 2008: 42) – transformed into a creature that smoothly fits in with the flows and pulses of the global market. Dufour speaks of ‘a precarious, acritical, psychotisizing subject’ and specifies the latter term as follows: ‘by “psychotisizing” I mean a subject that is open to all identity fluctuations and thereby is susceptible to all commercial bifurcations’ (Dufour 2008: 12, 93).12 This late modern subject imagines himself to be free, because he experiences himself as self-referential, self-determining, self-realizing. But the only thing in fact that is really free, says Dufour, is the ‘divine market’,13 in the sense that its worshipped dynamics in the end are decisive, also for the constitution of the subject. The global market of ‘total capitalism’ destroys institutions and reshapes procedures ‘in such a way as to produce individuals who are supple, insecure, mobile and open to all the market’s modes and variations’ (Dufour 2008: 157).14 ‘Neo-liberalism’ and ‘consumerism’ as terms to describe this late modern context are inadequate because they tell only a part of the story. It is ‘producerism’ as well, in the sense that the modern professional is supposed to be a flexi-worker, a position which matches with the pliability of the trend-watching consumer. And secondly, the ‘neo’ is not new but an intensification of something that goes way back to Adam Smith, and even further, to Blaise Pascal. The Liberal Cultural Revolution Liberalism, states Dufour, means primarily a liberation of the passions (Dufour 2009: 113). And this liberation has puritan roots. It was Pascal who halfway through the seventeenth century started to tamper with the classical Augustinian hierarchy of Amor Dei and Amor Sui, divine love and self-love. In a letter written in 1651 Pascal admits the following on self-love: ‘It was natural to Adam, and just in 12  Here I do not follow the translation by David Macey. 13  Title of one of Dufour’s studies: Dufour 2007. 14  The power/desire opposition constructed by the left was a mistake, says Dufour,

it created blindness for the Sadean side of capitalism (Dufour 2009: 271). The English sociologist Nikolas Rose makes a similar remark when he states: ‘power and freedom are not antitheses’ (Rose 1998: 98).

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its innocence; but it became criminal as well as intemperate due to his sin’ (Dufour 2009: 56). This small concession started a development of gradual revaluation of self-love, making the puritan more and more ‘perverse’, that is inverting the original hierarchy. Via the Jansenist Pierre Nicole and the Calvinist Pierre Bayle, Dufour arrives at the Calvinist physician and economist Bernard de Mandeville and his famous Fable of the Bees of 1714, the text in which private vices are declared to bring public benefits. Liberation of the passions produces affluence, their restriction brings on misery. Half a century later economist and theologian Adam Smith followed in Mandeville’s footsteps, made his ideas acceptable,15 and via his Wealth of Nations founded liberalism and its religion of the free market guided by a divine ‘invisible hand’. Private vices, that is private interests, should have a free hand, because they lead to public happiness. Amor Sui is the main road to glory.16 After Smith another liberalizing step had to be taken, Dufour continues, and this was done in a very radical way by the libertine writer Marquis de Sade, also at the end of the eighteenth century. Sade made the perversion, that is to say the reversal, complete by staging, in literary space, the experiment of radicalizing certain basic elements of liberalism, which led to his notion of ‘isolism’, an utmost extreme combination of egoism and hedonism. Showing immediately what the key thought of the book is, Dufour starts The Perverse City with the following revealing parallel quotation (Dufour 2009: 9): Give me that which I want, and you shall have this which you want. Give me that part of your body which is capable of giving me a moment’s satisfaction, and, if you desire, amuse yourself with whatever part of mine that may be agreeable to you.

The first line is by Adam Smith, the second is De Sade’s.17 ‘Liberalism means Smith together with Sade,’ Dufour states provocatively. Today the infamous

15  Initially Mandeville was considered to be a heretic and was therefore nicknamed Man Devil. The neutral, scientific adaptation of his thought by Smith made it acceptable and respectable (Dufour 2009: 112; 2011: 77). 16  Adam Smith versus Immanuel Kant, deregulation versus regulation: the key struggle within our culture between the English and the German Enlightenment for the time being is decided in favour of the first (Dufour 2011: 52ff, cf. 213, 233, 324, 332; see also Dufour 2009: 169ff). 17  From The Wealth of Nations, resp Juliette. At the end of L’Individu qui Vient, with the aim of a ‘sympathetic individualism’, Dufour presents the following reversal of the ultraliberal reversal : ‘What I have received, I should be able to return’ (Dufour 2011: 347).

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Marquis has us firmly in his grasp: ‘We live in an increasingly Sadean world’ (Dufour 2009: 172, 11).18 In 1929, of all times, the year of the economic world crisis, something happened in New York that Dufour marks as the moment at which the Sadean spirit really came mightily upon us.19 As a promotion of cigarette consumption a titillating parade of seductive smoking women takes place near Central Park. It was a real spectacle. The press were invited. The whole thing was devised by father of spin Edward Bernays, next of kin of Sigmund Freud, whose ideas Bernays uses, together with mass psychological views of Gustave LeBon and Wilfred Trotter. The new thing was that it was news. Actually the event was plain advertising, but it was designed as news. And the association which drew the attention was that of cigarette enjoyment with sensuality and liberation: the unconventional, sensuous women smoked their torches of freedom. ‘The entire new capitalist spirit of consumption can be told from this inaugural act of Bernays,’ Dufour writes. And: ‘Capitalism could only recover from the big crisis of 1929 through democratizing pleasure, through becoming Sadean, or rather, taking into account the prevailing Puritanism, crypto-Sadean’ (Dufour 2009: 178, 180). After this inauguration there is no stopping the new spirit. By means of the pin-up, among other things, sensualized consumption is mobilized. Everywhere ‘perversion lessons’ are being taught, that is skilfully wrapped instructions for uninhibited gratification of desires. And eventually television takes a key part in this Sadean ‘education’: the entertainment industry as disciplining agency. However, the puritan foundation remains. Dufour speaks of a double bind, ‘accelerating and slowing down at the same time’ (Dufour 2009: 322f). Enjoy abundantly, but consume moderately. The smoking Amazon grew into a solitary Marlborough man. Our contemporary world is monadic; we are a collection of islands in an ocean of commodities. The global market releases us, but not to set us free. It ties us to our roles of consumer and flexi-worker. It summons us to ‘be ourselves’, but tempts us to do the opposite 18  In L’Individu qui Vient Dufour also uses the term pleonexia to characterize the spirit of our times. It is a term that figures in Plato’s Politheia, and refers to the insatiable desire to have more (than other people) and is regarded as dangerous hubris, haughtiness. According to the Spanish philosopher Nemrod Carrasco this concept is part of the centre of Plato’s thought: justice flows from the permanent fight against the temptation of pleonexia. Currently however this haughtiness makes up the heart of our ultraliberal culture, says Dufour, and the numerous scandals in the news concerning bribery, excessive bonuses, sexual splurges and so on are only its most blatant offshoots. When Mandeville publishes his Fable of the Bees, Dufour writes, a direct heir of Glaucon from Politheia seemes to raise his voice. The English Enlightenment resumes the debate precisely at the point where Plato had closed it two millennia earlier. (Dufour 2011: 95ff; cf. 117, 361). 19  ‘Sade leaves hell’, writes Dufour (2009, 175). He was exiled to it as being a pernicious, perverse writer in the narrow sense of the latter word. The moment the market was mortally wounded – by the world crisis – he is released, in order to give global capitalism a new vital impulse. This, on the basis of the pursued perverting (in the broad sense of the word) of the relation Amor Dei/Amor Sui.

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by offering all sorts of artificial identities. Don’t have your dream killed, so the message reads that is constantly thrown at us. Make your wishes come true, exploit your talents, get the most out of yourself, even though it might be hidden. Do it quickly, do it now. Realize yourself, and enjoy! The promise is great, the pressure is huge, and the possibilities offered by the market are countless. The ´liberated´ passions are permanently mobilized, addressed and exploited, on the basis of a dominant discourse of ´self-fulfilment´. The English sociologist Nikolas Rose therefore, following Michel Foucault, speaks of a ‘regime of the self’, ‘technologies of the self’ and ‘technologies of subjectification’. The concepts of autonomy, responsibility and self-realization, says Rose, function as instruments of ‘the conduct of conduct’ (Rose 1998: 2, 78, 150ff., 186).20 We are in danger of becoming playthings. The late modern individual hovers between megalomania and its opposite, depression. The postmodern subject is evolving towards a subjective condition defined by a borderline neurotic-psychotic state. This subject is increasingly trapped between a latent melancholy (the depression we hear so much about), the impossibility of speaking in the first person, the illusion of omnipotence, and the flight forward into a false self, a borrowed personality or even the multiple personalities that are made so widely available by the market. (Dufour 2008: 71)21

With regard to this melancholy or depression, however, Dufour is ambivalent and ambiguous. On the one hand he suggests that the depression epidemic might be ‘one of the most evident signs of resistance of the subject to the economy of the generalised market’ (Dufour 2007a: 325f; 2007b: 107) yet without explaining what kind of resistance this might be; there is only the minor indication of ‘a form of retreat’ and ‘the withdrawal of desire in order not to fall into a trap or traps’ (Dufour 2011: 125, 279). On the other hand he presents depression as nothing more than a shadow of perversion: ‘The depressed person is a subject that doesn’t get round to becoming perverse’, or rather, ‘the depressed person is a pervert that ignores himself’ (Dufour 2009: 297). Such indications ought to be expounded. Dufour regrettably stops here. Raging Standstill The neurotic age is over, so one of the main conclusions of Dufour goes, and of Ehrenberg as well (Ehrenberg 1998: 16ff, 2010: 19f). Late modernity is not dominated anymore by prohibition but by incitement. What is expected 20  Cf. his essay ‘Becoming neurochemical selves’. There he touches on Ehrenberg’s depression study, declares that ‘such a global cultural account is unconvincing’, but passes over the issue of the nature of depression as experience (Rose 2004: 17f). 21  Slightly altered translation.

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from the individual is not restriction and sublimation but mobilization and expression of his passions. Henceforth the thing is to get the most out of oneself. One needs to ‘be oneself’ and become it even more. One must show initiative, motivation, determination, purposefulness, versatility and communicability. Human despondency thus is no longer understood in terms of conflict and guilt, but of defect and shame. Depression in this context appears as failure in what is being called for. Being depressed means not being able or willing to have a project, be enterprising, assertive, on the move. It means being unwilling or unable to realize oneself. Depression, in Ehrenberg’s words, is ‘the disease of responsibility’, or ‘the fatigue of becoming oneself’ (Ehrenberg 1998: 10). Who suffers from it should be ashamed and work on the problem, or get treatment, on penalty of social exclusion. Lack of energy or initiative is nowadays the principle defect of the depressed person. And the new anti-depressants that were launched in the 1970s and 1980s, and became highly successful in the 1990s, the so-called SSRIs, (Selective Serotonin Reuptake Inhibitors) aim at reverting this, at restoring the enterprising spirit of the disheartened. Ehrenberg: ‘Prozac is not the pill of happiness, but that of initiative’ (Ehrenberg 1998: 203).22 Is it a medicine or is it a drug, one might ask? The boundary between the two is blurring. For it does not matter anymore if one is really ill or not, as long as one loses one’s listlessness and regains one’s enterprising spirit.23 But in what way, one might ask, could this failure be a 22  Cf. ‘pills of performance’ (Ehrenberg 2010: 215). In Ehrenberg this is the central contradiction concerning depression as key experience of late modernity: showing enterprise versus lacking enterprise. Depression is failure or insufficiency. It is privatively defined as lack, shortage, or gap, after which it is linked to addiction as response to impotence or apathy: ‘Addiction is a means of fighting against depression’. This fight ‘fills the depressive emptiness’, it is ‘a way of withdrawing from the world’ (Ehrenberg 1998: 16, 145; 2010: 232). Addiction, in short, is a reaction against ultimate passivity. In contrast thus with Dufour, who understands depression itself as a (possible) form of retreat or moving back: one withdraws one’s desire in order to protect oneself against the identity games played on the global market of ‘total capitalism’, or in other words, one turns away from the ultraliberal sham liberty – ‘virtual liberty’ is highly applicable here too – which in fact is a new slavery, the servitude of ‘anti-authoritarian totalitarianism’ (Dufour 2011: 14). This slavery is our addiction: ‘We have become our own proper tyrants, we have become the slaves of our passions/pulsations’ (Dufour 2011: 277). So in Dufour, addiction (in the narrow sense) is not a defence against depression, but in reverse depression is a defence against addiction (in a very broad sense). 23  Precisely this boundary blurring is the starting point of the American psychiatrist Peter D. Kramer in his book Listening to Prozac (1993) which in the booming 1990s turned into a bestseller. Later Kramer wrote Against Depression (2005). The ‘against’ is a twofold one: it refers firstly to the disorder depression that according to Kramer needs to be considered as a plain illness, with a neurobiological basis; and secondly it refers to the long tradition of ‘heroic melancholy’, which in Kramer’s eyes has mistakenly taken depression for much more than an illness, a mistake that led to ‘two thousand years of therapeutic

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defence as well? Should we consider depression, like Dufour cryptically does, as a protective move? Protective or not, in any case the depressive move has a temporal dimension that needs to be considered first. The depressed person decelerates, slackens, stagnates, halts. What exactly does this temporal switch involve? ‘Depression and time’: it is a classic connection in psychiatry and psychology.24 It is also a central link in the acceleration study of Hartmut Rosa, Beschleunigung. Depression there appears as ‘pathology of time’, a pathological twist of a ‘fundamental experience’ of the late modern subject (Rosa 2005: 387, 40). Rosa starts his book by pointing out the big temporal paradox of our times: we have a chronic lack of time, whereas prosperity and technological progress provided us with a profusion of it. In order to explain this paradox, says Rosa, we need to unscramble the acceleration logic that dominates our late modern society. Time structures are not at our disposal, they determine individual thinking and acting and that way have ‘an unavoidable normative character’ (Rosa 2005: 26). The time structures that dominate modernity are marked by acceleration. In late modernity – roughly the last 40 years – this ‘social acceleration’ has turned into a self-driven mechanism. This process has reached a point after which the claim to social synchronization and integration no longer can be substantiated. The consequence of this is a fundamental shift in the forms of social control and individual selfrelation: these become ‘situative’, that is to say, they are determined each time anew on the basis of the context concerned. One lives ‘in the moment’, in a present that tends to shrink because it is less and less destined by the past and tailored to the future, since the past has lost its binding power and the future is experienced as utterly unpredictable. One lives context-oriented and relates to oneself in a very flexible way. The late modern individual therefore has a ‘situative’ or ‘transitive’ identity (Rosa 2005: 373, 364). It is a reduced identity: Rosa speaks of ‘identity shrinking’, the reduction of the individual identity to a pointed self that no longer identifies with its roles, relations or potential designations, but has a more or less instrumental attitude towards these. This flexibility involves a ‘temporalization of time’, because no longer a preceding time schedule organizes activities; decisions on duration, order, rhythm and tempo are made during their execution, or in other words ‘in time itself’ (Rosa 2005: 365).25 The modern ‘time manager’ is thus impotence’ (Kramer 2005: 214). Kramer, one could say, voices consistently the ultraliberal spirit of late modern times. 24  See for example Kobayashi 1998, Theunissen 1991. 25  In all sorts of ways Rosa tries to show how late modernity gives a twist to key aspects of modernity. Distinctive of modernity was a ‘temporalization of life’, that is a temporal design of it as a project. In late modernity this preceding time design more and more loses significance and is exchanged for a situative organization, an arrangement ‘of the moment’. This detemporalization of life paradoxically is termed ‘temporalization of time’ by Rosa. In doing this, he refers to the concept of ‘timeless time’ as used by Manuel Castells in The Rise of the Network Society. In this first volume of his famous trilogy on the ‘information age’ the Spanish sociologist writes: ‘Compressing time to the limit

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replaced by the late modern ‘time-juggling player’. The linear, calculating and planning time-orientation makes way for a situation-sensitive and event-focused time practice (Rosa 2005: 368). This new time-orientation goes hand in hand with a systematic social stimulation of individual flexibility and readiness for change. Those who do not go along with this run the risk of deep frustration ‘if their stability-focused identity designs are threatened to be made into a failure by a rapidly changing environment’ (Rosa 2005: 240).26 The transition to a situative identity and situative politics is a very fundamental turn, Rosa emphasizes, since what is abandoned in it is nothing less than the normative core of the modernity project: the claim to individual and collective autonomy. Life goes off course, it can no longer be understood and narratively reconstructed as a directed movement; ‘in the end it comes at a high speed (of change) to a halt’ (Rosa 2005: 384). In the thick of all acceleration a structural and cultural stagnation manifests itself. Rosa speaks of a conflicting ‘fundamental experience’ and a ‘structural unavoidable general experience’ (Rosa 2005: 40, 388) and borrows from acceleration philosopher Paul Virilio the concept of ‘raging standstill’ (Rosa 2005: 41, 385, 437). This key experience becomes pathological in clinical depression as the sensation of a ‘stopping time’. And indeed a not insignificant number of psychologists today, against the dominant DSM-based symptom-fixation, do regard depression as a ‘reaction to unfulfillable acceleration ordeals’ (Rosa 2005: 43). It is a disturbance on the rise, in a time in which growing uncertainty is linked to an increasing incitement to plan and acquire stability. Depression, in brief, is the ‘pathology of time’ (Rosa 2005: 387) that is, firstly: the key disorder of late modernity, secondly: an outcome of the time pressure that marks this epoch, and thirdly: a sensation of stagnation and futurelessness which announces itself in the middle of all dynamism. If we look upon depression like that, the depressed person no longer appears merely as ‘disturbed’ or ‘disordered’

is tantamount to make time sequence, and thus time, disappear’ (Castells 2000: 464). Intensified time compression (temporalization of time, situative orientation) involves the loss of linear, irreversible, measurable, predictable time (detemporalization of life, timeless time). Connected to this paradoxical timeless time, we will see below, is the experience of ‘raging standstill’. 26  This is the key thought in Richard Sennett’s The Corrosion of Character (1998), a text to which Rosa refers, classifying it as ‘pessimistic’. Oddly enough the ending of Rosa’s book appears to be even more gloomy: our future will probably be ‘the unrestrained moving on into an abyss’ (Rosa 2005: 489). This final pessismism however, Rosa cannot reconcile with his sociological conscience, so he ends his book – quoting his French colleague Pierre Bourdieu – with the desperate suspicion that possibly one day a more positive option will appear: ‘If it is profound and consistent, sociology cannot consent with a bare conclusion that can be called deterministic, pessimistic or demoralizing’ (Rosa 2005: 490). To my mind this is a somewhat unsatisfactory deus ex machina ending to an intriguing study.

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but acquires the status of ‘most sensitive seismograph of present and coming transformations’ (Rosa 2005: 390).27 Twilight State Could we derive further clues concerning ‘the coming individual’ from the phenomenon depression? Should we expand on the idea of the depressed person as a ‘seismograph’ and try to record what he registers? What does the fundamental experience of the ‘raging standstill’ involve, precisely there where it becomes pathological? And what does ‘pathological’ exactly mean then? Our situation calls for a phenomenology of depression. The point is to get access to the phenomenon from the phenomenon itself. Two such paths I will discuss briefly now: the ‘Daseinsanalysis’ of Alice Holzhey-Kunz and, in the next section, the ‘pathoanalysis’ of Jacques Schotte. The main thesis of Holzhey-Kunz is that all mental suffering is rooted in the ‘philosophical nature’ of the human being. Because human beings know about their own existence, because they relate to it, they can become neurotically or psychotically ‘disturbed’. Mental suffering therefore in the end is always Leiden am Dasein, suffering from existence itself. On the basis of her focus on ‘the reflexive moment of human being-in-the world’ (Holzhey-Kunz 2001: 40) Holzhey-Kunz comes to an understanding of depression as a Stellungnahme, a very active positioning by the Dasein. In order to be able to elucidate this understanding, first a criticism Holzhey-Kunz puts forward against the way Heidegger presents the voice of ‘common sense’ needs to be explained. In Being and Time (1996) Heidegger speaks of this voice in terms of das Man, the They or the One, and das Gerede, the chatter or gossip, and of the daily existence as Verfallen, falling, Flucht, flight, or Abkehr, turning away. The key sentence from Being and Time concerning Holzhey-Kunze’s explanation of depression is the following: ‘Mood does not disclose in the mode of looking at thrownness, but as turning toward and away from it’ (Heidegger 1996: 128). The mood of everydayness mostly and primarily discloses as a turning away from the burdensome call to Eigentlichkeit, proper-ness, own-ness, or, as it is mostly translated, ‘authenticity’. The Unheimlichkeit, unsettledness, or Un-zuhause, notbeing-at-home, which is the core or ‘basis’ of Dasein, is so unsettling that it pushes Dasein towards the safety and familiarity of an absorption in the world of ‘common sense’, das Man and its Gerede. This ‘chatter’, connected with ‘curiosity’ and ‘ambiguity’, is presented by Heidegger in such a way, says Holzhey-Kunz, that the positive meaning of this absorption is repressed. For the flight is a homecoming as well. The world of ‘the They’ offers the Dasein a familiar place to seek concrete tasks and pleasures, without having to bother about its own being, without having 27  Rosa takes this term from another interesting, and very different, book on acceleration: Keine Zeit! 18 Versuche über die Beschleunigung, by the German writer and translator Lothar Baier (2000).

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to deal with its own angst. And furthermore, underlines Holzhey-Kunz, this place involves a living tradition as well: ‘The They’ manifests itself as ‘the always historical home’ (Holzhey-Kunz 2001: 123). Today this unavoidable and indispensable ‘homecoming’ is more and more difficult to accomplish, because as communities we share less and less; our traditional frames of reference have been – and are still – increasingly corroded by processes and practices of delocalization, deterritorialization, uprooting. Depression therefore is more likely to occur nowadays than in times past. How exactly? What precisely is depression, in the Daseinsanalytical view of HolzheyKunz? Very briefly: a twilight state. It is a state in between An- und Abkehr, in between the act of turning-towards and that of turning-away. The usual flight from the unsettling core of Dasein fails to occur, or does not work, so the normal absorption of Dasein in the world of ‘common sense’ does not follow. But neither follows an abnormal turn to the Eigentlichkeit. Dasein gets loose, but is not set free. It is confronted with the unsettledness as such, it has found its way out of the masking chatter of ‘common sense’ but cannot find its way back to its own ‘home’, die Eigentlichkeit, its own-ness or proper-ness, because, says HolzheyKunz – inserting a Freudian/Lacanian element in her story – the depressed person will not or cannot accept that paradise is lost. But it is lost, forever. The state before the Urverdrängung, the primal repression, will never return. Depression in other words, means rejection of the finiteness of being-in-the-world. The apparent passivity of depression in fact is an active positioning, a stand against the burden of the thrown project, the geworfene Entwurf. The depressed person deems this burden too heavy and turns away from it. Thus he finds himself in the twilight state of a double refusal. Depression has a special status, says Holzhey-Kunz, because it is the most ‘philosophical suffering’. It is the utter disillusionment, involving a twofold illusion which normally protects against the direct confrontation with oneself: the belief that ‘one’s own existence is fundamentally secured in meaning’ and the illusion that ‘the basic conditions of life which are acknowledged as unhappy can be improved by acting’ (Längle and Holzhey-Kunz 2008: 308). The designation ‘philosophical’ refers here to the disclosure of an unavoidable truth on an ontological loss. And all the depressed Dasein can do is show itself as what it is, or as how it feels; it is not able ‘to stage some sort of self-presentation’ (Längle and Holzhey-Kunz 2008: 304). It is what it feels and feels what it is. There is no way of escaping. In this condition the depressed person also experiences being disconnected from intersubjective time. Time passes him by, or has stopped; it only passes for the others. The depressed individual has ‘fallen’ out of communal time. For, writes Holzhey-Kunz, taking on one’s own life and submitting to the law of time are one and the same (Längle and Holzhey-Kunz 2008: 312). So depression is not so much a passive state of sadness, but a double denial: a turning away both from the world of the Man as well as from the move to the Selbst. This means that the depressed subject rejects the task to be a subject (Längle and Holzhey-Kunz 2008: 310) and, being a semi-subject, he is well at

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ease with a treatment that only very partially addresses him as a subject. And that is exactly what the prevailing DSM-based solution does: evade the subject as subject, or the Dasein as Da-sein. Currently the dominating approach of mental disorders is one that deindividualizes the individual by taking the sufferer as a sort of ‘black box’28 displaying certain external features that count as ‘symptoms’, which are to be counteracted by administering medicine, applying electroshocks, inserting electrodes, or by using other technological tools. What happens this way is the opposite of what according to Holzhey-Kunz needs to be done: not an avoidance or numbing of the confrontation that is at the core of depression, but a radicalization of it. The latter not as a Calvinist-like mere stimulation of the human sense of sin, but as the enabling of the individual to be an individual, the Dasein to be Da-sein, helping him to come to terms with his very own ‘abyss’. Attunement and Distunement At the end of Leiden am Dasein Holzhey-Kunz writes: ‘A concrete disorder forces “back to thrownness”. This infringement always is an opportunity as well’ (Holzhey-Kunz 2001: 201). In the eyes of Holzhey-Kunz the name of this opportunity is Trauerarbeit, work of mourning, that is to say the individual acceptance of the loss of ‘paradise’. But could it be an opportunity for something else as well? Does the concept of mood, interpreted in Heideggerian terms, not lead us to a sphere beyond or before that of intentionality? Holzhey-Kunze’s understanding of depression as ‘an intention directed against oneself’ (HolzheyKunz 2001: 177) is not the final phenomenological step to be taken concerning the phenomenon of depression. It is Jacques Schotte who took the next step, the one to a pre-intentional level. Jacques Schotte (1928–2007) was a Belgian psychiatrist and psychoanalyst who was acquainted with, among others, Leopold Szondi and Jacques Lacan. He was chiefly active in Leuven and advocated a psychiatric approach that resists the ‘Kraepelinian spirit’ of present-day psychiatry (Schotte 1989: 66) and does justice to the whole human being (‘anthropopsychiatry’). He took the view that via pathology the sources of human existence could be unlocked (‘pathoanalysis’). In his perspective on mood and pathology Schotte based himself, among other 28  Returning to Dufour’s marking of 1929 as the take-off of the Sadean ‘upbringing’: it does not seem to be a coincidence that this moment coincides with the rise of (neo) behaviourism, the psychological perspective that reduces the individual to a ‘black box’ in which a ‘stimulus’ enters and from which a ‘response’ leaves. The assumptions on what exists and happens between the S and the R – referred to with the O of ‘organism’ – are reduced to the minimum. See the controversial remark made by a French TV-channel director, quoted by Dufour: ‘Our broadcasts aim at making the brain of the viewer available: that means entertaining him, relaxing him, in order to prepare him in between two commercials. What we sell to Coca-Cola is time of the available human brain’ (Dufour 2011: 317).

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texts, on the famous study Classical and Christian Ideas of World Harmony. Prolegomena to an Interpretation of the Word ‘Stimmung’ by Leo Spitzer (1963).29 The German word Stimmung, mood, is close to Abstimmung, attunement, and this latter concept is the starting point for Schotte’s reinterpretation of mood. Being in a mood means being tuned in one-way or another. It is not so much an internal state but a way of relating to or being in the world. It is an accordance with the environment or ambiance, and so the possibility of a discordance. ‘Environment’ is understood here as the ancient Greek periechon (Schotte 1982: 648) which meant something like ‘the encompassing-bearing’. It is not an extension of us; we take part in it, we participate. A basic, primordial dimension, to which the term ‘relation’ does not apply; it concerns an affective being-in-the-world before any subject–object opposition. The affectivity at stake here is a pathos in the original sense: ‘primary passion of the soul, through which this soul starts to appear in the world, to the others, and via these to itself’ (Schotte 1982: 667). Attunement or distunement that takes place at a pre-intentional, pre-subjective, participative level. The being at issue here is not a subject yet but a presubject, a pré-moi participatif, a participating pre-ego: ‘Presubject feeling-itself moving and so living-itself dying, participating rhythmically in the coming-and-going of nature and of life’ (Schotte 1982: 670, 665f). The basis that is found by this presubject is that of a movement of taking and being taken, holding and being held in the periechon, ‘with which he can find himself more or less in a “Stimmung”, that other word for “harmony”’ (Schotte 1982: 667). Correspondence that involves a continuous adjustment, ‘in a sort of reciprocal interiority of “self” and a world constituted by others as well, who together with this “self” (re)find themselves already on their way in the coming-and-going and the general anonymity of a primary participation’ (Schotte 1982: 668). It is se trouver in the double sense of the French word: be somewhere and find oneself. Schotte refers to a key term from Heidegger’s Being and Time, namely Befindlichkeit, translated by the way by Stambaugh as ‘attunement’ (Heidegger 1996: 126). Primordial sphere of contact, typified with the musical terms ‘tone’ and ‘rhythm’: in the mood a correspondence is executed with the environment ‘according to the tone of a situation and according to the rhythm of an exchange which already on this elementary–primordial “level” can realize themselves as harmonious or, on the contrary, be analyzed as more or less disharmonious’ (Schotte 1982: 623, 673). Correspondence that must be realized, so it involves as it were a ‘task’ that must be acquitted, and during this discharge problems might occur: the participation can be in disordance, the Stimmung can turn into a Verstimmung, a mood disturbance or distunement. These mood disturbances are in Schotte’s eyes basic problems since they touch the basis of human existence. ‘Pathoanalysis’ thus means investigating the human condition through the prism of psychiatry, which involves, first of all, 29  Another important source of Schotte of course is the work of Martin Heidegger. One could say that he is incorporating Heidegger’s rethinking of affectivity in Sein und Zeit into psychiatric thought.

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gaining an insight into the movement of human existence. Mood disorders should be considered as ‘moments of this movement’ (Schotte 1982: 637). Disturbances of the ‘primordial dialectics of feeling and moving’; the ‘feeling pre-subject’ has problems with ‘participating productively-receptively in the global ambient coming-and-going of nature and life’ (Schotte 1982: 643, 638). Schotte’s use of dense language is an attempt to find words that do justice to this unspeakable sphere of primordial interwovenness. ‘Environment’ for instance suggests a separation that has not yet happened; inside/outside, passivity/activity, receptivity/ productivity, be tuned/tune in, and so on, converge here, in this dimension of the basic rhythmicity of life: primordial motion or emotivity; a pre-subjective, preintentional movement and involvement. To be in tune or to be untuned, that is the question. Mood disturbances are the via regia to the sources of human existence, says Schotte, and on that road depression is the sovereign to follow. All specific symptoms of mood disorders relate to the primordial, pre-subjective level, and this goes especially for depression: ‘weariness, heaviness and pressure, slackening of all functions of resonance as well as exchange: of the “dialogue ” with the entourage or rather with the milieu, in the whole indivisibility of their vital, social and “personal” sense, at the basic prepersonal level of all possible “personation”’ (Schotte 1982: 669). Inability to enjoy, or even worse, to be interested, and along with that a heightened dependency with regard to the entourage in order to maintain a minimum of comovement, which strengthens the tendency to ‘recover’ with the help of drugs. Schotte opposes ‘pure, basic depression’ to melancholy (Schotte 1989: 78). The first, according to him, is a simple and universal condition, the second a very complex and typical Western one.30 He even calls melancholy ‘the most complex – heterogeneous – state of all, due to the additional contribution of psychotic moments or specific “ego-disturbances” on “top” of the neurotic ones already combined with the depressive nucleus’ (Schotte 1989: 78). Melancholy is Western because it is linked to the Western key idea of personal responsibility and connected feelings of guilt (Schotte 1989: 71). Depression by contrast, as a ‘nucleus’, can be regarded ‘as the structurally “simplest” and therefore properly basic type of psychiatric disturbance’, and therefore ‘as the most ubiquitously important one of the whole of psychiatry in the practice of medicine in general, and 30  This distinction is questionable. The ‘pure, basic depression’, it seems to me, cannot be pure and basic in the sense of ‘natural’ or ‘universal’, because as a disturbance of an attunement of ‘pre-subject’ and ‘environment’ it is always historically determined. It can be pure though in the sense of ‘not composite’. Is it ‘basic’ then in the sense of the Heideggerian ‘basic mood’, Grundstimmung? Ehrenberg spoke of a ‘tonality of our collective psychology’, Rosa of a ‘structural unavoidable general experience’, and Dufour referred to the typification of depression as ‘mental illness of the postmodern epoch’ (Ehrenberg 2010: 20; Rosa 2005: 388; Dufour 2011: 125). What ‘collective’ or ‘general’ or ‘postmodern’ experience phenomenologically involves here, is still an unanswered question.

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as having played therefore its frequent paradigm-role in the history of psychiatry’ (Schotte 1989: 79).31 The key distinction for Schotte with regard to depression is consequently not endogeneous/exogeneous or major/minor but simple/complex. Depression is presented as a third category, in addition to neurosis and psychosis; and several combinations of these two with depression are possible, leading to all sorts of compound pathological phenomena. A third category, but in fact, underlines Schotte, it is the first: it leads directly to the basic movement of life (Schotte 1982: 637). Three main characteristics are pointed out by Schotte: anhormia, lack of drive or zest, anhedonia, lack of interest or pleasure, and arrhythmia, disturbance of the rhythm of life (Schotte 1989: 72). There is a strong suggestion in Schotte’s text that this arhythmicity or dysrhythmicity is the root or the source of the other two. Schotte points in that direction when he writes about the temporal dimension as ‘the true primordial dimension of all living functioning’; when he refers to the primordial sphere of contact with the words ‘tone’ and ‘rhythm’; and when he writes on the pre-subject’s ‘participating rhythmically in the coming-and-going of nature and of life’ (Schotte 1982: 644,32 623, 665f). Could it be that our highly demanding, hyperdynamic late modern culture more and more, and increasingly intense, brings about a disturbance of that basic ‘rhythm’? Is it in the end this primordial bond which is in disorder? And does that disorder also involve – in an indirect, concealed or dormant way – a rapprochement? Loss of contact, and so contact with what is lost; failure, and thereby enduring what is failing. At the end of his text ‘Comme dans la vie, en psychiatrie …’ Schotte refers to the ancient Greek poet Archilochos, quoting his famous line on the primal rhythm of life: ‘Appreciate what rhythm holds men’ (Schotte 1982: 673).33 Could lending a phenomenological ear to depression, like Schotte is suggesting, make us more appreciative here? I would like to think so. It seems to me a necessary thought. It can bring us closer to our reality. These ‘neo-liberal’ times give us the illusion of ultimate freedom, but actually involve a new, extreme kind of servitude. And within this constellation depression asserts itself especially there where this servitude as such is making itself felt. What manifests itself then could be called ‘attunement disorder’ or ‘resonance gap’. Remaining a key question of course is how at this primordial pre-intentional level of the ‘primary passion of the soul’ 31  Cf. Schotte 1982: 639. 32  Here Schotte also links attunement, bon accord, to kairos, the right moment or

good time. 33  This line is also quoted by Heidegger in a brief late text on Rimbaud. Heidegger’s German translation of the line goes like this: lerne kennen aber, ein wiegeartetes Ver-Hältnis (die) Menschen hält (Heidegger 1983: 167). In English this means literally something like: ‘get to know, however, what kind of sus-tainment humans holds’. In this Ver-Hältnis resonate the following words: Verhältnis (relation/relationship), Verhalten (conduct/attitude), halten (hold/keep) and Verhaltenheit (restraint/collectedness). Again a fine example of a ‘loaded’ Heideggerian translation.

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depression still can be understood as ‘active’ response. What kind of activity would that be, which the pre-subject executes in the ‘primordial dialectics of feeling and moving’? The answer to this far-reaching question presupposes an extensive and thorough reflection on the primordial sphere of affectivity, of pathos in the original sense. A challenging task. And a primary one, I would say. Most certainly in these hyperdynamic and durably depressing late modern times. References Baier, L. 2000. Keine Zeit! 18 Versuche über die Beschleunigung. München: Verlag Antje Kunstmann. Castells, M. 2000. The Rise of the Network Society (2nd edition). Malden: Blackwell. Dufour, D.-R. 2003. L’Art de Réduire les Têtes. Sur la Nouvelle Servitude de l’Homme Libérale à l’Ère du Capitalisme Total. Paris: Éditions Denoël. Dufour, D.-R. 2007a. Le Divin Marché. La Révolution Culturelle Libérale. Paris: Éditions Denoël. Dufour, D.-R. 2007b. Dix lignes d’effrondements du sujet moderne. Relevés sismographiques, in Les Maladies du Libéralisme. Cliniques Méditerranéennes. Psychanalyse et Psychopathologie Freudiennes 75. Paris: Érès, 91–107. Dufour, D.-R. 2008. The Art of Shrinking Heads. On the New Servitude of the Liberated in the Age of Total Capitalism. Cambridge: Polity. Dufour, D.-R. 2009. La Cité Perverse. Libéralisme et Pornographie. Paris: Éditions Denoël. Dufour, D.-R. 2011. L’Individu Qui Vient … Après le Libéralisme. Paris: Éditions Denoël. Ehrenberg, A. 1991. Le Culte de la Performance. Paris: Hachette Littératures. Ehrenberg, A. 1995. L’Individu Incertain. Paris: Hachette Littératures. Ehrenberg, A. 1998. La Fatigue d’Être Soi. Dépression et Société. Paris: Éditions Odile Jacob. Ehrenberg, A. 2009. The Weariness of the Self. Diagnosing the History of Depression in the Contemporary Age. Montreal: McGill-Queen’s University Press. Ehrenberg, A. 2010. La Société du Malaise. Paris: Éditions Odile Jacob. Heidegger, M. 1983. Denkerfahrungen. Frankfurt am Main: Vittorio Klostermann. Heidegger, M. 1996. Being and Time, translated by J. Stambaugh. Albany: State of New York Press. Hofstede, G. 1980. Culture’s Consequences: International Differences in Workrelated Values. Beverly Hills, CA: Sage. Hofstede, G. 2001. Culture’s Consequences: Comparing Values, Behaviors, Institutions and Organizations Across Nations (2nd edition). Thousand Oaks, CA: Sage.

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Holzhey-Kunz, A. 2001. Leiden am Dasein. Die Daseinsanalyse und die Aufgabe einer Hermeneutik Psychopathologischer Phänomene. Vienna: Passagen Verlag. Kobayashi, T. 1998. Melancholie und Zeit. Basel/Frankfurt am Main: Stroemfeld Verlag. Kramer, P.D. 1993. Listening to Prozac. New York: Penguin. Kramer, P.D. 2005. Against Depression. New York: Penguin. Längle, A. and Holzhey-Kunz, A. 2008. Existenzanalyse und Daseinsanalyse. Vienna: Facultas. Rosa, H. 2005. Beschleunigung. Die Veränderung der Zeitstrukturen in der Moderne. Frankfurt am Main: Suhrkamp Verlag. Rosa, H. 2012. Weltbeziehungen im Zeitalter der Beschleunigung. Umrisse einer Neuen Gesellschaftskritik. Frankfurt am Main: Suhrkamp Verlag. Rose, N. 1998. Inventing our Selves. Psychology, Power and Personhood (2nd edition). Cambridge: Cambridge University Press. Rose, N. 2004. Becoming neurochemical selves, in Biotechnology. Between Commerce and Civil Society, edited by N. Stehr. Somerset: Transaction Publishers. [Online]. Available at: http://www2.lse.ac.uk/sociology/pdf/rosebecomingneurochemicalselves.pdf [accessed: 20 January 2012]. Schotte, J. 1982. Comme dans la vie, en psychiatrie … Les perturbations de l’humeur comme troubles de base de l’éxistence, in Qu’ Est-ce Que l’Homme? Philosophie/Psychanalyse. Hommage à Alphonse De Waelhens (1911–1981). Brussels: Publications des Facultés universitaires Saiont-Louis, 621–73. Schotte, J. 1989. From redefining depressions to reassessing ‘nosology’ in presentday psychiatry. A three-fold post-script to the papers of van Praag and van den Hoofdakker, in Biological Psychiatry. Marching Backwards into the Future, edited by H. de Cuyper and G. Buyse. Leuven: Leuven University Press, 61–110. Sennett, R. 1998. The Corrosion of Character. The Personal Consequences of Work in the New Capitalism. New York/London: W. W. Norton & Company. Spitzer, L. 1963. Classical and Christian Ideas of World Harmony. Prolegomena to an Interpretation of the Word ‘Stimmung’. Baltimore: Johns Hopkins University Press. Taylor, C. 1989. Sources of the Self. The Making of the Modern Identity. Cambridge: Cambridge University Press. Taylor, C. 2003. The Ethics of Authenticity. Cambridge, MA: Harvard University Press. Taylor, C. 2007. The Secular Age. Cambridge, MA: The Belknap Press of Harvard University Press. Theunissen, M. 1991. Negative Theologie der Zeit. Frankfurt am Main: Suhrkamp.

Chapter 6

The Pathologization of Morality Svend Brinkmann

Allow me to begin with an anecdote: I recently heard an experienced sexologist being interviewed on the radio, who said that people used to come to her clinic because they had too much desire and sexual drive, something they felt was problematic and possibly even pathological. Now, she told the listeners, this has changed, and people in general come to her clinic because they have too little sexual drive. Although this is just an anecdote, I believe it illustrates a fundamental change in our conceptions of human problems: wanting too much in a society of prohibitions is no longer people’s main difficulty; rather, wanting too little in a society of excess is. In what he calls liquid modernity, Zygmunt Bauman (2007) has argued that we witness a fundamental change in the sources of human suffering. Our problems and disorders used to originate from a profusion of prohibitions, but nowadays they tend to grow from an oversupply of possibilities. In plain terms, this means that ‘I have done something wrong’ is replaced by ‘I cannot catch up’ as a fundamental explanation of human distress. In Bauman’s words, the consequence is: … that depression arising from the terror of inadequacy will replace the neurosis caused by the horror of guilt (that is, of the charge of nonconformity that might follow a breach in the rules) as the most characteristic and widespread psychological affliction of the denizens of the society of consumers. (Bauman 2007: 94)

We increasingly orient ourselves according to the antinomy of the possible and the impossible rather than the antinomy of the allowed and the forbidden. This does not mean that norms as such disappear and that everything is suddenly allowed. Rather, it means that some of our most important norms in society become oriented to performance and the future in a new way. ‘You have to!’ becomes a more pervasive demand than ‘You may not!’ One might say that it is no longer allowed not to do the possible, not to live up to one’s potentials, not to realize one’s true self etc. Self-realization and human potential movements have become democratized, and are no longer the privilege of a small elite. Self-realization has become a duty; a demand for the masses that is central to the reproduction of late modern capitalist society (Honneth 2004). Marginalization no longer follows from a transgression of the norms only, but – to put the matter paradoxically – from a failure to transgress, develop and constantly be on the move. As indicated

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by the sexology example above: the problem is no longer a surplus of desire, but a lack of it. In accordance with these transformations, we see that functional and even managerial languages are replacing moral languages when it comes to understanding human misery. Suffering is now rarely seen as a meaningful moral reaction to events, but becomes a mental dysfunction; a sign that one has not lived up to the demands for change, flexibility and constant desire. As many social analysts of the current ‘age of depression’ have argued, a lack of desire is a key symptom of illness in a culture that valorizes development and self-realization above all else (Petersen 2011). In a ‘society of consumers’ (Bauman 2007) one is easily seen as suffering from some pathology or other, if one does not have the desire or will to consume, develop and learn. In this chapter, I intend to investigate how moral and existential forms of suffering have become pathologized and transformed into psychiatric issues; how, in other words, we witness a pathologization or medicalization of morality. I will try to unfold my argument between the Scylla of global pathologization (according to which any kind of human suffering can – and must – be seen in the light of psychiatry and psychology) and the Charybdis of anti-psychiatry (according to which psychiatric diagnoses per se represent an unwarranted medicalization of morality). On the one hand, it has undeniably been a major humanist breakthrough that we no longer hold people responsible for things that they cannot control. It is a good thing that we in such cases have replaced a moral understanding (implying responsibility) with a psychiatric one (exempting responsibility) but, on the other hand, a widespread medicalization today threatens to eradicate not just our sense of moral responsibility, but also our ability to experience suffering as something meaningful. The challenge, therefore, is how to distinguish warranted from unwarranted pathologization. How to strike this balance depends on how we conceive of mental illness and disorder, and I shall therefore go into some detail concerning current theories of mental illness. I will argue that we risk losing touch with vital aspects of (moral) reality, if we further enhance the processes of pathologization. A feeling of guilt, for example, need not be a psychiatric symptom, but is more often a sign that someone has transgressed a moral imperative (see the case described below). Learning to live with a guilty conscience may be a significant and meaningful existential experience that should not necessarily be fixed medically or therapeutically. Can we find room for this kind of moral understanding in our discussions of suffering in the twenty-first century? Can we articulate a view of moral suffering as a meaningful phenomenon in a medicalized culture? Could some of the problems people face today (sadness, emptiness, a loss of meaning) actually stem from a lack of moral resources with which to understand one’s life? Can society in a liquid modernity tolerate a moral perspective on suffering that may run counter to society’s demand for efficient and flexible individuals? These are some of the questions that I wish to raise in what follows and to which I return explicitly in the conclusion.

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A Short History of the Loss of Moral Suffering There is immense variety across the world’s cultures concerning how what we call mental illness and suffering are conceptualized. According to Richard Shweder, an authority on psychological anthropology, experiences of suffering tend to cluster around three main metanarratives: (1) The biomedical narrative, according to which suffering is explained as a result of material events (e.g. harmful molecular processes in the body), (2) the moral narrative, which frames suffering as a consequence of a breach in the moral order (e.g. expressed in the Buddhist idea of karma) and (3) the interpersonal narrative that refers to magic, witchcraft or spirits as driving forces behind experienced suffering (Shweder et al. 1997: 127). Most people in the Western part of the world today seemingly subscribe to some version of (1), but Shweder estimates that only around 15 per cent of the world’s explanations of suffering belong in this category. Most conceptualizations of suffering draw upon the moral and interpersonal metanarratives, so the world is still ‘superstitious’ when seen through the prism of Western science. Metanarratives (1) and (3) share the assumption that suffering is causally inflicted (either by molecules or magical techniques) whereas (2) distinguishes itself by framing suffering as a meaningful (rather than causal) phenomenon. There used to be much more openness to moral understandings and treatments of suffering in our culture. Early forms of mental treatment were significantly called ‘moral treatment’ and were particularly associated with the names of Tuke (England), Pinel (France) and Chiarugi (Italy) in the first half of the nineteenth century (Lilleleht 2003). The term ‘moral’ signified something much broader than our contemporary understanding of morality (as the human and social sciences were seen as belonging to ‘the moral sciences’) but moral treatment was nonetheless based on explicit moral values, and ‘involved the creation and administration of corrective experience within a specialized setting’ (Lilleleht 2003: 169). In Denmark, the pioneer of psychiatric treatment Harald Selmer practised moral treatment in the mid nineteenth century, which involved work and occupational therapy, general encouragement and a gradual moral edification of the patients’ characters (Møllerhøj 2008). In short, mental suffering was framed within a moral rather than a medical discourse. Modern forms of psychotherapy have since evolved in two directions, both of them departing from the original basis in moral values. The first direction is that of medical health care, where morality became significantly downplayed when moral ‘sinners’ became psychiatric ‘degenerates’ and morality was ‘medicalized’ in the course of the nineteenth century (Rimke and Hunt 2002). The second direction is the humanistic one, where psychotherapy became a secular technology of self-realization, incarnated most clearly in Carl Rogers’s client-centred therapy (Brinkmann 2008). I close this chapter with an example from the latter form of psychotherapy. Concerning psychology in general, it is the case that this discipline originally emerged from a specific moral discourse that particularly flourished in eighteenth century Britain. According to historian of psychology Kurt Danziger, this moral

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discourse was ‘based on a fundamental sense of separation between human individuals as well as between individual agents and their actions’ (Danziger 1997: 181). Psychology was then wedded to a moral framework based on individualism and utilitarianism. Yet, when modern psychology struggled to become a respectable science down through the nineteenth and twentieth centuries, a need arose to separate it from all moral issues (Graumann 1996). This separation was reflected in a large number of conceptual changes. A term like ‘behaviour’, which is absolutely central to psychology (as well as other behavioural sciences) originally belonged in a discourse of moral praise and blame (Danziger 2003). We still have remnants of this today, as when we say ‘behave yourself!’ to others (the emphasis here is not just on ‘behave’ as a moral category, but also on ‘yourself’, indicating a form of subjectification, as described by Michel Foucault). But with the rise of behaviourism and contemporary forms of behaviour analysis, ‘behaviour’ became a morally neutral concept. The early methods of personality reformation called ‘moral therapy’ were transformed into the value neutral notion of ‘psychotherapy’ (Charland 2004) and a journal like Character and Personality became Journal of Personality as late as 1945, in order to avoid the moral connotations of ‘character’ that was loaded with value (Greer 2003: 97). And, to give a final example, in clinical and abnormal psychology, the standard term ‘moral insanity’ became ‘sociopathy’ or ‘personality disorder’. The conceptual and discursive shifts that occurred around the eighteenth and nineteenth centuries were so massive that Danziger (1997) talks about this epoch as ‘the Great Transformation’ that paved the way for a modern, non-moral understanding of psychology. In psychiatry, the moral approach to mental illness and suffering was also gradually left behind in the course of the nineteenth century, when the German psychiatrist Emil Kraepelin, by many considered the founder of scientific psychiatry, began to develop an understanding of mental disorders as brain disorders (Peeters 1996). This contributed greatly to modern psychiatry as such, and hospitals, clinics and asylums emerged throughout Europe after this. From a sociological perspective, it was no doubt the highly specialized demands of the modern nation states that were instrumental in separating a number of individuals as unfit for work and unable to take part in the national community (Peeters 1996: 210). The medical model of mental illness reigned for nearly 100 years after this, and Sigmund Freud’s psychoanalysis from around 1900 onwards was not really a break with this, but (at least according to Freud the neurologist) a modern version of a causal–medical approach to mental problems. It was not until around the 1960s that the medical model was challenged in large measure by different movements and countercultures such as interaction psychiatry (Sullivan) systemic therapies (Cecchin) critical interpretations of the history of mental illness (Foucault) and anti-psychiatry (Szasz).

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Mental Disorders Today: Epidemics or Pathologization? Today, we live in a time and place where a psychiatric language and its diagnostic categories have become more important for our self-understanding than ever before. Terms that have specific meanings within psychiatry, such as stress, anxiety, depression and mania, have become part of people’s everyday vocabularies. We use such terms to understand the behaviours, reactions and emotions of ourselves and others. To mention just one example of how the everyday lives of men, women and children have become psychiatrized, a recent large-scale study of 122 Danish public schools demonstrates that teachers believe that, on average, 24.9 per cent of their pupils have problems to such an extent that they could (and should) be given a psychiatric diagnosis (Nordahl et al. 2010). For the boys in particular, the figure is a striking 30.8 per cent. Especially the Attention Deficit and Hyperactivity Disorder (ADHD) category has become important for teachers’ and parents’ interpretations of children’s behaviours, and prescriptions of Ritalin (a drug that is supposed to reduce the symptoms of ADHD) have grown several hundred per cent in the course of just a few years (there has been, for example, an increase of 600 per cent in the use of Ritalin for the age group of 15 to 19 from 2005–2009 in Denmark). Even if we grant hypothetically that children may be more unruly and disobedient now (certainly a ‘moral’ verdict) than in the past (a likely sign of ‘liquidity’ in Bauman’s liquid modernity, with moral rules themselves being liquid and often negotiable) it still seems very implausible that one-third of all boys in the normal school system suffer from mental disorders, which appears to be evidence of an unwarranted pathologization of child misbehaviour. Many critics have argued more generally that there is an ongoing cultural process of pathologization, which means that many traits and behaviours that used to be considered as normal human problems (sorrow, melancholia, guilt, shyness, etc.) are now conceptualized as mental disorders that can be diagnosed and treated medically and therapeutically (see the contributions to Brinkmann 2010a). When epidemiological studies demonstrate that up to 27. 4 per cent of all men and women in the European Union will have symptoms of at least one psychiatric disorder in the course of one year (Wittchen and Jacobi 2005) this may be interpreted as representing genuine epidemics of depression, anxiety, social phobia etc., but, on a less dramatic interpretation (although perhaps rather more realistically) it may testify to a massive pathologization of human life; a breakdown of our conventional distinctions between problems in living and psychiatric disorders. A problem is, according to the critics, not just that so many parties, from the biomedical industry to psychotherapists, benefit from educating individuals in the art of interpreting their problems in light of medicine and psychology (Kutchins and Kirk 1997) but also that such pathologization runs the risk of ‘cultivating vulnerability’ in human beings that may become less able to tolerate pain and distress as they are constantly on the lookout for emergent symptoms (Furedi 2004). As Barsky (1988) argued some years ago, there seems to be a ‘paradox of health’ since more and more people experience more and more symptoms and subjective distress at the same

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time as (and perhaps even as a consequence of) more and more treatments become available. When new treatments become available along with new diagnostic categories, new ways of suffering emerge that can be ‘taken up’ by individuals in a dynamic process that Ian Hacking has called ‘the looping effect of human kinds’ (Hacking 1995, 1998) that is an interaction between categories that designate human doings and sufferings on the one hand and human beings who may act and interpret their lives in light of these categories on the other. This invites everyone into seeing oneself as a victim or a patient. What seems clear is that there is great confusion among scientists, mental health practitioners and also the public concerning how the frightening epidemiological statistics should be explained. Are we witnessing epidemics of mental disorders or massive processes of pathologization? Or perhaps both at the same time? I shall not try to settle this complex issue here once and for all, but merely state that I find much plausibility in the pathologization thesis: that more and more human traits and problems are seen as pathological today and explained with reference to a psychiatric and/or biomedical vocabulary rather than a moral and/or existential vocabulary. How we make up our minds about these questions, and think about the adequacy of understanding life in light of psychiatry, depends in large parts on how we implicitly or explicitly conceptualize mental disorders (or mental illness) which takes us to the next theme. What is Mental Disorder? Those who develop new diagnostic categories and new treatments very rarely discuss the difficult question: what is a mental disorder? That we are in fact shockingly far from being able to give a clear answer to this question is reflected in a recent book by the leading authority on psychopathology, Derek Bolton.1 Bolton concludes the following: There is, as far as I can see, no stable reality or concept of mental disorder; it breaks up into many, quite different kinds, some reminiscent of an old idea of madness or mental illness, others nothing like this at all. (Bolton 2008: viii)

Bolton thus emphasizes the heterogeneity of what is conventionally called mental disorder, and, in the present context, this may serve as an indication that although some diagnostic categories may refer to genuine illnesses that are best understood as brain disorders for example (schizophrenia and bipolar disorder come to mind) others may more adequately be grasped within (what I call) a moral framework. For a range of so-called mental disorders, we have reason to think that they are not disorders at all, but rather ordinary human behaviours and reactions that would be 1  Bolton is Professor of Philosophy and Psychopathology in the Institute of Psychiatry at King’s College, London.

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expected given the circumstances that people are in. This might be the case with conditions such as common depression and ‘everyday sorrows’ (Williams 2009), social phobia (Lane 2007) and perhaps the aforementioned ADHD (Nielsen and Jørgensen 2010). But let us look more closely at the notion of mental disorder. Bolton lists four quite different theories of what mental disorders are: 1. The neuroscientific theory, according to which mental disorders express structural or functional problems in neural processes. This theory (in different versions) is very widespread today, especially in light of the recent renaissance of biological psychiatry and the emergence of a human selfinterpretation that has been called ‘the neurochemical self’ (Rose 2007). This has led to ‘molecular’ interpretations of mental disorders replacing ‘molar’ interpretations, which took the human being as a whole into account (Rose 2007: 199). I cannot do justice to the complex discussions around neuroscience and the associated danger of reductionism, but the main problem with the neuroscientific theory is no doubt the often weak links between the neural and the psychological domains. Two people who both suffer from the same mental disorder may have no brain dysfunction in common as there is often no one-to-one isomorphism between brain, mind and behaviour. Furthermore it is still the case (in spite of recent technological advances in neuroimagery) that mental disorders are defined and identified phenomenologically and behaviourally, and there is good reason to believe that this must remain so for philosophical reasons (Brinkmann 2011a). Regardless of how the brain works, if a person functions normally, there is no reason to consider the person mentally disordered, and there is in this sense an internal relation between mind and behaviour. For these reasons, the neuroscientific theory is bound to remain auxiliary, that is, it may study the neural correlates of mental disorders, but this is different from studying mental disorders per se, and it is therefore very unlikely that the neuroscientific theory will ever be able to tell the whole story about mental disorders (see also the arguments against neuroscientific reductionism in Brinkmann 2011b). 2. The medical theory, which claims that illness in general is simply a name for subnormal functioning. This theory has been advocated with particular force by Christopher Boorse (1976) and its aim is to provide a value-neutral understanding of illness and health by defining disease as an internal state of the organism that interferes with the performance of a natural function of the species (Boorse 1976: 62). Thus, a mental disorder is defined as subnormal functioning concerning one or more psychological functions. The main problem with this theory is that it remains unclear, especially when we consider mental disorders, what a ‘natural function’ is. For humans, it is surely ‘natural’ to be cultural, and there is much variety and many divergent norms around the world concerning normalcy and disorder

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(as we saw above with reference to Shweder’s work). Furthermore, for quite a few conditions (for example mouth diseases such as caries) it seems that it is statistically normal to be ill, but without this disqualifying the conditions as illnesses. This theory, in short, seems to be too simple and suffers from too many problems (Bolton 2008). 3. A third contender is Wakefield’s (1992) theory of mental disorder as ‘harmful dysfunction’. This theory builds on the medical theory, but adds a value component. Thus, something is a mental disorder, according to Wakefield, if (a) the state arises because of the failure (or dysfunction) of some naturally evolved psychological mechanism that (b) affects the person in a destructive (or harmful) way; hence: disorders are harmful dysfunctions. As Wakefield makes clear, the second condition (b) implies a value judgement, since something can be judged as harmful only relative to the norms of a person’s culture. An interesting consequence of this theory is that many disorders, currently listed in the Diagnostic and Statistical Manual (DSM) and International Statistical Classification of Diseases (ICD) diagnostic systems, are in fact not genuine disorders. Although it is experienced as harmful, common depression, for example, is usually not the result of a malfunctioning psychological mechanism, but more often the result of social conditions that exceed the capacities of an individual, causing stress, exhaustion and eventually depression (Horwitz and Wakefield 2005). According to Wakefield, it is therefore unwarranted to classify common depression as a mental disorder. However, the main problem with this theory is similar to the previous one: it seems quite impossible to factor out cultural from natural functions and conditions in human lives and isolate ‘naturally evolved psychological mechanisms’, since most – if not all – higher mental functions depend on socialization and culture (Vygotsky 1978). 4. The final broad theory mentioned by Bolton is perhaps the least specific, but also in my opinion the one with the greatest appeal. This is what we might call a phenomenological theory, which states that mental disorders represent breakdowns in the meaningful connections and relations in our mental lives, but without specifying the causes of such breakdowns. If there is no traceable connection between what happens and how a person reacts (for example between a non-dangerous situation and anxiety) and if the person’s reaction is painful and lingering, then it seems relevant to talk about a mental disorder (whether the lack of connection stems from a dysfunctional ‘psychological mechanism’, neurological processes or whatever). This theory, which I believe holds the greatest promise (perhaps because of its lack of specificity) takes us straight to the issues of meaning and normativity that are relevant in relation to moral conceptualizations

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of suffering.2 For when we talk about ‘meaningful connections’ we are in the realm of norms and values. A fear of pigeons can be pathological, because there is no reason to fear them. A fear of poisonous snakes, on the other hand, may be rational, because they are in fact dangerous. A fear of death is surely not pathological, but may stem from the human capacity for recognizing finitude, which can be the basis for authentic, resolute living (Heidegger 1927). So there is nothing about fear or anxiety in itself that determines its status as pathological, rational, existential or something else. It depends on contextual and relational conditions of meaning. How one sees an instance of fear (and other human actions and reactions) depends on the explanatory resources that one has available. In what follows, I shall introduce a distinction between two broad ways of explaining actions, one in terms of morality and meaning (and reasons) and the other in terms of pathology (and causes). Explanations of Human Action: Moral Reasons or Pathological Causes? There are many ways to explain human action but there is agreement that two overarching forms exist. We can either explain human action with reference to causes or with reference to reasons. If we ask: ‘Why did Jack and Jill go up the hill?’ an explanation in terms of causes can state that they did so because their brains initiated a reaction in the locomotive system that made their legs move (a physiological explanation) because their genes wanted to replicate themselves in organisms known as offspring (a sociobiological explanation) or because they were forced to go up there by an inner demon (a psychiatric explanation that invokes a psychotic symptom). However different these are (and they need not rule one another out) they are all species of causal explanation that frame the situation as behaviour rather than action. What I mean by ‘behaviour’ in this context is that it designates something that simply happens as a consequence of some mechanism

2  Readers may be puzzled about my use of the term ‘normativity’. I use the term to designate any domain of ‘oughtness’, that is, any domain in which it makes sense to draw a distinction between correct and incorrect. Thus, logic is normative, since it builds on a difference between valid and invalid inferences. Football is a normative activity, because there are rules that can be obeyed or broken, and the game can be played more or less well. Many other processes, however, are not normative, like the grass growing on the football field, which is simply something that happens according to causal laws of nature. Thus, there are no rules that control the growing of the grass (and no rules that can be broken) only forces of nature. We can only talk about agency in the full sense when we are in the realm of normativity, where we can live up to a norm (or not) and obey a rule (or not). Normativity, agency, meaning and reasons are concepts that form one whole cluster, while causality, effect, natural law and causes form another.

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(in the brain, genes or whatever) that is either working well or in a pathological way, but without invoking meaning or normativity. However, we may also say that Jack and Jill went up the hill because they wanted to smell the daisies. In this case, we understand the episode not as a causal happening but as human action that is based on a reason and an intention and express meaning (Jack and Jill have heard that the hill is full of daisies and wish to experience the scent of these wonderful flowers). In this case we conceive of Jack and Jill as agents that can act for a reason and to some extent articulate the reason that individuates their action (thereby accounting for their action). It is difficult to imagine what human life would be like if we had no recourse to a language of reasons. That is, it seems to be impossible to uphold an understanding of ourselves as agents without a normative language of reasons. Only in those cases when no reason can be found for a given action do we begin to look for a causal explanation, so there is a fundamental primacy of normativity over causality in human life and in explanations of human action. In classical sociology Max Weber can be mentioned as having put much emphasis on the need for understanding action in scientific endeavours, highlighting a difference between instrumental Zweckrationalität and value-oriented Wertrationalität. For Weber, we need hermeneutic Verstehen to grasp human action as something other than pure causal happenings. Like other philosophers (for instance MacIntyre 1999) sociologists (for instance Tilly 2006) and a few psychologists (for instance Dryden and Still 2007), my approach builds on the (Weberian) premise that human beings are essentially reason-giving animals (see Brinkmann 2010b on which the following is based). Giving reasons when asked ‘why?’ is a pervasive feature of everyday life and coconstitutive of personhood. Thus, if a person accused of having committed a crime in a court of law is completely unable to account for her actions, that is if no reasons are available to her that render the action understandable (however reprehensible it may otherwise be) the person is likely to be sent to a mental institution rather than a prison. Subject status in the full sense will thus not be recognized if one is unable to provide reasons. As Hegel argued in his Philosophy of Right, punishing the criminal (in opposition to treating her in a mental institution) is a way of recognizing the individual as a rational subject, subject to those normative demands that have been broken (Hegel 1821). As Alasdair MacIntyre (1999) has shown, it is the case that an understanding of what others are doing emerges only through ascribing reasons to them. Often, it is necessary to know the reason in order to be able to interpret the action correctly (for the same physical movements may express quite different actions relative to the reasons involved in performing the movements). Also ethnomethodologists have had a long-standing interest in those reasons that figure in the accounts we give in everyday life. For ethnomethodologists all social order is locally produced (Garfinkel 1967) and the central method that people use to produce order is through account giving. In some sense, therefore, society is constantly made and remade when people succeed in stabilizing the social by giving reasonable accounts of

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what happens, and reason-giving-and-receiving are therefore significant ‘kinds of social praxis in their own right’ (Coulter 1989: 5). At least three things are important in relation to such reason giving: (1) that there is a primacy of reasons over causes in explanation of human action, (2) that reasons, unlike causes, are intransitive, and (3) that reasons are particularistic. As Hollis (1977) has argued regarding the first point, it seems to be the case that reasons are generally enough to explain actions. If a person does something and we are provided with a reason that satisfactorily explains the action then the search for explanation normally stops. Only irrational actions call for causal explanations, that is if we cannot find a reasonable explanation as to why someone did something. Furthermore, unlike causes, reasons are not transitive. That is, if A is the cause of B, and B is the cause of C, then A is the cause of C. But this does not go for reasons, for if A is the reason for my action B, then I am responsible for B, but I am not similarly responsible ‘for what others do autonomously because of what I set in motion’ (Hollis 1977: 108). Responsibility and other normative concepts are not transitive in a simple way like causality. Finally, causes– explanations work by bringing particular observations under a general law, but reasons–explanations work differently, viz. by explaining ‘the particular by the particular’ (Hollis 1977: 108). In general people do not act because their actions are instances of a general causal law (for example I do not love my wife because there is a general law specifying that humans of type X are attracted to humans of type Y, but because she is lovable!). Even if there is a general law this is not the reason why we act as we do. If we relate these general considerations to the theme of pathologization, we can say that pathologizing some action often means suspending our common reason-giving practices and reinterpreting it in light of a causal explanation. This can involve understanding the individual’s behaviour as an instance of a general law (‘this is what ADHD patients generally do’) or even invoking some causal mechanism in explaining a given occurrence (‘it was the ADHD that caused him to …’) rather than invoking particularistic circumstances that render the action meaningful. A Case of Morality and Pathology In order to make these abstract matters more concrete I shall present one brief example here taken from the case description of a psychotherapist (Jonathan 1997). The therapist brings it forth as a best practice example. Its main character is Janet M, who is a very successful businesswoman, 38 years old, and the owner of a software company with more than 100 employees. She comes to therapy because she feels lost and alone, although she has dozens of friends who like and admire her. In her own view, she ought to be happy, satisfied and fulfilled, but she feels none of these things, and wants to understand why (Jonathan 1997: 127). In the first session, she informs the therapist that her husband Bill has recently died, but that she is not looking for a ‘bereavement counsellor’ (Jonathan 1997:

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128). Yet in the following sessions the main focus in fact (quite unsurprisingly) becomes her relationship with Bill. Bill was not nearly as successful as Janet, and Janet was beginning to feel ashamed of him, and they had grown apart. She concentrated on her work and Bill on his hobby, skydiving. In one later session the whole atmosphere suddenly becomes much more intense and nervous when Janet is led to talk about Bill’s death. It turns out that he died as a result of his parachute not opening, and Janet comes to the conclusion that Bill killed himself. Janet is described as ‘full of guilt and remorse’ and also shameful (Jonathan 1997: 129–33) because she finds that she had made Bill’s life miserable, among other things by being engaged in an extra-marital love affair: ‘all focus in her life was solely on her career; there were no other categories of meaning’, the therapist concludes; ‘many values had been stripped from her life and the only values she could now recognize were values to do with success’ (Jonathan 1997: 130). Therefore she now describes herself as searching for ‘a personal value system’ (Jonathan 1997: 131). The therapist works on the basis of client-centred therapy, but we do not hear much else about his interventions. He states his fundamental premise of work, however, as ‘accepting and working with whatever is presented by the client without, from the outset, seeking to impose upon the enterprise any preconceived … assumptions concerning the meaning … of the presented material’. He aims to be ‘non-judgemental and accepting of whatever stance the client maintains’ (Jonathan 1997: 136). What this means in practice, however, is that although the client formulates her problems as deeply meaningful moral problems (and talks about guilt, remorse, shame, value emptiness) the therapist does not take these up as genuine moral issues (arguably because he considers all values as deeply subjective). Instead of thematizing these moral issues the therapist urges the client to discover what she really wants to do (in this case to give up her business career and pursue a career in teaching; something, however, she finally decides against). For there are no moral authorities external to the client’s private worldview: ‘all issues in the client’s life’, the therapist tells us, ‘reflect assumptions or worldviews held by the client’ (Jonathan 1997:138). As the case is described, the moral issues in the therapy that come from the client are bypassed or levelled by the therapist. From a moral point of view, which Janet certainly seems committed to, there is a genuine normative question whether she in fact was guilty in bringing about Bill’s death. This is a real normative question about the meaning of the event that makes her reaction existentially significant. But the question of guilt cannot be tackled by this therapist, who sees his prime goal as assisting the client in overcoming the alleged pathological suffering, teaching her to feel good about herself. The moral question of guilt is thus levelled (to use a Kierkegaardian expression) and transformed into a question of feeling good versus feeling bad. The suffering is transformed from a meaningful, normative reaction into a pathological entity that occurs causally in the client’s mind. Ultimately, the therapeutic question becomes: How does she stop feeling guilty? How can the guilt be removed from the patient’s mind? (analogous with removing a tumour

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from a patient’s body). The normative question whether feeling guilty could be morally warranted is ignored. Unlike earlier forms of ‘moral treatment’ referred to above, modern psychotherapy and also psychiatry in general offer few chances of ‘corrective experiences’ since there are no moral authorities to serve as the standard of correction. Concluding Comments After having reflected on the questions of mental disorder and pathologization, I will conclude by returning to some of the questions that I raised at the beginning of this chapter. Can we find room for a moral understanding of suffering in the twenty-first century? The case of Janet is meant to signal that people often experience suffering as deeply connected to moral and existential issues (rather than just medical and pathological ones) and that it represents a problem if professional practitioners do not take such experiences seriously. One problem is that practitioners (for example psychologists and psychiatrists) are trained in a scientific tradition that has very little understanding of meaning, reasons and normativity and thus of the morality of human lives (Miller 2004). As we have seen, current theories of mental disorder are ill-equipped to understand the idea that suffering can sometimes be meaningful. Can we articulate a view of moral suffering as a meaningful phenomenon in a medicalized culture? I believe so, but this demands going beyond the mainstream and perhaps learning more from literature and the arts than from psychiatry. Artists are often capable of portraying these issues (particularistic as they are) much better than scientists (for example Henrik Stangerup’s novel in Danish The Man Who Wanted to be Guilty. This book is about a future society which has radicalized the current medicalizing and pathologizing tendencies, and the protagonist – who has killed his wife and wants to be punished, because he considers himself guilty – is constantly excused by the authorities with reference to the scientific knowledge of the causes of his behaviours). Could some of the problems people face today (sadness, emptiness, a loss of meaning) actually stem from a lack of moral resources with which to understand one’s life? I believe the answer is yes, which means that it is doubly tragic that moral and existential forms of suffering, stemming from a lack of meaning and value, are routinely pathologized, thus stripped of whatever meaning that was left. People who are looking for meaning meet a system of treatment that tells them that their suffering is meaningless and should be understood causally, thus possibly reinforcing the very ground of their suffering. Can society in a liquid modernity – that is, a society in which the grounds of morality are eroded, where previously solid normative rules that ought to be obeyed are dissolved and liquidated – tolerate a moral perspective on suffering that may run counter to society’s demand for efficient and flexible individuals? To this, my answer must be an honest ‘I don’t know’, for it is, in one sense, clearly

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more demanding to tackle problems in living as moral problems since there will often not be a pill or a therapeutic quick-fix available. However, it might also often be (if I dare say so) a more humane way of engaging with pain and suffering. Understanding the suffering of others as meaningful responses to life’s difficulties goes against objectifying their behaviours as causal reactions. Instead, the demand is to see people as agents who can act for reasons. Only when this becomes absolutely impossible should we invoke causal explanations and replace a moral with a pathologizing viewpoint. The point of this chapter has not been to say that a causal look at human life should always be avoided; rather, it has been to say that we should preserve the possibility of using moral and existential languages in order to grasp the meanings of the different forms of suffering that come with being human. References Barsky, A. 1988. The paradox of health. New England Journal of Medicine, 318, 414–18. Bauman, Z. 2007. Consuming Life. Cambridge: Polity Press. Bolton, D. 2008. What is Mental Disorder? An Essay in Philosophy, Science, and Values. Oxford: Oxford University Press. Boorse, C. 1976. What a theory of mental health should be. Journal for the Theory of Social Behaviour, 6, 61–84. Brinkmann, S. 2008. Identity as self-interpretation. Theory & Psychology, 18, 404–22. Brinkmann, S. 2010a. Det Diagnosticerede Liv: Sygdom uden Grænser. Aarhus: Klim. Brinkmann, S. 2010b. The ethical subject. Sats – Nordic Journal of Philosophy, 11, 75–89. Brinkmann, S. 2011a. Psychology as a Moral Science: Perspectives on Normativity. New York: Springer. Brinkmann, S. 2011b. Towards an expansive hybrid psychology: Integrating theories of the mediated mind. Integrative Psychological and Behavioral Science, 45, 1–20. Charland, L.C. 2004. Character: Moral Treatment and the Personality Disorders, in The Philosophy of Psychiatry: A Companion, edited by J. Radden. Oxford: Oxford University Press. Coulter, J. 1989. Mind in Action. Oxford: Blackwell. Danziger, K. 1997. Naming the Mind: How Psychology Found Its Language. London: Sage. Danziger, K. 2003. Where History, Theory, and Philosophy Meet: The Biography of Psychological Objects, in About Psychology: Essays at the Crossroads of History, Theory and Philosophy, edited by D.B. Hill and M.J. Kral. Albany, NY: State University of New York Press.

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Dryden, W. and Still, A. 2007. Rationality and the shoulds. Journal for the Theory of Social Behaviour, 37, 1–23. Furedi, F. 2004. Therapy Culture: Cultivating Vulnerability in an Uncertain Age. London: Routledge. Garfinkel, H. 1984 [1967]. Studies in Ethnomethodology. Cambridge: Polity Press. Graumann, C.F. 1996. Psyche and her Descendants, in Historical Dimensions of Psychological Discourse, edited by C.F. Graumann and K.J. Gergen. Cambridge: Cambridge University Press. Greer, S. 2003. Self-Esteem and the Demoralized Self: A Genealogy of Self Research and Measurement, in About Psychology: Essays at the Crossroads of History, Theory, and Philosophy, edited by D.B. Hill and M.J. Kral. Albany: State University of New York Press. Hacking, I. 1995. Rewriting the Soul. Princeton: Princeton University Press. Hacking, I. 1998. Mad Travelers: Reflections on the Reality of Transient Mental Disease. Charlottesville: University Press of Virginia. Hegel, G.W.F. 1991 [1821]. Elements of the Philosophy of Right. Cambridge: Cambridge University Press. Heidegger, M. 1962 [1927]. Being and Time. New York: HarperCollins Publishers. Hollis, M. 1977. Models of Man: Philosophical Thoughts on Social Action. Cambridge: Cambridge University Press. Honneth, A. 2004. Organized Self-Realization. European Journal of Social Theory, 7, 463–78. Horwitz, A.V. and Wakefield, J.C. 2005. The Age of Depression. The Public Interest, 158, 39–58. Jonathan, A.L. 1997. Unhappy Success – A Mid-Life Crisis: The Case of Janet M., in Case Studies in Existential Psychotherapy and Counselling, edited by S. du Plock. Chichester: John Wiley and Sons. Kutchins, H. and Kirk, S. 1997. Making Us Crazy – DSM: The Psychiatric Bible and the Creation of Mental Disorders. Chicago: University of Chicago Press. Lane, C. 2007. Shyness: How Normal Behavior Became a Sickness. New Haven: Yale University Press. Lilleleht, E. 2003. Progress and Power: Exploring the Disciplinary Connections between Moral Treatment and Psychiatric Rehabilitation. Philosophy, Psychiatry & Psychology, 9, 167–82. MacIntyre, A. 1999. Dependent Rational Animals – Why Human Beings Need the Virtues. London: Duckworth. Miller, R.B. 2004. Facing Human Suffering: Psychology and Psychotherapy as Moral Engagement. Washington: American Psychological Association. Møllerhøj, J. 2008. ‘thi Sindssygdomme helbredes ikke ved Piller og Draaber alene’ – det psykiatriske sygdomsbegreb og den moralske behandling i dansk psykiatri ca. 1840–1900, in Psykens historier i Danmark: Om forståelsen og styringen af sjælelivet, edited by S. du Plock. Frederiksberg: Samfundslitteratur.

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Nielsen, K. and Jørgensen, C.R. 2010. Patologisering af uro?, in Det diagnosticerede liv: Sygdom uden grænser, edited by S. Brinkmann. Aarhus: Klim. Nordahl, T., Sunnevåg, A.K., Aasen, A.M. and Kostøl, A. 2010. Uligheder og variationer: Rapport til skolens rejsehold. Aalborg: University College Nordjylland. Peeters, H. 1996. The historical vicissitudes of mental diseases: Their character and treatment, in Historical Dimensions of Psychological Discourse, edited by C.F. Graumann and K.J. Gergen. Cambridge: Cambridge University Press. Petersen, A. 2011. Authentic self-realization and depression. International Sociology, 26, 5–24. Rimke, H. and Hunt, A. 2002. From sinners to degenerates: The medicalization of morality in the 19th century. History of the Human Sciences, 15, 59–88. Rose, N. 2007. The Politics of Life Itself: Biomedicine, Power and Subjectivity in the Twenty-First Century. Princeton: Princeton University Press. Shweder, R.A., Much, N., Mahapatra, M. and Park, L. 1997. The “Big Three” of Morality (Autonomy, Community, Divinity) and the “Big Three” Explanations of Suffering, in Morality and Health, edited by A.M. Brandt and P. Rozin. London: Routledge. Tilly, C. 2006. Why? Princeton: Princeton University Press. Vygotsky, L.S. 1978. Mind in Society: The Development of Higher Psychological Processes. Cambridge, MA: Harvard University Press. Wakefield, J.C. 1992. The concept of mental disorder: On the boundary between biological facts and social values. American Psychologist, 47, 373–88. Williams, R.F.G. 2009. Everyday sorrows are not mental disorders: The clash between psychiatry and Western cultural habits. Prometheus, 27, 47–70. Wittchen, H.U. and Jacobi, F. 2005. Size and burden of mental disorders in Europe: A critical review and appraisal of 27 studies. European Neuropsychopharmacology, 15, 357–76.

Chapter 7

The Multiple Self: A Social Pathology? Annalisa Porfilio

In Western psychology instances of multiplication of one’s customary Self, ranging from day-dreaming to split-off states and entirely distinct experiential alters, have long been understood as ways in which a bounded rational individual coterminous with a physical body would cope with deep traumatic experiences through dissociated mental processes. The underlying assumption has been that these would develop from a unitary consciousness in consequence of its pathologic fragmentation. During the last decades, however, these ideas seem to have lost popularity and mental health professionals have been confronted with the new phenomenon of the inherently multiple Self (Gergen 1991, Kvale 1992, Littlewood 1997, Fee, 2000, Frie 2003, Littlewood 2004). Certain currents within the discipline have deliberately chosen to embrace this image, already popular in other cultural domains, in order to reinstate the liberty of the autonomous individual. From their point of view the image of a volitional subject actively engaged in the construction of plural identities in a globalized world constitutes a far more plausible conceptualization of the contemporary Western individual than that of a person whose volition is influenced by disavowed processes of different nature. Thus in the literature produced by several mental health therapists accounts of persons claiming to possess multiple identities healthily coexisting in a single body have gradually replaced narratives of patients relating the split of their consciousness and its incapacity to follow a linear development. These identities, which in everyday language are commonly referred to as ‘personalities’, are not regarded as symptomatic of distressful life experiences, but they are approached as the work of individuals creatively seeking for opportunities of inner enhancement through different personae. As such, they can be phenomenologically accessed, assessed and, when necessary, reshaped through the use of appropriate self-help techniques or ad hoc administered treatments. Under the extreme circumstances of a mental pathology, such as Borderline Personality Disorder, Multiple Personality Disorder or Post-Traumatic Stress Disorder, the owners of these personalities may depict them as entirely independent experiential alters, whose attributes vary according to their life occurrences. Though these alters are generally endowed with anthropomorphic features, they can be occasionally portrayed as strange nonhuman creatures in need of being medically managed, like aliens and demonic spirits. During the great wave of Multiple Personality Disorder cases of the 1980s, for instance, American psychiatrists treated patients whose alters included

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extraterrestrial entities, earlier life forms, deceased family members, sexual predators and even aborted foetuses. What needs to be remarked is that many mental health professionals working on preserving the safety of patients affected by these syndromes currently opt to address their multiplicity like an attribute to be maintained and cultivated,1 while in the past they would have typically aimed at its suppression.2 Some of the fundamental steps of their therapeutic approaches, which aim at liberating the patient from the burden of collective history and repressing social obligations, encompass the personalization of each Self with a proper name in order to address them as separate entities in their own right; their treatment through techniques commonly applied in family therapy where a Helper Self is summoned as convenor of the whole group (Ross 1994) the organization of competing selves in the form of a federal government (Rowan 1990).3 Theories advocating the inherent multiplicity of the Self have been acquiring increasing popularity following the marketization of publications that encourage the development of our different identities for the sake of some unspecified inner growth. So much so that constantly re-fashioning one’s ‘selves’ has turned into another globalized business among many others and we have been flooded with manuals that teach us how to cultivate our identities by means of fashionable techniques of cultural creolization and indigenization of alien practices. At the same time some renowned psychology manuals have indicated that in the US half of the female population possesses traits belonging to latent multiples and so does at least one out of ten psychiatric patients (Casey 1991, Littlewood 2004). These observations could lead us to conclude that behavioural patterns which were previously ascribed to the pathologies of a biographical framework of a unique consciousness located in a single body, during the latest wave of globalization have acquired an existence of their own and have become indicative of a subject that is naturally multiple. If so the modern Self – what Geertz (1985: 59) critically depicted as ‘bounded, unique, … a dynamic centre of awareness, emotion judgement and action organized into a distinctive whole’ – might have definitely left the place to an inherently plural Self, constantly seeking for novel forms of embodiment independent from his physicality. Social scientists, who have been traditionally attentive to the correspondences between accelerated social transformation and instances of loss of psychological entirety, have tended to regard the latter as emblematic of the fragmentation of the collective body or of the deficiencies of larger structural formations, if not as locii of a society’s fault lines. The epidemic of dédoublement de la personalité which 1  The psychotherapist E. Tick (2005) for instance, proposes to treat US veterans affected by Post-Traumatic Stress Disorder by working on the different archetypes constituting their souls.. 2  In the classical case of Miss Beauchamp, her therapist, Morton Prince, planned to kill her multiples in order to pursue her real Self. 3  Examples of these therapeutic techniques can be found in Primal Therapy, Psychosynthesis, Transactional Analysis.

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took place in France during the nineteenth century, for instance, was described as a mirror of the fragmentation of modern society (Young 1995). Similarly, the wave of Multiple Personality Disorders diagnosed in Great Britain and in the US during the 1970s was explained by social scientists as an expression at the individual level of wider social processes involving class struggle (Kenny 1986).4 The evidence provided by this body of work would encourage one to suspect the existence of a strong interdependence between the current popularity of the notion of the multiple Self and the specific transformations which are currently taking place in Western societies. This hypothesis has induced me to survey the cultural connotations of the psychological concept in question and investigate the social processes which could be influencing the ways in which we perceive our personal identity at this moment in time. Do contemporary instances of multiplication of the Self represent only a phase in the linear development of Western psychology, a fashionable cultural trend or could they constitute socio-political cases? In the following chapter I will illustrate the results of this investigation. My ultimate objective will not consist in judging the work of authoritative mental health professionals on matters that fall much beyond my comprehension, nor at establishing a causal relationship between our physical and our social bodies or proposing a cure for the healing of our system. Instead I will try to instigate an interdisciplinary conversation on the condition of our present and on its possible pathologies, guided by the philosophical argument that there is no phenomenological difference between the suffering of an individual and that of a society (Malabou 2004). The Multiple Self and Technological Post-humanism Notwithstanding the number of cases of psychological loss of coherence which are part of our social history, it can be preliminarily observed that in Western psychology the concept of the unitary and internally consistent individual bounded by a physical body has occupied a normative position since the emergence of this discipline. At the beginning of the twentieth century Pierre Janet, reflecting on the progression in the understanding of demonic possession through spiritualism, hysteria and anxiety, presciently remarked that Western psychology would have advanced in the comprehension of personal distress from more primitive, naturalistic and folkloric models, symbolically representing man’s mystical participations in an unknown and terrifying cosmos, towards more internalized 4  In Great Britain class identity has been traditionally used to trace individual sicknesses back to the fractures of the wider political body. Differently in the US a person’s mental condition has always been addressed as a personal concern first. The 1970s US epidemic of Multiple Personality Disorders constituted the first significant exception due to the number of cases of sexual abuse of children involved in it and the huge sums of money that were claimed by sex-abuse survivors in the course of therapeutically encouraged legal suits (Littlewood 2004: 170).

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ones, indicative of the rational modern subject distinctively separated from the rest of the universe. In fact his medical conceptualization of a split consciousness, or conscience double, served to encompass in one clinical category a variety of phenomena of loss of psychological unity considered residual of primitive forms of magical thinking and suggestibility.5 Remembering these facts, one could quickly dismiss the current popularity of the image of the multiple Self as a minor interruption in the progression of Western psychology. However, arguments against the unity of the Self have also been raised recently by scientists working in other domains, who argue that this notion is biologically problematic. From their perspective no such thing corresponding to a single Self can be materially identified in our physiological make-up and social action represents an insufficient binding factor for substantiating the hypothesis of a unitary Self (Braude 1991, Dennett 1991, Hacking 1995). In cognitive philosophy, for instance, Daniel Dennett (1991) explains that multiple selves correspond to the multiple functions of the mind, each one located at a different point in space and time, where they generate distinct biographical drafts. The mind, in fact, cannot be regarded as a unitary centre of awareness, for we have no definite proof either of a single canonical experience of the external world or of our representation of it. A similar concept is defended in neuropsychology, where the alterations suffered by a person’s identity in consequence of a localized brain injury or a surgical intervention have been considered a proof of the natural multiplicity of the Self. Recently developed cybernetic theories picture the mind as a distributed network of multiple elementary subsystems working by trial and error, rather than according to a unified design (Littlewood 2002: 178).6 Within their framework the perception of our ‘selves’ as multiple would be generated by the uncountable operations which run simultaneously through these subsystems located all over our bodies. It can be questioned, however, if the success of such models might not constitute an instance of further mechanization of an already hyper-mechanized nature, rather than a useful tool for understanding the Self. After having over-crowded nature with technologies, we are now forcing these onto our bodies, so that these can be transformed into self-sufficient mechanisms. In turn the enhanceability of their functions will grant us the power of permanent self-manipulations, while continuing to feed our illusion that time and space can be endlessly disposed of. Multiple selves, therefore, could be the unwanted off-spring of this dysfunctional relationship between linear time and the time of our bodies:

5  Somnambulism, hypnotism, catalepsy, demonic possessions, telepathy, automatic writing, ambulatory automatism, folk panics and others. 6  These theories have upgraded some computational ideas of the 1960s, which defended the analogy between the computer and the brain. This analogy rested on the twofold assumption that the computer and the brain share the notion of ‘program’ intended as calculus, and that the act of thinking consists in performing calculations (Jeannerod 2002).

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unrelated biographical narratives that cannot be organized into a coherent whole.7 Undoubtedly, one could remind us that with the blurring of the limits between nature and technology, technological post-humanism has become the fashionable framework for thinking the plausibility of multiple selves, with the techno-cultural fantasy of the cyborg as one of its signature products. Cyborgs do not exist; they are all chimeras, theorized and fabricated hybrids of machine and organism. Yet they are all too real: ‘… in short, we are cyborgs’, Donna Haraway (1991: 153) ironically informed us.8 Experts of Artificial Intelligence portray our simulated alters as the newest relocation of the ‘I’, whose every added feature equates with yet another extension of the human faculties. If no clear distinction can be made between a human and a robot, then the notion of a unitary consciousness located in a single body seems to be no longer relevant. Analogously, it does not really matter whether we conceive the Self as one or many, as long as we can technologically enhance it (Littlewood 2004). Indeed we are still very much fascinated by the modern aesthetic dream of recreating the human sensorium:9 an artificial body as prosthetic Gesamtkunstwerk (Connor 2004) where perceptions can be expanded and recombined in unlimited number of ways. This is why we have been busy inventing a powerful lineage of technological interfaces which have extended our psychic surfaces and, like the neat modernist grids, allowed us to play games of infinite exchangeability between ourselves and the world. The latest realization of this modern fantasy has materialized in the reconfiguration of our sensorium in cyberspace, the locus able to realize the wish to multiply our perceptions without the need of multiplying our physical bodies. But, as already diagnosed by Simmel and Benjamin, overexposition to sensory stimulation has numbing effects on the psyche.10 Caught 7  In the description of the writer Don DeLillo: ‘There is a balance, a kind of standoff between the time continuum and the human entity, our frail bundle of soma and psyche. We eventually succumb to time, it’s true, but time depends on us. We carry it in our muscles and genes, pass it on the next set of time-factoring creatures, our brown-eyed daughters and jug-eared sons, or how would the world keep going. Never mind the time theorists, the cesium devices that measure the life and death of the smallest silvery trillionth of a second … We [are] the only crucial clocks, our minds and bodies, way stations for the distribution of time’. 8  ‘By the late twentieth century, our time, a mythic time, we are all chimeras, theorized and fabricated hybrids of machine and organism: in short, we are cyborgs. The cyborg is our ontology: it gives us our politics. The cyborg is a condensed image of both imagination and material reality, the two joint centers structuring any possibility of historical transformation’. 9  From the industrial revolution onwards there has been a great drive towards the development of technologies which would extend the human locomotor apparatus and the nervous system through the application of various prosthetic devices. 10  In a piece on the aesthetic theory of Walter Benjamin, Susan Buck-Morss (1992) reminds us how during the nineteenth century modern subjectivity came to be organized around the need to filter external stimuli and block bodily responses. From her perspective

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in the illusion of being part of a global communication network,11 we may be wandering in a mirror maze of cybernetic worlds unable to dissociate our ‘selves’ as seen from the rest. Here our alters appear empty representations of a serial multiplicity: too weightless and impalpable to be authentic personae. The Multiple Self, the Body and the Environment If in cyberspace the Self has finally emerged from the limitless introspection of modernity, its most intimate sensations and thoughts have been turned outwards in an endless projection of reflecting surfaces. Similarly his body has been emptied out by the media and reduced to a flat image, so that all the boundaries between the Self and the world have come to dissolution. The Self, in turn, has become pathologically incapable of grasping the location of its physical experience in a form which Deleuze has emblematically identified with the schizophrenic’s anguish about the perforation of the surface of his body. There is not, there is no longer, any surface … The first schizophrenic evidence is that the surface has split open … bodies have no surface. The primary aspect of the schizophrenic body is that it is a sort of body-sieve. Freud emphasized this aptitude of the schizophrenic to grasp the surface and the skin as if they were punctured by an infinite number of little holes. The consequence of this is that the entire body is no longer anything but depth – it carries along and snaps up everything into this gaping depth which represents a fundamental involution. Everything is body and corporeal. Everything is a mixture of bodies, and inside the body, interlocking and penetration. (Deleuze 2004)

The panic of the schizophrenic for the loss of his bodily surfaces described by Deleuze echoes Virilio’s concern about the pathologic contiguity between ourselves and the world which is caused by the intolerable immediacy of our shared tele-existence: a contemporary form of alienation that has catastrophically polluted the life size of our experiences. In the immobility of this tele-matic existence characterized by continuous interfaciality, we might have been engorging our ‘selves’ with fictional others evoked through the pseudo-powers of our tactile tele-presence (Virilio 1997: 28) in the vain attempt of making our real body coincide with the ubiquitous fictional bodies of today’s electronic media. To any attentive observer these diminished simulacra look like any other product on our market shelves: serially manufactured in the name of unlimited choice and this would explain the neurasthenia epidemic that exploded during that period of time and the huge progress in the development of techniques for anesthetizing the body. 11  The philosopher S. Žižek (2008: 29) in analyzing the illusoriness of being in a global communication network, concludes that in cyberspace we are like a Leibenizean monad: we mirror the entire universe without a single window open onto external reality.

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mass consumption. Indeed the incontinence of certain MUDs12 users resembles very much the voracity of today’s consumers immersed in the all-you-can eat advertising culture: both seek reassurance in a self-consuming kind of obesity which will ultimately lead them to disappear in search of unobtainable fulfilment. Reflecting on these phenomena of loss of bodily surface, one could suggest that the spectacle of impassionate battered and mutilated bodies, which today are frequently shown on televisions series and movies, can be diagnosed as a symptom of this anguish for the loss of our physical contours and a longing for its palpable materiality, which we attempt to violently achieve by making this the object of repetitive assaults. One could add that it is not a coincidence that many individuals today experience an increasing obsession with the definition of their bodies and a surging anxiety about their loss of shape. But while the aesthetically enhanceable body continues to be campaigned as the self-empowering choice which is conducive to the realization of the idyllic house for our true Self, our real bodies remain unacceptably different from the fictional bodies which are fetishized in the media. The increasing diffusion of practices such as body-piercing, scarification and tattooing clearly manifests a generalized desire to regain contact with our physicality and to erect the consistency of our bodies back on a world where these are perceived as being volatile as images. As explained by the psychiatrist A. Favazza (1996) the self-perforation of the body is the ultimate violent resort to cope with the loss of one’s boundaries, a way to retrieve some form of selfcohesion through pain.13 The terror of a rupture of the physical locus of experience causing the dispersion of the Self does not exclusively concern our bodies. During the last decades many sociological studies have highlighted in contemporary Western culture a diffused necessity to attune the Self to the prevention of risk coming from the environment (Beck 1992, Sennett 1998). Interestingly, many of the Multiple Personality Disorder cases which were reported by American psychiatrists during the 1970s and the 1980s, when environmental concerns actually became global, coincided with reports of sexual abuse committed by extra-terrestrial kidnappers (Jaroff 1993, Mack 1994, Bryan 1995).14 In 1994 the American psychiatrist J. Mack publicly declared that the abduction stories told by his Multiple Personality Disorder patients manifested at their core an anxiety with the preservation of life on earth at a time when this was 12  MUDs, or Multi-User Domains, are real-time virtual worlds where multiple players, having assumed fantasy roles, meet to create stories. 13  The diffusion of syndromes related to the misperception of the body, like body dysmorphic disorder and apotemophilia can be regarded as an extreme pathologic correlate of these developments: our bodies’ demand for the ultimate manipulation which will finally make them perfect. 14  Curiously these aliens appeared initially green in colour, while during the Civil Rights movement became grey if not much darker, while at the apex of the feminist movement manifested an interest in performing gynaecological examinations (Bryan 1995).

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profoundly threatened. Certain instances of multiplication of the Self could thus be related to our pressing environmental concerns about incumbent planetary catastrophes: unable to take any drastic action which could prevent these from happening, we spend time indulging in the cultivation of apocalyptic fantasies where our species is infected by aliens harbouring their offspring into our bodies and our civilization is brought to an end by asteroids precipitating from unknown corners of the universe. Alternatively, we dream about ways of experiencing extraordinary moments of mystical connection of our Self with nature. Oblivious of our Western spiritual resources, some of us hope to achieve them through rituals of self-transcendence borrowed from ancient Asian religions; others turn to antianthropocentric ecological philosophies which defend, through different logics, a non-hierarchical relationship between man and nature. Advocates of evolutionary epistemology and deep ecology, for instance, theorize the existence of a nonhuman larger immortal Self, a kind of higher consciousness, which collapses the notion of the autonomous ‘I’ in a wider universal category. Critical of these positions, the philosopher Žižek (1997) poignantly remarks that the defence of such a radical anti-anthropocentric notion of the subject paradoxically ends up charging contemporary man with the duty of subordinating the interests of the entire human species to those of other forms of life while elevating his powerful Self to the status of sacrificial subject of the biosphere par excellence. All in all we might here be facing an old acquaintance: the uncanny revenant of the Cartesian cogito disguised under the attributes of yet another universal Self. Though this subject understands itself to be one among the many elements of a natural world which is indifferent to human interests, it still considers itself greater than it, for it continues to perceive in its folds the reflexes of its knowledge. If it were able to proclaim its manifesto, this would probably sound remarkably similar to one of Deleuze and Guattari’s grievous pronouncements: [I] make no distinction between man and nature: the human essence of nature and the natural essence of man become one with nature in the form of production or industry, just as they do within the life of a man as a species … man and nature are not like two opposite terms confronting one another rather, they are one and the same essential reality, the producer-product.15

The Postmodern Self The image of the multiple Self with its autobiography of multiple, often colliding drafts, is obviously connected with a certain conceptualization of the Self which has become popular with postmodernism. In illustrating the changes undergone by 15  The original quote starts with a ‘we’ but I decided to change it to an ‘I’ in order better express my idea. Deleuze, G. and Guattari, F. 1983. Anti-Oedipus: Capitalism and Schizophrenia. Minneapolis, MN: University of Minnesota Press,. 4–5.

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the notion of the Self during postmodernity,16 the psychologist K.J. Gergen (1991) explains that the characteristically frenzied pace of this period has obliged us to entertain multiple relationships and play different roles in society, all of which have progressively saturated our authentic Self. As a result we now find it extremely difficult to sustain a sense of coherence about who we are. This process of social saturation according to Gergen has also challenged previous understandings of the Self, displacing the modern and romantic connotations of this concept and turning it into a multiplicity of incoherent and unrelated languages. For everything we know to be true about ourselves, other voices within respond with doubt and even derision. This fragmentation of self-conceptions corresponds to a multiplicity of incoherent and disconnected relationships. These relationships pull us in myriad directions, inviting us to play such a variety of roles that the very concept of an authentic Self with knowable characteristics recedes from view. ‘The fully saturated Self becomes no Self at all. To contrast with the modern and romantic approaches to the Self, I shall equate the saturating of self with the condition of postmodernism’ (Gergen 1991: 6). Though the Self depicted by Gergen has to cope with the affection of multiphrenia, which he attributes to the consumption of a myriad of self-signifiers, the main connotations which the psychologist attributes to it can be said to be positive overall, because of the liberating possibilities that this subject enjoys in these postmodern times. Nevertheless it needs to be remarked that, even though Gergen does not equate multiphrenia with a splitting of the mind or any other specific symptom of a mental illness, his descriptions of this condition present several similarities with the symptomatology of cases of loss of coherency of the Self presented in popular psychology books. Of course the story of the postmodern Self, the cultural index of our epoch born out of fast-evolving communication technologies, multinational hyper-capitalism and our sense of the limits of Enlightenment rationality (Lather 1994), cannot be equated with that of the saturated Self as described by Gergen. Other strands of postmodernism, in their battle against modernist metaphysics and its classical concern with reality (Baudrillard 1995), have contributed to reducing the Self to an image which can be spotted here and there in a hyper-real world of which we need to say no more. Abruptly sparkling before our eyes in moments of public display of the personal, the postmodern subject neither possesses a meaningful presence to which one can coherently relate, nor any defined essence one might bear on, but it is a plethora of unlimited possibilities of being that can be picked and chosen like the products on a supermarket shelf. We can see it on display in the media, where accounts of multiple selves proclaiming their liberation seem to have put a definite end to the crisis of the embattled Self of modernity. Unfortunately what 16  Gergen qualifies postmodernity as a period in which ‘the concepts of truth, objectivity, and knowledge, the very idea of individual selves - in possession of mental qualities – is now threatened with eradication’ Gergen, K.J. 1991. The Saturated Self: Dilemmas of Identity in Contemporary Life. New York: Basic Books.

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happened was that this victorious ideal type of Western globalization, numbed by binge consumption of self-signifiers mistaken for self-liberating activism (Denzin 1991) progressively lost any sense of mastery over its affairs. Invaded by its own doubles, it has been apocalyptically condemned to implode into black holes of mere signposts of the real (Baudrillard 1995). The falling trajectory of the postmodern Self indicates that by despising the grand narratives of self-constancy and fostering a general political apathy, the advocates of this subject have effectively purged of meaning earlier forms of subjectivities and deprived us of any instrument we could solidly rely on for recounting the tale of who we are and what is happening to us. Masked in acts of reflexive irony and playful probing of one reality after the other in the attempt to supersede all ideology critiques, they have transmitted to us the ill impression that no deep subjectivity is possible anymore (Eagleton 2007) while the actual achievement of new better selves proclaimed by most of the advocates of this subject has been de facto continually deferred (Falk 1994, Littlewood 1997). Apparently the only thing they have left us is a yearning for unattainable moments of seclusion and re-centring of one’s persona, symptomatically expressed through the jingles of identity discourses. Though we might have finally come to terms with the impossibility of the modern Self as a reflexive project (Giddens 1992) we are clearly unhappy with the flux of postmodern selves. In reality since the collapse of a phase of capitalism which was essentially performative and auto-referential (Glucksmann 2009) Western societies have recognized the problematicity of many of the economic and political presuppositions of the postmodern Self and reached the conclusion that these have reduced the lives of many people to an appendix of a global market ruled by signs and spectacles. Therefore, they now refuse to be perceived as two-dimensional affectless surfaces, where ‘signifiers lord it over signifieds’ (Eagleton 2007: 38) and see themselves in the midst of a massive haemorrhage of meaning made worse by the present economic crisis. Stuck between the need for major normativity and the defence of pluralism and personal self-transformation, however, they are unable to elaborate a proper ‘cognitive-mapping’ (Jameson 1991) which would lead them out of the impasse. Their citizens, deprived of opportunities for social mobility and increased material prosperity, have lost faith in the possibility of unlimited managerial self-development and now feel increasingly pessimistic about their future, over which they no longer have control. Uninspired by history, they have opted for fuelling their gothic imagination in a fashion which much recalls the cultural response given to the nineteenth century epidemics of pathologic multiplication of the Self. Stories of attacks against humanity by vampires or zombies17 which suddenly emerge out of nowhere contain evident allusions to the terrorizing loss of material and spiritual resources unexpectedly inflicted on many people by the recent collapse of the world economy. These, while offering a palliative 17  One could think about the recent success of sagas such as Twilight, The Vampire Diaries or The Return of the Living Dead.

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encounter with something eternal in a pathologic reality where social change and self-manipulation have gone out of control, provide a perfect displacement for their fear of being contaminated by foreign others intruding their agencies and controlling them from within. Such neo-Romantic responses (Ellenberger 1970) are not new in the history of Western countries, for who could not remember the UFO abduction epidemic that exploded in the US during the Cold War or the hysteria epidemic in a eighteenth century France? But what are the real demons that these fantasies try to exorcise? Perhaps it is time to reject those theories which imply that ‘self-reference, self-concern and definitions of self-worth are no more authentic than ostensible realities of television commercials’ (Holstein and Gubrium 2000: 61) and it is time to articulate a shared understanding of experiential realities of multiplication of one’s persona and consider whether the multiple Self could be an expression of some form of estrangement imposed on us by certain social forces. The Multiple Self and Neo-liberal Capitalism Many theorists have investigated the similarities existing among the scientific languages currently used to describe our brains, which support the inherent multiplicity of the Self, and the ways in which we perceive ourselves as subjects and neo-liberal capitalism. Deleuze and Guattari (1983) for instance, have suggested that the concept of the brain defended by technological posthumanists is one more instance of naturalization of the socio-political conditions we are living in, carried on through the authority of certain scientific discourses. Boltanski and Chiapello (1999)18 have discovered the existence of some disturbing commonalities between the current organization of capitalism and the scientific representations of our neurons: according to the two sociologists the notions of network and connectionism are now dominant in the neuro-sciences because they correspond to the main organizational features of post-Fordist capitalism. Following the research path they laid out in Le Nouvel Esprit du Capitalism (1999) the French philosopher C. Malabou (2004) has shown how the medical idioms of the ‘cerebral’ mirror the idioms of post-Fordist organizations. Looking at the numerous discoveries made in the neurosciences during the last decades she critically points out that we still know very little about our inner selves and that ‘the neural man hasn’t got a conscience yet’ (Malabou 2004: 11). One may not entirely agree with the arguments advanced by these theorists and reject tout court the possibility of any causal relationship between neo-liberal capitalism and 18  In their work Le Nouvel Esprit du Capitalism Boltanski and Chiapello (1999) have explained that each form of capitalist production, as it develops, is responsible for the mobilization of determined concepts in the fields of scientific knowledge. With regard to post-Fordist capitalism, they observe that this is peculiarly organized in networks and that ‘connectionism’ can be considered its prominent quality.

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the popular image of the brain as a network of multiple functions constituting the Self. Nevertheless one should at least acknowledge the signs of some kind of semantic confusion which is worth investigating further. In the field of psychology Alain Ehrenberg (1998) who has studied large organizations such as multinational companies and international institutions, has discovered a great resemblance between their characteristics – lack of hierarchy, absence of distinct localized conflicts and unlimited flexibility – and the psychological qualities which ideal employees today are required to possess. Ideal employees, in fact, are expected to plan their existence like a business enterprise and orient it towards practical goals and material achievements. In order to pursue this objective, they must maintain a high level of flexibility and be able to keep up with a fast-moving environment. Ultimately, they must shape their ‘being in the world’ according to the changing circumstances of the economic system. These phenomena can be immediately associated with the problematic diffusion of thymus-regulatory remedies in our societies: these drugs, in fact, are usually ingested to improve the mood, facilitate action, boost confidence and, basically, allow an individual to present the right personality for every occasion (Fukuyama 2003, Malabou 2004). Multiple selves, therefore, appear as the unhealthy consequence of a life conducted within certain types of organizations highly diffused in our globalized world: a loss of entirety more or less voluntarily undergone by individuals in order to be able to survive within these environments rather than a creative option representing the autonomy of the Self. But large international organizations are not the only place where this loss of entirety can be spotted. The sociologist Robert Castel (1995) in fact has observed the increasing presence in our societies of subjects whose personae fluctuate like ghosts without being able to settle anywhere because they are prevented from playing a significant part in the consecrated dynamics of social exchange. One may glimpse their undefined silhouettes wandering at the borders of the working system: they are inhabitants of banlieues, workers surviving on minimum wage, young people moving from one internship to another in desperate search of a professional identity, illegal immigrants looking for a new self-image in their host country. Indeed the correspondences between the features of the current socio-economic landscape and the popular image of the multiple Self are striking. In a scenario characterized by the difficulty to experience conflict and by the fuzziness of the rules regulating the economic and the political, loss of coherence, schizoid divisions of one’s customary Self and loss of agency seem more and more unavoidable affections for the contemporary subject rather than healthy choices of a globalized Self. Returning to the work of the sociologists Boltanski and Chiapello (1999), their analysis of the third spirit of capitalism, which illustrates the novel features characterizing its ideological functioning and the ways in which this shapes the self-perception of individuals, may help us to shed further light on many of the connotations of the concept of the multiple Self. Post-Fordist capitalism, having absorbed in its normative mechanism the logic of artistic creativity and authentic realization of the Self, demands individuals to be constantly flexible, mobile,

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enterprising and innovative. Like nomads with no ties, they must creatively move from project to project in a trajectory that shows adaptive indeterminacy and, according to the ideological teaching of capitalism, all the necessary qualities for high employability. In an analogous kind of critique of globalized capitalism, R. Sennett (1998) suggests that this has originated in the individual instances of corrosion of character,19 meaning by this expression the progressive diminution of the longterm aspects of our emotional experience. While character needs to be forged through loyalty, responsibility, mutual commitment and delayed gratification for the pursuit of long-term objectives, the functioning of post-Fordist capitalism encourages individuals to focus on short-term projects, immediate satisfaction, Schumpeterian creative destruction, flexibility and risk. It obliges them to be infinitely adaptable and capable of reengineering their being in the world according to the requirements of the economic system, rather than maintaining a certain fidelity to their ‘selves’, if they wish not to be excluded from the developments of an economy beyond their control. In this state of affairs uncertainty, which Sennett sees as deeply interwoven in the practices of capitalism, while in the past was always linked to circumscribed occurrences in human history like wars, famines, natural disasters, with the rise of globalized capitalism has turned into a condition existing without any circumscribed historical disaster that could somehow explain it (Sennett 1998: 31). Autobiographical narratives, in turn, can no longer hold together fluxes of unforeseen events happening without any clear logic, such as the current economic crisis, so they lose coherence, unity, authorship. The Self, deprived of auto-control, is intruded upon by external wills that plagiarize and steal its moral agency while providing him occasions for illusory multiplicity. In addiction failure, the greatest taboo of our time, has become the remarkable mastering elision of many autobiographies (Sennett 1998: 118) which opt to portray a subject creatively seeking to express itself through unrelated forms of embodiment, rather than to narrate a broken course of life. Multiple selves, therefore, can be regarded as pathologic instances of suffered inadequacy of particular identities to themselves, caused by the experience of a kulturlos universality (Žižek 2008: 68) whose anxiety for de-centredness has left people incapable of sustained life narratives.20 Terry Eagleton (2007: 37) who equally qualifies the organization 19  Sennet (1998) inspired by the work of Riesman (1950) decidedly differentiates the concept of character from that of personality. Specifically, he explains that the first is much more encompassing, for it refers, as Horace first taught us, to a person’s connections with the world. The second on the other hand, concerns desires and sentiments that mature in one’s inner Self and have no necessary link with external reality. Sennett R. 1998. The Corrosion of Character. The Personal Consequence of Work in the New Capitalism. New York: W.W. Norton & Company Inc. 10. 20  In the theorization of Žižek (2008: 132) globalized capitalism, which has become universal by accommodating itself to different kinds of civilizations, has undermined all

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of advanced capitalism as a condition of progressive deprivation of meaning, recognizes that this, by engaging individuals subliminally, at the level of visceral responses rather than through reflective consciousness, has been expunging all traces of deep subjectivity in a homogenizing fashion that is generally disguised as cultural pluralism. In this unhealthy scenario individuals are schizophrenically expected to be both mere subjects of consumption and ethically responsible, selfdetermining citizens actively making choices in their lives (Eagleton 2007: 39). Indeed, since the collapse of the socialist economies and the expansion of neoliberal capitalism we have observed a significant political enhancement of the autonomous subject through increased individual responsibilities in an overregulated world, where failures are categorized as haphazard accidents caused by someone’s negligence rather than as systemic problems. In the US, for instance, social failure has been typically explained as the consequence of a competitive disadvantage of the individual which could be legally redressed, rather than as the consequence of inequality. By the same token strategic self-management has been regarded as the practical tool available to any citizen wanting to improve his social condition and become the perfect American citizen, while American identity has been historically presented as the fulfilment of an inherent potentiality leading to a positive transformation, often of a financial kind. All these observations encourage us to suspect that at the heart of contemporary phenomena of loss of unity of the Self could in fact be some kind of hermeneutic deficiency implying the perception of social problems as individual fatalities. In relation to this the French philosopher C. Malabou (2007) has observed how today’s victims of various socio-political traumas are summarily described as possessing the same psychic profile of people who have suffered an accident which has irreversibly damaged their brain: their psychic lives have lost the ability to organize their biographies in a coherent whole.21 This equalization of the psychic reactions of differently traumatized people, mainly identified as an inability to recover the past and to explain the problems which triggered the changes in the economy of the psyche, according to Malabou means that we might be dealing with a dangerous combinations of nature and politics, which hides the political significance of contemporary forms of violence behind the impersonal character of different kinds of traumatic episodes and their apparent lack of authorship. Perhaps it is this very experience of a generalized lack of sense which needs to be therapeutically addressed in order to heal the current inability of many people to

life-worlds, cultures and traditions, gradually corroding their particularity from within in order to impose its truth-without-meaning of the ‘Real’ of global markets mechanisms. 21  This transformation is explained in medical terms as an unforeseen irreversible alteration of the cerebral mechanisms responsible for the regulation of the emotions, not necessarily categorized as noxious: usually a variation in the dynamic of the cerebral functional system, which can happen, for instance, at the level of the hippocampus, of the amygdale, of the pre-frontal cortex.

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narrate their life as a meaningful, coherent story. And such a task is obviously too complex to be assigned exclusively to Western psychology. Conclusion When I developed this chapter, I did not intend to put into question the reality of some biological data on our brains or the conceptualization of mental pathologies, but rather the choice of framework through which these can be interpreted, and how independent this framework is from social processes. In this respect the notion of the multiple Self as advocated by certain fashionable psychological trends has proven to be highly unsatisfactory for understanding the experiences of subjective loss of entirety which can be observed in Western societies, especially during this dramatic phase of their history. This phase has not terminated yet: even though both global hyper-capitalism and the notion of a multiple Self have started to crack under the burden of their polysemic self-refractions, no alternative framework capable of replacing them has so far emerged. I would like to conclude this chapter with some of Malabou’s wise reflections on one of the greatest challenges ahead of us: the fundamental issue that every one of us must face today is not to become some kind of replica of a caricaturized world. Refuse to be the flexible individuals able to conjugate permanent selfcontrol with the ability to modify one’s persona on demand. Accept to lose our temper from time to time. Be able to negate our acquiescence to a culture that obliterates all the conflicts in the name of the supreme qualities of adaptability, flexibility and docility, which are marketed, more often than not, with the true objective of perpetrating exploitation. Today, more than ever, it is fundamental to be able to think in a balanced way about the sculpture of one’s identity and its differentiation. After all, to exist, Malabou says, is to be able to change one’s difference while respecting the difference of change: the difference between a continuous transformation, without adventure, negativity, and a change that can be formative, that can tell an actual story as it happens, with fractures, elisions, conflicts and dilemmas.22 References Baudrillard, J. 1995. The Gulf War Did Not Take Place. Bloomington: Indiana University Press. 22  In the original French text: ‘Exister, c’est pouvoir changer de différence en respectant la différence de changement: différence entre un changement continu, sans limites, sans aventure, sans négativité et un changement formateur, qui en effet raconte une histoire effective et procède par ruptures, conflits, dilemmes’ (Malabou, C. 2004. Que Faire de Notre Cerveau? Paris: Bayard, 159–60).

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Beck, U. 1992. Risk Society: Towards a New Modernity. London: Sage. Boltanski, L. and E. Chiapello. 1999. Le Nouvel Esprit du Capitalisme. Paris: Gallimard. Braude, S.E. 1991. First Person Plural: Multiple Personality and the Philosophy of Mind. London: Routledge. Bryan, C.D.B. 1995. Close Encounters of the Fourth Kind: Alien Abduction, UFOs Witnesses and Scientists Speak Out. London: Weidenfeld & Nicholson. Burk-Morss, S. 1992. Aesthetics and Anaesthetics: Walter Benjamin’s Artwork Essay Reconsidered. October, LXII. 3–41. Butler, J. 1990. Gender Trouble: Feminism and the Subversion of Identity. New York: Routledge. Casey, J.F. 1991. The Flock. The Autobiography of a Multiple Personality. New York: A.A. Knopf. Castel, R. 1995. Les Métamorphoses de la Question Sociale. Une Chronique du Salariat. Paris: Folio Essais. Connor, S. 2004. The Book of Skin. London: Reaktion. Deleuze, G. 2004. The Logic of Sense. London: Continuum. Deleuze, G. and F. Guattari. 1983. Anti-Oedipus: Capitalism and Schizophrenia. Minneapolis: University of Minnesota Press. DeLillo, D. 1997. Underworld. London: Picador. Dennett, D.C. 1991. Consciousness Explained. New York: Little, Brown and Co. Denzin, N. 1991. Images of Postmodern Society: Social Theory and Contemporary Cinema. Newbury Park: Sage. Eagleton, T. 2007. Ideology. An Introduction. London: Verso. Ehrenberg, A. 1998. La Fatigue d’être Soi. Dépression et Société. Paris: Odile Jacob. Ellenberger, H.F. 1970. The Discovery of the Unconscious. New York: Basic Books. Falk, P. 1994. The Consuming Body. London: Sage. Favazza, A. 1996. Bodies Under Siege. Self-mutiliation and Body-modification in Culture and Psychiatry. Baltimore: Johns Hopkins University Press. Fee, D. 2000. Pathology and the Postmodern: Mental Illness as Discourse and Experience. London: Sage. Frie, R. 2003. Understanding Experience: Psychotherapy and Postmodernism. New York: Routledge. Fukuyama, F. 2003 Our Posthuman Future: Consequences of the Biotechnology Revolution. London: Picador. Geertz, C. 1985. Local Knowledge: Further Essays in Interpretative Anthropology. New York: Basic Books. Gergen, K.J. 1991. The Saturated Self: Dilemmas of Identity in Contemporary Life. New York: Basic Books. Giddens, A. 1992. The Transformation of Intimacy: Sexuality, Love and Eroticism in Modern Societies. Cambridge: Polity.

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Chapter 8

Possible Explanations for Increasing Antidepressant Treatment in Modern Society Margrethe Nielsen and Gunnar Scott Reinbacher

The primary aim of this chapter is to analyse possible explanations that could add knowledge about the increased usage of antidepressants in modern society, using Denmark as an example. We describe the development in usage of newer antidepressants in the European countries in the light of the socio-economic and societal development with the ideal of self-realization and emphasizing such individual characteristics as flexibility, mobility, innovation, enterprise, willingness to change and adaption and vigorousness. The period we focus on is from 1988 and up to today, which corresponds to the period characterized by increasing use of antidepressants, a period that also encompasses changes in the way the depression diagnosis is made, with respect to the criteria for the disease but also the development of diagnostic tools. The pharmaceutical industry has improved their marketing of the products through awareness campaigns of the disease and its treatment which is communicated throughout society. Through three different but inter-related sociological concepts we identify the strongest explanations. First the concept of medicalization; how powerful groups in society such as the government, the pharmaceutical industry, the medical professionals and many other groups are influencing citizens and make them use drugs much more than needed. Second the concept of governmentality: how relationships between government and citizens, as well as health professionals and patients are changed through new forms of power. Third the concept of biopolitics and molecular biopolitics: focusing on how modern medical science monopolizes expertise in social life extending even to the capitalization of life itself. Over the last approximately 20 years there has been an increase in the use of antidepressants. The newer antidepressants, specific serotonin reuptake inhibitors (SSRIs) were introduced on the market in the late 1980s in the European countries and later on also other specific reuptake inhibitors were introduced (Rose 2009). The Organization for Economic Co-operation and Development (OECD) has shown an increasing usage of antidepressants in all the OECD countries over a period of two years. The overall increase in usage of antidepressants in all OECD countries together is 40 per cent from 2000 to 2005 (OECD 2007). Rose has shown the same development in the European countries expressed as a doubling in prescriptions of antidepressants over a 10-year period from 1990 to 2000 and a 14fold increase in prescriptions of the newer antidepressants of the type SSRI (Rose

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2009). Nielsen and Gøtzsche have shown the same development in Denmark over a 30-year period, with a rather stable usage of other psychotropics but newer antidepressants and the group of benzodiazepines, which are used as anxiolytics or hypnotics (Nielsen and Gøtzsche 2011). Nielsen’s research shows that in Denmark, between 1994 and 2010, the use of antidepressants, measured in defined daily doses (DDDs) per 10,000 persons, as a whole has increased from 15 DDDs in 1994 to 85 DDDs in 2010; the use of SSRIs has increased from 8 to 55 DDDs; the consumption of other newer selective reuptake inhibitors have increased from zero to 22 DDDs. The use of older nonselective monoamine reuptake inhibitors and monoaminooxidase inhibitors (MAOIs) has remained unchanged during this period. The increase in use of antidepressants is found within the newer antidepressants. Model for Utilization of Drugs We used a modified model based on a model proposed by Andersen (1995) for exploring the causes for the utilization of health care services, in this case utilization of antidepressants. Even though it was developed as a more general model for explanation of utilization of health care services, Andersen’s model could encompass possible factors which influence utilization of antidepressants. Andersen’s model consists of three levels: First, there is an upper level, encompassing the ‘social and political environment’ – for example the societal health perceptions, health politics and legislation. Second, there is a middle level, encompassing ‘supply’ factors, such as the pharmaceutical industry manufacturing and promoting their products, and general practitioners and psychiatrists prescribing antidepressants. On this level the working environment, professional attitudes towards health, illness and treatments, and professional guidelines could influence the prescribing pattern. Third, there is a ‘demand level’, which means the population and the individual person with subjective and objective needs. Income, health insurance status, personal values concerning health and illness, knowledge about disease and treatment and attitude toward health services could be some of the factors on this ‘demand’ level that could influence utilization. All these are factors from the three different levels that could influence the utilization of drugs and antidepressants (Andersen 1995). Social and Political Environment Level In the 1960s there was on the one hand the anti-psychiatry movement and on the other hand the psychoanalytic dominance in psychiatry. But within a few decades the perception of the brain’s function changed to the idea of chemical communication between neurones and that the activity of neurotransmitters and receptors could influence behaviour. This grounded biological psychiatry and

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cleared the way for the pharmaceutical industry researching and developing treatment possibilities for depression. This added new theories and the ‘receptors’ came into focus, being able to recognize certain amines and which were either activated or blocked by the newer antidepressants. In this image neurotransmitters and receptors were imagined as locks and keys. It gave rise to the picture of smart drugs that could specifically lock into identified receptors being specific in their target and with a low adverse effect profile (Knapp et al. 2007, Rose 2009). Serotonin was believed to be the neurotransmitter linked to depression. Research, however, has never been able to support this theory, but it is still widely accepted (Valenstein 1998). The prevalence of depression in the general population has been assessed by several sources to be around 5 to 10 per cent (Andrade et al. 2003) but also numbers up to 20 per cent have been proposed. It should be supposed that the prevalence of depression would be more or less constant, but the changing prescription patterns show that something is going on. In a period of 25 years the main indication for prescribing psychotropic drugs was anxiety, but this indication decreased as prescribing of antidepressants increased and prescribing of benzodiazepines decreased. It could be that depression is more common than previously recognized and that effective drugs with more acceptable adverse effects profiles makes more people want to be treated for their depression. The World Health Organization (WHO) published a report in 2001 claiming that depression affects more than 340 million people worldwide and predict that: By the year 2020, if current trends for demographic and epidemiological transition continue, the burden of depression will increase to 5.7% of the total burden of disease, becoming the second leading cause of DALYs lost. Worldwide it will be second only to ischaemic heart disease for DALYs lost for both sexes. (WHO 2001, 30)

This has been questioned by the psychiatrist and historian David Healy (2003) and others. ‘Nobody seemed to question how a society could have become so depressed so fast. Depression was now being touted as a serious illness; but the emergence of a comparable epidemic of any other serious illness on this scale would have led to serious questioning as to what had happened. There appeared to be no such questioning in the case of depression’ (Brody 2007). In 1987, just before the SSRIs were launched into the market, the Diagnostic and Statistical Manual of mental diseases (DSM) was revised and published and carried forward the major changes that were already started in the third edition of the manual (American Psychiatric Association 1987). The DSM forms the background for research in psychiatric diseases and further was also in the beginning of the 1990s harmonized with the International Classification of Diseases (ICD-10) and forms the basis for diagnosing psychiatric diseases. As a new approach to mental illness, symptoms rather than speculations about cause–effect mechanisms were described as the means to substantiate the diagnosis, and this change has had a

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major influence on the thinking about psychiatric diagnoses. New disorders were included and existing disorders were ‘exploded’, for example anxiety neurosis was split into seven new disorders: agoraphobia, panic disorder, post-traumatic stress disorder, obsessive–compulsive disorder, generalized anxiety disorder, simple phobia and social phobia (Lane 2007). The symptom-based approach has been criticized for creating diseases, in so far as normal life distress and sadness can today be classified as mental disease and thus be treated with drugs (Horwitz and Wakefield 2007). It has been criticized that the criteria for major depressive disorder, as described in DSM-IV and in ICD-10, have been changed in a direction where more and more normal life conditions could be picked up as major depression (Horwitz and Wakefield 2007). The symptoms described as criteria for depression are now broad and common, for example fatigue, insomnia or diminished ability to concentrate, and do not distinguish between a disorder and expected reactions to a situational context, for example the loss of a beloved person (Horwitz and Wakefield 2007). Many of the European national health authorities now recommend screening for depression (Sundhedsstyrelsen 2007). The recommendation of screening finds support in WHO-Five Well-being Index and in several national guidelines, for example the National Institute of Clinical Excellence (NICE) guidelines from the UK (NICE 2007) and the recommendation from the US Preventive Services Task Force (US Preventative Services Task Force 2002). From the WHO report Mastering Depression in Primary Care it appears that screening for well-being should be a standard procedure, in the same manner as screening for hypertension, and that the WHO-Five Well-being Index could be used for screening all people for depression or reduced quality of life. This is though a recommendation, which goes beyond the available evidence. As it is recognized that there are problems with the evidence for general screening of the whole population the recommendation is screening in primary care of several subgroups that should be at high risk of depression. It is expected that screening will encompass approximately one million persons in Denmark (Lundh 2008). The rationale behind the recommendation of screening is that depressive disorders are a major health problem and that many disorders remain undetected. But there is also a current discussion about over (and under) treatment of depression and the risk of over-diagnosing depression (Mitchell et al. 2009, Mulder 2008). However, the recommendation of screening of risk groups for depression builds upon little evidence. It appears from the Danish guideline (Sundhedsstyrelsen 2007) that the evidence is on level IIa, corresponding to ‘nonrandomized controlled studies. In the NICE guidelines (2007) the recommendation of screening of high-risk groups is built on the evidence of level C, corresponding to IV, which is ‘expert committee reports or opinions or clinical experiences of respected authorities’. In the US preventive Task Force report (US Task Force 2009) screening of the population is a B recommendation, which means that there should at least be fair evidence that the service improves important health outcomes and that benefits outweigh harms. Fair evidence is classified as evidence

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which is sufficient to determine the effects on health outcome, but that the number, quality or consistency of the individual studies, generalizability to routine practice, or indirect nature of the evidence on health outcomes, limits the strength of the evidence. However, it is not clear how it can be concluded that benefits outweigh harms when the US Task Force describes the potential harms of screening and treatment: ‘The potential harms of screening include false positive screening results, the inconvenience of further diagnostic work-up, the adverse effects and costs of treatment for patients who are incorrectly identified as being depressed, and potential adverse effects of labelling. None of the research reviewed provided useful empirical data regarding these potential adverse effects’ (US Preventative Services Task Force 2002). A Cochrane review (Gilbody et al. 2005) showed a minimum of impact of screening on the detection of depression. However, some smaller studies using a two-stage selective procedure, whereby only patients scoring above a certain threshold were entered into the trials, suggested some effect. There was no evidence of clinical effect on the outcome of the depression (Gilbody et al. 2005). There are conflicting opinions on systematic screening on the level of the general population, but there seems to be a ‘general agreement’ that screening of high-risk groups is recommendable. However, relatively little is known of the impact of screening, particularly in primary care, on outcomes for those identified. The price of the drugs influences their usage. Most EU countries use some kind of price control as a means to reduce pharmaceutical expenditure, which could include reference pricing, delay in approval, procedures and restrictions on dispending and prescribing, price freezing, and reimbursement systems. As price controls differ between EU countries, ‘parallel trade’ with intermediaries buying pharmaceutical products in countries with lower prices and selling them in countries with higher prices is an issue. This could result in different prices of antidepressants in different countries, influencing utilization in the different countries (Knapp et al. 2007). Supply Level The pharmaceutical industry has researched and offered new treatments for depression. The SSRIs were approved for treatment of depression, but slowly other indications were also approved. Today at least eight different indications are approved, and in some countries probably more. Some of these indications include: Major depression, bulimina nervosa, obsessive–compulsive disorder, social phobia, generalized anxiety, panic disorder, prevention of periodic episodes, post traumatic stress. These new indications for SSRIs are an extension of the earlier indication that also cleared the way for increased prescriptions and usage. Compared to earlier antidepressants, for example the tricyclic antidepressants, the newer antidepressants also had fewer and less serious adverse effects and together with a claimed better effect this could be used in the marketing of the newer antidepressants (Nielsen and Gøtzsche 2011).

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In Europe there is a ban on direct advertising of pharmaceuticals to consumers, so the pharmaceutical industry has been forced to communicate their messages in other ways, such as disease awareness campaigns. One that was run in UK was called the Defeat Depression campaign, launched in 1992 by the Royal College of Psychiatrists in association with the Royal College of General Practitioners. The campaign was economically supported by one of the manufacturers of SSRIs (Healy 2003). The campaign built on a two-fold strategy: First to alert physicians and others of the economic burdens of untreated depression and the magnitude of the problem and second to educate the general practitioners to detect and treat depression. A campaign of the same kind was seen in Denmark. It was run by the Psychiatry Association (an association with membership of both professionals and patients) and was also supported by the pharmaceutical industry. It reached the public through a disease awareness campaign on television and reached the general practitioners through their own journal with an advertisement of the drug, another advertisement about an educational video they could get for free about how to detect depression in their patients and a third advertisement referring to the general disease awareness campaign that was also run on television. In Denmark the general practitioners are mainly responsible for the large sales of psychoactive drugs, as 80 to 90 per cent of all drugs are prescribed by them (Bjerrum 2002) and as the vast majority of patients treated for a mental, nonpsychotic condition are treated in general practice (Dansk Psykiatrisk Selskab 2001). Unfortunately, general practitioners rely on the drug industry as their main information source (Schramm et al. 2007) and most doctors believe that the information is helpful for them (Miren et al. 2001) although it is rather clear that this interaction could have negative consequences for the patients because the choice of drug may not be evidence based. Demand Level There is evidence that factors such as poor housing, poverty, unemployment or stressful working conditions are associated with increased levels of psychiatric morbidity. But this seems insufficient to account for the rapid increase in the diagnosis and prescription of antidepressants. Earlier sociological explanations of the increase in mental disorders were, for example, that urban life stressed the individual leading to what was called neurasthenia, or that capitalism isolates the individual, or that patriarchry withheld women from rights and equality. But also these explanations, of anomie and alienation, for example, developed by classical sociology, Durkheim and Marx, for instance, in the late nineteenth and early twentieth centuries, seem insufficient to account for the rapid increase in depression in the late twentieth and early twenty-first centuries (Rose 2009). Giddens (2004) has developed the general thesis that the modern individual is reflexive in its approach to itself and its environment, but with the risk of

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developing social pathologies of modernity. Giddens describes four dilemmas of the modern self, which are: unification versus fragmentation; powerlessness versus appropriation; authority versus uncertainty; and personalized versus commodified experience. Traditions do not determine our lives; it is up to every person to decide their own lifestyle in a world with expert systems. This leaves the individual to orientate in all possibilities given in modern society and to decide how to create a happy and successful life. So on the one hand the individual can choose between all possibilities, and on the other hand the society also builds frameworks, which gives limitations to possibilities. The happy and successful life is understood as a life lived in high tempo and with room for everything. This puts a lot of people in a dilemma and some will fail in their efforts to create a happy and successful life. Ehrenberg (2009) has suggested that depression is the backside of the new individuality. If the individual is unable to live up to the challenges of individual responsibility, personal initiative and active self-fulfilment the risk is depression. In this perspective depression is a social pathology that has originated in modernity and the impossibility to be oneself when markers of identity are uncertain. Depression is a tiredness of being oneself, when being oneself is impossible. As mentioned above the pharmaceutical companies have an indirect influence on the construction and definition of diseases through people involved in the production of the DSM having ties to the industry (Cosgrove et al. 2006). Further, the pharmaceutical companies have invested resources in raising public awareness about underdiagnosed and undertreated problems, like, for example, depression. This has been executed in coalition with other stakeholders like doctors and patients groups (Moynihan et al. 2002). The key strategy is to target news media with stories about the disease, creating fear and worries and to draw attention to the very latest treatment. A part of the campaigns is also to widen up the boundaries for when a condition or distress should be treated or when treatment is possible. Disease awareness campaigns almost always propose the reader or viewer to seek the doctor if any of the mentioned symptoms are present. So in one movement the consumer is made aware of a distress or a condition which is annoying in daily life, is made aware of a possible treatment (and the company that can provide the treatment) and is on the way to the doctor (Cosgrove et al. 2006). Medicalization Medicalization has been described as a process by which everyday experiences and non-medical problems become defined and treated as medical problems. Conrad defines medicalization as a problem ‘defined in medical terms, described using medical language, understood through the adoption of a medical framework, or “treated” with a medical intervention’ and should be understood as a process (Conrad 2007). Some common life phenomena have been medicalized, for example mood and anxiety, menstruation, childbirth, menopause and aging. In this context medicalization is not about assessing whether any problem is a medical

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problem but as much to study the social implications of medicalization. According to Conrad the increase in medicalization can be explained not only by a medical colonization of human life conditions but also a decreased tolerance of symptoms, with social movements and patient organizations advocating for medicalization on the one hand, and the pharmaceutical industry disease mongering as a way to increase profit on the other (Conrad 2007). Psychopharmacology was developed in the early 1950s before there were few effective treatments for severe mental illness. Still people were hospitalized when seriously ill but receiving very little specific treatment for their condition (Paris 2010). In 1952 the first DSM was published containing 106 psychiatric diagnoses. This increased in the second, DSM-II, published in 1968, to 182 entries; in DSM-III (1980) to 265; in 1987 to 292 in DSM-III (Revised) and in 1994 to 297 psychiatric diagnoses in DSM-IV (Conrad 2007). Psychiatric diseases are defined and diagnoses are made by the means of symptoms, because psychiatric diagnoses cannot be based on laboratory findings. Many of the symptoms that are described are normal reactions that we all have and feel in our normal daily life, without being ill (Horwits and Wakefield 2007) like for example fatigue, not being able to concentrate, feeling sorrow. Social phobia is one of the diagnoses that have been promoted by the industry both towards doctors but also towards consumers with a tag line like ‘imagine being allergic to people’ but also with self-tests on the internet, convincing people that they suffered from a disease that was both common and abnormal and that they needed treatment (Maturo and Conrad 2009). Disease mongering has been described by Moynihan as a special form of medicalization, extending the boundaries of treatable illness through alliances between pharmaceutical manufacturers, doctors and patient groups. The alliance is based on company-sponsored symposia and courses, involvement in companysponsored clinical trials, as key-note speakers, marketing, gifts and so on (Moynihan et al. 2002). But patient organizations might also take part in the medicalization process. In a Danish context, for instance, there was an exchange of views between the chairperson for the patient-organization of extreme fatigue and a doctor in a journal, the first arguing for the condition being a disease with a diagnosis and the latter arguing that the condition or distress should be managed in another way and not as a disease. But when a condition is accepted with a diagnosis it is also accepted in the society as a condition that should be taken care of in health and societal systems (Brinkmann 2010). The medicalization thesis as an explanation for the epidemic of depression has recently been developed by Greenberg (2010). The introduction of the new antidepressants, SSRIs, with fewer adverse effects than the older antidepressants, played together with the new diagnostic tools in the DSM-IV, with which general practitioners were able to diagnose more patients as depressive than before. Also the way people were talking about depression changed, because of a new theory that depression was caused by a biochemical imbalance in the brain, specifically lack of serotonin, which could be cured with the new antidepressants. This theory of serotonin deficiency is not evidence based,

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but despite the emphasis on ‘evidence based’ as the benchmark of good practice in medicine, this unsupported theory has had, according to Greenberg, great impact on our current perceptions of depression and its treatment. Abraham (2010) has coined ‘pharmaceuticalization’ as a new term, indicating something more specific than medicalization. Medicalization is when normal life events like depressed mood or anxiety before making a speech in front of an audience is changed to a pathological event with a diagnosis and a treatment. Pharmaceuticalization is an increasing use of pharmaceuticals not only in the case of medicalization but that pharmaceuticals are always the first choice of treatment and are used without cost–benefit analysis and without balancing harms and benefits. This also offers an explanation of the increased rate of treatment that seems to have affected both professionals and lay people. Governmentality What has governmentality to do with explanations of increasing antidepressant treatment in modern societies? Is governmentality an attempt to decrease the use of antidepressants by forcing the population not to use drugs, or is it an attempt to increase the use of drugs? There is no simple answer here. Governmentality is mainly developed as a concept by the French philosopher Michel Foucault in his lectures at the Collège de France during the period between 1977 until his death in 1984 (Foucault 2008), the late period of his life. Governmentality can be understood as the way in which governments try to make the citizens fulfil best policies of governments. It could also be understood as the organizational practices (mentalities, rationalities, demands and techniques) through which citizens are governed. Foucault’s usage of governmentality is strongly connected to the concept of power and in his latest writings connected to power in our selves, not an external power as government, but power ‘subjectivized’, that is internalized, where we, so to speak, perform power as an integrated part of our life. In that sense power of the state has become integrated into our bodies in our selves. In Danish science the term ‘leading our selves’ [selvledelse] is a typical contemporary instance of governmentality. An example of this is the Danish healthy lifestyle campaign KRAM, with its focus on healthy food, exercise and avoidance of smoking and alcohol. ‘Leading ourselves’ has a double meaning. It can be understood positively as the citizens’ ability to organize their own lives, but behind that understanding lays values and demands from society to make us do the right thing as seen from the government side. The citizens are not free citizens in a democratic world, but we act as we are expected to. Or do we? Miller and Rose (2008: 84) talk about ‘the death of the Social’ and ‘the birth of the Community’ as a new trend in modern societies. They chart a transformation from the Social state with all its possibilities, contradictions and problems to a modern well-organized society where we have new relations between the state and the citizens. Citizens are now subjects in a less class-oriented but more

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governed society. In a similar line of argument Dean (2007) focuses on the concept of governmentality in modern societies as neoliberalism. His argument is that governmentality concerns the transformation of sovereignty and power of life and death and how it is integrated to governing liberal–democratic societies. Again in a similar vein, Greenberg (2010) and Fleck (1935) focus on how society produces diseases such as depression. Diseases are a product of how we produce and govern, so that diseases bear the mark of the societies in which they emerge. Fleck demonstrates this in the case of old capitalist societies; Greenberg makes the same argument in contemporary societies. So what we are dealing with here is the fact that society itself provides the background for the structure, amount and distribution of diseases such as depression. Within the perspective of governmentality it would then be possible to explain the increase in use of antidepressants not only by the empirical facts in this article, but also as a consequence of the structure and the way the society is governed. Governmentality, the modern way of governing liberal and democratic societies, is the tool by which the relations between the citizens and the state are handled. Society produces depression and the state makes a lot of regulations on how people should live their lives. These regulations, which have been increasing throughout the last 20 years, taken all together form a system of governmentality. From a sociological point of view the increase in use of drugs may be explained more deeply as an integral part of the development of structures of governmentality in modern societies. The problem for governmentality is that to regulate peoples’ behaviour can be in contradiction to the idea of free people in a free democratic society, and in that sense we are dealing with an ethical problem on a state level. It is complicated for the government in a democratic society to govern citizens, because citizens are ‘free’ people with the right to govern themselves. Biopolitics The third concept, a concept that encompasses medicalization and governmentality, is the concept of biopolitics. Biopolitics is a concept coined and elaborated by Michel Foucault (2009) in his lectures about ‘the birth of the biopolitics’ in which he analyses the relations between governmentality, biopolitics and liberalism. The concept of biopolitics has several meanings. We can see biopolitics as a new type of political governing, and in that sense it relates to governmentality but in a wider meaning, focusing on how the body is governed in modern societies, including subjectivity and power connected to human beings in the twenty-first century (Lemke 2009). In that sense biopolitics affects all aspects of human life including diseases, and our present concern, depression and the use of antidepressants. It can also be understood in a more narrow sense, meaning politics about abortion, racism, medical research, biogenetics and all aspects of biomedicine. Biopolitics has a broader meaning than governmentality; it addresses all aspects of human life. Nikolas Rose (2009) talks about a new concept of

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citizenship, he calls it ‘biological citizenship’. It is no longer the human being as a subject who is governed by society, but the body, and all aspects of the body which is governed by society. From a biopolitical point of view we can discuss whether the increase in the use of antidepressants is good for society or bad for society, and discuss whether it is good for human beings or not. Can we regulate the population by the use of drugs and are we willing to do so? In the framework of biopolitics we can discuss regulations of the social body and all the ethical questions for life itself in modern societies. In that sense the framework is an excellent opportunity to understand the increase in use of antidepressants. Conclusion The aim of this chapter is to provide an explanation for the increase in antidepressant use in Denmark, and by extension to modern western society more generally, within a sociological paradigm derived from three central and inter-related concepts: medicalization, governmentality and biopolitics. Each of these concepts has some explanatory power and they each seem coherent and persuasive. They are not mutually exclusive; on the contrary they are complementary to one another and their explanatory power is cumulative. A dimension of the increasing antidepressant use that has not been mentioned here is the questioning of the relative efficacy of newer antidepressants (SSRIs) in comparison with placebo and doubts about the utility of SSRIs for mild or moderate depression (Turner et al. 2008, Fournier et al. 2010). Another problem that does not easily fit into the abovementioned concepts is that only half of those with depression are diagnosed and treated, an underdiagnosing and under-treatment problem (Mitchell et al. 2009). References Abraham, J. 2010. Pharmaceuticalization of Society in Context: Theoretical, Empirical and Health dimensions. Sociology, 44(4), 603–22. Andrade L, Caraveo-Anduaga J.J., Berglund P., et al. 2003. The Epidemiology of Major Depressive Episodes: Results from the International Consortium of Psychiatric Epidemiology (ICPE) Surveys. International Journal of Methods in Psychiatric Research, 12(1), 3–21. Bjerrum, L. 2002. Lægemiddelordinationer i Almen Praksis (Drug prescription in general practice). Ugeskr Læger, 164, 5273–7. Brinkmann, S. 2010. Det Diagnosticerede Liv. Aarhus: KLIM. Brody, H. 2007. Hooked: Ethics, the Medical Profession, and the Pharmaceutical Industry. Lanham, MD: Rowman and Littlefield. Conrad, P. 2007. The Medicalization of Society. Baltimore, MD: Johns Hopkins University Press.

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Cosgrove, L., Krimsky, S., Vijayaraghavan, M. and Schneider, L. 2006. Financial Ties between DSM-IV Panel Members and the Pharmaceutical Industry. Psychother Psychosom, 75(3), 154–60. Dansk Psykiatrisk Selskab. 2001. Behandling af Psykisk Lidelse af Ikke-psykotisk Karakter. Aarhus: Dansk Psykiatrisk Selskab. Dean, M. 2007. Governing Societies. Maidenhead: Open University Press. Ehrenberg, A. 2009. The Weariness of the Self. Diagnosing the History of Depression in the Contemporary Age. Montreal: McGill-Queen’s University Press. Fawcett, J. 2010. Antidepressant Drug Effects and Depression Severity. A Patientlevel Meta-analysis. Journal of the American Medical Association, 303(1), 47–53. Fleck, L. 1935. Genesis and Development of a Scientific Fact. Chicago, IL: University of Chicago Press. Foucault, M. 2008. Sikkerhed, Territorium, Befolkning. København: Hans Reitzels Forlag. Foucault, M. 2009. Biopolitikkens Fødsel. København: Hans Reitzels Forlag. Fournier, J.C., DeRubeis, R.J., Hollon, S.D., et al. 2010. Antidepressant drug effects and depression severity. A patient-level meta-analysis. Journal of the American Medical Association, 303(1), 47–53. Giddens, A. 2004. Modernitet og Selvidentitet. København: Gyldendal Akademisk. Gilbody, S., House, A.O. and Sheldon, T.A. 2005. Screening and Case Finding Instruments for Depression. Cochrane Database of Systematic Reviews 2005(4), Article number CD002792. Greenberg, G. 2010. Manufacturing Depression. The Secret History of a Modern Disease. New York: Simon and Schuster. Healy, D. 2003. Let Them Eat Prozac: The Unhealthy Relationship Between the Pharmaceutical Industry and Depression. New York: New York University Press. Horwitz, A.V. and Wakefield, J.C. 2007. The Loss of Sadness. New York: Oxford University Press. Knapp, M., McDaid, D., Mossialos, E. and Thornicroft, G. 2007. Mental Health Policy and Practice Across Europe. Maidenhead: Open University Press. Lane, C. 2007. Shyness: How Normal Behaviour Became a Sickness. New Haven and London: Yale University Press. Lemke, T. 2009. Biopolitik. København: Hans Reitzels Forlag Lundh, A. 2008. Er der Evidens for Screening for Depression. Ugeskr Laeger, 170(17), 1479. Maturo, A. and Conrad, P. 2009. Salute e Societa. The Medicalization of Life. Bologna: F. Angeli. Miller, P. and Rose, N. 2008. Governing the Present. Cambridge: Polity Press. Miren, I., Jones, S., Greenfield, C. and Bradley, P. 2001. Prescribing New Drugs: Qualitative Study of Influences on Consultants and General Practitioners. British Medical Journal, 2001(323), 1–7.

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Mitchell, A.J., Vaze, A. and Rao, S. 2009. Clinical Diagnosis of Depression in Primary Care: A Meta-analysis. The Lancet, 2009(374), 609–19. Moynihan, R., Heath, I. and Henry, D. 2002. Selling Sickness: The Pharmaceutical Industry and Disease Mongering. British Medical Journal, 2002(324), 886–91. Mulder, R.T. 2008. An Epidemic of Depression or the Medicalization of Distress? Perspectives in Biological Medicine, 51(2), 238–50. National Institute for Clinical Excellence (NICE). 2007. Depression: Management of Depression in Primary and Secondary Care. London: NICE. Nielsen, M. and Gøtzsche, P. 2011. An Analysis of Psychotropic Drug Sales. Increasing Sales of Selective Serotonin Reuptake Inhibitors are Closely Related to Number of Products. International Journal of Risk and Safety Medicine, 23(2), 125–32. Rose, N. 2009. Livets Politik. København: Hans Reitzels forlag. Schramm, J., Andersen, M. and Vach, K. 2007. Promotional Methods Used by Representatives of Drug Companies: A Prospective Survey in General Practice. Scandinavian Journal of Primary Health Care, 25(2), 93–7. Sundhedsstyrelsen. 2007. Referenceprogram for Unipolar Depression hos Voksne. København: Sundhedsstyrelsen. Organization for Economic Co-operation and Development (OECD). 2007. Health at a Glance. Paris: OECD. Paris, J. 2010. The Use and Misuse of Psychiatric Drugs. Chichester: WileyBlackwell. Turner, E., Matthews, A., Linardatos, E., et al. 2008. Selective Publication of Antidepressant Trials and its Influence on Apparent Efficacy. New England Journal of Medicine, 358, 252–60. US Preventative Services Task Force. 2002. Screening for Depression. [Online]. Available at: http://www.ahrq.gov/clinic/3rduspstf/depression/depressrr.pdf (accessed: 22 January 2009). Valenstein, E.S. 1988. Blaming the Brain. New York: The Free Press. World Health Organisation (WHO). 2001. The World Health Report 2001. Mental Health: New understanding, New Hope. Geneva: World Health Organization.

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Part III Social Pathologies: Biopower, Subjectification and Civilization

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Chapter 9

Does Society Still Matter? Mental Health and Illness and the Social Sciences in the Twenty-first Century Pia Ringø

At the rise of the twenty-first century there is an increasing awareness of the crucial role of mental health and illness for the welfare of societies. Currently, the contribution of the social sciences to the actual discussion on the aetiology of mental illness and the further development of interventions for mental health promotion and mental health is rather small, and it seems that the biological perspective has become the leading scientific paradigm (ISA 2010). The purpose of this chapter is to inspire reflection on, and a problematization of, the changes that are occurring in the basic conditions of the scientific character and transformation of the current knowledge, understanding, and treatment of mental and social problems in contemporary society. In the following pages, the role of the humanities and social sciences in helping to understand the connection between social transformations and mental health and well-being, as well as the aetiology and historical sociogenesis of psychiatric illnesses, will be analysed as embedded in social and technical discourses; in other words as a development which is institutionally determined rather than epistemologically so. Using concrete examples, this article will elaborate on the close connection between the current debate about mental ailments and the treatment hereof and political ideologies and goals at this point in history, at the rise of the twenty-first century. In the transcription of the Aubrey Lewis lecture at the University of London (2006), Nikolas Rose refers to Aubrey Lewis’s anthology as follows: Since the end of the Age of Reason came to close the face of psychiatry has changed: no one could doubt that it has changed for the better. But how much of this change is the work of doctors and how much the product of the Zeitgeist, or rather of social and technological movements working powerfully on the course of human affairs? [M. Foucault’s] brilliant book, erudite but overloaded with antithesis and abstruse generalizations, is the most original contribution that has been made to wretched story of unreason in the Age of Reason. Carried to a later period, his studies might illuminate problems that have contemporary urgency. (Lewis 1967b: 8)

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Rose follows up on Lewis’s quote by asking: What would it take to answer this call; to apply Foucault’s studies to our own time and deal with problems that are urgent today? And what, in recent history, has been the result of medical science and practice, and what is caused by other social and technological tendencies? I intend to pursue these questions in this chapter, mainly through concrete examples from Danish research and Danish psychiatric practice and scientific character, which will be elucidated along with current social and technological tendencies at the rise of the twenty-first century. The social hegemonization of the biomedical perspective in the beginning of the twenty-first century has been heavily criticized. The success of the neuropsychiatric research tradition is in part attributed to extensive technological advances, which seem to have dominated the practice of psychiatry. The question is whether the social hegemonization of the neuropsychiatric research tradition and of the dominance of the biomedical perspective, addressed in this anthology, is exclusively attributable to the scientific success of this discipline at a time, when methods and scientific disciplines are becoming increasingly qualified within their own systems. Or if this development is best understood in a complex interaction with less visible, complex circumstances, discursive, regulative and societal changes and mechanisms? By extension, the question is whether we should exercise restraint in our criticism of this paradigm, which has been heavily criticized in the past 20 years. As pointed out by Kuhn (1962), criticism alone has never brought about major paradigm shifts. Paradigm changes require a realistic, viable, researchable alternative – a paradigm candidate, as Brante phrases it (2010). Therefore, one obvious question is, what the most feasible alternative to the existing neuropsychiatric modes of explanation is, and what challenges must be faced in trying to establish a viable and qualified alternative. However, the social hegemonization of the biomedical perspective in the twenty-first century is not just a matter of knowledge – and the need to create viable alternatives is not just a matter of qualifying knowledge within the research traditions of isolated disciplines. To establish viable alternatives is also a matter of political discourse and regulation, and it is about the influence of politics and regulation on knowledge and the opportunities to develop new knowledge, possibly through new combinations of methods, which may transcend the interests and horizons of isolated disciplines. In other words, it is about pluralism versus reductionism. In continuation of this it is only part of the point to shed light on changes, opportunities and challenges in the field of psychiatry, through research and through those engaged in the practical and social work in the field. There is an equally important point, which is to apply historical and scientific reflections to the current social and clinical issues, and to discuss the political, structural and regulative changes that influence the social, psychological and scientific development of knowledge, as well as the practice of psychiatry and its view of human nature. The dominance of certain forms of knowledge does not exist within an institutional and societal vacuum. It is produced and reproduced through political, managerial and economic discourses, institutional solutions and organizations, which should be taken into account to gain a complex

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understanding of the current scientific character and transformation of our knowledge, understanding and treatment of mental and social problems or social pathologies in contemporary society. Using concrete examples, this chapter discusses the close connection between the current debate about mental ailments and the treatment hereof and political ideologies and goals. Analytically, the chapter will revolve mainly around development of certain governmental technologies in Danish psychiatry, specifically the evidence-based practice (EBP) and evidence-based medicine (EBM), the psycho-educative practice and the practice of diagnostics. The chapter will focus on the construction of basic categories and forms of intervention which the technological solutions legitimate and are based on. Thus, the purpose is to inspire reflection on the way in which managerial forms enable the emergence of certain ‘problem definitions’, which in turn influence the scientific character, transformation, understanding and practice of psychiatry, at this time in history. Social and Technological Movements In recent years, Danish psychiatry has been influenced by new ways of producing truth, based on two different, but intertwined technologies; technologies of agency, which seek to elevate and improve our abilities to participate, consent and act; and performance technologies, which make it possible to calculate and compare these abilities with the purpose of optimizing them. In Mitchell Dean’s words: ‘Together, these technologies forge a new linkage between the regulation of conduct and the technical requirements of the optimization of performance’ (Dean 1999: 173). As described by Dean (1999) we are currently witnessing a radical increase in what he describes as performance technologies: These are the plural technologies of government designed to penetrate the enclosures of expertise under the welfare state and to subsume the substantive domains of expertise (of the doctor, the nurse, the social worker, the school principal, the professor) to new formal calculative regimes. (Rose and Miller 1992, in Dean 1999: 169)

These techniques set up indicators of quality and results, among other things, in order to secure the optimization of performance. These technologies are used as an indirect means to regulate the efforts of psychiatry and social psychiatry and to make them calculable and transparent by re-establishing the trust in professional expertise with reference to ‘unfailing, research- (evidence-)based knowledge’ (Rose and Miller 1992; Dean 1999). Thus, modern management is based on scientifically verified knowledge, which ensures an inextricable link between management and knowledge. ‘It is a mutually conditional relation: the exercise of power is supported and justified by scientific categories, but the scientific

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categories, in turn, are often established in close connection with practices for the regulation, administration and control of people’ (Villadsen 2007: 21). Through a historical account of the emergence of psychology, Rose elucidates how knowledge can be conceived as a part of this managerial process in which knowledge, societal development and management are inextricably linked: ‘the history of psychology in liberal societies joins up with the history of liberal government’ (Rose 1996: 12). Rose’s genealogical account of the history of psychology illustrates how an understanding of science, in this case psychology, is not to be seen as a relatively autonomous system or project, but as a scientific programme which is largely institutionally, not epistemologically, determined. This is highly relevant with respect to the current discussions of management, which must necessarily understand knowledge, truth, power, the development of liberalism and ideals of management as linked (Rose 1999). As such, according to Rose, psychology develops as a practical science, or techne, which attains truth and recognition through the applicability of its techniques in a concrete societal project. Evidence – and the Construction of Basic Categories and ‘Target Groups’ One development in governmental technologies which clearly illustrates this connection between knowledge and regulation is the recent emergence of ideals of evidence-based management, evidence-based medicine and evidence-based practice, defined as the transfer of research-based guidelines onto management, psychiatric practice and medicine. Evidence is defined as generalizable knowledge of causal relations derived from randomized, controlled tests, observation and measurement, and analysis of the causal relation between intervention and result. The proponents of evidence in political and management research believe that the evidence-based foundation results in a more consistent obligation to, fulfilment and attainment of the given objectives and standards, because an evidence-based foundation of knowledge is founded on empirical data (Stacey 2010). Thus, leaders, political decision-makers and practitioners will be able to base their actions on ‘facts’ and absolute knowledge, and to respond to the criticism against the basis of decisions made within the organizations, in this case within the psychiatric field, as being based on personal convictions, interests and experiences, by staging continuous testing and development of best-practice ideals, which can ensure economic growth or sustainability (Stacey 2010). When viewing the term evidence in its widest possible sense, few would disagree; psychiatric and socio-psychiatric work should make use of knowledge, results and experiences accumulated through research. However, in spite of a consensus on the need for knowledge sharing, quality and an efficient utilization of resources, disagreement and discussion arise at several levels when the criteria for evidence-based practice are introduced. One area of evidence thinking often criticized is the selection of primary studies which forms the basis of the compilation of meta-analyses and thus the guidelines of

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the evidence-based practice. With the hierarchy of evidence as the foundation of this selection of primary studies in the systematic reviews, critics emphasize the probability that a series of (primarily qualitative) studies may be screened out in advance, while studies based on randomized controlled trials are considered most valid based on empirical–analytical ideals of scientific clarity. Behind the more technical, practical and methodological arguments for and against evidence often dominant in this debate, one can almost make out the contours of different understandings of causality based on different paradigms of knowledge. The Danish evidence debate rarely explores these paradigmatic reasons to argue for or against evidence, but rather remains at a practical– methodological level (Rieper and Hansen 2007). There is thus a distinction between technical, methodological discussions, which focus largely on the methodological limitations connected with randomization and security in measurements, the debate surrounding the hierarchy of evidence, the underlying understanding of causality and the arguments concerning the basic conditions and standards of validity of psychiatry, the contours of which are discernible behind the more technical, practical and methodological arguments. The latter are related to the construction of basic categories and forms of intervention which the evidencebased practice continues and is based on. In my opinion, this is a more interesting angle on the issue, because it illustrates how certain understandings, interpretations and explanations of the social or psychiatric problem are perpetuated and can be characterized as a specific ‘governmentality’ in the psychiatric research practice. Such an angle concerns itself with the way in which humans become objects in scientific and quasi-scientific discourses, as well as how humans become objects of knowledge and how this knowledge is connected to political, institutional and technological factors. As such, I will be taking several steps backwards compared to the governmental technological (primarily EBP) approaches currently in existence. I have chosen this starting point because, as pointed out by Taylor and White (2009), Pearson (2007), as well as Levine and Fink (2006), the quality and management initiatives of recent years do not take into account the implicit assumptions, basic conditions and standards of validity upon which the development in governmental technologies is based, which ‘leaves the messy business of categorization or “diagnosis” unexplored’ (Pearson 2007, Taylor and White 2009). The categorization of ‘target groups’ for intervention and management thus assumes such a natural and logical character that we rarely question what it actually is that we are categorizing, or consider the validity of the problem constructions upon which the governmental technological solutions are based. It is my belief that increased focus on the construction of basic categories that a governmental technological, evidencebased foundation of knowledge legitimates and is based on might increase interdisciplinary interest in the multicausal aetiology and historical sociogenesis of psychiatric illnesses, including their societal and social anchorage.

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Understanding ‘The Problem’ Then and Now Relating historical and scientific reflections to current social and clinical ways of understanding problems clarifies how the dominance of certain treatment methods, knowledge forms and views of human nature is produced and perpetuated through political, managerial and economic discourses. When thus considering the construction of basic categories, the first thing that comes to mind is that since the psychiatric classification system DSMIII was introduced in 1980, diagnostic practice has concerned itself exclusively with symptoms, or ‘superficial’ problem definitions. The change in the diagnostic practice in Denmark occurred simultaneously with a series of discursive shifts in the Danish welfare state. Many of the socio-political concepts of the time, which had previously sought to explain the emergence and development of social and psychiatric problems with reference to social and societal structures, were excluded from the socio-political agenda. At the same time, psychiatric treatment and (re)habilitation were decentralized, and increasing attention was given to creating an institutional network outside the state for the management of psychiatric and social problems (Villadsen 2004: 2007). The decentralization of the psychiatric area in the early 1980s was also a part of a market-oriented organizational structure, where technologies of agency seek to make the institutional spaces self-regulating and responsible through ideals of empowerment and self-management (Dean 1999). Subsequently, social research assumed the important and necessary responsibility of dealing with the social consequences of mental illness, or the remains of the psychiatric phenomenon for which medicine has no scientific explanation or treatment method. This socio-scientific focus became increasingly crucial due to the social consequences of deinstitutionalization and the structural reorganizations and decommissioning of the psychiatric state hospitals in the 1980s, which saw patients transferred to open care in their own communities. However, the socio-scientific focus on consequences also caused an apparent lack of research environments with interdisciplinary approaches to psychiatry in socio-scientific research after the mid 1980s. A survey of Danish research into mental illness (Høgsbro 1994; 2004) illustrates how the social sciences started to abandon discussions regarding the aetiology, or historical socio-genesis, of mental illnesses in the mid 1980s, while resources in the research field in general were reserved for the identification of biological mechanisms. Thus, the increased focus on helping the individual to cope with everyday life meant that the investigation of the mechanisms that had contributed to the development of the social and mental problems was neglected. Simultaneously, new technologies for social and psychiatric work emerged in the form of empowerment programmes, motivational conversations, social contracts and psycho-educational programmes where independence, self-care and the ability to cope with life outside institutions became highly valued properties. A development which collectively, and with reference to Foucault, can be understood as a new discursive formation in the form of new institutions, technologies and practices, which at this time created and

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perpetuated new circumstances for practice and concept formation in social and psychiatric practice (Villadsen 2007). Diagnostic Practice – ‘Categorizing the Problem’ In the practice of psychiatric diagnostics, this discursive shift found its expression from 1980 in the shift from aetiological psychiatry to new non-theoretical diagnostic classification systems: The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV, APA 1994) and the International Classification of Diseases (ICD-10, WHO 1996), which no longer included theoretical models of explanation and which defined diagnoses solely based on symptoms and processes. The classification systems established in 1980 were based on an understanding of mental illnesses as essences, which can be divided into separate categories and defined on the basis of a categorical classification and a clear distinction between the opposite concepts of ill/healthy, in which the illness will exhibit clear deviations from the existing understanding of normality (Sadler, Hulgus and Agich 1994). Although no biological evidence or objective tests form the basis of this division of psychiatric symptoms, the tendency of these diagnostic systems to understand mental illnesses as essences tends to make people view possible social and psychological factors as epi-phenomena of the biological processes (Rosenbaum 2004; Terkelsen 2009). As described by Brinkmann (2010), the new classification systems were constructed in a way that made it possible to link a patient’s symptom image to a category in the classification system whether the symptoms fit the life situation of the patient or not (Brinkmann 2010). At the same time, the diagnostic manuals from 1980 brought about an exchange of diagnoses from the previous psychoanalytical tradition. Put simply, the focus of the psychoanalytical tradition is aimed at involving subconscious processes in the understanding of the phenomena of the mind. In other words, it is assumed that previous experiences are stored in the human mind, only to find their expression later in potentially psychopathological behaviours and mental problems. Psychoanalysis and the psychodynamic psychiatry can be seen as a contribution to a non-linear causal explanation of the aetiology of mental illnesses through an understanding of the significance of previous experiences for the formation of personality and the psychiatric symptoms or mental illnesses that may retroactively emerge later in life (Kernberg 1984; Rosenbaum 2004). Freud managed to transcend the evolutionary biological–explanatory approach by illustrating the life historical ‘meaning’ dimension in the human psyche, which Foucault, in his early studies (1954–1962), describes as an ‘intentional escape from a problematic present, and as such should first and foremost be seen as a defense mechanism’ (Foucault 1962; 2005: 82). To elaborate, Foucault concludes that ‘the illness contains all the flight and defense mechanisms which the ill person uses to react to the situation he is in’ (Foucault 1962: 82). However, Foucault ultimately concludes that ‘the pathological universe’ cannot be explained by reference to

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a life historical causality, because such forms of psychological causality ‘are only possible because the pathological world exists in a specific form in the consciousness of the ill person: it is what creates a connection between cause and effect, between the previous and the following’ (Foucault 1962: 104). Therefore, Foucault ultimately emphasizes the way the existential and phenomenological analysis understands ‘the pathological universe’ as the key to understanding the existence and forms of manifestation of the ill person by ‘taking the leap all the way into the consciousness of the ill person and attempting to see the pathological universe through the eyes of the ill person himself’ (Foucault 1962: 92).1 The existential–phenomenological approaches do not view the person’s memories of past experiences as the (only) way to gain an understanding of the observed phenomena and symptoms, but understand the mental reactions in relation to the way the self understands its own relationship to the surroundings, to others, and to itself (Rosenbaum 2004). Thus, the existential–phenomenological approach assumes a non-theoretical, descriptive stance on the understanding of that which is visible and that which can be experienced. In this way, it resembles the diagnostic way of thinking, but it deviates from the way of thinking of traditional psychiatry in several ways (Parnas 1994). The current systems of classification, unlike the existential–phenomenological way of thinking, are based on a clear distinction between the opposite concepts of ill/healthy, in which the illness will vary radically from the existing understanding of normality (Sadler, Hulgus and Agich 1994), and in which diagnoses are defined solely by symptoms and processes. At the same time, the categorization of what is defined as the objective aspects of the consciousness, according to the classification systems, is what determines the psychiatric diagnosis, which is also different from the more existential–phenomenological approaches. The difference between the existential–phenomenological approach and the diagnostic epi-phenomenological approach is exemplified by Rosenbaum (1994) through the psychiatric symptom of auditory hallucinations. In traditional psychiatry, based on the current diagnosis systems, auditory hallucinations are considered perceptual disturbances that are best explored by comparing the pathological (brain) process to the functional modes of the brain in the normal perceptional act (Rosenbaum 1994; 2004). In contrast to this, an existential– phenomenological approach will seek the ‘method in the madness’ of the mentally ill person by examining the intentum, i.e. the object of the hallucination, and the intentio, the characteristics of the orientation (Rosenbaum 1994; 2004). With reference to Foucault, this approach does not assume the shape of a ‘monologue of reason about madness’, but is an acknowledgement of the private and subjective 1  In his later studies Foucault abandoned the focus on the existential and phenomenological analytical understanding of ‘the pathological universe’ – and he became more concerned with the way in which humans become objects in scientific and quasiscientific discourses, as well as how humans become objects of knowledge and how this knowledge is connected to political, institutional and technological factors.

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character of experience (Foucault 2006; Rosenbaum 1994; 2004; Stephens and Graham 1994). The existential–phenomenological perspective was also the foundation of the psychiatry-critical movement of the 1960s (Laing 1960; 1961). In contrast to this, the development since DSM-III in 1980 is based on a clear distinction between theory and empiricism, with the most recent classification systems emphasizing the atheoretical and strictly descriptive foundation of these systems (American Psychiatric Association 1994; World Health Organization 1994). Like the logic behind the randomized controlled trial examinations, this view of science is based on the assumption of logical empiricism that descriptive categories can exist in an unmediated relation to that which can be observed (Hempel 1965; Schwartz and Wiggins 1986; Wifstad 1990, 1991). Thus, the idea of scientific clarity in DSM and RCT (Randomised Controlled Trials) is similar to that of physics, in that it considers the diagnostic process a simple either/ or relation: the observable psychiatric symptoms either belong to a category, or they do not. In that way, the given symptom image is defined and distinguished from other illnesses on the basis of a set of rules or criteria for the symptoms that must occur for the diagnosis to be given (Munk Jørgensen 1988; Wifstad 1991). Whether the observed symptoms are due to mental illness is determined primarily by the evaluation of professionals of the occurrence of the observed symptoms. As such, the foundation of the psychiatric diagnosis systems DSM-IV and ICD-10 is a division into subjective and objective phenomena. Unlike other theoretical models and perspectives, it is the categorization of what this view of science considers the objectively definable aspects of the conscious mind that forms the basis of the psychiatric diagnosis (Rosenbaum 2004). However, as Wifstad (1991) is asking: the question is whether the idea of being able to describe a symptom image neutrally and objectively does not already become problematic when dealing with the most basic term in psychiatry, ‘mental illness’. Although, according to the empiricist logic of the diagnostic systems should be possible to define a state as ‘abnormal, deviant, disturbed or pathological’ without being influenced by an attitude to cultural, social and subjective values and definitions of normality, this seems impossible in practice, as pointed out by Levine and Fink (2006) as well as Spitzer (1981): ‘It begins by assuming that discrete categories exist and produces a document that divides psychiatric illness into discrete categories. In practice, however, the separation of categories is imprecise, and there are no objective tests to separate or identify the conditions’ (Levine and Fink 2006), or as defined by Spitzer: ‘The concept of “disorder” always involves a value judgement’ (Spitzer 1981). Despite the intentions to distinguish clearly between the pathological and the healthy, the deviant and the normal (or between two illnesses) to avoid overlap between the separate conditions and diagnoses, it seems that such clear distinctions are impossible in actual practice. This results in the risk that psychiatrists, researchers and other professionals with differing evaluations or slightly varying criteria could reach very different results, and it is potentially vague what the different categories actually mean (Wullf, Pedersen and Rosenberg

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1990). Nevertheless, DSM-IV and ICD-10 are launched as atheoretical, non-aetiological systems, which enable value-free and context-independent classifications to be used as an efficient communication tool all over the worlds, so that a diagnosis means the same thing wherever it is applied. In my opinion, this empiricist postulate causes a consolidation of the biomedical paradigm by denying the theoretical understanding of other paradigms of the potential contextual anchorage, expression and function of the psychiatric symptoms. In clinical practice, psychiatric inquiry, diagnosis and treatment can therefore be initiated without any insight into what the mental reactions, or psychiatric symptoms, are an expression of (Jørgensen, Bredkjær and Nordentoft 2006; Rosenbaum 2004). The new classification practices have thus rendered it uninteresting whether the observed and classified psychiatric symptoms are expressions of adaptive strategies and reactions to chaotic environmental conditions, of communicative phenomena at a group level, of social and societal transformation processes, or of ailments caused by mental or biological phenomena. Or, if the aetiology of psychiatric symptoms is to be understood as a complex combination of the above-mentioned factors, which would be best understood through different approaches, methods and combinations of methods (Brante 2001; 2010; Pichot 1994; Rosenbaum 2004; Sadler, Wiggins and Schwartz 1994). In this way, the focus of classification systems on securing maximum reliability results in a striking lack of fundamental theoretical reflection, which could answer the previously mentioned questions concerning the relevance of the diagnoses and the preferred (medical/cognitive) treatment choices, such as: What is it that we are trying to classify, and what is the most relevant treatment in light of this? With respect to this, Jørgensen, Rosenberg and Mainz (2007) emphasize that: The taxonomy of illness should be aetiological (causal), exhaustive, exclusive and unambiguous. But it is not. The process bites its own tail: The ICD-10 illness category schizotypy cannot be fully validated through biological or neurological methods. So how can we determine the circle of people to be examined in a further attempt at external validation? (Jørgensen, Rosenberg and Mainz 2007: 92–3)

To return to the evidence debate, the basis of the evidence-based practice in psychiatry is criticized for being based on an imprecise and poorly founded diagnostic system (Levine and Fink 2006). It is also suggested that the empiricist ideals of the diagnostic systems must limit theoretical reflection about what constitutes mental health and illness, as reflections about the potential cultural, social, societal, communicative, mental and or biological anchorage of mental illness are not relevant for fulfilling the empiricist ideals for context-independent, value-free, universal classifications and initiating relevant evidence-based treatment and (re)habilitation. Research on the terms of the empiricist tradition, which is the scientific theoretical foundation of the diagnostic practice, as well as for randomized controlled trial designs in an evidence-based development of

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knowledge, thus causes an increased focus on the symptom image as the basis for inquiry and diagnosis, as well as an ensuing initiation of relevant efficient treatment, which is monitored through simple measurements of effect. These measurements of effect do not offer an understanding or explanation as to why a given effort works or does not work, for whom and under what circumstances, and the meaningfulness of the effort is not considered. At the same time, there is no theoretical explanation of the substantial content of the basic categories used by the randomized controlled experiment to carry out experiments with an intervention group, which is subjected to an isolated stimulus (intervention) and a control group, which is definitely not subjected to that stimulus, but which otherwise resembles the intervention group in all essential variables (Olesen 2007; Levine and Fink 2006). In this we see the contours of a development that marginalizes in-depth, pluralistic problem understandings. Explanations that go ‘behind’ the human being, which incorporate societal transformation processes, contextual differences, varying social circumstances or deeper psychological explanations, are phased out and replaced with an empiricist focus on observation and the classification and treatment of human illness, or problems, in the present. Or, to put it differently, this process eliminates societal structures, mechanisms and transformation processes as necessary observational tools (Howe 1996). The development described above can be seen, in part, as a macro-political discourse, but also more generally as a management rationality, a governmentality, as a unit of power, knowledge and subjectivity, which also increasingly operates at a micro-level (Agamben 1998; Foucault 1982). As described by recent governmentality studies (Rose 1996; 2007), the responsibility of subjects themselves is emphasized in this kind of governmentality, while the psychological space is flattened. The Psycho-educative Practice – ‘Treating the Problem’ If we abandon the focus on the current production of evidence for a moment, the same epi-phenomenological construction of basic categories and problem understandings is continued in what Dean (1999) defines as technologies of agency. In Danish specialized socio-psychiatry, these technologies are expressed as an increase in the use of contracts, personal plans of action with detailed subsidiary and ultimate goals, which in practice take on the shape of a sort of negotiated inter-subjectivity between practitioners and citizens. Technologies of action include what Barbara Cruikshank (1993; 1994) has termed ‘technologies of citizenship’ (Dean 1999: 168), which engage patients and citizens as active, free, educated and responsible citizens with autonomy and independence as central western liberal ideals and terms (Foucault 1982). In Danish hospital psychiatric practice these technologies are expressed through a psycho-educative practice as a new discourse, where the impetus for the creation of such treatment

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programmes was the explicit and derived consequence of the decentralization and de-institutionalization of the psychiatric hospitals and the consequent need to reintegrate psychiatric patients into society. Thus, the programmes seek to reinforce or utilize the patients’ capacity for action: The objective of the [psycho-educative] program is self-governance and independency, and through a specific knowledge regime designed for regulating psychotic thoughts, feelings and behavior, patients are supposed to detect and manage symptoms with the help of professionals from the psychiatric field. (Terkelsen 2009)

The psycho-educative programme is constituted within a medical frame of understanding in order to educate patients, allow them to gain insight into their own illnesses, and train competences to manage the psychiatric symptoms in a way that will let them live as normal lives as possible outside the psychiatric institutions. In the psycho-educative practice, it is the intention that patients who receive psychoeducation are better equipped to gain insight into and understand what has already been defined as illness based on the basis of diagnostic manuals (Hertz 2010). The purpose is to teach the patients self-observation, self-classification and selfexamination in accordance with the diagnostic psychiatric categories and the related evidence-based instructions and reference programmes. In continuation of this, medical compliance is a positive result goal in the monitoring of the treatment. In The History of Madness (1961, 2006), Foucault wrote, that the mediation between the madman, as defined by Foucault, who is perceived, and the ‘illness’, which is analyzed and treated, or in other words; the connection between the madman and the madness is significant for the madness to make sense for the madman and for the establishment of connections between past, present and future (Foucault 1961, 2006). The question is whether the psycho-educative practice contributes to the development of this mediation? In The History of Madness, Foucault asks whether we create this mediation by claiming that we examine, diagnose and treat a person because he is mad. By calling the effect (psychiatric symptoms) the cause to be treated, by teaching the madman to deal with the effect through practices that regulate cognition and behaviour, and by renaming the historically generated effect, which has been renamed the cause, as an ahistoric nature with no connection to the life lived before the ‘madman’ went ‘mad’? (Foucault 1961; 2006: 222–6). Applied to our time, Foucault is revived along with an interest in the way humans become objects in scientific and quasi-scientific discourses that are connected to political, institutional and technological factors. The discourse is considered performative in the sense that the diagnosis as a problem definition in the psychiatric practice, and psycho-educational programmes, creates its own reality and its own solutions, and has its own power, which makes the ‘condition’ real and gives it meaning. When we look at the process of ‘problem-definition’ in this way, discourses and diagnoses exhibit a series of qualities that become visible and real. They contain their own problem presentations, which in turn

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yield illness-specific answers. Ian Hacking (1998) defined diagnoses as interactive categories; as categories that, when applied in institutional contexts, change or influence the interaction between people and the behaviour, emotions and selfimage of the diagnosed person in an interplay between the category (diagnosis) and the diagnosed person (Hacking 1998). Not only can the atheoretical, nonaetiological classification systems communicate a fundamental confusion of social, psychological and biological mechanisms, they can also communicate a set of role expectations that fill out and maintain the structure of the interaction behind the backs of those involved (Høgsbro 2004: 48). In the practice of psychiatry, the diagnosis, as a problem definition, creates its own reality and its own solutions, and in a way the diagnosis has its own power that makes the ‘condition’ real and gives it content. The psycho-educative programmes can be associated with neo-liberalist ideals in the western societies, which on one hand expect patients to learn and develop ‘ability’ that enables them to act according to ideals of self-governance and responsibility for one’s own actions and well-being, which can prepare them for a life outside the institution and on the other hand limit this ‘freedom’. The technologies of action work as a sort of “obligatory passage point” (Callon 1986) through which individuals are required to agree to a range of normalizing, therapeutic and training measures designed to empower them, enhance their self-esteem, optimize their skills and entrepreneurship and so on. (Dean 1999: 168)

Apart from social and economic conditions that limit the freedom of the individual outside the institution, the mentally ill are expected, through the psycho-educative programmes, to gain insight into their illnesses based on the diagnostic categories, and to exhibit medical compliance by maintaining the psycho-pharmaceutical treatment (Breggin and Cohen 1999). As pointed out by Rose: Modern individuals are not merely ‘free’ to choose, but obliged to be free (Rose 1986; 1999: 74; Terkelsen 2009). Does Society Still Matter? There are two crucial points here: first of all, these technologies of agency and performance, in the examples of this chapter, are brought into play when certain individuals become ‘categories’, or what Dean (1999) defines as ‘target groups’, and it is made clear how the international systems of classification; the Diagnostic and Statistical Manual DSM of Mental Disorders (DSM-IV, APA1994) and the International Classification of Diseases (ICD-10, World Health Organization 1994) have contributed to this development, and play an important role in this context. Second of all, the definition of the problem seems to take on such an obvious and logical character that we rarely question what it is we are categorizing or the

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validity of the problem constructions upon which the management technological solutions are based. In continuation of this, the definition of the problem also defines its solution and eliminates certain understandings of its cause. In the words of Nikolas Rose: At any time and place, human discontents are inescapably shaped, moulded, given expression, judged and responded to in terms of certain languages of description and explanation, articulated by experts and authorities, leading to specific styles and forms of intervention. What, then, is specific to today? (Rose 2006: 479)

Thus, with any given discourse-come-procedure of exclusion which excludes themes, arguments and speech positions enable other statements in certain discourse formations. In this way, the shaping of subject positions and certain ways of acting and intervening are based on certain mechanisms, techniques and technologies as well as procedures for the production of truth. As such, knowledge cannot just be seen as an autonomous system or project, but should be viewed as a scientific programme or techne, which attains truth and recognition in the psychiatric practice and societal transformation process through the applicability of the techniques in a concrete societal project. In continuation of the examples given in this chapter, a look at historical development tendencies in the foundation of knowledge and management practice of social and psychiatric work can illustrate patterns in what can be said and what is considered taboo in spite of the many possibilities for concept formation, understanding and explanation of psychiatric and social issues. Thus, although there are many definitions of what social and psychiatric problems are, and what social and psychiatric work is, or should be, certain forms of knowledge and problem understandings attain recognition and validity in mutual interconnections with certain political, managerial and economic discourses (Dean 1999). These determine the view of human nature and define concepts such as responsibility, guilt and treatment. And it is important to incorporate an understanding of this connection in a complete understanding of current trends in scientific character and transformation at this point in history at the rise of the twenty-first century. Secondly, at the beginning of this chapter I described how the contribution of the social sciences to the actual discussion on the aetiology of mental illness and the further development of interventions for mental health promotion and mental health is rather small, and it seems that the biological perspective has become the leading scientific paradigm. When phenomena are described and understood without reference to context, as is the case in the diagnostic practice and in randomized controlled experiments, it reduces the understanding of the complex contributory mechanisms, which in a specific context produce or enable the observed phenomenon, whether that phenomenon manifests itself as psychiatric symptoms or observed effects of certain forms of interventions. This process also excludes a wider understanding of circular, interactive connections

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between biological, social and psychological mechanisms in the understanding of the psychiatric phenomenon in a wider societal context. As mentioned above, the change in diagnostic practice in Denmark occurred alongside a series of discursive shifts in the Danish welfare state, resulting in a new way of understanding humans, responsibility, guilt and knowledge, which eliminated many of the terms, explanations and solutions of contemporary social politics from the socio-political agenda. In the examples given in this chapter; the evidence-based practice, the diagnostic practice and the psycho-educative practice, we see the contours of a development where explanations that go ‘behind’ the person, which incorporate societal transformation processes and social circumstances or deeper psychological explanations, are phased out and replaced by an empiricist focus on observation and classification, and immediate treatment of the person’s ailments or issues. Thus we see the beginning of a practical and management technological shift from ‘in-depth problem understandings and solutions’ to ‘superficial problem solving’. Nikolas Rose approaches a definition of such an in-depth/surface perspective, but has first and foremost attempted to develop a model or descriptive method, a way to analyze inter-related concepts and account for transformations that remain on the surface, and the connection between these things (Rose 2007). It is debatable whether such a focus on accounting for inter-related phenomena and transformations on the surface is sufficiently distinguishable from the selfperception of liberalism, or whether the epistemological orientation of these analyses and their lack of focus on the examination, explanation and description of social ontology perpetuate the same surface considerations that the management technological and social movements establish, and thus leave us with epistemic as well as judgemental relativism, with little opportunity to evaluate the meaningfulness and applicability of different management techniques, practices, strategies or discourse formations. What is interesting for the focus of this chapter is the way that Rose, just like Dean, emphasizes the fact that the degree of individual freedom established through ideas of ‘the autonomous subject’ is historically unprecedented. If we follow through on this thought, it seems relevant to address whether there is a downside to the forms of subjectivization which different liberalist governmentality rationales and practices seek to establish, and whether the societal management and solution models produce new social and psychiatric forms of expression. Do the new possibilities and demands in contemporary civilization bring about their own costs? The paradox is that to address such contexts, a broader understanding of the social ontology of mental illnesses is needed. However, as discussed in this chapter the social and technological movements in the ‘century of freedom’, as Rose defines our time, often eliminates societal structures, mechanisms and transformation processes as necessary observational tools in understanding the aetiology and sociogenesis of mental illness at this time in history. But does that make this research less relevant and useful?

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Mental Health and Illness and the Social Sciences in the Twenty-first Century – What is the Problem? In this chapter I have not concerned myself with the question of whether the increasing demand for psychiatric inquiry, diagnosis and treatment can be exclusively attributed to a too inclusive diagnostic practice. Instead, I have focused on the loud silence that has surrounded the practice of uncovering the aetiology and sociogenesis of mental symptoms since the 1980s, a development which has been analyzed as being embedded in social and technical discourses, in other words a development which is institutionally determined rather than epistemologically so. As the research methods we choose, our attitude to mental illnesses and the ways in which we evaluate the effect of, and thus legitimize, our treatments of mental illnesses depend strongly on and influence our ontological potential for understanding, one might argue, as Bent Rosenbaum does, that ‘a dominant view of knowledge that often equates truth with certain ways of attaining knowledge can result in a lack of insight into ontological and metaphysical questions and thus in a limitation of the possibility to expand and diversify the understanding of mental illnesses’ (Rosenbaum 2004: 93). What the management technological tendencies and the transformation of the scientific character of psychiatry that have been presented in this article have in common is an increased focus on the symptom formation as a foundation for examination and diagnosis, as well as a subsequent instigation of relevant, efficient treatment monitored according to simple measurements of effect. The analytical outline in this chapter has emphasized the way in which scientific explanation of the substantial content of the basic categories applied by randomized controlled experimental designs, as well as contextual, pluralistic problem understandings and explanations that go ‘behind’ the individual, are edged out in this development, and replaced by an empiricist focus on the acute observation, classification and treatment of the illness or the problems of the individual. In other words, the focus has been on the way in which contextual differences, societal structures, mechanisms and transformation processes have been increasingly neglected as necessary tools of observation in this process. While the perspectives introduced in this articlemainly those of Foucault, Rose, Miller and Dean, offer an excellent analytical understanding, which illuminates the discursive conditions of possibility of the presented social practices, the span of this production of knowledge leaves us unable to immediately uncover whether the social and psychiatric problems and illnesses actually exist in the world as anything other than a product of procedures of exclusion which exclude themes, arguments and speech positions in the social practice. So although it was Foucault’s point that nothing is more at the heart of society than its ‘drop-outs’, surrounded and pervaded as they are by the effects of society and life force, and that it would be through the study of insanity or the marginalized groups that we would gain our greatest knowledge of normal society, Foucault’s view, as well as the more recent studies of governmentality, exclude a wider understanding of the

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ontology of social and mental problems. which analytically limits the possibility of expanding and nuancing our understanding of psychiatric and social problems and illnesses and thus determining the treatment of them. Therefore it seems relevant to return to this chapter´s initial reference to The Structure of Scientific Revolutions, in which Thomas Kuhn (1962) points out that criticism alone has never been sufficient to bring about paradigm change; what is also needed is a viable, realistic and researchable alternative that has prospects of being able to be explicated, tested and verified – an alternative ‘paradigm candidate’. Thus, we must ask ourselves what the alternative is if we are ever to discontinue the criticism of the neoliberal management discourses and biomedical hegemony addressed in this anthology. The suggestion of this chapter is that interdisciplinary attention to the multicausal ontology of social and psychiatric illnesses makes it relevant to ask whether the liberalistic ideals of the autonomous subject come with their own costs and create new forms of social pathologies and psychiatric symptoms. Do the observed and classified psychiatric symptoms constitute adaptive strategies and appropriate reactions to certain life circumstances; as communicative phenomena, as moral judgements on unwanted or deviant behaviour, as expressions of social and societal transformation processes, or as ailments that arise from mental or biological phenomena, and should therefore be treated as such? Or do they arise as a complex combination of these different factors, which would be best understood through different approaches, methods and combinations of methods? Thus, if these are the questions, the focus must be expanded from management technological solutions or coping strategies based on forms of manifestation, discursive problem constructions and symptom treatment, defined as ‘superficial problem understandings and solutions’, to expansive ontological realistic understandings and explanations that can contribute with an increased and more nuanced comprehension of the complexity that is characteristic of social and psychiatric problems in contemporary society. In order to facilitate a more reflexive and qualified foundation for evaluating which solutions, coping strategies or treatment methods seem relevant in our time, we need an equal emphasis on interdisciplinary research into defining, understanding, and explaining the complex nature of psychiatric and social problems, compared to the research resources now dedicated to defining the symptoms of these problems and initiating the treatment of symptoms, based on the predominant management technological trends and surface considerations. For example: Should we strive for individual medical or behaviour-regulative solutions, or for wider societal, structural solutions? Is it necessary to imagine other ways of practicing and imagining personal and mental ‘freedom’ in the psychiatric regime of practice other than individualizing ways that are centered around the mentally ill person and his/her behaviour and capacities? Or as Kaspar Villadsen puts it: ‘Today, liberation is not very concerned with mitigating and fighting unfortunate societal conditions, but rather with liberating the client from his/her own mental constraints’ (Villadsen 2004: 264). This prompts Villadsen to

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ask whether this means that we now know what we need to know about socioeconomic conditions, and that the efforts to change them have come to an end? ‘Have material questions become secondary or irrelevant?’ (Villadsen 2004: 264). As long as the biomedical models of explanation cannot be considered validated, it must be considered possible that several explanations interact or reinforce each other in complex, open systems, although such multi-causal pluralistic and complex explanations may seem difficult and at odds with the current trends of simplification. What is suggested here, however, is an increased interest in ontological alternatives in which ‘the social’ includes not only the life circumstances of the individual, but also social and societal movements and transformation processes, institutional contexts, wider socio-economic structures and managerial discourses. in which ‘the biological’ is not limited to narrow biomedical or neuropsychiatric research programmes, but, as Brante (2001; 2010) puts it, is to be understood in a dialectic relation with human and social sciences, which can explain the variation in the social and psychiatric symptoms defined as abnormal, deviant or pathological in our era of modernity, and in the psychiatric system in particular (Brante 2001). And we should bear in mind that the diagnosed mental illnesses, as described by Horwitz (2002, 2005), may also result from moral judgements passed on unwanted or deviant behaviour, and that ‘the psychological’ is not confined to forms of therapy which maintain a focus on individualistic practices and medications for the regulation of cognition and behaviour. However, an important point in this chapter is that the establishment of a viable, realistic and researchable alternative that can be explicated, tested and verified poses the challenge that the recognition and validity of certain forms of knowledge and problem understandings arise in interconnection with certain political, managerial and economic discourses, which enable and acknowledge certain understandings of problems and languages of description and explanation, and exclude others. And an understanding of this connection must be incorporated in a complete understanding of the current psychiatric scientific character and its function, transformation, challenges, and possibilities at this point in history. References Agamben, G. 1998. Homo Sacer. Sovereign Power and Bare Life. Stanford: Stanford University Press. American Psychiatric Association. 1994. Diagnostic and Statistical Manual of Mental Disorders DSM-IV. Washington, DC: American Psychiatric Association Brante, T. 2001. Consequences of Realism for Sociological Theory-Building, in Journal for the Theory of Social Behavior, 31, 2. Brante, T. 2010. Den nya psykiatrin: exemplet ADHD (The new psychiatry: The example of ADHD) in Diagnosens Makt Om Kunskap, Pengar och Lidande (The Power of Diagnostics: Knowledge, Capital and Illness), edited by Hallerstedt, G. Göteborg: Daidalos.

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Breggin, P.R. and Cohen, D. 1999. Your Drug May be Your Problem: How and Why to Stop Taking Psychiatric Drugs. Reading, MA: Perseus Books Brinkmann, S. 2010. Det Diagnosticerede Liv – Sygdom uden Grænser (The Diagnosed Life – Diseases without Borders). Århus: Forlaget Klim. Cruikshank, B. 1993. Revolutions within: Self-governance and Self-esteem. Economy and Society, 22(3), 327–55 Cruikshank, B. 1994. The will to empower: Technologies of citizenship and the war on poverty. Socialist Review, 23(4), 29–55 Dean, M. 1999. Power and Rule in Modern Society. London: SAGE Publications Ltd Ekeland, T.-J. 2005. Kvalitetssikring eller Instrumentalistisk Fejlgreb (Quality Proofing or Instrumentalist Error), in Social Kritik (Social Criticism), 102. Foucault, M. 1982. The Subject and Power, in Critical Inquiry, 8(4), 779–95. Foucault, M. 2006. History of Madness. London: Routledge. Hacking. I. 1998. Mad Travellers: Reflections on the Reality of Transient Mental Illness. London. Free Association Books. Hammersley, M. and Treseder, P. 2007. Identity as an Analytic Problem. Who’s Who in ‘Proana Websites?’, in Qualitative Research, 7, 283–300. Hempel, C.G. 1965. Fundamentals of taxonomy, in Aspects of Scientific Explanation and Other Essays in the Philosophy of Science, edited by C.G. Hempel. New York: Free Press. Hertz, S. 2010. There is a Crack in Everything, That’s How the Light Gets in, in Det Diagnosticerede Liv – Sygdom uden Grænser (The Diagnosed Life – Diseases without Borders), edited by Brinkmann, S. Århus: Forlaget Klim. Horwitz, A.V. 2002. Creating Mental Illness. Chicago: University of Chicago Press. Horwitz, A.V. and Wakefield, J.C. 2005. The Age of Depression, in The Public Interest, 158, 39–58. Howe, D. 1996. Surface and depth in social-work practice, in Social Theory, Social Change and Social Work, edited by Parton, N. London and New York: Routledge. Høgsbro, K. 1994. Dansk Forskning Vedrørende Sindslidelser (Danish research concerning mental illness). København: CASA Høgsbro, K. 2004. Forskning vedrørende sindslidendes forhold i samfundet (Danish Research concerning the condition of the mentally ill in society), in Socialpsykiatriens kompleksitet (The Complexity of Social Psychiatry). Frederiksberg: Samfundslitteratur. ISA World Congress of Sociology. 2010. Sociology on the Move. Gothenburg, Sweden. Jørgensen, P., Bredkjær, S. and Nordentoft, M. 2006. Psykiatriens Udfordringer (The Challenges of Psychiatry). København: FADLS Forlag. Jørgensen, P., Rosenberg, R. and Mainz, K. 2007. Psykiatri, Forskning, Teknologiudvikling og Kvalitetsudvikling (Psychiatry, Research, Technological Development and Quality Development). København: Munksgaard.

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Kernberg, O, F. 1984. Diagnostic considerations, in Severe Personality Disorders. New Haven: Yale University Press Klerman, G.L. Vaillant, G.E., Spitzer, R.L. and Michels, R. 1984. A Debate on DSM-III, in American Journal of Psychiatry, 141, 539–53. Kuhn, T. 1962. The Structure of Scientific Revolutions. Chicago: University of Chicago Press. Kutchins, H. and Kirk, S. 1997. Making Us Crazy – DSM: The Psychiatric Bible and the Creation of Mental Disorders. New York: The Free Press. Laing, R. 1967. The Divided Self: An Existential Study in Sanity and Madness. London: Penguin Books. Levine, R, and Fink, M. 2006. The case against evidence based principles in psychiatry, in Medical Hypotheses, 67, 401–10. Lewis, A.J.S. 1967a. Inquiries in Psychiatry: Clinical and Social Investigations. London: Routledge and Kegan Paul. Lewis, A.J.S. 1967b. The State of Psychiatry: Essays and Addresses. London: Routledge and Kegan Paul. Olesen, S.P. 2007. Tidens Optagethed af ‘Evidens’ – Hvad gør den ved Praksis i Socialt og Pædagogisk Arbejde? (The current preoccupation with ‘Evidence’ – How does it influence the practice of social and pedagogical work?) in VERA, 39, 8–17. Parnas, J., Gjerris, A., Reisby, N. et al. 1994. Klinisk Psykiatri. (Clinical Psychiatry), 281–377. København: Munksgaard Pearson, M. 2007. Systematic reviews in social policy: To go forward, do we first need to look back?, in Evidence and Policy, 3(4), 505–26. Pichot, P. 1994. Nosological Models in Psychiatry. British Journal of Psychiatry, 164, 232–40 Rieper, O. and Foss Hansen, H. 2007. Metodedebatten om Evidens (The Methodological Debate about Evidence). København: AKF. Rose, N. 1986. Becoming neurochemical selves, in Biotechnology, Commerce and Civil Society, edited by N. Stehr New York: Transaction Press, 89–128. Rose, N. 1996. Inventing Our Selves. Psychology, Power and Personhood. Cambridge: Cambridge University Press. Rose, N. 1999. Powers of Freedom. Reframing Political Thought. Cambridge: Cambridge University Press. Rose, N. 2006. Disorders Without Borders? The Expanding Scope of Psychiatric Practice in BioSocieties, 1(4), 465–84. Rose, N. 2007. The Politics of Life Itself. Biomedicine, Power and Subjectivity in the Twenty-First Century. Princeton, NJ: Princeton University Press. Rose, N. 2010. Normality and pathology in a biomedical age, in Sociolological Review, 57, 66–83. Rose, N. and Miller, P. 1992. Political power beyond the state: Problematic of government. British Journal of Sociology, 43(2), 173–205.

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Rosenbaum, B. 1994. Det er et bånd der taler. (It’s a tape talking). København. Gyldendal Rosenbaum, B. 2000. Tankeformer og Talemåder – en Undersøgelse af Skizofrenes Udsigelse, Tankeforstyrrelse og Kommunikation (Modes of Thought and Figures of Speech – A Study of the Statements, Thought Disturbances and Communication of Schizophrenics). København: Multivers Aps Forlag. Rosenbaum, B. 2004. Psykiatriens aktuelle videnskabelighed (The Contemporary Scientific Character of Psychiatry), in Videnskabens ansigter (Faces of Science), edited by Aagaard, L. and Brock, S. Århus: Forlaget Philosophia. Sadler, J.Z., Hulgus, Y.F. and Agich, G.J. 1994. On values in recent American psychiatry classification, in The Journal of Medicine and Philosophy, 19, 261– 77. Sadler, J.Z. Wiggins, O.P and Schwartz, M.A. 1994. The Philosophical Defence of Psychiatry. London: Routeledge. Schwartz, M.A. and Wiggins, O.P. 1986. Philosophical Perspectives on Psychiatric Diagnostic Classification. Baltimore and London: Johns Hopkins University Press. Spizer, R.L. 1981. The diagnostic status of homosexuality in DSM-III: A reformulation of the issue, in American Journal of Psychiatry, 138, 210–15. Stacey, R.D. 2010. Complexity and Organizational Reality. London: Routledge. Taylor, C. and White, S. 2009. Practising Refelxivity in Health and Welfare – Making Knowledge. London: Open University Press. Terkelsen, T.B. 2009. Transforming subjectivities in psychiatric care, in Subjectivity, 27, 195–216. Villadsen, K. 2004. Det Sociale Arbejdes Genealogi – Om Kampen om at Gøre Fattige og Udstødte til Frie Mennesker (The Genealogy of Social Work – The struggle to liberate the Poor and Deprived). København: Hans Reitzels Forlag. Villadsen, K. 2007. Foucault: Den bevægelige velfærdskritik (The flexible criticism of welfare), in Magtens Former (Forms of Power). København: Gyldendal Akademisk Forlag, 16–42. Wifstad, Å. 1991. Helhetsforståelse og kommunikasjon (Holistic Understanding and Communication), in Filosofi for klinikere (Philosophy for Clinicians). ISM nr. 18. Univ. In Tromsø. Wifstad, Å. and Foss, T. 1990. Krise på avveie. Viteskapsteoretiske problemer i dagens psykiatri (Crisis gone Astray – Philosophical Problems in Contemporary Psychiatry), in Nordisk Psykiatrisk Tidsskrift (Nordic Psychiatric Journal), 44, 489–93. Wulff, H.R., Pedersen, S. and Rosenberg, R. 1986. Philosophy of Medicine. Oxford: Blackwell. World Health Organization (WHO ICD-10). 1994. Psykiske Lidelser og Adfærdsmæssige Forstyrrelser – Klassifikation og Diagnostiske Kriterier

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(Mental Illness and Behavioral Disorders – Classification and Diagnostic Criteria). København: Munksgaard. World Health Organisation (WHO). 1996. International Statistical Classification of Diseases 10 rev, Vol. 1, Geneva: WHO. World Health Organization (WHO). 2001. Mental Health: New Understanding, New Hope. Geneva: WHO.

Chapter 10

Evaluations as a Process of Disenfranchisement Anders Petersen and Rasmus Willig

It is hardly provocative to claim that we find ourselves in a culture of evaluation, in which evaluations are perceived as indispensable tools of government that pave the way for a positive, valuable and accumulative learning process (Salamon 2007). Alas, under certain circumstances, the exact opposite holds to be true. Evaluations can actually possess the function of de-skilling that which may already be functioning well by placing critical questions. For each criticism, a wellfunctioning working routine may be rejected. When asked to fill out evaluation forms, the underlying assumption is that it will help us to learn something new. But the reverse is also the case. As we intend to show, people filling out evaluation forms are sometimes left with the feeling that their skills are being ‘unlearned’ because of the evaluation per se. In fact, the hypothesis we wish to advance is that some people suffer mentally as a result of these evaluation exercises, which result in harm to both their professional and personal integrity. The evaluation forms often begin innocently enough, from an informative point of view. ‘It takes just 15 minutes’ – but in some cases the critical issues get under the skin of the employee and become a permanent mode of self-criticism that damages professional and personal integrity. These innocent 15 minutes can thus turn out to be anything but innocent. This is not something to which the conventional and established evaluation literature appears to pay much attention (see for example Green and South 2006; Rossi et al. 2004). Nonetheless, as the American professor of management Hendrie Weisinger so concisely puts it, evaluations are in fact criticism (Weisinger 2000). This should not be taken lightly. The evaluation forms consist of a series of questions, and are critical in the sense that they help to point out what the recipient could and ought to do differently. It is the relationship between what you do, and how you should or could do it that forms the basis for the criticism. Typically, the questions relate to organisational goals, and deviations from the formulated goals represent the specific field of critical tension. The questions quite literally question the way things are done: Are things being done correctly? Couldn’t they be done a little bit better? Could you be a little bit more efficient? Etc. In this chapter we will begin by briefly summarising the results of a qualitative empirical study conducted in Denmark in which several respondents expressed criticism of the prevailing culture of evaluation. This empirical study was

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intended to trace processes of disenfranchisement, which we might briefly define as processes which deprive contemporary employees of the ability to express criticism of their working conditions without fear of reprisal. In continuation of the study’s main focus, several respondents felt that the evaluations per se led to detrimental self-criticism and feelings of inadequacy. In order to approach a theoretical understanding of the respondents’ negative experiences with this prevailing culture of evaluation, we turn to Jean-Pierre Le Goff’s study of the significance of management strategies in the perception of work. Le Goff’s study helps to explain why some people feel that the evaluation forms place them in a permanent examination situation, in which they are tested to see whether they exhibit the correct degree of flexibility and adaptability. We then draw upon the work of Christophe Dejours, who describes how evaluations can be seen as tools that place so much pressure on the modern employee that they help to create an actual culture of fear. These theoretical considerations are then related to the idea of evaluation as a powerful process of disenfranchisement. On the basis of these strong critiques of the culture of evaluation, it becomes possible to formulate a new research hypothesis. The Empirical Study – Focus Group Interviews Over the past 10–15 years, an ideological wave has washed across the public sector in Demark, demanding better services for less money. This ideological wave goes under many different designations, such as ‘new public management’, ‘neoliberalism’ or ‘strong leadership’ (see for example Campbell and Pedersen 2001; Horton 2006; Lane 2001) but common to them all is that they place financial/ economic rationality above other kinds of rationality. As a consequence, even some of the most fundamental ideas, such as that of the autonomy of the public sector professions and the knowledge base upon which they rely, have been wholly or partly set aside. It is as though each of the public sector professions has become the object of political consumerism and hence forced to measure themselves with standards of efficiency, effectiveness, productivity, etc. – all logics we normally associate with the spheres of economy. Soon, no year will pass in Denmark without new reforms being proposed and implemented, in the name of ensuring the greatest possible efficiency and service – such as the recent reforms in the elementary schools, upper secondary schools and universities have shown (Auken 2010). No area or professional grouping has escaped. The consequences of each of these reforms have been colossal. The human and institutional catastrophes are hard to overlook, but the criticism has barely had time to reach the public arena before a new and improved reform promises a remedy. On the basis of these developmental tendencies, which appear to characterise the entire Western labour market (Bourdieu 2000: 30–31), the study which was later given the title Disenfranchisement (Willig 2012) investigated the qualitative consequences of the prevailing neoliberal organisation of work. Specifically, the study sought to

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demonstrate the consequences of this neoliberal form of organisation for one the most basic reproductive stages of society; it demonstrated how criticism by kindergarten teachers of deteriorating working conditions was ignored and dismantled, and how these processes of disenfranchisement were reproduced towards the children. For example, more use was made of comforters to curb the children’s noise, since, as a result of the many cut-backs there were not enough teachers to meet the children’s primary needs (Willig 2012). The empirical examples presented here derive from a series of focus group interviews conducted in the years 2008 and 2009. In the first series of interviews, 20 focus group interviews were held over four days, with a total of 110 participants. In the second series, 28 focus group interviews were held over seven days, with a total of 138 participants. The first series of focus group interviews encompassed kindergarten teachers, kindergarten managers, staff representatives and day care centre managers, while the second series involved staff representatives and joint staff representatives. The interviewed persons all live in medium-sized towns in Denmark,1 and the group of joint staff representatives was drawn from the whole country (Willig 2012). The focus group interview was chosen because this method is particularly good at mapping and identifying the common interpretations and understandings that different groups generate towards a given subject. A much referred-to definition of focus groups is that it is ‘a research technique that collects data through group interaction on a topic determined by the researcher’ (Morgan 1996: 130). This very broad definition implies three things: 1. Focus group interviews are used to collect data, as opposed to in marketing, where the method is applied as a mean to selling ideas, products, political content etc. 2. Group interaction is the main source of data. 3. The researcher/moderator plays a significant role in creating the group discussion that generates the data (Kitzinger 1995). In our study only oral group interaction was accounted for, that is, we paid no analytical attention to body postures, gesticulations, etc. Due to this fact, we invited all the participants in the focus groups to talk to each other, ask questions to each other, comment on each other’s experiences and to be critical towards each other about the topic in question. The point is that the researcher via focus groups is interested in more than just the sum of individual utterances but in the accumulated interpretations of the group (Kitzinger 1995: 299). The moderator/ researcher plays a vital part in trying to encourage this interaction. In our particular case, where the topic we wanted to study was the processes of disenfranchisement taking place within the working area of a specific professional group, the moderator was definitely significant. As this theme may be perceived as being relatively 1  Including Silkeborg, Skanderborg, Odder and Aarhus, which vary in population size from 35,000 to 250,000 inhabitants.

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delicate and sensitive by the participants, we took a gentle approach to initiating the focus group interviews regarding the kindergarten staff’s perception of which processes of disenfranchisement were most prevalent. Two ethical strategies were utilised for this purpose. Firstly, it was emphasised that all statements would be anonymous, and secondly, the serious nature of the topic was defused via a series of oral presentations by the researchers (see also Mariampolski 1989: 7; Greenbaum 1990). Processes of Disenfranchisement In the aforementioned study, enfranchised individuals are defined as people who are able to make their own choices, i.e. people who can exert an influence over their own lives. To have a say in your own life, you must be able to speak freely and thereby influence your surroundings. You must also be able to actively contradict ‘the regulations’, so to speak, in order to assert such an influence, which means being able to voice critique. The enfranchised person may thus be defined as one who is able to voice criticism, as it is through criticism that such a person asserts his or her influence and choices (Willig 2012: 26). Individuals may be said to be able to voice critique when they are able to express their opinions without the threat of reprisals, i.e. without fear. However, it is difficult to determine the nature of such fear, which depends upon the environment of the person concerned and the person or group that is the object of the critique. A person’s level of fear or lack of same may for example depend on whether the society in which the criticism is presented guarantees freedom of speech, a free press and the right to assembly and on whether this society possesses a protective layer of norms in which the existence of criticism is regarded as a positive phenomenon, rather than one that is condemned. Fear exists when there is the possibility of reprisals, i.e. more or less specific sanctions. In the legal area, such sanctions might for example involve the imposition of punishment on people for their statements, while in the normative area, the sanctions might consist of a person being punished by being bypassed, ignored or overlooked. Enfranchised individuals who are able to voice critique may thus be defined as persons who can express themselves freely without fear of reprisals, whether in the form of normative or legal sanctions, and who can thereby, via their critique, create autonomous scope for influence over their own lives (Willig 2012: 27). Conversely, processes of disenfranchisement may be described as processes which cause one or more individuals to fear reprisals in the form of sanctions. A process of disenfranchisement may furthermore be defined as a series of acts or changes which alters the sense of enfranchisement of a person or group. This process is negative inasmuch as it deprives the individuals concerned of the ability to criticise, and is manifested as a loss of the sense of identity and a feeling of powerlessness and paralysis. On the moral–psychological level, being deprived of enfranchisement can lead to a loss of personality; the individuals

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concerned lose the ability to construe their biographies – i.e. their life stories – in a meaningful way. Their sense of meaning diminishes in parallel with the growing pressure exerted on their ability to criticise, which robs them of the ability to influence their lives. Processes of disenfranchisement often take place without the conscious knowledge of the disenfranchising or the disenfranchised party, or with the tacit acceptance of both parties. Sometimes, individuals who are subjected to such processes may even perceive them as liberating, even when they are actually repressive. Evaluations Lead to Detrimental Self-criticism The promotion of freedom via evaluations seems to be a predominant norm in our culture of evaluation. In that respect evaluations are presented as contributing to the development of professional skills and competences (Green and South 2006), which aids the evaluated at accomplishing autonomy at work. But questions which are supposed to take just 15 minutes to answer may also possess a punitive function: they may involve a process of disenfranchisement. Insofar as the questions in the evaluations are internalised they punish the sense of self of the individual, who continually asks ‘Could I do things a little better?’, ‘Could I become a bit more efficient?’, again and again – until the next evaluation form needs to be filled in. But which kinds of evaluations are we more specifically talking about? First of all, in the context of our study, evaluations are to be seen through the analytical prism of what Stephen J. Ball calls the performative society. As Ball states: Performativity is a technology, a culture and a mode of regulation, or even a system of “terror” in Lyotard’s words, that employs judgements, comparisons and displays as means of control, attrition and change. (Ball 2004: 143)

From this perspective evaluations are, something which became vividly clear in our empirical study, highly corroding. To further clarify this point, a distinction may be drawn between two different kinds of evaluation, namely external and internal. External evaluation is implemented by outsiders, such as local authorities who undertake an assessment and general inspection of the institution in question. This kind of assessment often consists of a number of concrete questions, which systematically tries to evaluate the daily work of the kindergarten teachers with one thing in mind – to optimise their performativity and make their work more effective. Some of the questions kindergarten teachers are met with are: 1. Which social competences are you trying to pass on to the children and how? 2. What are you focusing on when you asses the children’s overall development?

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3. Which values and ways of communicating these are you trying to pass on to the children? 4. Etc. Now, these sorts of question are not – in themselves – troublesome. But they become so because of the fact that each evaluation is always concluded by a section of self-reflection. The questions asked here are often few, but they tend to leave a mark: 1. How are you able to do your job better? 2. How are you able to optimise your performativity at work? A very odd thing is that such external evaluation, in practice, is administered by the employees themselves, which leads to confusion between internal and external evaluations. That is, it is actually a member of staff that hands out the evaluation forms to his/her colleagues. This sometimes leads to confusion between external and internal evaluations and makes it difficult to see who bears the responsibility of the evaluations, and who is actually criticising whom. To make matters worse, internal evaluations are often sent to an external control organ, but according to the participating kindergarten teachers, they then seem to disappear without trace. None of the participating kindergarten teachers actually knew where these evaluation forms went. Nonetheless, they often felt that such evaluations could be located and used against them if the initiators of the evaluations were to find this convenient. These internal evaluations are interesting inasmuch as they reflect new forms of control in which responsibility can only be located among the staff, since it is they who have established the current standards and procedures which form the basis for their own evaluation. Ownership of the procedures, standards and evaluations thus lies with the institutions themselves, since they have helped to formulate them – in theory, at any rate. But that is often altered. As soon as, for example, an alarmingly high level of noise in a kindergarten is discovered by an outsider – let’s say an alert journalist – it turns out that the critique coming from the internal evaluations does not belong to the institution itself after all, but to the public sphere. The ownership is thus only genuine as long as the critique does not reach the ears of the management or the municipal politicians. At the moment it does so, ownership passes to the broader public. This has the effect of placing the professional standards of the kindergarten teachers under extreme pressure. Karen, who has worked as a kindergarten teacher for 24 years, says for example: Now, for instance, we have to work out a new institutional policy, and while that’s going on, we can’t do our proper work and see happy children around us. This retards the children’s development. The pressure that is being brought to bear on us is ruining our pedagogical work. You just can’t live up to your own professional standards.

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According to Karen, it will not take much to cause her workplace to break down entirely, especially now that they have to tick boxes to register and evaluate the development of each individual child. They spend their time documenting the very developmental processes that they do not have sufficient time to promote. Karen continues: We spend a lot of time on evaluations, setting up plans for the kids etc. in a very rigid way. And in order to survive we just tick off the question boxes in the seemingly most appropriate places. In that way we get the job done. The most troublesome part of this practice is that we don’t do it correctly and the evaluations themselves are not done correctly.

Bente, who has worked as a kindergarten teacher for 11 years, continues along this line: Deadlines for the different evaluation forms are often confusing, which leads to the fact that we fill them in without looking at the content.

But even though the evaluations are not done properly, they still leave a mark on the kindergarten teachers. That is, the evaluations support the prevailing norm in our contemporary performative society, namely that ‘you can always do things a little better’. The logic entailed is almost a common consensus. The question that arises in this context, however, is not so much whether you really always can do things a little better, as whether you ought to do so, from a pedagogical perspective. Logic dictates that we can always do things better, so the answer would appear to be yes – but in reality it is no, because ‘better’ means more efficient child care; and the more efficient the care, the less staff are required, since efficiency in this context is synonymous with child care for fewer resources. In that sense the kindergarten teachers are actually performing what John MacBeath and Archie McGlynn (2002) call self-evaluation. In their perspective: Self-evaluation takes place whenever teachers consider more effective layouts for their classroom, when a school considers the need to change a reading scheme or seeks to improve the style and tone of its letters and reports to parents. Whenever existing provision is examined with a view to its improvement internal evaluation is at work, often informally but increasingly in a self-conscious and systematic way. (MacBeath and McGlynn 2002: 25)

In that way the evaluation forms contribute to the internalisation of selfevaluation and hence to the ideology of efficiency. As Bjarne, one of the few male participants, stated: We never seem to get the required time we need to take care of the kids properly. We have to make different educational plans, fill in evaluations forms of different

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Structurally imposed predicaments are being personalised. As Louise, a kind and very obliging nursery teacher said right after one focus group interview, she and her colleagues always gave the children top marks for everything in the evaluation forms, while they tended to undervalue their own professional performance. She concluded by saying, ‘After all, you can always do things better’. That which functions well can in other words always be improved; this is the logic that you hear, again and again. As a consequence of this thinking, practices which work well are being scrapped for no reason. The idea that things can always be done ‘a little bit more efficiently’ is destroying well-functioning working routines. In the worst cases, this can result in a sense of enfranchisement being replaced by a process of disenfranchisement under the beguiling heading of ‘improved efficiency’. In this respect, the evaluations represent a political critique of public sector employees, the responses to which provide the yardstick by which acceptable performance is judged. In reality, therefore, their function is not to improve the conditions of the children nor the kindergarten teachers but to protect the managerial layers (municipal politicians etc.) whenever external critique reveals that things are not as they should be. Kindergarten teachers can gain the impression that earlier evaluation forms can be brought up from the town hall cellar as evidence to show that they have ‘voluntarily’ expressed the wish ‘to do things a little better’. In this sense, there is always a critical field of tension between the kindergarten, the staff and the child concerning the issue of how they can ‘do things a little better’. Seen from this perspective, evaluations comprise one of contemporary society’s most refined means of holding critique in check. Instead of critique being directed at poor working conditions, it becomes an internal matter as soon as the evaluation forms are submitted. The evaluations absorb whatever remnants of critique that remain and transform it from outwardly-directed critique into critique which is inwardly-directed. The critical questions are no longer structurally directed at, for example, municipal politicians, but at the kindergarten teachers themselves. Apparently then, the evaluation forms create a U-turn for the critical traffic. The consequence of this is an ongoing self-evaluation, or more correctly a continual legal proceeding of the self that judges the self to being more and more effective. Kindergarten managers often say that filling out the evaluation forms takes very little time. In fact, the focus group interviews revealed that while the kindergarten staff members had not received an abundance of evaluation forms, they nonetheless tended to worry about them a great deal, apparently because such evaluations are so symbolically significant that they have a psychological effect. That is, the criticism exposed in the evaluation forms becomes internalised in the inner consciousness of the individual kindergarten teachers. The result is a permanent alteration in ethics and norms, as the critical questions are now repeated within the boundaries of the self, rather than within the framework of the State or the municipality. The critique goes from being extrovert – ‘There’s something

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wrong with our working conditions’ – to introvert – ‘There’s something wrong with me’, and the central question becomes: ‘How can I become more efficient?’ The remarkable result is that the kindergarten teachers lose their sense of enfranchisement when they turn their critique inwards instead of outwards. Each time kindergarten teachers criticise themselves, the profession loses a little more of its vital sense of enfranchisement – and each time they turn their critique inwards, they increase their own risk of suffering stress, depression and burnout (Ehrenberg 2010; Petersen and Willig 2004; Willig 2012). The criticism thus not only holds dissatisfied staff members in check, but also punishes them. Evaluations as Barbarism Into which theoretical framework can we place these negative experiences? Over the past decade, the French philosopher and sociologist Jean-Pierre Le Goff has attracted attention with analyses of the growth of management strategies in working life (1992; 2000), and what he describes as the blind process of modernisation in businesses and the public sector (1999). Le Goff’s fundamental assumption is that adaptation to a constant process of modernisation has been articulated as a social imperative, the legitimacy of which must not be challenged. The negative consequences of such processes of modernisation can thereby be neglected, in spite of their strong propensity to erode social and societal communities. In the wake of this blind modernisation comes that which Le Goff terms ‘gentle barbarism’ (Le Goff 1999). It is gentle because it is supported by modern normative demands, such as for increased autonomy, transparency and accountability; and it is barbarism, because these normative demands pave the way for the introduction of new methods of manipulation and repression. What is new about these normative demands is that they appear to be impermeable to and reject any form of resistance. As a result, the normative demands are practically totalitarian, in the sense that any attempt to reject them is doomed to failure. Briefly put, Le Goff regards the endless demands for change produced by blind modernisation as a destabilising factor, because the mental capacity of the individual has trouble keeping up with the permanent development shifts. This gentle barbarism thus promotes a kind of continuous cultural revolution, which transforms the individual’s ways of living, acting and thinking, without allowing him or her sufficient breathing space to adapt (Le Goff 1999: 8). The concept of blind modernisation is accompanied by a professionalisation of life itself, in which individuals are exhorted to live out their autonomy and accountability, and to be constantly able to motivate themselves and invest their optimum performance and skills in their work. In Western societies, in particular, this has been fostered by the parallel growth of management strategies, the normative demands of which have exerted an extremely powerful influence on the nature of the work. A common feature of these management strategies is that they have helped to break down the hierarchical organisation principles which previously characterised

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the Taylorist form of organisation. This process has amongst other things contributed to the incorporation of the ‘whole person’ into the work, focusing on the so-called ‘human factor’ (Le Goff 2000: 16; see also Cohen 1999). This means, firstly, that the competencies individuals are likely to internalise include such qualities as mobility, flexibility and polyvalence (see also Bauman 2001). These skills are presented as aspects of self-realisation, and thus as tools for securing the employability of the individual (see also Boltanski and Chiapello 2005). Secondly, a moral dictum, in which working individuals must always be able to motivate themselves and optimise their performance on the basis of a vision of the appropriateness of incorporating their entire knowledgeability in the work, has prevailed (Le Goff 1999: 32). In order to demonstrate that they have invested their knowledgeability in the work, individuals must live up to and realise the normative demands towards flexibility, mobility and polyvalence. According to Le Goff, the individual’s flexibility and mobility skills are determined by his or her mental pliancy and elasticity (Le Goff 1999: 26; see also Sennett 1998). These two terms refer to the individual’s mental ability to display continuous adaptability, flexibility and elasticity, in the sense that the individual does not return to any fixed point. There are thus no limits to the amount of pliability and elasticity required, which is why the polyvalence of the individual acquires such great significance. Le Goff perceives the idea of autonomy as one of the most important dynamics of modernisation, in that it is inextricably bound up with the extensive responsibility that has been assigned to individuals. The state of autonomy is not, however, something that can be assigned, but must rather be achieved. Autonomy is something to be strived for (Le Goff 1992: 276), and any quest for further autonomy takes place in the form of individual, active liberation from fixed, meaning-giving frameworks. Autonomy is therefore something that must be developed by oneself, not by society’s institutions. From this perspective, the goal of work becomes the conquest of autonomy, which implies that work must provide the structural and psychological conditions for this conquest to take place. Paternalistic and hierarchical organisational structures thus harmonise poorly with this new form of conquest, whereas accommodating the flexible, mobile and polyvalent requirements of work precisely enables such a conquest to take place. In relation to the psychological conditions of work, individuals are reminded that they must attend the management-inspired self-development courses, where they are inculcated with the link between work and personal fulfilment. In addition, individuals must meet the efficiency and productivity requirements that are constantly being laid down by the enterprise. It is in the light of the demand for continuous improvements in efficiency that the use of evaluation forms becomes particularly trenchant, since in both private companies and public institutions, an increasing number of evaluation processes are being initiated in which individuals are tested on their ability to exhibit flexible, mobile and polyvalent behaviour at work (Le Goff 1999: 30). From Le Goff’s perspective, the expectation of individual autonomy thus also depends on whether the individual follows the path of efficiency and productivity, and the

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individual must also always expect to be subjected to continuous proficiency tests. This places individuals in an extremely contradictory and destabilising situation, in which they are simultaneously obliged to realise their own autonomy and adhere to specific normative codes for increased efficiency and productivity. This paradoxical situation, in which the individual experiences a kind of quasiautonomy and quasi-accountability, does not meet the individual’s expectations of being able to see his or her own influence in the workplace. The increasing focus on accountability and autonomy thus becomes a burden, as it backfires on individuals in their attempts to live up to the normative demands. Whereas the dissolution of the Taylorist workplace model ought to secure the increased humanisation of work, it is Le Goff’s argument that the post-Taylorist focus on individual performance and obligatory autonomy in work has led to a new dehumanisation of work. The point is that the pressure on an individual’s mental capacities is simply increased to such an extent that the individual’s relationship with work becomes characterised by insecurity/uncertainty, further exacerbated by the fact that individuals are not given the necessary time and space to stabilise their skills in relation to their work (Le Goff 2000: 79). In the pervasive zeal for transformation, work is reduced to a continuous process of adaptation to evaluations, which present themselves as the means to make everything more efficient. However, when the expectations of adaptation and change are illusory in relation to the possibility of compliance, what happens is that the individual is separated out and abandoned to his or her own uncertainties. This also erodes the core of collective practices, which is why ‘gentle barbarism thus manifests itself as a machinery of meaninglessness that destabilises both individuals and collectivities’ (Le Goff 1999: 112, our translation). The essence of this gentle barbarism is meaninglessness, which Le Goff associates with the gradual siphoning off of substance by virtue of the normative demands. By this he means that the normative expectations towards mobility, flexibility and polyvalence are practically devoid of any specific content which individuals might otherwise be able to use to guide them in their attempts to adhere to them. The only thing you can be sure of with respect to these normative demands is that you can never be sufficiently mobile, flexible, polyvalent, etc. The demands are therefore continually pursued, which creates a breeding ground for the emergence of new control mechanisms, exemplified by ongoing internal evaluations, for which the external evaluation procedures act as accelerators. Evaluations Create a Culture of Fear Where, with Le Goff, we can understand evaluation as a form of barbarism, the French psychiatrist and psychologist Christophe Dejours give us the analytical tools to view them as fear-generating. Over the past three decades, Dejours has analysed the psychological influence of working life on the individual. In his first

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book, Travail. Usure Mentale (1980), Dejours describes how the development of the social and organisational division of labour has demanded not only the corporal subjugation of employees, but also the suppression of their personalities. For Dejours, ‘suffering’ is a key term which he unfolds in his analysis of work. What makes him an interesting thinker in this context is that in the later work Souffrance en France. La Banalisation de l’Injustice Sociale (1998, hereafter: Souffrance), he specifically examines suffering in the light of the increased social internalisation of neoliberal, economically-based values and norms. In order to understand Dejours’s perspective, it is essential to clarify his concept of work. He defines work as follows: In our view, from a clinical standpoint, work is what is implied, in human terms, by the fact of working: gestures, know-how, the involvement of the body and the intelligence, the ability to analyse, interpret and react to situations. It is the power to feel, to think and to invent. In other words, for the clinician, work is not above all the wage relation or employment, but ‘working’, which is to say, the way the personality is involved in confronting a task that is subject to constraints (material and social). (Dejours 2007: 72)

Dejours’s view implies that no work is purely mechanical. Even the most Taylorist form of work involves a certain degree of involvement of the personality. Therefore Dejours – in contrast to, for example, those postmodernists who proclaimed the demise of the vitality of work (see Rifkin 1995) – views work as a key aspect of individual identity (see also Sennett 1998). In other words: work is an intellectual act of exploration which is associated with personality formation for the individual (Dejours 1998: 2). Work is thereby ascribed an emancipatory effect, but according to Dejours, it also generates suffering (Dejours 1998: 49). As we shall see, Dejours believes that suffering has taken over in the neoliberal-oriented work organisation, which focuses to a large degree on continuous competition. In Souffrance he thus diagnoses competition as the primary cause of suffering (Dejours 1998: 9–10). In spite of the fact that competition is by definition asymmetrical, and intended to optimise and combat inefficient economic entities without reference to social exclusion, it operates, according to Dejours, as a self-explanatory aspect of contemporary human life. It is in this context of suffering that Dejours concludes that the integration and production skills of work operate as the fundamental pivot for the reproduction of the neoliberal economy (Dejours 1998: 175–6). In relation to this, the organisation of work, in the neoliberal context, has come to rely on individual rather than collective premises. Continuing this reasoning, Dejours has observed the existence of three types of fear which abound in modern business and organisational culture. Firstly, there is the constant fear of being found incompetent (Dejours 1998: 30), accompanied by the fear of dismissal, and thereby the fear of being ‘weighed and found wanting’. This leads to a fatiguing internal evaluation of the employee’s own abilities and skills. Secondly, there is the fear of underperforming (Dejours 1998:

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33). This involves the fear of not being profitable, which results in a debilitating external evaluation of individual performance. The individual thus participates in a perpetual examination, and due to fear, is forced to constantly perform at the ‘top of his game’ without being given the necessary time for recuperation. As a consequence, he or she has no opportunity to become at one with the work, or in the words of Richard Sennett, the individual is constantly ‘in recovery’ (Sennett 1998: 135). Thirdly, there is the fear of not achieving recognition for your work (Dejours 1998: 36). Dejours’s point is that the latent fear of not being able to live up to the neoliberal expectations of competitiveness and profitability has an extreme effect on the mental state of the individual. Fear of incompetence and of permanent exclusion leads to an imbalance in the individual’s perception of his or her actual capabilities. Dejours regards this latent, destructive contradiction as a kind of default state, in that the dominance and fear of competition has become so ubiquitous and general that suffering has become the normal state of affairs (Dejours 1998: 39). Consequently, individuals, in an attempt to protect their vulnerable mental fragility, accept the demands of competition towards efficiency, flexibility and mobility. The immediate consequence of a division of labour that operates with the normality of suffering is that individuals become unsure of their own abilities and skills, since the expectations are distorted, and they are thus obliged to constantly strive to achieve recognition for their accomplishments. In other words, Dejours regards reciprocal recognition as a determining factor in the subject’s personal development. As he puts it: When the quality of my work is recognised, then my efforts, my anxiety, my doubts, my disappointments, my despondency also make sense […] In the recognition of work, indeed, even in the work itself, the subject can then apply this in the construction of his or her identity […] But when recognition is lacking in work […] the subject is condemned to suffering, and only that. (Dejours 1998: 37, our translation)

Dejours distinguishes here between two kinds of achieved recognition. Firstly, there is the hierarchical and vertical recognition provided by your superiors with respect to the usability and value of your work, and secondly, the horizontal recognition of peers and colleagues of your work’s quality. Both forms of recognition serve as a kind of symbolic payment, which must be made if the individual is to maintain the necessary balance under which to develop his or her personal potential (Dejours 1998: 121). Recognition is thus a vital element in alleviating suffering, but according to Dejours, the problem is simply that both modes of recognition are becoming increasingly subverted by the fear-based organisational principle upon which competitive work is based. Thus, while the individual is constantly seeking recognition, the conditions for attaining such recognition are changing faster than the individual can benefit from it. The individual is thereby trapped in a wearying

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‘almost there’ hunt for recognition.2 Seen from this perspective, neoliberalism’s embedded forms of fear contribute to the breaking down of the individual by two different types of evaluation. While the fear of incompetence results in a continuous and ever more intensive evaluation of one’s own abilities and skills, the fear of underperforming contributes to the flourishing of external forms of evaluation which focus on the individual’s profitability. The point is that these forms of evaluation are mutually reinforcing, and thereby create the basis for a spiral of evaluation that undermines the ability of the individual to maintain a coherent or cohesive personality. This is further underlined by the fact that neoliberalism undermines the very conditions for achieving adequate recognition of one’s work, thereby intensifying the third form of fear. Evaluation as a Process of Disenfranchisement We have so far attempted to place the empirically-identified processes of disenfranchisement in a theoretical context. With the help of the theoretical perspectives of Le Goff and Dejours, it has become possible to describe various forms of evaluation as disenfranchising. Common to these two perspectives is that they regard evaluation as the outcome of the development of a new way of organising work. In this new organisation of work – whether the result of blind modernisation or of a neoliberal process of development – evaluation can be seen to act as an apparently powerful process of disenfranchisement. It is in this perspective that we place Le Goff’s analysis of the demand for continuous individual efficiency, for inasmuch as individuals are confronted with the persistent expectation to optimise and operationalise themselves, they are also forced to internalise the idea of ‘becoming more efficient’. This has the effect of creating an externally-appointed internal review tribunal, via which individuals submit themselves to constant self-scrutiny. This internal action, which draws nourishment from external evaluations, functions, from this point of view, as a control measure within the individuals themselves. The control evaluation directs the critical questions inwards: the question of whether you are complying sufficiently with the demand for permanent flexibility, polyvalence and mobility thus becomes one which individuals must in general answer for themselves. The internal control also ensures that individuals are constantly optimising their employability, since failure to continually fine-tune and adjust will result in prompt punishment in the form of being excluded or overlooked. 2  Perret and Roustang (1993) make a similar point when they state that the postindustrial organisation of work has not produced adequate recognition structures to accommodate the recognition expectations of employees, as a result of which lack of recognition of the value of one’s work has become a social and cultural problem (Perret and Roustang 1993: 138–9).

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Through Dejours’s perspective, we can analyse the three types of fear as separate processes of disenfranchisement. The first form of fear, the fear of incompetence, entails an internal (debilitating) evaluation of the individual’s abilities and skills. In this mode the fear manifests itself internally in the individual, thereby affecting the ability to generate a stable personality. The individual is placed in a situation in which there is a requirement to constantly prove your own worth, whether in relation to your colleagues or superiors. This leaves the kindergarten teachers with insufficient possibility to stabilise their psychological well-being. The fear of under-performing, and thereby the fear of not being profitable, is however accompanied by an external form of evaluation, which evaluates the individual’s actual performance and hence his or her performance capabilities. Seen from this point of view, this form of evaluation functions like a kind of examination which continuously grades the individual’s abilities and awards proficiency marks. In order to avoid receiving a poor evaluation (or grade), individuals must therefore train themselves to constantly perform at their best. The performance curve must always be rising, as a declining curve cannot be tolerated. Fear of failing to achieve recognition for your work constitutes the third form of fear, and consequently, the third process of disenfranchisement. From Dejours’s perspective, adequate recognition forms the foundation for the development and identity of the individual, and appears to be the only real counterbalance to suffering. It is therefore devastating for the individual if the possibilities for achieving recognition are eroded. The problem is that the conditions for obtaining recognition are somewhat obscure, and the compliance requirements are constantly changing – as ensured by, amongst other things, evaluations. This supports a development in the direction of premises for recognition that can never be completely defined and made comprehensible: evaluations constantly alter what may be considered the object of recognition. With Le Goff and Dejours, we can therefore observe a development that supports the empirical statements from the kindergarten teachers, namely that the critical questions are directed at them, and not at the structural factors that are the cause of their deteriorating conditions. Or to put it another way: the critique is turned away from society and towards the individual. The demands for improvements, flexibility, mobility, etc. are imposed on the individual, not on the structural conditions. Consequently, it is increasingly a question of how to exceed the individual’s skills and abilities, not about the structural prerequisites which require this. Evaluations are the means and the method for this change. This does not mean that actual causal relationships may be inferred between the prevailing culture of evaluation and the ability to speak out critically. What we did however find among the kindergarten teachers was that they tried to meet the demands for greater efficiency. As in Le Goff’s description, they attempted to become more flexible, but some of them also found that this destabilised their sense of professional skill as well as their own mental stability. The fear of not being regarded as sufficiently flexible, mobile and efficient brings about a situation in which evaluations can be characterised as a process of disenfranchisement,

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as they are not subject to criticism from any party. No-one dares to criticise the evaluations, as this would signal that you are one of those who cannot meet the demand for greater efficiency. This perspective is reinforced by Dejours’s argument that evaluations help to establish an actual culture of fear. Evaluations internalise the fear of being found to be incompetent or under-performing, or failing to achieve recognition for your work. The process of disenfranchisement now becomes explicit, as the reprisal takes a concrete form. New Research Hypothesis In his famous essay ‘What is Critique?’, the French philosopher Michel Foucault states that critique is the ability to pose questions (Foucault 1997). There is, however, a marked difference between the kind of questions that Foucault describes and those that appear on many contemporary evaluation forms. In Foucault’s text, the questions are directed at the State or at the theocracy of the early 1500s. In these cases, it was the people who put the questions to their respective rulers, not the authorities who asked questions of the people, as is the case today. Today, sophisticated evaluation forms bombard staff with questions. As the criticism of the growing culture of evaluation points out, it is beginning to take more time to evaluate services than to provide the services that are evaluated (Salamon 2007). However, as we have just described, there is apparently also another reason why many people feel uncomfortable about filling out evaluation forms. The question is whether evaluations are in fact perceived as sophisticated management tools, which convey a minor but not inconsiderable criticism of the individual employee. Am I doing things well enough? Could I be a little bit more efficient? In his famous dystopian novel 1984, George Orwell provided, with the Ministry of Love, an almost too appropriate illustration of this pervasive culture of evaluation (Orwell 1991). For those who do not remember Orwell’s book, the Ministry of Love arrested those who failed to obey the marching orders of the future and subjected them to torture in the ministry’s cellars. Their treatment was deemed to be ‘complete’ when they once again thought ‘correctly’. Today, noone needs to be arrested – why arrest those who fail to toe the contemporary line when the interrogation can simply be posted in a stamped, addressed envelope, or filled in online? It saves both time and resources. Evaluations have rationalised away Orwell’s interrogation rooms. Take any evaluation form, and think about the structure of an interrogation. First come the factual questions: age, sex, residence and workplace. Then a series of questions which begin to approach the desired information: What could you do better? Finally, there is a small box in which you can add a personal comment, which is consanguine to: ‘Do you have anything to add before we conclude the interrogation?’ If we permit ourselves to regard evaluation as a management tool that promotes the partial internalisation of the idea of greater efficiency and creates a culture

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of fear, this goes a long way towards explaining why many of the interviewed kindergarten teachers perceived evaluation forms to be an expression of control. The new research hypothesis we wish to advance is based on the idea that evaluations can even in some specific empirical cases be interpreted as instruments which help to reverse critique, so that the originators of the critique are no longer the employees, but the employers. Evaluations can thereby be considered instruments to control critique. References Auken, S. 2010. Hjernedød: Til forsvar for det borgerlige universitet [Brain-dead: In defense of the respectable university]. Copenhagen: Informations Forlag. Ball, S.J. 2004. Performativities and fabrications in the education economy, in The RoutledgeFalmer Reader in Sociology of Education, edited by S.J. Ball. London: Routledge, 143–56. Bauman, Z. 2001. The Individualized Society. Cambridge: Polity Press. Boltanski, L. and Chiapello, È. 2005 [1999]. The New Spirit of Capitalism. London: Verso Books. Bourdieu, P. 2000 [1998]. Acts of Resistance. Against the New Myths of Our Time. Cambridge: Polity Press. Campbell, J.L. and Pedersen, O.K. (eds) 2001. The Rise of Neoliberalism and Institutional Analysis. Princeton, NJ: Princeton University Press. Cohen, D. 1999. Nos Temps Modernes. Paris: Flammarion. Dejours, C. 1980. Travail. Usure Mental. Paris: Le Centurion. Dejours, C. 1998. Souffrance en France. La Banalisation de l’Injustice Sociale. Paris: Éditions du Seuil. Dejours, C. 2007. Subjectivity, work, and action, in Recognition, Work, Politics. New Directions in French Critical Theory, edited by J.P. Deranty et al. Leiden: Brill, 71–87. Ehrenberg, A. 2010. The Weariness of the Self: Diagnosing the History of Depression in the Contemporary Age. Montreal and Kingston: McGill-Queen’s University Press. Foucault, M. 1997. What is critique? In The Politics of Truth, edited by S. Lotringer and L. Hochroth. New York: Semiotexte, 41–81. Green, J. and South, J. 2006: Evaluation. Maidenhead: Open University Press. Greenbaum, T.L. 1990. ‘Focus groups spurt predicted for the 90s’, in Marketing News, 24(1), 21–2. Horton, S. (ed.) 2006. New Public Management, its Impact on Public Servants’ Identity. Bradford: Emerald Group Publishing. Kitzinger, J. 1995. ‘Introducing Focus Groups’, in British Medical Journal, 311, 299–302. Lane, J.E. 2001. New Public Management. London: Routledge.

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Le Goff, J.-P. 1992. Le Mythe de l’Entreprise. Critique de l’Idéologie Managériale. Paris: Éditions La Découverte. Le Goff, J.-P. 1999. La Barbarie Douce. La Modernisation Aveugle des Entreprises et de l’École. Paris: Éditions La Découverte. Le Goff, J.-P. 2000. Les Illusions du Management. Pour le Retour du Bons Sens. Paris: Éditions La Découverte. MacBeath, J. and McGlynn, A. 2002. Self-evaluation: What’s in it for Schools? London: RoutledgeFalmer. Morgan, D.L. 1997. Focus Groups as Qualitative Research. London: Sage Publications. Orwell, G. 1991 (Danish Translation). 1984. Copenhagen: Gyldendal. Perret, B. and Roustang, G. 1993. L’Économie contre la Société. Affronter la Crise de l’Intégration Sociale et Culturelle. Paris: Éditions du Seuil. Petersen, A. and Willig, R. 2004. Work and Recognition. Reviewing New Forms of Pathological Developments, in ACTA Sociologica, 47(4), 338–50. Rifkin, J. 1995. The End of Work. The Decline of the Global Labour Force and the Dawn of the Post-market Era. New York: Putnam Books. Rossi, P.H., Lipsey, M.W. and Freeman, H.E. (eds) 2004. Evaluation, a Systematic Approach. Thousand Oaks: Sage. Salamon, K.L. 2007. Selvmål – det Evaluerede Liv [Own goal – the evaluated life]. Copenhagen: Gyldendal. Sennett, R. 1998. The Corrosion of Character. New York: W.W. Norton. Weisinger, H. 2000. The Power of Positive Criticism. New York: AMACOM. Willig, R. 2009. Self-Realization Options: Contemporary Marching Order in the Pursuit of Recognition, in Acta Sociologica, 52(4), 350–64. Willig, R. 2012. Disenfranchisement. An Essay on the Infrastructure of Critique. London: Peter Lang.

Chapter 11

Schismogenesis, Liminality and Public Health Agnes Horvath

Health, especially public health, cannot be reduced to the absence of illness and measured by indicators collected in a number of disjointed areas. It rather refers to the harmonious manner in which various aspects are combining together. Eating, drinking, mental health, and so on, all add – or should add – to a harmonious whole for everyone, and for society as a whole. This is the perspective in which classical philosophy reveals itself to have a surprising relevance for our contemporary world. It is this, broader aspect of public health that several chapters in this volume also address from compatible angles. This perspective on health helps to date a fresh insight concerning the reasons for the loss of public health towards degenerative social pathologies. In my research I increasingly focused on the enormous power, a quasi ‘magical’ impact, exerted by images in the public sphere on individual human beings. Such images, by captivating the mind, might play a major role in disintegrating the manner in which individuals by their consciousness and by their cognition keep different aspects of their lives together in harmony. Such an impact exerted by images is particularly great in ‘liminal’ places or during ‘liminal’ moments; liminality being a concept developed in anthropology to capture the formative impact of uncertain, transitory moments;1 a concept close to interests in Greek philosophy about the ‘apeiron’ or the ‘metaxy’.2 Similar concerns have been at the centre of the attention of not only Plato but also two contemporary scholars who arguably closely follow the spirit of Plato, Gabriel Tarde and Gregory Bateson. As I argue in this chapter such dissolving power of images can be literally modelled by the qualities of the zero, an argument that was first formulated in Leonardo da Vinci’s ‘philosophy of the nulla’. This idea helps to give a new perspective on the manner in which images stimulate unconscious subordination impulses that drive away from reality, and thus undermine harmonious living, creating acute problems of public health. My interest in this prospect emerged out of my thesis which dealt with the rise of totalitarian power, where I noticed that public reception of certain repeated rhetorical turns and forceful images do 1  See the special issue on liminality, International Political Anthropology, May 2009 (www.politicalanthropology.org). 2  About metaxy, see Voegelin (1978: 103, 138, 154 and 176).

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have the power of creating a lasting transformation of reality, leading me to query whether the explanation of totalitarianism lies in a magical and enduring hold exerted on the imagination. This chapter suggests that the term social pathologies, just as the emotional mobilisation characteristic of modern politics, should be connected with liminal conditions: situations in which the previously taken-for-granted order of things is dissolved and everybody is faced with uncertainty concerning what to do and anxiety about what is going to happen. My proposition is that a genuine proliferation of the liminal took place in Europe over the last centuries, with the dissolution of social order that came about through ‘passionate interests’ (Latour and Lépinay 2009). The central argument of this chapter is that, using as a background Plato’s philosophy, complemented with the anthropological concepts of liminality (Turner 1967) and schismogenesis (Bateson 1958; Horvath and Thomassen 2008) a study of Communism provides us with a unique angle in understanding the exact nature of the transition from high modernity, with its universalist rationalism, to the confusing kaleidoscope of the postmodern identity politics of our days. The world in which we live is not produced by the inexorable growth of Enlightenment reason, not even as a promise, but neither is it identical to capitalism in the sense of exploitation, oppression and class power. Of course it has elements of both, but such accounts leave out of consideration the central driving force behind the rise to dominance of the modern world: an asocial and tyrannical drive – quite irresponsibly, under the guise of the growth, efficiency and production – with the forces of liminality. In terms of its methodological perspective this chapter belongs to the field of ‘Political Anthropology’ as it is introduced and practiced by the journal International Political Anthropology of which I’m one of the founding editors. The central idea is that contemporary social and political theory which emerged too much out of the self-understanding of modern society needs to be renewed from the double reference point of social and cultural anthropology and philosophical anthropology. Concerning the first, the aim is to use extensively the work of scholars who managed to overcome the limitations of contemporary Enlightenmentinspired and critical social theory by being immersed in the reality of non-modern societies, thus overcoming their own prejudices, including the perspectives which their teachers – including, directly or indirectly, such classical figures of modern anthropology as Franz Boas, Émile Durkheim, Bronislaw Malinowski, Alfred Radcliffe-Brown and Max Gluckman – were teaching them. Such figures include Gregory Bateson, Paul Radin and Victor Turner, who developed the concepts schismogenesis, trickster,3 and liminality, central for Political Anthropology, and this chapter. Concerning the second, the idea is to revitalise the classic works of philosophical anthropology, especially the ideas of Plato, following suggestions by contemporary social thinkers and political philosophers like Eric Voegelin, Michel Foucault and Jan Patocka. 3  About the trickster, see Radin (1972), and also Horvath (1997; 1998; 2008; 2010).

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Passion and Communism Communism as a political system emerged at a very definite time and place: East Europe, towards the end of, or just after, a World War. Such a combination is so important for the emergence of Communism that it was even repeated: Russia and the First World War; the other East or East-Central European countries and the Second World War. Yet, instead of simple repetitiveness, we should rather talk about imitation; and not in the sense of simply following a model, but of repeating an imposed scenario where in the second case the experience of the first was used exactly in the sense of the deliberate and artificial stimulation and perpetuation of an in-between situation; the artificial maintaining of liminality; preventing the countries under Soviet occupation from returning to the kind of (normal) living that to some extent still existed before the World Wars. However, it was not accidental that this takeover by a Western ideology (Marxism) happened in the Eastern part of Europe. Lenin’s idea concerning the ‘weakest link’ and the revolutionary situation was based on a very acute understanding of the long-term liminal situation of the area. Thus, returning to ‘normality’ after the World Wars would have been difficult anyway given that – whatever could be considered a ‘normal’ situation – the countries of the region even before the wars had long lost it. We cannot stop, however, at this point, essentially blaming Communism on the ‘backwardness’ of East European countries. The problem of normality with the modern world, exactly in the sense of the artificial simulation of desires, runs much deeper. This can be understood through the work of one of the most forgotten classical figures of sociology, Gabriel Tarde. Just before his famous, and much misunderstood public debate with Durkheim (in 1903) which was shortly followed by his death (in 1904), Tarde published in 1902/3 a voluminous work on modern economics and the modern economy, entitled La Psychologie Économique, of which a résumé recently appeared (see Latour and Lépinay 2009). As Latour and Lépinay argue, Tarde offers us a language that is completely different from the one used by economists at his time and ever since, but that has striking insights which, especially in the current situation, might be worthwhile taking seriously. The most important of these is the expression ‘passionate interests’, selected as the title of the résumé. The concept can help us understand why and how not only the Eastern part of Europe was no longer ‘normal’ before the World Wars, but the Western part as well. Economists, and social and political scientists who follow their lead, well beyond the narrow confines of rational choice theory, argue that human beings are fundamentally driven by the rational pursuit of the satisfaction of their objective interests. The objectivity of interests is just as fundamental a concept for Marxist and revolutionary discourses, except that they root such objectivity in social classes instead of individuals. However, there is something deeply perplexing in such claims, as ‘interest’ simply means inter essere, or ‘being in between’. It is thus a term particularly suited for an analysis that takes its departure from Plato’s analysis of in-between-ness in the Symposium. Latour and Lépinay’s book on Tarde indeed

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offers fundamental insights in this direction. For Tarde, the interests that are the subject matter of modern economics, and on which the modern economy is based, are by no means ‘objective’, but passionate. Far from being objective, interests involve a state of passion, a tension and intention, not to be sought at the level of the hidden essence of a human being. However, they can indeed be fixated, with a degree of skilfulness, with the help of the proper ‘tricks’, if they are purposefully directed to certain objects, and if the satisfaction of such desires becomes tied to the heart of personal identity. When this is done on a mass scale at the collective level the result will be a social entity where human life is increasingly reduced to the mechanical and predictable satisfaction of a certain amount of prefabricated interests and desires, which furthermore involves the complicity of individual human beings. Such a situation is not hypothetical, but is considered by Albert Hirschman as an explicit political project that was at the heart of the ‘political arguments of capitalism before its triumph’ (Hirschman 1977). The conditions for such a project were given by the period of incessant religious and civil wars dominating the sixteenth and seventeenth centuries, central for the ‘pathogenesis’ of modernity, according to Reinhart Koselleck (1988). The objectivation of ‘passionate interests’ into a rational and calculable, manageable and predictable form was considered as a solution to the religious and political crisis that otherwise proved intractable. It also rhymed perfectly with the philosophies of Descartes and Newton and the mechanical world image they propagated. However, as it became increasingly evident over the course of decades and centuries, such a solution came at a price on its own. The fixation of such ‘objective interests’ entrapped concrete human beings in the ‘iron cage’ of their own mechanical, calculative and rational self, instrumentalising and destroying both the ‘care of the self’ and the delicate tissue of social life, the very fabric of human existence. Human communities have never and nowhere been the sum of their members, driven by their own inexorable and objective interests. They were the concrete and historically unique outcome of lives and experiences, events and encounters, where every human being had a certain valorised reputation, based on innumerable acts of mutual recognition (Pizzorno 1991). Events, of course, included crises and challenges, and for them bad or unsatisfactory responses were also given. This could entail the dispersal of the entire community, or alternatively its survival in a low level of existence, where violence and hostility became endemic within a community that became internally split. It was for such a situation that Gregory Bateson (1958; 1972) developed his Plato-inspired concept schismogenesis, and for which Europe in the sixteenth century was a model case. The solution, in the form of passionate interests, as governed first through the absolutist state and then the free market managed to stabilise order, but only at the price of resigning to give up the core values of human personality and political community. Order was restored at the price of subjugating, in principle, every single human being to his or her ‘passionate’ interests. In the words of Eric Voegelin, it was an ‘order without meaning’ (Voegelin 1999: 153–5).

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A central role was played in this process by the Enlightenment, which accepted the commercial harshness and hysteria of capitalism and appropriated the central values of European culture. Gradually this led to the dissolution of understandings of reason and knowledge rooted in Antiquity, and their connections to the care of oneself. The search for discipline and composure has been replaced with an obsession with self-abandonment in the service of ideological considerations for the sake of the ‘public’. The Enlightenment, this strange, artificial design that freed people from moral and formal commitments and generated a wholesale disengagement from the social realm, while contingent on the rationality principle in its every effort, also instigated the passions, justifying the crudest egoism and self-interest as means to an end, investing every human being with a possessive and conquering zeal that radically departed from the rational temperance or harmonious proportion of the classics. Capitalism was born with little protest, though also without approval, as everything was processed, forged, and turned around at the end of the eighteenth century. Once Western societies had become persuaded of the rightness this change, thus justifying the unjustifiable, they were transformed into an emotional storm of insatiable interests. This transformation is masterfully captured by Weber at the end of his Protestant Ethic. Mechanical rationalisation on the one hand and mere stimulation of the senses on the other guided the utilitarian vision of society. The accumulation of vacuity initiated a continual process of destruction, an ever-renewed shift from earlier to later forms, from monarchies to revolutions and vice versa, until all sense of judgement was undermined. This Age of Revolutions periodically dragged the population into fearful passions of terror, moaning, and suffering, continuously provoking warfare, shifting from championing individualised human rights to the needs of the abstract community and back. This was the context in which the forces that opposed the mechanised world governed by passionate interests came to side with and generate energy from an abstract and overarching view of the ‘social’ or the ‘public’. The problem was posed in the following terms. While the state and the market functioned, in the sense that the devastating period of civil wars ended, the price was increasing inequalities and the marginalisation of a substantial part of the population, as a kind of ‘sacrifice’ in the name of the common interest. This resulted in the following, double-edged critique of the system of ‘passionate interests’. On the one hand, those human beings who were marginalised in this game had to be taken care of. This led to the idea that some kind of ‘standards’ should be defined in terms of basic human needs which should be satisfied for everybody, associated with the championing of human rights. On the other hand, and in a closely connected manner, the perceived anomie and loss of sociability led to the championing of an abstract idea of society as the greatest good. The best minds and spirits felt that something was not right in this contrast between the absolutisation of the individual on the one hand, and the social on the other, but it was difficult to put one’s finger on exactly what it was. As it is always

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the case of schismogenic developments, one excess justified another. Everyone was forced to take sides in an impossible debate; not doing so meant to be resigned to the position of a weightless outsider. The outcome was an extremely tricky and particular circle on which the indeed tight affinities between sociology and socialism were based: the sacralisation of individual rights, but only in so far as these are basic and merited through suffering; and the sacralisation of an abstract ideal of society, where concrete human relations and sociability were replaced by the community of sufferers, imposed through moral terror. The acceptance of such an outcome was due to a vague but dominating sense of guilt, based on a looming background feeling that something is wrong with the proliferation of egoism and greed as the very substance of social life, and yet not being able to step outside one’s own ‘passionate interests’. Thus it happened that the classical conception of politics as being concerned with the common good was replaced with a drive to offer oneself up for the sake of others. The cultivation of the relationship between the state and the community was transferred to the field of political communication, image building, propaganda, or political marketing, all deployed in order to ‘care’ for the citizens’ souls through increasingly institutionalised personal instruction and guidance (Gordon 1987). It was considered a logical outcome of such a ‘serving the people’ philosophy that the driving forces of social life should be ‘collective values’. These represented the only way to overcome the conflict of private interests, because only these values allowed for the efficient construction of an organic nation rooted in a particular culture. The reversal that took place with Communism was thus the mirror image of modern politics – the reversed mirror of an already reverse mirror. As Durkheim argued with particular zeal, god is nothing but society writ large, so in a secular world society is nothing else than god. From here it is only a short step to say that this abstracted society and the common good, or at least its representatives, should be ‘loved’. In the following an account will be given of this loving desire in Communism, which trapped and redirected Eros into the direction of ‘serving the people’, urging its adherents to giving up themselves in an eroticised environment. This happened first through the ideology of marginality, which advocated self-effacing by entrusting everything to the hands of the ‘party’; and second, by the parallel call for taking up the side of the oppressed and the sufferers, promising to eradicate suffering from the world. Such a giving up of personal integrity resulted in split personality, emptying the inside and trusting in the ‘outside’, which transformed life itself into a gloomy emptiness in attendance for atonement.

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Passion through Common Suffering Communism substituted the central and difficult value associated with Antique European culture, the care of the self,4 the search for tightness and composure, already weakened by passionate interests, with self-abandoning to the service of ideological considerations. In Eastern Europe, where everything is considered as intellectual, and where thus all things become over-intellectualised, impressing every quality – and non-quality – by this feature, this suggestion had a special appeal. When people are endowed with a faith and a desire to actively subscribe to and promote their intellectuals’ own version of the world, the advocating of a giving up of one’s personal integrity and entrusting everything in the hands of collective others is very much a way to smoothen one’s existence. Since a long time this geographical area acquired the label of ‘the lands in-between’ (Kumar 2001: 1)5 where every move was justified by the need to take the side of the oppressed and the sufferers, thus promising to eradicate suffering from the world. When the occasion finally came – with the social body further and desperately weakened by a World War – for putting into practice the ideas dreamed up by the ‘philosophers’ of the Enlightenment and their followers, thus giving real power to the intellectuals, this only resulted in a soft receptiveness with respect to a new unexpected impetus that came on the back of the fascination towards the weak – an ugly uninvited quest for the feast of pure intellectual idealism (Kundera 1984). This is because Eros is invasive, targeting the soft and the defenceless with its dissolving, annihilating power, a power that at a fundamental anthropological level, in Antiquity as much as in modernity, is rooted in memories, images and dreams, and where the basic difference between the original and the copy can easily evaporate, leading to the conflation of genuine and fake emotions. Eros’ sensitivity, which seeks out genuine properties that are inside a soft tissue, thus can be attacked, ready for possession or take-over through infiltration, is a very delicate poison. Its training therefore cannot be restricted to morals or the law, but rather poses more fundamental questions of ethics, character, conduct of life and concrete human personality, as Eros possesses the power of identity deprivation, or integrity dissolution.6 Without a learned, trained, distinction-making attitude towards Eros, the result will be palsy.

4  This idea was emphasised by Pierre Hadot and Michel Foucault, two of the most important French philosophers of the last decade. Interestingly, both recognised a crucial East-Central European dimension with this concern, Foucault through the ideas of Jan Patocka, while Hadot through the work of Juliusz Domanski. 5  The original Hungarian title of the book written co-authored with Arpad Szakolczai (Horvath and Szakolczai 1992) was On the No Man’s Land. 6  It was by seeing this danger and the need for proper training that Plato argued about Eros possessing the power of ‘[I]nterpreting and transporting human things to the gods and divine things to men’ (202 E).

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There is a huge literature on paralytic (or ‘palsied’) societies, starting with Gibbon’s classic analysis of Byzantium, written in the eighteenth century. But contemporary societies do not often receive this label, probably because it does not fit well with Enlightenment optimism. Communism maintained its fascination among many, as it seemed to exist as if behind a glass, at a mysteriously undefined level of busy events, where no sounds or noises could trace the interactions amongst groups and parties, the contours were blurred, and the unforgettable awkwardness of Communism that shocked both its adherents and opponents was not easy to recognise – its genuine emptiness. One of the few was Borkenau, who recognised already in 1938 that Communism is unable to change (Borkenau 1962). During its entire existence it was out of touch with the world. Neither the Communist vanguard, nor the population under its control managed to ever discover the direction into which their joint deeds were carrying them: Where are the final ends? What is the limit of their cooperation? After the first years of Communist rule, through nationalisation, the trials, deportations, detentions, the tectonic shocks of the disaster, the Communist presence was profoundly stamped on the nations under its control. After the War the passing away of the immediate danger did not lead to a clarification of a common direction but only intensified the disappearance of distinctive forms leading towards a general haziness that is the characteristic of liminality. The only certainties the Communists offered in this vagueness were pressures; whatever could intensify the unifying links inside the society. The energy to respond to such pressures was taken from the same place where the pressures and the vagueness themselves came from: the destruction of boundaries, both at the level of the individual human being and of social relations. Communism offered a truly ‘demonic’ pact: in perpetuating the liminal situation that was the condition of possibility of its functioning it increasingly lured those who responded to its first appeal, in the name of fighting for the oppressed and establishing the perfect social order, to give up increasingly more of the forms and stabilities around themselves, in their lives, even in their personalities. Obsession with Subjection The particular obsession of Communism was to achieve the subjecting of oneself. In the twentieth century, the idea of self-sacrifice suffered a particular inflexion, and became widely used all around Europe as an exclusive and increasing slogan in the public sphere by various kind of extremist political ideologies and movements, ending up being the major justification of totalitarian forms of governments, influencing both left- and right-wing politics, and eventually arriving at shaping social and economic policy all over the world, in a manner whose depth is still not fully recognised. This implied a major remodelling of the classical conception of politics as the concern with the good life, implying that the common good can be realised not only through friendship and the promotion of harmonious

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relations between the citizens, but by offering yourself up for the sake of others. The positive aim of political life became replaced by the double negation of eliminating all negativities – creating a perfect social order by eliminating all suffering from the world. It also had a peculiar precondition, which seemed only natural, and whose lethal aspects would only become visible much later: in order to eliminate suffering from the world, you have to understand the sufferers, by being one of them yourself. When we interviewed the party instructors, members of the district-level Communist Party apparatus in Budapest in 1988, this was one of the most astonishing results that came out from the interviews: the offering of your own suffering self for the sake of the public, with district-level Communist party secretaries complaining about their own childhood sufferings (with their parents often being members of the Communist party apparatus in the 1950s or 1960s) and current powerlessness. Even further, considerations related to the economic prosperity of nations were also formulated accordingly. They were considered important in themselves, a central means for attaining the most important goal: strengthening and promoting the ideal unity of the community. But as time elapsed the substance of this ‘unity’ became less and less noble and elevated, as the quality of existence diminished, together with the declining quality of the ruling elite, until it arrived at the lowest common denominator, the political foundation characteristic of our contemporary times: pain and suffering as propagated originally by the Communists. The Communists were a peculiar kind of people with a particular faith that differed, though only slightly, from this general ‘serving the people’ ethos; and this particularity was their mystical longing for giving up themselves, exposing themselves to suffering and dislocating their integrity by offering up their own body for the big structure. Emptying yourselves even at the price of pain, offering your own body for suffering, these features marked the extraordinary selflessness and inner determination of the Communists from the beginning, giving them the force to transmogrify themselves outside the boundaries of reality and meaningful conduct. They could reach a high level of devotion without any rational principle, as the reason for their dedication remained blurred. Scholars like Merle Fainsod, who used the word ‘totalitarianism’, noted that this was an ‘inefficient totalitarianism’, as its efficiency is beyond any rational comprehension (Fainsod 1958). The demolishing force of collectivisation (Conquest 1986) that meant killing and deportation, the abolition of private property,7 were all directed towards vague goals. Others like Koestler (1980) or Getty and Manning (1993) suggested that a particular technique was used for unearthing energy and channelling it towards undefined ends: that technique was sacrifice. As they argue, neither was this technique a merely secularised version of religious sacrifice, nor can it be conceived of as channelling towards state building, as in this case it would be just another attempt at a formation of a religion, or a class, national or party identity. It was rather sacrifice per se – a clear symptom of political pathology. 7  On property being linked to identity, see in particular Verdery (2000).

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Communism as Sacrificial Mechanism Recently René Girard returned to the idea, originally formulated by Robertson Smith, further developed by Mauss, and canonised by Durkheim, that sacrifice has a foundational role in social life. Girard has connected the ‘sacrificial mechanism’ to situations of dissolution of order and social crisis, themselves liminal phenomena, in the context of his theory of mimetic desire. Sacrifice, however, cannot be considered as merely a symptom of or solution to a social or political disorder. As long as this mechanism occurs, one is under the obligation to use it, and its mechanical efficiency is tied to the softness of its users. Thus, the ‘sacrificial mechanism’ is not something that can be taken for granted to play a role of foundation. Quite on the contrary, any machine has a tendency to eliminate any real virtue that is life-promoting; it needs soft issues, sub-human existences, ready to be moulded, having no integrity. Mechanisation, following a spiralling logic, reduces its victims to a slave state, until it sucks up into its vacuum every value and quality necessary for any foundation. The idea of Communism is intimately tied to the idea of machine, to industrialisation and efficiency, but the effect of mechanisation is to make it impossible for anyone to be oneself. Communism never moved away from its original coordinates, terminating on the stage of the slave-state where it started, as during its whole history it remained parasitic on the mobilisation of the sacrificial mechanism. Both its beginning and end were about sacrifice, where the circle started and finished, without any mental progress. Mechanical efficiency is tied to softness in a dual way, firstly because it furiously presses towards possessions that are external to it, whether it is at the individual or social level. Consequently, once it reaches its aim, it empties its target out of all possessions, and thus of all independent being. However, this targeting is blind and is easily deceived by any substitution – which is indeed one of the main mechanical aspects of sacrifice – scapegoating – where an animal is supposed to take away all the sins of the community. During sacrifice a dislocation of existence occurs, the unsettling of ordinary conditions, a breaking or fractioning.8 Through destruction a transformation process is set in motion, which transports its subjects out of reality into (temporary) death. In this drama the sacrificer and the sacrificed seemingly stand in sharp opposition, where the first is the designer of the act and the second is the one subjected to its violence. It is important to notice that the sacrificer is the guiding person, the master of ceremonies, possessing the knowledge of the sacrificial technique – just as in metallurgy the smith is the one who makes the iron suffer in order to transform it into steel, whereas its subject is vulnerable, its integrity, the hardness of the stone, being softened up. However, as soon as the victims are humans, the opposition between the sacrificer and the sacrificed is no longer absolute, as everyone can learn the technique and start to 8  See also Hubert and Mauss (1981).

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use it for its own sake, because sacrifice produces a constant efficiency, a growth that is blindly given to any skilful applicant. Indeed, the incredible speed of the build-up of economic and military potential under Communism is hardly possible to explain in any other way than a release of energy through sacrifice. It also has affinities with the rise of capitalism through passionate interests, where the ‘sacrifice’ of immediate pleasure for future pleasures through saving came to be the moving force of economic growth, rendering both devotion to pleasure and resignation to sacrifice acceptable, even routine. Conclusion We thus have arrived back to our original problem: how can something that was an insignificant, marginal movement gain a dynamic of its own and develop into a major force – though still remaining forever in paralysis? How could Communism become an object of enthusiasm when its world was filled with injustice and cruelty? How could the crafty and least scrupulous be turned into the humble servants of the people? The machine of sacrifice explains the possibility of mutually exchanging roles, both in victimisation and in the sharing of enthusiastic glory. Sacrifice channels and celebrates annihilation. It takes away life in order to promote life, but the life which is offered for sacrifice is again the very same that rendered the committing of sacrifice possible in the first place, joined by a belief in the necessity of the sacrificial act – as if a serpent was biting its own tail.9 This explains the increased importance attributed to the common understanding of the final, elusive aim on the proverbial horizon – total unity or wholeness in efficiency. Both sides of the statement are equally relevant, as agreement with sacrificial reasoning is just as crucial as agreement with the gigantic aim of the sacrifice. During Communism all kinds of sacrificial acts were committed, directed towards the most different objects. Social, political and economic life was each reduced to an unending series of sacrifices that aimed at honour and glory, constituting an eroticised unification into the same, soft body. ‘The party’s blood is the blood of the workers’; ‘The party must be not only respected but loved’, these were typical words of the Communist leaders,10 where ‘being loved’ appeared as the main, erotic reinforcement between the Communists and the nation, the path towards collective subordination. The gist of passion is to possess each other, where all guilt is assumed, and all knowledge is withheld in the fascination between the party and the whole nation, while they are interchangeable with each other through their mutual sacrifice in order to reach the efficiency of infinite growth and irresistible progress.

9  See the story of the serpent sacrifice of Janamejaya in the Mahabharata. 10  From the speeches of Mátyás Rákosi; see Horvath (2000: 119, 122).

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Index

acceleration 84, 85, 93–5 addiction 1, 2–3, 92n22 ADHD (Attention Deficit and Hyperactivity Disorder) 107 Aeschylus 48 agency, technologies of 155, 158, 163–4, 165 ‘American Jeremiad’ 12, 15, 17, 18–19, 20, 21 anti-psychiatry 5, 104 antidepressant treatments 5–6, 137–8, 139, 142 antidepressants 5–6, 92, 137–8, 139, 141, 142, 144, 146, 147 Athens 50–51, 52, 54 Attention Deficit and Hyperactivity Disorder see ADHD attunement 48, 49, 98 auditory hallucinations 160 autonomy 184–5 awareness campaigns 2, 137, 142, 143, 145 balanced consciousness 49, 54–5, 56 Bateson, Gregory 27, 28, 43, 46, 55, 194, 196 Bauman, Zygmunt 71, 103 behaviour 106, 107, 108–9, 111–13 biological citizenship 146–7 biopolitics 137, 146–7 blind modernisation 183 bodily surfaces 124–5 Boltanski, L. and Chiapello, E. 129, 130–31 Bolton, Derek 108, 109–11 brain disorders 106, 108 Brinkmann, Svend 5, 159 candid camera shows 44–5 Canguilhem, Georges 31–2, 33

capitalism 67, 87, 88, 103–4, 129–32, 194, 197, 203 Castel, Robert 130 character neurosis 11, 15 civilization 1, 3–4, 25–7, 28–9, 45–6, 49, 63 collective personality 14, 15 communism 7, 26–7, 194, 195, 198, 199, 200–201, 202, 203 Conrad, P. 143, 144 cyberspace 123, 124–5 cyborgs 122, 123, 124 Daseinsanalysis 84, 95–7 de Tocqueville, A. 13, 19–20, 21 Defeat Depression campaign, UK 142 Dejours, Christophe 176, 185–8, 189, 190 democratic society 13, 20, 51, 146 Denmark 107, 140, 144, 155, 157, 158–9, 163–4, 167, 176 antidepressants 138, 142 awareness campaigns 142, 145 kindergarten teachers 6, 177–8, 179–83, 189–90, 191 depression 1, 2, 5–6, 84–5, 91, 92–3, 94–7, 99–101, 139–42, 143, 144–5 desires 72, 90–91, 104, 196 diagnostic systems 108, 139–40, 159, 160, 161–3, 165, 167 disease awareness campaigns 142, 143 disenfranchisement 175–6, 178–9, 182, 188–90 DSM (Diagnostic and Statistical Manual) 110, 139–40, 143, 144, 158, 159, 161, 162, 165 Dufour, Dany-Robert 83, 84, 85–6, 87–8, 89, 90, 91, 92n22, 97n28 Dumont, Louis 20–21 Durkheim, Émile 19, 33, 142, 198

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Eagleton, Terry 131–2 Eastern Europe 195, 199, 200 efficiency 181–2, 184–5, 187, 188, 189–90 Ehrenberg, Alain 3, 5, 83, 84, 85, 92, 130, 143 enfranchised individuals 178 Enlightenment 194, 197, 199 epi-phenomenological 159, 160, 163 Eros 77, 198, 199 Europe 28, 107, 194, 195, 196–7, 199, 200 antidepressants 6, 137–8, 141 depression 140, 142 evaluations 6, 175–6, 179–80, 181, 182–3, 184–5, 186–7, 188, 189, 190–91 evidence 140–41, 156–7, 162–3 existential-phenomenological 160, 161 expectations 35, 38, 40 Keynes 36–8 Koselleck 38–9 Weber 35–6 experiences 29–30, 38–9, 40, 46, 47, 57, 159–60 fear 176, 178, 185, 186–8, 189–90 financialization 4, 63–4, 65 Foucault, Michel 26n3, 29, 31, 51, 145, 146, 159–60, 164, 168–9, 190 France 12, 13, 14, 21, 22, 120–21 Freud, Sigmund 14, 63, 77, 106, 159 gentle barbarism 183, 185 Gergen, K.J. 127 Giddens, A. 142–3 Girard, René 27, 72, 73, 202 global markets 63–4, 86, 88, 90–91, 128 Gnosticism 46, 47 governmental technologies 155, 156, 157 governmentality 137, 145–6, 147, 163, 168–9 Hacking, Ian 108, 165 harmful dysfunction 110 health 1, 2, 3, 6–7, 27–8, 29, 30, 31–2, 33, 40, 193 Heidegger, Martin 95, 98, 100n33 Heraclitus 48 hierarchy 20–21 Hofstede, Geert 81

Holzhey-Kunz, Alice 84, 95–6, 97 Horvath, Agnes 6–7 households 65, 66–7, 68–9, 73, 74, 75–7, 78 houses 4, 64–5, 66, 69, 70–71, 72, 73–4, 75–7 human actions 51, 54, 111–13 ICD (International Statistical Classification of Diseases) 110, 139, 140, 159, 161, 162, 165 identity 14, 33–4, 78, 83, 93–4, 196 ideologies 30, 48, 56 illness 32, 104, 109–10 incompetence, fear of 186, 187, 188, 189, 190 independence 20–21 individual personality 15 individualism 12, 13, 15–16, 17–18, 19–21, 81–2, 84, 85, 86 individualistic anxiety 19, 20, 21, 22 interdependence 20–21 International Statistical Classification of Diseases see ICD isolisme 5, 86, 89 Janet M 113–14, 115 Keohane, Kieran 4 Keynes, John Maynard 35, 36–8 kindergarten teachers 6, 177–8, 179–83, 189–90, 191 kinesis 52–3 Koselleck, Reinhart 38–9, 40, 196 Lacan, Jacques 66, 69n3, 72–3 Lasch, Christopher 12, 17, 18 Le Goff, Jean-Pierre 176, 183, 184–5, 188, 189 liberalism 16, 30, 34–5, 88–9 libidinal economy 63, 67, 68, 69, 72, 73 liminality 4, 64, 70, 193, 200 liquescence 4, 64, 70, 77 liquid modernity 64, 103, 107, 115 Malabou, C. 129, 132, 133 ‘malaises of modernity’ 82–3

Index management evaluations 176, 183–5, 190–91 knowledge 155–6, 157, 166 Mandeville, Bernard de 89 Marxism 26, 30, 195 meaningful life 28–9, 33–5, 38 mechanical efficiency 202 medical theory 109–10 medicalization 5, 104, 137, 143–5, 147 melancholy 83, 91, 99 mental disorders 97, 106, 107–11, 115, 142–3 mental health 2, 97, 105–6, 144, 153, 166–7, 168, 193 mental illness 106, 139–40, 144, 153, 154–5, 158, 159–62, 166–7, 168, 169–70 mental pathologies 3, 11, 119–20 metaxy 54, 55, 56 Miller, P. and Rose, N. 145–6 mimetic desire 72, 76, 202 modernity 29, 30–31, 39, 48, 55, 82–4, 91–2, 93–4, 143 money economy 4, 64, 65, 72 mood 95, 97–9 morality 5, 68, 104, 105–6, 114, 115–16 multiphrenia 127 multiple personalities 5, 119–21, 125–6 Multiple Personality Disorder cases 119–20, 121, 125–6 multiple self 5, 119–21, 122–3, 126–7, 128–9, 130, 131, 133 narcissism 3, 12, 13, 14, 15, 17–18, 21, 22, 82 neo-liberalism 16, 72, 88, 100, 129–30 neuropsychiatry 154 neuroscientific theory 109 neuroses 11, 15, 140 NICE (National Institute for Clinical Excellence) 140 Nietzsche, F. 27, 30 non-recognition, fear of 187–8, 189, 190 norms 31–2, 33–4, 38, 103–4 oikos (household) 66, 69, 73, 74, 76, 77 organizations 130, 131–2

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passionate interests 195–8 pathoanalysis 84, 95, 97–100 pathological civilization 26–7, 28–9, 45–6, 47, 49, 57–8 pathologies 2, 3, 4, 11, 29, 31, 45, 47, 48–9, 50, 55 pathologization 104, 107–8, 113 pathology of time 85, 93–5 performance technologies 155, 165 personality 14, 15, 16, 106, 159, 186 Petersen, Anders and Willig, Rasmus 6 pharmaceutical industry 6, 137, 139, 141, 142, 143, 144 pharmaceuticalization 145 phenomenological theory 110–11 Plato 48, 50, 51, 54, 57, 75, 90n18, 199n6 Political Anthropology 194 Porfilio, Annalisa 5 postmodernism 127–8 Preventative Services Task Force (US) 140–41 psychiatric diagnostics 139–40, 144, 158, 159, 160, 161–2, 165 psychiatry 6, 106, 107, 138–9, 154–5, 165, 168 psycho-educative programmes 163–4, 165, 167 psychoanalysis 11, 14, 17, 106, 159–60 psychology 14, 105–6, 121–2, 156 public health 2, 6–7, 193 Puritanism 12, 13, 17 raging standstill 94 rational choice 34, 38 Rawls, John 30, 34 real estate 4, 66–7, 69, 70–71, 72, 73–4, 75–7 reality 54, 56 recognition 16, 33–4, 40, 187–8, 189 Reinbacher, Gunnar Scott and Nielson, Margrethe 5–6 Rieff, Philip 16, 17 Ringø, Pia 6 Rosa, Harmut 84, 85, 93–5 Rose, Nikolas 91, 137, 146–7, 153–4, 156, 165, 167 Rosenbaum, Bent 160, 168

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sacrificial mechanism 202–3 Sade, Marquis de 86, 89, 90 schismogenisis 28, 43, 51, 196, 197–8 Schotte, Jacques 84, 85, 95, 97–100 Selective Serotonin Reuptake Inhibitors see SSRIs self 12–13, 15–16, 21, 22, 84, 124–9, 131, 133 self-evaluation 6, 175, 176, 181, 186–7, 188, 189 self-reliance 13, 16, 17, 18 self-sacrifice 200–201, 203 Sennett, Richard 12, 17, 18, 71, 131, 187 serotonin 139, 144–5 see also SSRIs Shweder, Richard 105 Simmel, Georg 63, 64–5, 66, 68, 69, 70, 71–2, 73, 77–8 Smith, Adam 89 social action 35–6, 122 social pathologies 1, 2–3, 7, 11, 194 sophists 75 Sparta 50–51 spiritual disorder 47, 56 SSRIs (Selective Serotonin Reuptake Inhibitors) 92, 137, 138, 141, 144, 147 sub-prime mortgage derivatives market 4, 64, 71, 73–4, 75–7 subjection 200–201 suffering 5, 29–30, 39, 104, 105, 108, 115–16, 186, 187, 201

Szakolczai, Arpad 3–4, 46 Tarde, Gabriel 195, 196 Taylor, Charles 5, 82–3, 84, 86 Thomassen, Bjørn 4 Thucydides 49–51, 52 transference neurosis 11 truth 53–54 ultra-liberalism 5, 87 under-performing, fear of 186–7, 188, 189, 190 unitary self 119, 121, 122, 123, 132 unsecured derivatives market 4, 73–4, 75–6, 77 USA (United States of America) 132, 140–41 individualism 12–13, 14, 15–16, 17–18, 19, 21, 22 multiple self 119–20, 125–6 van den Bergh, Bert 5 Voegelin, Eric 4, 26n3, 45, 46–7, 48, 49, 52, 53–4, 55–6, 57 Wakefield, J.C. 110 Weber, Max 35–6, 66, 67, 112, 197 well-being 1, 2, 3, 30, 140 WHO-Five Well-being Index 140