Filed under: Mental health, Recovery, Uncategorized | Tags: good life, recover college, recovery
Talk presented at recent seminar at the Faculty of Health and Social Care at The Open University.
Recovery has become popularised in mental health care as a means of empowering service users to construct their own identity and meaning of recovery. Recovery is a term often used indiscriminately but what does it mean to recover? The strength of recovery apparently lies in its ability to mean different things to different people allowing people to construct their own version of a meaningful life. However I will argue in this presentation that the shift in emphasis to the individual in the rhetoric of recovery has meant that recovery becomes the responsibility of the individual. As recovery becomes an individual obligation or requirement, the promise of recovery rather than freeing people to construct their own meaning serves to reaffirm existing norms on how to function and manage mental distress in order to obtain the good life.
Recovery, as I am sure many of you are aware, has become increasingly popular in mental health care services. Services now describe themselves as ‘recovery-focused’ and ‘recovery orientated’, Recovery colleges that provide a variety of courses for service users are being set up across the country. An increasing academic interest in recovery in mental health care has lead to the creation of a number of seminars and conferences and research networks, and is what has brought us all here today.
In my own PhD research I am exploring how recovery from grief is understood and experienced. My interest in recovery has led me to learn about the uses of recovery more broadly in mental health care and also to speak with several current and ex-mental health service users each with differing views on recovery.
So what does recovery actually mean? In brief the use of recovery appears to have emerged from the psychiatric survivors movement, where recovery referred to the right to live with mental distress rather than see it as something to overcome.
However many definitions of recovery have been proposed with no universal agreement on what recovery should look like. This is in part because recovery was intended to be self-defined.
Most descriptions tend to focus on building hope, creating a new identity, having a meaningful life, and taking control over one’s life.
South London and Maudsley’s (SLAM) Recovery College prospectus defines recovery as:
Recovery is about people with mental health difficulties having the same opportunities in life as everyone else. It is about a personal journey towards a meaningful and satisfying life. It is about hope, control and opportunity. It is about living as well as possible.
Another example taken from a report entitled ‘Making recovery a reality’ published in 2008 by the Sainsbury centre for mental health describes:
(Recovery) can only be resolved if the person can discover – or rediscover – their sense of personal control (‘agency’) and gain a belief in the future (hope). Without hope they cannot begin to build their lives.
However since recovery’s incorporation into mainstream mental health care a number of more specific models such as the ‘recovery star’ have been developed which predefine the parameters of recovery.
The Recovery star includes the following dimensions:
- Managing mental health
- Physical health and self care
- Living skills
- Social networks
- Addictive behaviour
- Identity & self-esteem
- Trust and hope
There is also the new ‘Wheel of well-being’ which contains 6 elements: body, mind, planet, place, people, spirit. And another model called the Tree of life, all of which are taught at the recovery colleges.
The point I wish to highlight here is in these models recovery is given outcomes and priorities that are not set by the service user themselves but by the NHS trust delivering the service.
I would argue these priorities are reliant on an assumed understanding of what constitutes a good life and living well. The recovery colleges for instance deliver courses on how to stop smoking, how to eat better, and how to get a job. In these models of recovery there is an implicit judgement over how one should successfully live out their personal lives.
As one participant I interviewed in my research commented, in the recovery model it is as though you need to recover from being yourself. Daily activities such as taking a shower, or walking outside, and eating a balanced diet become ‘self-care activities’ rather than just living.
By establishing markers of recovery such as the recovery star it becomes possible for the relevant medical authority to make a judgement on whether or not someone is recovered.
People then become responsible for adhering to prescribed ways of governing their lives, but the medical authority still remains in tact – as psychiatrists become recovery experts and mental health care becomes ‘recovery orientated’ and ‘recovery focused’.
A contradiction then arises as recovery is described as a unique individual journey to self-control and autonomy over one’s life yet it is taught and learnt via a set of experts and in adherence to a set of predefined criteria.
As SLAM’S recovery college prospectus states:
“The workshops and courses we run aim to provide the tools… to help you become an expert in your own recovery.”
And whilst recovery is claimed to be a co-production, if someone fails to reach recovery the blame is squarely on the individual.
Again from the SLAM Recovery college prospectus:
“Treatment and support from mental health professionals can be helpful but every person with mental health problems can become an expert in their own self-management. Whatever challenges you face, recovery involves ﬁnding the personal resourcefulness and resilience to take back control over your life and what happens to you.”
If something bad might happen then, something that might not fit within the recovery model, the blame will then fall on the individual because in this understanding recovery is always possible, no matter how serious the person’s difficulties you just need to find your inner ‘resourcefulness’.
This is the promise of recovery: you can get better according to pre-existing normative ideas of what a satisfying good life is, because the only thing that needs changing is you and how you currently live your life and we (being the relevant medical authority) are here to tell you how to do that.
This obligation to recover thus becomes a way to abdicate responsibility for mental distress elsewhere, that is to the person experiencing the distress themselves.
It is for this reason amongst others that the recovery model has come under criticism from service users and others working within mental health care. Recovery is seen as a way to cut back on services, to eradicate long-term care, where referring people to recovery colleges is a way to discharge them quicker.
For an increasing number of people then, recovery is a shiny gloss on an unchanged system that remains unequal in practice and which shifts responsibility to live a certain way on the service user.
A group of people have formed on Facebook to express their disapproval at the way recovery has been appropriated in a group they have called ‘Recovery in the bin’. The members of this group contend that ‘recovery’ has been colonised and used to discipline and control people with mental distress and argue for a ‘Social Model of Madness’, placing mental health within the context of the wider class struggle.
Some of the group have claimed the title of “UnRecovered” to replace “Recovered”, to express their rejection of what they see as a neoliberal intrusion on the word ‘recovery’ that has been redefined, and taken over by marketisation, an capitalist values.
To recover from mental illness, to adhere to the model of recovery, involves a considerable amount of work on behalf of the service user. To recover involves a range of activities such as attending recovery colleges, completing recovery plans, taking medication, getting a job, sustaining good relationships with others, eating well, not smoking, creating a new identity, being mindful and taking walks in nature.
People using mental health services are increasingly finding themselves obligated to undertake this sort of ‘recovery-work’ in the promise of becoming well.
Yet the promise of recovery possesses a cruel contradiction in that the highly prized ability to become autonomous and have self-control to manage one’s life is only possible through submitting to experts who help people navigate their way through to recovery.
The service user is taught how and what to desire all in the name of self-fulfilment and individual freedom.
And because recovery is always possible it can only be the individual’s failure of will or resilience if they are seen to relapse or fail to recover in the terms that have been proposed.
Filed under: Grief, Mental health, Recovery, Resistance | Tags: diagnosis, freud, normalcy, posthuman, recovery, sovereignty
Paper presented at Theorising Normalcy and the Mundane, University of Sheffield, July 2014.
I’ve always been interested in people who don’t do as they’re told. They excite me, intellectually and personally. In my PhD research I am interested in those that are seen to have failed to recover from their grief following bereavement.
The failure to recover from grief is defined in contemporary society by bereavement theories and increasingly by psychiatric diagnostic categories that place a time limit on the appropriate length of mourning as well as delineating what behaviours and emotions are normal and acceptable in grief and those which are not.
In grief and bereavement research there was much controversy over the publication of the Fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) last year that saw the omittance of the bereavement exclusion in the diagnosis of Major Depressive Disorder, which was included in previous editions of the DSM. What this means is that someone who is bereaved could potentially be diagnosed with depression as little as two weeks after bereavement. Further the DSM-5 also included the diagnosis of ‘Persistent Complex Bereavement Disorder’ for further consideration in the next edition of the manual. ‘Prolonged grief disorder’ has also been proposed for the revised version of the International Classification of Diseases (ICD-11).
There are overlaps and inconsistencies in each diagnostic category, but the push toward what has been seen as a medicalising of grief relies upon claims that there are a number of people (research varies from 7-20%) who have ‘complications’ or fail to recover from grief. These complications are described as a ‘derailing’ of ‘normal’ grief or a ‘delay’ in integrating loss. The markers of someone failing to grieve properly are overwhelming time specific – people should be moving toward healing in a few months, struggling 6 months on is classified as complicated. The diagnosis are also structured – in vague psychiatric terms – in accordance with the degree to which behaviour is deemed inappropriate or out of line with the dominant cultural and social norms in which the bereaved person is situated.
As a commonplace and yet problematic event, grief marks the line between normal (does not require medicalising) and abnormal (intervention is necessary to ease suffering) emotional behaviour.
The search for the pathological in grief also presumes a normative mode of grieving yet this is never made explicit, or been proven. The normal way of grieving is instead defined by the ways in which the line between abnormal and normal grief is drawn. My focus has been then to uncover who draws the line, who has the power to draw the line, with what claims and with whose interests at stake.
Those that do not recover within these paradigms risk being read as resistant, problematic and in need of psychiatric treatment. The failure to recover is often seen as a failure of the individual rather than the individual being a victim of the ever-expanding field of psychiatric diagnosis. For example in the current era of the DSM-5 and the future world of the ICD-11 the bereaved person might be considered mentally ill but in the era of past editions of the DSM or before psychiatry began to make claims on grief, bereavement and grief were experiences situated within the normal side of the line.
The developments in grief treatment can be seen as a reflection of broader changes in mental health services and psychiatry. The Recovery Model is the current popular model of providing mental health services that has been met with much enthusiasm and success.
The recovery model encourages people to find their own individual path to life without mental illness.
Recovery Colleges have been set up to provide courses for people with mental health difficulties on recovery and how to recover from mental illness. These colleges also run courses on ways to well-being, how to find work and how to manage one’s diet.
Recovery began as a radical movement to reclaim power back to the patient from the psychiatrists, but in being co-opted by the mainstream the vision has become a conventional one that places emphasis on the individual and their responsibility to change. The recovery model relies upon an idea of the ideal person as being a functional citizen, someone who gives back to society, someone who has the capacity to make the right choices.
However many patients and service users have now turned their back on the recovery model due to what they feel is a lack of acknowledgement of the social factors that contribute, create and maintain mental difficulties. When recovery is ‘always possible’ failing to recover can only ever be the fault of the individual. Critics have also argued how the recovery model is still one very much dependent on the deficit model – where people with mental illness are in some way deficient and require fixing. The recovery model was adopted in order to remedy this; an attempt to allow people to uncover their own unique individual journey to recovery, to the good life. But the journey to recovery is filled with yet more normative fantasies.
The obligation to recover is one of the obligations we encounter when the human is considered to be a sovereign subject. Experiences such as grief can work to unsettle our sense of sovereignty, problematising what it means to be able to choose, how capacity is defined, revealing instead a self that may be incoherent, ambivalent, not in control of themselves. I will talk about how and why grief has the power to make us come undone, but first a note on sovereignty.
Sovereignty, in a truncated form, is about having the power over one’s life and having the ability or capacity to decide how you live your life. Sovereignty is mostly used in political and legal terms when discussing the sovereignty of the head of state where sovereignty is understood as having the power over life and death – that is to permit life and to take it away. There is much debate in political philosophy over the uses of sovereignty, but here I am picking up the concept in a similar way to Lauren Berlant but in a perhaps somewhat more crude fashion and placing it in an individual context to refer to a way of being which has capacity to make decisions, is consistent, intentional, and has coherent explanations for actions.
In many ways I am also talking largely about capacity – and the capacity to make choices and decisions for oneself (to be autonomous) is arguably the paradigmatic feature of what it means to be human in a contemporary neo-liberal society.
After all it is often when sovereignty is taken away that we feel injustice is taking place. It also reveals the rights we assume to have by virtue of being human (which may or not be supported in law). As I work within the field of death and dying I have been exploring the ways this sense of sovereignty is interrupted and destabilised through the act of death. Sovereignty is not necessarily something we have simply by virtue of being human but something that is granted or taken away.
It also serves to pathologize those that deviate from these expectations.
As Berlant describes:
Without attending to the varieties of constraint and unconsciousness that condition ordinary activity, we persist in an attachment to a fantasy that in the truly lived life emotions are always heightened and expressed in modes of effective agency that ought justly to be and are ultimately consequential or performatively sovereign. In this habit of representing the intentional subject, a manifest lack of self-cultivating attention can easily become recast as irresponsibility, shallowness, resistance, refusal, or incapacity; and habit itself can begin to look overmeaningful, such that addiction, reaction formation, conventional gesture cluster, or just being different can be read as heroic placeholders for resistance to something; affirmation of something, or a world-transformative desire. – Lauren Berlant, Cruel Optimism, p.99.
When the intentional, positive active subject is considered to be the truest enactment of being human, emotions such as grief – which may leave the subject irresponsible, unemployed, and ambivalent – are devalued and are seen as negative, unproductive, something to be recovered from.
The over-psychologisation in grief theory has meant normal grief tends to involve integrating the loss, claiming that in order to recover, the relationship with the deceased has to be reconfigured in some way, either as a process of detachment or reinstating and/or continuing bonds in order to accept the loss.
Sigmund Freud in ‘Mourning and Melancholia’ (1917) is often attributed as the first thinker to promote the idea of the need to detach from the deceased, and that ‘hanging on’ to the deceased is pathological and an obstruction to healthy mourning. The melancholic figure persists as an example of what happens when people fail to mourn successfully, when they are unable to let go of the deceased. This at least has been the way in which Freud’s ideas have been interpreted by later theorists.
The melancholic is one who is never sure what he or she has lost. That is to say, what has been lost remains unconscious to the melancholic, they do not know what they are missing. The melancholic knows whom they have lost but not what is lost in him/her. The melancholic does not know what they have lost in themselves because the melancholic incorporates the lost person into his/her ‘ego’, so that he/she never fully experiences the loss, since the loved one, even in absence, becomes merged with the self. What this suggests therefore is that people who are seen to be ‘stuck’ in grief do so perhaps unknowingly because they are not fully conscious of how they are still tied to what they have lost. This is because the lost person has been incorporated into, in Freud’s terms, the ego. In other words the deceased person still makes up a large part of how the grieving person understands their sense of self.
To understand how someone could get stuck unable to face the ‘reality’ of their loss requires a refiguring of how the self is understood and how the sense of self is composed. It is to look upon identity as not something that is shaped and constructed autonomously, but composed in relation to others. Grief theories which describe continuing bonds or building biographies of the deceased attempt to explain how and why people talk about keeping the deceased inside themselves. However these theories often do not elaborate further on how grief and loss become an instance that reveals the one who has been lost already existed inside the subject. To say that the deceased person already existed inside the subject is to point towards the fact that people are shaped by one another, often perhaps ambivalently, in ways that do not presume two atomized autonomous individuals making an attachment, but rather a more intimate and intricate interface of being entwined into one another’s lives and sense of self. But the ways in which people are bound to one another is often not known until an event such as loss or the risk of loss that allows the recognition of how the sense of self is invested in another person. Grief therefore destabilizes the ‘I’ of autonomous thinking through a process of coming undone, being confounded by loss, in which the self, and not only the one who has died goes missing.
Certain types of attachments act to impede the ability to move on, even if they provide a sense of self, a sense of place in the world. The bereaved person is then suspended in the space of liminality, for to let go and leave the object of desire is to leave the anchor for optimism, and yet staying with this fantasy produces unhappiness. This sense of ambivalent attachment is captured by Lauren Berlant’s concept of ‘cruel optimism’ which describes how any form of attachment can become cruel when they become obstacles to flourishing. Berlant’s example is instructive for grieving for whilst recovery is constructed on the understanding that detaching from the lost object leads to successful mourning, the lost object is the very anchor that sustains hope.
This ambivalence also reveals a more complex view of agency, where the bereaved may desire and not desire to become attached to something that makes them lose control, a desire and lack of desire to become sovereign. Discourses that promote recovery often assume autonomy, choice and agency are desirable traits that everyone should wish to achieve and vulnerability is weakness and undesirable. What the sustaining of cruel attachments suggests on the contrary is that people often wish to not be sovereign, (and proposes further that sovereignty can never be anything but a fallacy) by violating their attachment to intentionality and give themselves over to something larger than themselves.
Melancholia and the refusal to recover or let go of attachments to the dead can not only be read as a sign of pathology but might be understood as an active choice to not be sovereign. This presents a contradictory twist – the right of choice we have over our lives can also be used to reject those choices. But there is also something more subtle taking place, it is about injecting the unconscious into the intentionality of the subject. It is suggesting that certain affective experiences such as grief can reveal to us we often do not know to what we are tied and why, the one who refuses to recover might not be aware of the ways they are attached to something that is actually becoming an obstacle to their ability to live a life.
To tell someone to lose the object of their desire and face up to the reality of their loss – the reality that is apparently evident to everyone but them – is to neglect to see how certain fantasies that people invest in provide a sense of belonging all of their own.
What if we do not presuppose the sovereign subject? How do we account for the self?
Should not the whole theory of the subject be reformulated, seeing that knowledge, rather than opening onto the truth of the world, is deeply rooted in the “errors” of life? – Michel Foucault
Borrowing from Judith Butler and Lauren Berlant I have been working with a description of grief as an instance which can make a person ‘come undone’. This is a coming undone of a self that was already not the sovereign person they took themselves to be. What this means is not that grief or loss merely breaks people down before they put themselves back together again (a recovery narrative that relies upon the self as normally integrated) but rather an instance that reveals the relational nature of their sense of self; the capacity to affect and be affected.
Injecting some incoherence, ambivalence, resistance into the subject then, the interest lies less in how people come undone – if we alternatively assume the subject is always somewhat prone to incoherence – but rather how do they hold themselves together, and what form this holding together takes and why. Or to take a Deleuzian line: how do we hang together when we are multiple?
The task remains for me to discover the discourses that mould the form of the grieving person into an identifiable recovering/recovered/not recovered subject. That is to say what are the discourses, structures, norms that may impinge, limit, obstruct the capacity for flourishing or for becoming otherwise.
There’s a labour to remaining within the bounds of normal, of which some feel more acutely than others. And yet there’s also a comfort to passing as normal because it means staying under the radar. Expecting or demanding a level of sovereignty over one’s life can serve a protective or liberating purpose but it can also enforce an unworkable and limited vision of what it means to be human. I’m not so sure about whether we need throw out the concept of the human and become post-human and I know too little to make a biological claim on things that are indisputably human. Rather I make the modest proposal that it is not the vision of the human that needs transforming but the world we inhabit so that is capacious enough to hold all the multiple ways of being human.
Filed under: Grief, Mental health, Recovery | Tags: affect, brain, complicated grief, grief, neuroscience, psychiatry
Recently I have become engrossed in discussions around the shifts in psychiatric research toward the brain.
This shift includes a number of different activities occurring in different disciplines and domains, most notably:
- Change in focus in mental health research from the psyche to identifying ‘biomarkers’. It is quite evident that funding is increasingly directed toward research interested in uncovering brain activity and biological causes that may underlie a mental condition, this also includes complicated grief.
- Part of this change in focus has come about due to growing criticism of the DSM and standardised modes of diagnosis based on self-reported symptoms. The director of the National Institute of Mental Health (NIMH) Tom Insel, has been openly critical of the DSM, critiquing its scientific validity. In response he has created the Research Domain Criteria (RDoC) which proposes to improve diagnosis of mental illness by incorporating genetics, imaging, cognitive science, and other levels of information to lay the foundation for a new classification system. This framework is based on the assumption that mental disorders are biological disorders involving brain circuits that implicate specific domains of cognition, emotion, or behaviour, and that mapping the cognitive, circuit, and genetic aspects of mental disorders will yield new and better targets for treatment. The RDoC aims to move away from using the DSM as the gold standard and base diagnosis on emerging scientific data.
- On the level of theory there has in recent years been a flurry of interest in social and cultural theory toward affect, and thinking about neurobiology, the human nervous system and brain functions to explain the self, subjectivity, consciousness and what it means to be human (writers such as Deleuze & Guattari, Nigel Thrift, Brian Massumi, Lauren Berlant, Eve Sedgwick, are often cited as proponents of this move). However there are considerable problems with how ‘affect’ is used, and varying interpretations of what affective awareness means of implies, often supported by wrongly or selectively interpreted neuroscientific data.
What reading this literature has brought up for me is:
- How to understand the self/subject, and avoid lapsing into either essentialism (it’s all chemical) or relativism (it’s all socially constructed)
- What can we take from affect theory?
- What bearing these different explanations have for grief, and the increasing focus on defining complicated grief?
I will try to outline some of my thoughts on each point below.
i. It’s all chemical or it’s all socially constructed: Moving beyond duality
Human behaviour is increasingly explained in reference to the brain, implying that the brain fundamentally shapes who we are and our capacities and attributes. Yet the increasingly fashionable focus in psychiatric research towards finding a biological – neurological, genetic – basis for mental illness speaks of a broader move to understanding the human as a biological organism that is no longer deterministic or essentialist as it was once criticised to be, but as providing an opportunity. The idea of biology as an opportunity, not destiny is becoming a prominent explanation for mental illness (Rose, 2013a). However as even my brief foray into neuroscience has shown, the more that is known about the brain, the more we realise we don’t know (ibid). It also produces basic or crude analysis of mental states where areas of ‘activity’ are pointed out on brain scans and sections of the brain are singled out as responsible for aspects of human functioning, when these areas of the brain involve billions of synapses of which little is still known. Studies into complicated grief (CG) have sought to identify what areas of the brain are activated in people with CG compared with people with ‘normal’ grief (O’Connor, 2012). Further a study (O’Connor et.al., 2008) revealed that the areas of the brain activated in people with CG is the same as the areas of the brain activated in people with addiction, a part of the brain concerned with reward. On viewing a picture of the deceased this part of the brain would be activated, thus leading the researchers to argue that people with CG find pleasure in their distress unlike people without CG. However whilst these provide interesting explanations and interpretations, often research that seeks out specific brain activities or biological markers ignores how the human organism works as a whole and how the brain is affected by its social environment. A project headed by Nikolas Rose seeks to understand precisely how experience gets under the skin, by situating the brain in its milieu. As Rose (2013a) states:
The scientist (is required) to realize that the conditions they are dealing with, whether they be psychiatric diseases, brain diseases, physical diseases are all diseases of human beings living in their social environment and they are not things that happen with genes in petri dishes in labs and that that’s a rather important scientific thing to recognize and not just, kind of, an addendum from the social sciences or from the ethics. Recognizing how the problem feels for those on the other side, for those who are experiencing it, and therefore what the solutions may look like for those on the other side.
By acknowledging the social embeddedness of neurobiological processes, and of biological processes this research is at the forefront of a new wave in thinking about mental health that seeks to bring together the knowledge from the social sciences and the biological sciences. It is argued that biological traces are produced through the practices and ideologies of modern social life and thus the biological and sociological life of the body and brain are inseparable. Both brain, body and environment all impact upon one another. The discourse that merely seeks to identify ‘biomarkers’ or ‘cognitive biases’ glosses over the complexities of understanding the situatedness of a mental disorder; of how the outside gets in.
This then poses a problem for how to account for the subject, the self, a self that is both social and biological and further is both social and biological in a way that the biological self and social self do not exist as discrete categories. Maurice Bloch’s ‘The Blob’ still perhaps for me presents the most convincing attempt at accounting for how a human – or the blob – can be both a process, a relational being and yet also have some type of biological consistency that makes the blob identifiably human. In thinking about grief, it has always been the potentially destabilising and disorientating power of grief that has been, for me, interesting to theorise. Borrowing from Judith Butler and Lauren Berlant I have been working with a description of grief as an instance which can make a person ‘come undone’. This is a coming undone of a self that was already not the sovereign person they took themselves to be. What this means is not that grief or loss merely breaks people down before they put themselves back together again (a recovery narrative that relies upon the self as normally integrated) but rather an instance that reveals the relational nature of their sense of self; the capacity to affect and be affected. Injecting some incoherence, ambivalence, resistance into the blob then, the question is less about what makes us come undone – the impact of trauma etc – but what holds us together. Grief might be one experience that can expose our potential or capacity to be different and yet we appear or tend to stay from one day to the next more or less the same. Or to take a Deleuzian line: how do we hang together when we are multiple?
ii) What can we take from affect theory?
I got drawn into affect theory as it promises a means of describing the self that incorporates ambivalent, irrational, and contradictory behaviours. Affect theory grew out of cultural theorists borrowing from the developments in neuroscience. What binds the affect theorists and the neuroscientists is their shared anti-intentionalism (Leys, 2011). Affects can be described as a non-conscious intensity, unlike emotions they exist prior and outside consciousness. Affects are only contingently related to objects in the world; they are non-signifying forces. What the establishment of a theory of affect has provided then is to draw attention to and elucidate the gap between a person’s affects and the cognition or appraisal of the affective situation. In other words, it gives space to suggest that behaviours are not always consciously directed, or further we are not always consciously aware of what might trigger a particular pattern of behaviour or action. Affect theory’s use of neuroscience has its own problems and contradictions which have been criticised (Leys, 2011; Rose, 2013a). However despite the precarious stance of arguing for anti-intentionalism, I don’t want to dispense with the contribution of affect theory mainly for how it emphasises a radical relational model of the self. Thinking about the capacity to affect and be affected I would argue goes further than talking about embodiment or materiality in that it places more focus on the spaces in between people; how people through interaction get caught up in an energetic exchange. This also avoids relying on a model of emotions that either go from the inside out or from outside in. Rather affect theory argues for the mutual interplay; where emotions belong neither to the individual nor exist somewhere outside. It opens up space for thinking about surfaces, impressions and atmospheres.
In terms of grief I have found these ideas useful to work with as it highlights how the experience of loss is one in which the self enters a space of liminality, of non-sovereignty, which involves violating an attachment to intentionality. But further there is an object in grief, the intense yearning for the deceased as described in complicated grief diagnosis, which gives grieving an intention – but this may not be easily available for conscious deliberation. This brings us back to the continuing bonds thesis, that provides little room to think about the how the grieving person’s sense of self is composed, rather an integrated self is presumed as the norm. It also glosses over contradictory and messy feelings, ambivalence, suggestibility, resistance and how these can all exist at the same time without necessarily being pathological. To reiterate the question above then; by thinking about the self in this way, the interest lies less in how people come undone – if we alternatively assume the subject is always somewhat prone to incoherence – but rather how do they hold themselves together, and what form this holding together takes and why.
iii) What bearing do these different explanations have for grief, and the increasing focus on complicated grief?
Attending a recent talk at St Christopher’s Hospice on complicated grief brought up some interesting questions around the diagnosis of complicated grief. Whilst the shift towards brain science is starting on the level of research, psychiatric practice still remains shaped by the diagnostic categories of the DSM and ICD.
In Colin Murray Parkes’ talk he focussed on the DSM-5 and the relevant developments and associated controversies as related to grief and bereavement. His presentation was quite skeptical and he felt that the DSM had put ‘too many eggs in one basket’. He also elucidated some of the politics behind the DSM-5 and the inclusion of the proposed criteria of ‘Prolonged Complex Bereavement Disorder’ (PCBD). According to Parkes, Holly Prigerson initially proposed ‘Prolonged Grief Disorder’ to the APA for inclusion in the DSM-5. This was then countered by Katherine Shear’s description of ‘Complicated Grief’, and in the midst of the controversy over the grief exclusion and Major Depressive Disorder, the DSM backtracked and ended up with PCBD, to be considered as a ‘condition for further study’. The definition of PCBD is quite evidently a mixed combination of symptoms lacking cohesion and agreement.
Here’s some of the criteria for PCBD:
To have at least one of the following symptoms for at least 12 months after death:
– Persistent yearning/longing for deceased
– Intense sorrow
– Preoccupation with deceased
– Preoccupation with circumstances of death
At least 6 of the following symptoms persisting for 12 months or more after death:
Reactive distress to the death
– Difficulty accepting death
– Difficulty in positive reminiscing
– Bitterness and anger
– Mal-adapative appraisals about self
– Excessive avoidance of reminders
Social identity disruption
– Desire to die
– Difficulty trusting people
– Feeling alone/detached
– Feeling life is meaningless/empty
– Confusion over one’s role in life
– Difficulty planning for future
Further this disturbance has to be deemed to be causing ‘clinically significant distress’ or ‘impairment in social, occupational or other important areas of functioning’. The ‘bereavement reaction’ is considered to be ‘out of proportion to cultural, religious and age-appropriate norms’.
There is a lot to comment on here, wading through the loaded language. What is quite striking as with most psychiatric diagnosis is how a pathology is defined by the extent to which it exceeds what might normally be expected, when someone becomes unable to function. As can be seen in the list of symptoms, it is pathological to either excessively avoid or be excessively preoccupied with the deceased and/or the death. The implied norm of functioning is understood to depend on the individual social context. This appears as a way to avoid stating a general norm of functioning and grieving for all people who have been bereaved. This apparent cultural sensitivity neatly hides the contradiction of why acting in excess of a norm – which is itself variable, arbitrary, and historically context-specific – is necessarily pathological, and further not recognising how by developing a standardised criteria, specific habits and behaviours have clearly been selected as being, in any social and cultural context, somewhat problematic.
At the St Christopher’s talk, whilst there was some interest in these broader debates around diagnosis, there seemed to be a feeling amongst the attendees that this was not relevant to their daily practice. One person commented that he felt it was distracting from the main issue which is helping people (to recover, we could add). This was not exactly a surprising perspective to hear but it does speak of the disjunctures between theory and practice. The actual process of diagnosing grief as complicated, prolonged or complex might not yet be regular practice in the UK, but some practitioners did speak of how a medical diagnosis of abnormal grief can/could be useful in referring people on to other services, or as means of protecting/preventing people from more severe mental health problems. In the end there was little conclusion and there was a sense that this sort of language was ‘clinical’ and hard to understand. Grief then continues to be an ambivalent object, at times medicalised, and at other times seen as part of the natural order of things. There’s more to say here but I think there is something interesting in this management of excess or the inappropriate that produces a certain form to a person (or perhaps rather it gives a person-like form to the blob). Similarly the person who doesn’t recover isn’t formless but has their own shape too. I still remain too clueless about the brain and genetics to talk in any conclusive way about a biological core of what it might mean to be human, and so the task remains to look to the discourses that might mould the form of the grieving blob into an identifiable recovering/recovered/not recovered subject. That is to say what are the discourses, structures, norms that may impinge, limit, obstruct the capacity for flourishing or for becoming otherwise. And perhaps by exploring what holds these identities together, space can be found for thinking about relationality, the non-conscious, and how experience gets under the skin.
Fitzgerald, D., Rose, N. & Singh, I. (2014). Urban life and mental health: Re-visiting politics, society and biology, Discover Society, Issue 5 February 2014.
Leys, R. (2011). The Turn to Affect: A critique. Critical Inquiry, 37: 434-472.
O’Connor, M.-F. (2005). Bereavement and the brain: invitation to a conversation between bereavement researchers and neuroscientists. Death studies, 29(10), 905–22.
O’Connor, M.-F. (2012). Immunological and neuroimaging biomarkers of complicated grief. Dialogues in Clinical Neuroscience, 14(2), 141–148.
O’Connor, M.-F., Wellisch, D. K., Stanton, A. L., Eisenberger, N. I., Irwin, M. P., & Lieberman, M. D. (2008). Craving Love?: Enduring grief activates brains reward center. Neuroimage, 42(2), 969–972.
Prigerson, H. G., Horowitz, M. J., Jacobs, S. C., Parkes, C. M., Aslan, M., Goodkin, K., … Maciejewski, P. K. (2009). Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11. PLoS medicine, 6(8), 1–12.
Rose, N. (2013a) The Human Sciences in a Biological Age. Theory, Culture & Society, 30(10): 3-34.
Rose, N. (2013b) What Is Diagnosis For?’, Talk delivered at the Institute of Psychiatry Conference on DSM-5 and the Future of Diagnosis, Kings College London, 4th June 2013.
Filed under: Grief, Mental health, Recovery, Resistance, Subjectivities | Tags: Berlant, composure, fantasy, grief, liminality, love, recognition, sovereignty, the good life
I’ve always been interested in people who don’t do as they’re told. They excite me, intellectually and personally. In my current work I am interested in those that are seen to have failed to recover from their grief over losing someone. What’s interesting is that it is hard, if not impossible, to identify cultural examples of someone who hasn’t recovered. The non-recovered mourner – like Freud’s melancholic – is the silent, shadowed figure that strikes fear in all us as we inevitably face the loss of someone we love. This is partly because in the modern rhetoric of recovery everyone is always on the road to recovery, and even if we haven’t faced a traumatic event we are (or should be) always on the way to bettering ourselves, trying to be happier, grasping that elusive ‘good life’ fantasy. The non-recovered are read as resistant, refusing, problematic, troublemakers because they appear to be actively rejecting the normative fantasies to which we are all obligated to subscribe. There was a telling moment in episode three of the Channel 4 programme Bedlam (an insight into the work and patients of the Maudsley psychiatric hospital), where we see a social worker knocking on the door of the home of a woman whose health he feared was taking a ‘downward spiral’. “Why are we going to these lengths when she is living the life she chooses?”, he remarks. And yet the woman, Rosie, was deemed as not having the mental capacity to make a choice, and so by law choices had to be made for her.
Many things are happening here and here’s a few to point out: having capacity to make a decision is part of what is considered to be a functional, mentally fit, human being yet these decisions and choices have to fit into a pre-existing framework that already decides for you what is normal and what is not normal, e. g. going to work, waged labour, owning a home = normal; singing Christmas carols to yourself in July, having a fear of bedbugs = not normal. Being normal then could be seen as more about making the ‘right’ decisions than about the level of perceived control one has over the decision. Yet we are encouraged to believe that by virtue of being human we have sovereign control over our lives, our behaviour, and our choices. The problem with sovereignty is that when someone makes a choice society at large disagrees with, and this could range from being overweight or a refusal of a 9-5 capitalist regime, it is deemed a fault of the individual. The problem individual just needs to be turned to face the ‘right’ way. In what follows I am going to attempt to unpack the notion of sovereignty by heavily drawing on Lauren Berlant’s ”Cruel Optimism’ to consider how sovereignty can be unsettled by affective experiences such as grief and love and can only ever be an aspirational concept that might better be expressed as a temporary display of ‘composure.’ Composure, as detailed in the middle section, is also worn thin by an unending desire for the good life where for the worker the act of reproducing life is also the means of being worn out by it. In closing I start to move on from Berlant and think about what responses might be possible to an attachment to a wearing way of life that is not working.
i. How can I keep my composure?
Sovereignty, in a truncated form, is about having the power over one’s life and having the ability or capacity to decide how you live your life. Sovereignty is mostly used on political terms, as in the sovereignty of the head of state. As a ‘death’ scholar, I explore the ways sovereignty is interrupted, and eventually destroyed, through the inevitable act of death. Ideas of sovereignty, and autonomy have only ever appeared to me as unsustainable pipe dreams, that provide at times a necessary illusion in the face of getting on with life.
In a previous post I argued that melancholia and the refusal to recover or let go of attachments to the dead can not only be read as a sign of pathology but might be understood as an active choice to not be sovereign. This presents a contradictory twist – the right of choice we have over our lives can also be used to reject those choices. But there is also something more subtle taking place, it is about injecting the unconscious into the intentionality of the subject. It is suggesting that certain affective experiences such as love and grief can reveal to us we often do not know to what we are tied and why, the one who refuses to recover might not be aware of the ways they are attached to something that is actually becoming an obstacle to their ability to live a life. We rarely get to choose what interrupts our lives or the attachments we forge to people, to ideas, to habits, to objects. Grieving and being in love are great exemplars where these features are exaggerated, where to be able to grieve and to be able to love require violating the attachment to our own intentionality, our sense of sovereignty. Why is it, we wonder, that when we are around a certain person we cannot keep our composure?
Composure is something we try to keep, maintain or that we lose. It is the ‘default’ setting, it’s something already there. Showing the right levels of composure at the right time is all part of the performance of normal. Composure is a way of holding the self, it is a maintainance of social identity, it helps provide a distance from our desires. A healthy level of composure is required in order to function and perform well in a world where losing one’s composure brings shame, or is read as incapacity, madness. The anxiety we feel over the struggle to keep our composure around certain people is a struggle over the fear of being mis-recognised by those whose recognition is so fundamental to our sense of self. I decided to do away with sovereignty too following Berlant when grief taught me that other people undo us over and over in ways we are unable to predict and control. These sort of experiences reinforce the importance of composure whilst simultaneously it’s fragility becomes all too apparent. But in the face of loss composure is about all you have to protect you. Keeping your composure means the world can come up to you when you choose and you can keep it at a distance. You can protect yourself from the world, other people, from coming in and interrupting you again.
Then love taught me that composure is only a holding ground until you find an environment in which you can relinquish your composure. Love doesn’t let you keep your composure, it’s too greedy. Composure is willed not natural, love is fantasy, not conscious – that comes later. A sense of sovereignty is considered a part of being a functional citizen and yet the moments of non-sovereignty are paradoxically seen as the moments where life truly takes place. Finding an easy friend, needing someone, thinking about someone, is what colours the otherwise weary days. It’s not so much the dependency that lifts the spirits but the chance to be recognised by another, for them to say ‘I see you’, for us to ‘feel ourselves’. I got obsessed with the MTV programme ‘Catfish’ as it documents a fascinating array of moments of misrecognition, of misplaced fantasies and overwhelming investments in a desired other. But as Catfish reveals, this sense of recognition is only the misrecognition we can bear, what we want to believe. We let someone carry an image of us, better than the one we can hold of ourselves.
ii. …never enough money, never enough love, and barely any rest…
Stories of love are all too often the plaster that fills in the cracks of the everyday overwhelmed life. Berlant’s ‘Cruel Optimism’ is remarkable in numerous regards but particularly in the way she describes how in modern industrial society the act of reproducing life (working for a living) is also the means of being worn out by it. We might not be fighting life and death on a daily basis, in fact the clinical, sanitized workplace might feel very detached from anything quite like a real experience. There’s something very ordinary about the crises encountered in the modern workplace. The labour is numbing and mundane, but still the dangers of precarity, little money, little time, work stress, and an exhaustion so very old and new all at the same time, feels pressingly real. As Berlant argues the feeling of deterioration is a fundamental part of the experience of modern working life. This not about a desire for the good life; it is the search for a less bad life. It is about finding resting places, someone who might understand our struggles, spacing out in mindless entertainment or seeking nourishment in food not for thought.
And modern life does provide pockets of intimacy to distract and soothe our overloaded sensorium: selling smiles and anecdotes on dating sites, or picking up whatever you can find on the weekend for some quick thrills and empty affection, or sleeping with him/her in the office. We are provided with things that promise reprieve but not repair: sex, mindfulness courses, energy drinks, all help keep the machine running smoothly, help us to catch up with a present that is always already happening too quickly. We’re keeping our composure even in intimate relations, discomposure is too unsettling, we haven’t time to come undone. The situations within which lie the potential for change are kept at bay – even the previous radical practices: mindfulness, yoga, are emptied out, re-branded and co-opted as a form of niceness production that keep us striving for the status quo. We’re not aiming for the horizon, just spreading out sideways, passing under the radar. But this is not a comfortable position, there’s little safety inhabiting the normal. It is a constant bargaining with what you can bear.
iii. The concrete realisation of being the odd one out.
Even if it doesn’t feel like it, the boundaries of normal are shifting all the time. This is what learning a bit of history can give you. ‘Doing your homework’ as Gayatri Spivak would say. This might sound less dramatic than it actually is. Encountering the fact that the prescriptions of the ‘good life’ you are encouraged to follow are not inevitable, and are in fact quite disagreeable, is the first step in the realisation of being the odd one out. Staying proximate to normality is a way of keeping out of view, toeing the line, not ruffling feathers. This is easily done if you happen to be born and grow up in a environment that is in line with the normative discourses on how best to live a life. But you might grow up as always already the outsider. You’re the odd one out without even trying. Either way, interruptions can work to destabilize the most comfortable of existences – the wearing out of working life, death, loss, scouring love – can elucidate in an often very banal and depressing way that the life you were living was held up by a series of attachments: to a person, a job, an ideology, a cat, or anything in which you had invested your sense of endurance about life. Losing that thing, interrupting the fantasy to which you had attached to it, is I think crucial in coming to a critical awareness of the world in which you live. I don’t know, this is just a hunch, but I think there has to be a loss. Even if not tangible, just the process of losing your sense of privilege. I don’t think there can be sovereignty in freedom. This is a view contrary to perhaps most movements that seek freedom, such as the recovery movement in mental health care, where freedom is conflated with reclaiming autonomy.
Discovering you are the odd one out, in my view is rather not about reclaiming sovereignty or autonomy but about dispensing with it entirely. Being the odd one out might sound like a passive position, but whilst yes you may feel as though you do not fit, you are also not accepting the life on offer. Who rejects who first is hard to tell, and perhaps not important. The rejection is not necessarily conscious either, we might spend many tiring years attempting to pass as normal before we realise that we had already given up on believing in the sustainability of this form of life a long time ago. This lag might mean we come to this impasse a little late, or not at all.
Talk of freedom might seem too corny and idealistic for jaded ears but again this might sound less radical than it actually is. It is a response that says: don’t try and reason, persuade, convince, expend energy as it does not serve you. When the system does not respect you, you owe nothing to it and you can make yourself free. And when I say freedom, I’m not speaking in sugarcoated tones, freedom without sovereignty is entering into what I can only describe as the realm of the ‘I don’t know’. It’s a liminal space, without boundaries or form, it is being in transit without knowing where it is leading. If you decide to reject the fantasies of the good life, than this is what you get. How to build a world that is not hopeless? Where to find a life worth living? In the liminal space of ‘I don’t know’ there is all to experience and different roads to go down. Choice is not pragmatic but whimsical. In this liminal space subjectivity is allowed the space to be non-sovereign, to be incoherent, changeable. We can mourn, love and lose our composure. The challenge is to find a sense of stability built through not being attached to what we attach to. Some call this nomadic theory, but I quite like unequal attachments that are sticky and messy. We might never quite become the person they wanted us to be, but in this liminal space of becoming the odd one out, unlike the cruel optimism of the fantastical good life, there are multiple exits.
Berlant, L. (2011). Cruel Optimism. Durham and London: Duke University Press.
Filed under: Grief, Mental health | Tags: counselling, depression, DSM-5, grief, orphan, recovery
Some stories won’t ever stop being told. Funny, I watch this: BBC Three’s Growing Up Poor and I’m 16 all over again. Twelve years down the line and how the memories of the weekly queue in the Post Office with my benefit giro book in hand suddenly emerges from a murky recess. Another life I tell myself. But I still remember queuing alongside the pensioners and the unemployed, me 15, 16, 17, 18 years old. A freak, scary, tragic and alive. I can still feel the stares. This shit doesn’t fade. In those sad girls I see myself. No-one now would place me in the same category as them. But I know them.
Funny because I was thinking about grief and categorising grief and the DSM-5 and I had this rant all planned out. And then a relinquished memory re-appears and illustrates the work of grief. “Complicated grief”, “Prolonged grief disorder” could be labels for this form of pathology. Grief research has told me there is a need to refine diagnostic criteria in order for formal intervention. Grief doesn’t make sense. The grieving individual doesn’t understand what is happening so new names and forms emerge from the experts in order to “work through” and “deal” with emotions.
I don’t want to deal or work through. I still want to feel it all the time. I want to remember this. Recovery becomes a means to forget. But some things shouldn’t be forgotten. It is easy to forget, especially in a world where very little is given the time it requires to unfold. Even love. Even love we don’t give time to.
Feelings always tell the truth right? We just need someone to pick them out and arrange them for us in a pretty pattern. And then we can flick through the DSM-5, “Ah, yes major depressive disorder. That’s you”. They gave me anti-depressants too at 19. Oh and steriods and other stuff. A whole kaleidoscope of medication in the morning.
If only someone had given me the opening chapter of Judith Butler’s Undoing Gender then. It would have helped. Or someone saying “You’ll never get over it”. That would have helped.
I didn’t want boundaries on my grief thanks or names. It was mine, and it was all I had along with my £40 a week (or however much income support was then).
But naming gives the opportunity to take a chaotic state and squish it into an acceptable coherence. I don’t know what I’m going through so please tell me. I read the books, I did the counselling with the patronising tissue box and bland wall paintings, I did the psychotherapy group for three years. Searching for a form for the intangible to fit. A medicalised form, a form borne out of the current thinking in psychology, counselling, bereavement literature, self-help jargon. These currents change though. The language we use to describe grief changes. The DSM diagnostic criteria shifts continually. What was grief is now depression and so on. Feeling down and not sleeping for more than two weeks is a pathology these days (by this logic I must have been schizophrenic in India…).
I don’t know about you, but I don’t know if I want my mind or my personality to be shaped by a whim in ill-advised research. I’d much rather find my own means to articulate a sensation in my mind and body. That might not be through language. It might be hard to to find a medium that can escape the double-bind of counselling speak – autonomy through other peoples versions of autonomy. And of course these feelings can take ‘maladaptive’ forms (as said to me by a doctor many years ago). Maladaptive behaviours like eating disorders, anxiety attacks, and the like.
Behaviours adaptive or mal- seem to me to produce a similar false consciousness by accepting the obligation to deal with emotions by first labeling them problematic and then seeking means to remedy them. In the quick-fix to remedy a distance is formed when we seek remedies not of our own making. It fosters a false sense of self that is contrary to the maturing of a person who knows herself and contrary to our best visions of what it is to be a human being (paraphrasing Ian Hacking in Rewriting the Soul).
My sister and I often remark on how ‘well’ we turned out. We’re miraculous and impossible beings. That doesn’t mean I don’t flinch every time someone I know talks about how much they love their parents, or people ask me where my home is. But remember: there’s no use in talking to people who have a home. They have no idea what it’s like to seek safety in other people, for home to be wherever you lie your head.
Emotions are unwieldy and can be immature, why would we want it any other way. To borrow from Lauren Berlant: sometimes we need an impasse in our present to place those events that have not found a genre. Maybe there is nothing to figure out after all. Maybe all that is needed is just a space for unhappiness to lie.
Filed under: Mental health, Recovery | Tags: fear, Howard Davies, LSE, meaning, nothing
I have a habit it would seem of proposing elaborate ideals whilst remaining incapable of adopting them in my own life. Last week I concluded with the following suggestion:
But if we live within our fears rather than attack them what other ways of being can we discover?
A question I believe in wholeheartedly. But on reflection how precisely does one live within their fears? Particularly when we live in a culture in which fear is regarded as a characteristic of the weak. To be defeated by ones fears is to give up. Fears must be faced, challenged and if we do not that is our choice.
To live within fears is an alternative to the instant erasure of fears by whatever means whether it is CBT or medication or some form of addiction. To live within fears, the idea I was hinting toward, is an exploration of fears. An exploration of its dimensions that does not seek only for its cause, but begins to unravels the multiple dimensions, ambiguity, the irrationality of fear that has no simple causality, no simple road to recovery.
But in this exploration we are left blind. No language in which to comprehend an illogical outburst of emotion, no rationality that will settle uncontrollable nerves. To live within our fears is not to attempt to counter the irrational with reason, but to embrace the irrational and understand it on its own terms. This is a markedly different approach, for it will involve delving in a great deal of meaninglessness. We are predisposed in many respects to understand and interpret what appears meaningless, which can enable us to feel we can conquer and control things. This makes us feel better, makes us feel significant. But how can we, as I suggested, embrace meaninglessness?
A hideous realization dawned on me as I considered what I would learn if I navigated through my own fears. I had perhaps optimistically hoped this would lead to freedom, or something closer to freedom. And yet I was suddenly struck by the paralyzing idea that what if by living within my fears I uncover only that there was not freedom, but nothing? I wondered whether the walls my fears created was to protect not my access to freedom, but the nothingness – the meaninglessness – that lay beyond. I wondered whether my irrational fears were just a sign I had reached my limits and despite my hopes for further progress, beyond this point only the nothingness of my personality existed.
In defence of exploring fears I questioned what do we lose?, what do we lose by the enforced requirement to overcome, attack and destroy our fears?
I think we risk losing a depth to our experiences, we lose the richness, the vibrancy, the beauty. And yet the avoidance of, or the smothering over of the uncomfortable means we also miss the pain, the mundanity, the continuing sense of inadequacy, the meaninglessness of it all.
Essentially if we explore our fears, attempt to live within them, we risk losing meaning. Or at least the meaning we possessed before. And if we do not either reclaim our original meaning or construct a new one we remain in this limbo of the incomprehensible.
And so now I ask is it worth it?
Is not contentment better than happiness after all? Is predictable sameness not better than the highs and lows? Is it not better to remain resilient and not come undone over and over again? Is not this half-existence better than the risk of ending up with nothing?
What really lies beyond, and do I have the courage to find out?
*IN OTHER NEWS: Howard Davies has resigned from the LSE, which has allowed me to feel less bad about the fact I called him a bellend a few weeks ago. His resignation has highlighted the ties LSE has/had with Libya, and the exchange of money and involvement of LSE and other university academics with North African politics. This is coming as a surprise to many people, yet for those within academia, I am sure most are aware of the fact of these numerous ‘donations’ and how academia is very much entwined with business and government.
Watching the documentary ‘Inside Job’ again reiterates the close relationship between academia and big business and of course there are many objectionable things about not only Howard Davies involvement but the extent to which such dealings take place (and I suspect that penetrate far and wide). Though is not the concept of clean money perhaps a bit naive? Some people are simply greedy, even academics that for some reason are depicted as objective or outside politics which is simply ridiculous, especially economists and politics professors. And lets not forget, academia with all its research assessment exercises, its competitveness, and struggle to obtain funding for research projects is a tough environment to work in, and if you have some rich overseas friends, regardless of their political orientations (which yes is quite a clumsy description for members of a corrupt, oppressive dictatorship), those with less ‘moral’ standing may give in to the allure.
I wonder therefore whether in some cases the means justify the ends? Some of the money donated from Saif Gaddafi for example funded a North African research programme. This does not appear a necessarily evil pursuit, but a productive and beneficial investment. More money surely went into creating the new academic building and the high tech lecture theatres, within which great lectures are given by great speakers. Moreover LSE is an institution which is home to many great academics, ones that worked hard to get where there are. It is also a place that does not only take on wealthy students (though there are many) but accepts those from less privileged backgrounds, people that did their undergraduate degree in the very un-prestigous Derby for example.
However I am certainly not in support of this continual corruption and dodgy dealings within academia with a regime as horrific as Libya. What worries me is that if these donations become monitored to the point money ceases to come in, the ones that will again bear the brunt are students, via higher tuition fees, poor facilities and poor teaching.
The money has to come from somewhere and I sure don’t think it is going to come from our delightful government or from the tax payer. It is times like these I both feel concern for academia, an institution which I believe still upholds certain principles of integrity, but also a sense of disappointment. And these unsurprising revelations only compound my current questioning of whether this is a life I want to enter into, and reinforce my desire to escape academia perhaps forever. But more on that next time.
Filed under: Mental health | Tags: fear, freedom, generalized anxiety disorder, pantophobia
I have recently become obsessed with the idea of ‘pantophobia’.
Pantophobia (sometimes called panophobia) is the fear of everything. ‘Panto’ is from the Greek to mean ‘all’.
In a recent post I included this picture.
This picture was originally featured in a book called ‘The physiognomy of mental diseases’ (1840) compiled by Alexander Morison. The picture was labelled with the following description:
“Portrait of a female in whom delusive fear of every object and person, pan[t]aphobia, keeps her in a state of perpetual distress.”
A ‘delusive’ fear of every object and person. The idea intrigued me. How is it possible to fear everything? A fear so total – a fear that includes objects, persons, animals, vegetation, earth. How can a phobia be sustained to all these elements all at the same time?
Pantophobia is not a term used nowadays, now we have generalised anxiety disorder. NHS direct describes generalised anxiety disorder (GAD) as thus:
GAD is a long-term condition which causes you to feel anxious about a wide range of situations and issues, rather than one specific event.
People with GAD feel anxious most days and often struggle to remember the last time they felt relaxed. GAD can cause both psychological (mental) and physical symptoms. These vary from person to person, but can include feeling irritable or worried and having trouble concentrating or sleeping.
GAD, like pantophobia, is a non-specific fear. What characterises pantophobia and GAD as pathological is their constant, never-ending nature. Pantophobia “keeps her in a state of perpetual distress”. GAD is diagnosed “when your worrying is uncontrollable”, and – because modern medicine requires time limits for determing the line between normality and abnormality – when “you have felt worried nearly every day for at least six months”.
This is a phobia that is not directed toward anything in particular but which may attach itself to any and numerous objects or elements haphazardly and inconsistently. This fear has no cause, no origin and no end.
Listening to a lecture by John Gray on the modern desire for immortality (again at the wondrous LSE) added a new dimension on the treatment and understanding of death and dying in modern society. Many scholars have written on the ‘sequestration‘ of death from modern life and the way mourning has becoming increasingly privatized. What was interesting in Gray’s analysis was his exploration of the rise and predominance of the theory of evolution in scientific thought and the role it played in repressing a more contingent and haphazard understanding of the universe. Evolution became associated with progress and improvement.
In an increasingly secular society, science acted in similar ways as religion by providing a narrative that endowed human lives with a larger meaning with laws and explanations that once again protected against disruptive notions such as no afterlife – eventhough this may have not been the original intention of Darwin et. al.
Meaning can be disrupted by the occurrence of events that appear illogical – bereavement or illness are commonplace examples. It is normal we are told to experience anxiety or fear following these events. But only as long as it is transitory. If we recover from illness, stop mourning and resolve our fears and anxieties – meaning is preserved. This is important because if we do not recover we remain in fear. We remain in meaninglessness, in a contingent universe where we have no control. If we return to what we were before, meaning is once again reinstated, it may even have been reinforced by the experience of meaninglessness.
It is possible to recover when the individual maintains that nothing is lost. If we believe that when others die we do not lose ourselves, we do not lose the other person either. Therefore, despite the fact humans die, WE, that is to say humankind, lives on.
But what if this disruption was not a transitory state but it was a perpetual and permanent condition of existence. Pantophobia is the perfect illustration of the meaninglessness that we try to escape from. Without meaning there is everything to fear. Without meaning everything is lost continually and without reason. There is no cause to pantophobia because it is not directed at anything. It cannot be redirected because it has no aim, it is at once all-encompassing and intangible – existing everywhere and nowhere.
Similiarly for GAD the NHS Direct website admits:
As with most conditions that affect mental health, the exact cause of generalised anxiety disorder (GAD) is not fully understood. Some people develop the condition for no apparent reason.
There is no cause but there are descriptions and definitions, and portraits that reveal a physiognomy, and CBT, and a plentitude of medications. There is a persistent striving to both define and remedy a phenomenon by means that are incapable of comprehending its dimensions. Like the picture above, these illustrations reflect only a poor fragment of what pantophobia is.
In 1840 diagnosis was conducted on the basis of physiognomy, on facial characteristics. Now we have lists of ambiguous symptoms and CBT that rearranges thoughts. The ultimate aim however has remained the same. Identification, categorization and treatment of an unknown and socially constructed problem that requires silencing in order for normal life to continue (that is to say, evolve).
What do we lose by striving to resolve these conditions with superficial remedies? What do we lose by attempting to define the intangible and ambiguous in definite (medical, scientific, Western, etc, etc) narratives? In this narrative of progress, of self-improvement, of the continual desire for better; whose voices are being pathologised?; what are we labelling with medical diagnosis?
We do not have to continue the search for a better definition. We do not have to seek causes or identify symptoms. The alternative does not have to be a choice between pantophobia or happiness.
It is an alternative in which uncomfortable feelings, anxieties are embraced as valid and real alongside the spectrum of human emotions. It is an alternative which accepts the resistance of fears and anxieties to language, that accepts their intangibility. It is an alternative in which meaninglessness exists. An alternative which is not always full of aims or possesses a direction. It is an alternative in which we give up the idea we as humans have ultimate control of our own lives, and the lives of others.
The alternative may not be a comfortable one, it is not always a happy one. It does not promise a happy ending.
But if we live within our fears rather than attack them what other ways of being can we discover?
Perhaps something resembling freedom?