politics of the hap


I am not my blob, Or It’s all chemical baby // some sketchy notes.
March 3, 2014, 1:03 pm
Filed under: Grief, Mental health, Recovery | Tags: , , , , ,

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:

  1. How to understand the self/subject, and avoid lapsing into either essentialism (it’s all chemical) or relativism (it’s all socially constructed)
  2. What can we take from affect theory?
  3. 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

– Disbelief/numbness

– 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.

References

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.



Reflections on Recovery: Research notes, Part II: Emotions, grievable lives and no recovery.

Read Part I first here.

1st March 2013

The past fortnight has felt a little meandering in regards to a specific focus of attention. This has not necessarily been a hindrance. I have mostly fixed my gaze on the reading of sociology and cultural analysis of emotions, with a few detours along the way.

A lot of the ideas and literature I have encountered have entailed a more contemplative mode of analysis, which feels like an ongoing process. Some of the texts have not been easy reading, especially thinking around ‘affect’, which is both an intellectually knotty concept as well as a demand, on the reader, to rethink one’s own affective response. In short, the delicate nature of the concepts I am dealing with has been brought quite sharply to my attention, especially when these ‘concepts’ are not just that, they are social constructions of a ‘real’ felt emotion – to return to a discussion we had a few weeks ago. Affect then perhaps is a way to describe that which remains outside of the concept; yet being both a socially named construct whilst also refuting social construction is why affect is proving such a slippery subject.

Affect however is not necessarily the focus of sociological explorations into emotions, the sociological view being one where emotions are an outcome and cause of social processes (Barbalet, 2001). For Barbalet it is not cultural rules and norms that shape emotions but the structural properties of social interactions that determine emotional experiences.  The culturalist perspective also borrows from social constructionist perspective but acknowledges the historical context, the situated-ness of emotions (Harding & Pribram, 2009). A culturalist perspective doesn’t limit its gaze to the individual but is instead engaged with how emotions, cultures and social formations are articulated in contextualised and historicised ways to produce boundaries that shape and position individuals and collectives. As Sara Ahmed describes, emotions produce the very surfaces and boundaries that allow the individual and the social to be delineated as if they were objects (Ahmed, 2004).

This way of thinking about emotions therefore maintains neither an ‘outside in’ nor an ‘inside out’ perspective. An outside in perspective would consider emotions as properties of social and cultural practices that ‘get inside’ the individual whereas an ‘inside out’ perspective would see emotions as something innate to the individual that emanate from within out onto the world. The inside out perspective is one that is broadly shared within the positive psychology/happiness/resilience camps where negative emotions (like depression, grief) are disturbances that leak out into the individual’s environment. Similarly it is the individual who has the power and responsibility to express positive emotions and happy feelings. By viewing emotions as something that emerges from an intersection of the two is a way to skirt sticky issues around free will in deciding how one presents or expresses themselves but also underlines the impossibilities of wrangling a subjective self from the social contexts, structures in which they are positioned. Perhaps Pierre Bourdieu’s (Wacquant, 1989) concept of ‘habitus’ can also be instructive here, which in thinking of how emotions shape boundaries also possesses a spatial quality in describing the ‘field’ of possibilities and struggles that moulds what is possible and how individuals are positioned.

Nikolas Rose, in line with Foucault, in his work on subjectivity (1989, 2007) persistently refuses to provide the self with any sense of agency that can be identified as originating from inside-out the individual. This is a view that frustrates Giddens-esque ideas around reflexive self-identity and sociological arguments that still maintain divisions between structure and agency, such as Gidden’s own structuration theory. What Rose’s work aims to demonstrate is as a culturalist theory would propose; that boundaries are created, in an ongoing process, between the individual and social such that they are established as objects – yet these objects cannot be identified as separate entities. As Ian Hacking (1986) has also argued; subjects are ‘made-up’ through various historical discourses and as these discourses shift so does the understanding of the subject.

In the new issue of Omega features an article by Tony Walter on disenfranchised grief (Walter & Robson, 2013). Walter argues against the idea of disenfranchised grief by arguing a person can undergo a ‘process of disenfranchisement’ but grief itself cannot be seen to be ‘disenfranchised.’ The use of the term disenfranchised constructs a binary that Walter argues is not applicable to grief. The assumption of disenfranchised grief theory supporters is that all grief should be made equal, that all norms around grief should be done away with. Walter argues that norms are essential to grieving and that not all losses are equal (e.g. can the loss of a goldfish be comparable to the death of a father) and thus we have hierarchies of grief that determine appropriate responses to grief. A mourning individual will only feel their position in the hierarchy negatively if they grieve too much or too little or if they feel their grief is not recognised correctly. In this situation the grieving individual may undergo a process of disenfranchisement.

This article provoked thoughts around recognition: both how recognition is sought and the failure to be recognised and what this entails for the construction of subjectivity and the expression of emotions. A piece by Jennifer Biddle (1997) described shame as a feeling that arises from the failure to be recognised. If a person’s grief is not recognised in the way the person would hope they might feel shame at grieving too much or too little. But it also might mean that the person’s position in the hierarchy is not recognised as being allowed to grieve. Walter’s idea of a hierarchy over disenfranchisement is understandable, yet the hierarchy he proposes leaves little space to understand complex or resistant emotions like ambivalence. A hierarchy of grief seems like a very crude gloss of the complex web of connections we have with one another that are often destabilised by grief.  A hierarchy is also constructed and maintained through what lives are considered ‘grievable’. To be considered grievable one has to have been recognised as living a life worth living whilst they were alive (Butler, 2004). It also supposes one accepts the position they find themselves. As Walter comments, to grieve too little or too much might require careful presentation of the self to appear to be grieving appropriately and thus elicit the appropriate responses from those around them. The grieving individual therefore might be recognised via the hierarchy yet might also still feel a sense of disenfranchisement due to the gap in felt emotion and the emotions they present to others. This gap might be filled with shame: the failure to be recognised.

Grief might then be felt as pathological, as a disturbance, as something that is leaking out onto the world. Grief becomes an unruly emotion to be managed rather than experienced. As Barbalet argued, emotions are not opposed to reason, they do not merely distract us from our purposes but re-establish those purposes anew (2001, p.31). Yet emotions such as grief are often considered as something that gets in the way. Time limits on grieving enforced by the demands of the workplace or by the DSM-5 or by a desire to avoid suffering, shape grief as an object to overcome. When something becomes our aim we establish a timeline to achieve it.

This has also made me reflect on the question ‘recovery of what?’ I have discussed grief above yet the question remains as to what precisely will be the focus of my looking into recovery. Though in a way to pose the question, ‘recovery of what?’ is instructive in itself by highlighting the need to posit an event or object from which one recovers (one can only recover when we have identified the object which is causing suffering – e.g. the first step on the road to recovery for an addict is to admit their problem). But it is also to ask what are we recovering, recovering what? Recovery is perhaps more accurately considered the process of adopting a new narrative, a narrative of self-empowerment, the sense of being strengthened by suffering, and thus appears as an act of covering over suffering rather than overcoming. The question of ‘recovery of what?’ is also muddled when we consider the extent to which we are encouraged to be prepared to recover for an event that has not yet happened. Happiness and resilience training in schools and life coaches etc are a fraction of the proliferation of the language of resilience into political, economic and social domains. So there exists a sense that we are already always recovering from something (life..?) because we are always discovering a new threat from which to protect ourselves from.

References

Ahmed, S. (2004). The Cultural Politics of Emotion. Edinburgh: Edinburgh University Press.

Barbalet, J. M. (2001). Emotion, Social Theory and Social Structure: A macrosociological approach. Cambridge: Cambridge University Press.

Biddle, J. (1997). ‘Shame’, Australian Feminist Studies, 12(26): 227-239.

Butler, J. (2004). Precarious Life: The Powers of Mourning and Violence. London: Verso.

Hacking, I. (1986). ‘Making Up People’, in Bagioli, M. (ed) (1999) The Science Studies Reader (pp. 161-171). London: Routledge.

Harding, D. and Pribram, D. (2009). ‘Introduction: the case for a cultural emotion studies’ in (eds) Emotions: A cultural studies reader (pp 1-24) Oxon: Routledge.

Rose, N. (1989). Governing the Soul: The Shaping of the Private Self. London: Free Associations Books.

Rose, N. (2007) The Politics of Life Itself: Biomedicine, Power, and Subjectivity in the Twenty-First Century. New Jersey: PrincetonUniversity Press.

Wacquant, L. (1989). ‘Towards a reflexive sociology: A workshop with Pierre Bourdieu’, Sociological Theory, 7: 26-63.

Walter, T. and Robson, P. (2013). ‘Hierarchies of Loss: A critique of disenfranchised grief.’ Omega, 66(2): 97-119.

13th March 2013

I have to begin with the caveat that the past ten days have not seen as much thought time as I would have wished, I have been attending various workshops at the university as well as seeking out other opportunities such as conferences and networking possibilities, so what I have to present my not be as substantial as hoped.

To begin, I came across a film centred on the theme of recovery featuring people who had undergone treatment for mental illness describing their personal experiences. This was a film conceived by ‘service user’ Michelle McNary along with the support of the South London and Maudsley NHS Foundation trust and was first released in 2009. It is available to watch online here: http://www.slam.nhs.uk/patients/recovery.aspx . There is also literature about the making of the film, for example this leaflet: http://www.slam.nhs.uk/media/115062/recovery_booklet.pdf, which provides further interesting information on the origins of the modern concept of recovery (which I am in the processing of reading in more detail). The film itself presents four people talking about their (ongoing) experience with recovery from various mental illnesses. The film is a rich source of recovery narratives, particularly the way in which people describe their experiences and the extent to which they identify with having a mental illness. Recovery was broadly understood as a way of coping with an illness as well as having a life. There was also a sense of the importance of recognising one’s self as mentally ill as the first step on the ‘road to recovery’. However though recovery is meant (or at least was meant) as a way to live a life with an illness rather than search for a cure; a way that was intended to put power and control back in the hands of the patient as opposed to the doctor/psychiatrist etc, the individual accounts were cluttered with talk of building a new life, creating a new identity, recovery was a ‘second chance’, a ‘rebirth’. And the possibilities of this new life were very much fostered by hope and positive thinking.

I was reminded of a short video interview where Nikolas Rose touches upon the idea of recovery. It is a ten-minute video available to watch here:

http://www.youtube.com/watch?v=P8mkcXdTZ_g. Rose starts to talk about recovery about 5 minutes in. I have transcribed some of his key remarks below:

But now in the same way as empowerment, people are obliged to recover, obliged to live a life and what does it mean to live a life today? It means to be in charge of your money, it probably means to have a job, it means to have housing, it means to be independent, it means to have choices, it means to be on Facebook, it means a hundred different things, all these obligations today. So in a sense recovery has the potential, and I think we can see this in some way, to be a kind of process of normalisation where recovery means from the professional point of view, demonstrate to me that you can live what I take to be a normal life, and I think those people who are arguing for normalisation did so for all the best possible motives… But I think the obligation to recover is linked to a reduction in the tolerance of our society for difference. And the belief that there is only one proper way to live your life and if you don’t live your life in this way, if you’re not autonomous, if you’re dependent on someone, if you need care all the time, if sometimes you don’t want to go to work, if couple of weeks you just want to stay at home and not talk to anybody, well that’s pretty pathological, and you’ve got to be brought back to being in a normal way of living. So that’s what I mean by being an obligation to recover rather than perhaps a toleration of the many different ways in which people actually do live their lives.

The idea of the obligation to recover as a reduction in tolerance of the different ways people live their lives has been such a useful tool to think with, both personally and professionally. For the individuals featured in the film it seemed that recognising oneself as ill was not so much a radical gesture to live a life based on this difference but more an acknowledgment that sent them on the road to adjustment.

I also returned back to Jeffery Kauffman’s (2008) great article ‘What is “No recovery?”’, which has many points to unpack, the central being the exploration of the idea of ‘no recovery’ not as a transitional state but as a condition of existence. On a parallel point, I read an article on the BBC about Paul Gascoigne and his recent return to rehab. There was a comment in the article by an addiction counsellor where they stated: ‘Relapse is part of recovery’. I found this poignant that even failures could become incorporated into this bigger more meaningful narrative of recovery. There was clearly a sense that recovery is the normative response, and perhaps the only desirable one, as failures too become meaningful as part of the road to recovery. There is the belief that no recovery is always a transitional state; ‘You’ll get over this’.

Kauffman looks upon no recovery as a product of a society where there is a loss of traditionally accepted authority over mourning. No recovery, and the questioning of recovery, is then a degradation of normative authority. I would add here that questioning recovery is also a result of becoming more aware of the ways people recover and live their lives following loss or the onset of illness. The eradication of traditional norms allows this questioning to become possible.

Kauffman also describes how recovery and identity are bound together so that without recovery there is no reflexive sense of identity. So like the individuals in the film, recovery was only possible through the adoption of a new identity and vice versa. A narrative of no recovery is not a rebirth. As Kauffman describes it:

No recovery is a volatile state of identity diffusion, in which one is always a stranger from oneself, and in significant ways also estranged from others. (2008, p76)

Here I am reminded of Judith Butler (2004) and her description of grief as being ‘beside oneself’. This type of estrangement might be commonly identified as a feature of grieving, yet Kauffman argues that recovery is not a transition out of this state but only indicative of the capacity to function and adapt to this state, which would then be labelled as recovery by others. Recovery is then a simulation that functions in place of a reality of no recovery. Recovery is a process of social adjustment (or normalisation to quote Rose) that induces people to forget. The search for a new identity and narratives of rebirth involves a strong dose of forgetfulness according to Kauffman. This idea of forgetfulness as key to recovery I find particularly interesting, and it is also a point made by Sara Ahmed (2010), who describes how recovery can often become a means of ‘covering over’. In this sense recovery is not so much a return to past selves (those selves are forgotten) but a better improved self.  It also implies that certain things must be forgotten in order to recover.

To extend this idea further there is also perhaps a connection to be made between forgetfulness and the pace of modern life. A book by Milan Kundera entitled ‘Slowness’ focuses on the absence of slowness in our lives and makes an interesting observation on the link between slowness/speed and the process of memory:

There is a secret bond between slowness and memory, between speed and forgetting… In existential mathematics, that experience takes the form of two basic equations: the degree of slowness is directly proportional to the intensity of memory; the degree of speed is directly proportional to the intensity of forgetting.

Kundera concludes that the modern drive for speed and efficiency is in fact caused by a desire to forget, to eradicate memory before it has chance to materialize. It may be that the very nature of modernity is so that all experiences, ideas and indeed memories are disallowed the opportunity to solidify. Modernity encourages us to forget. In terms of recovery, the incentive to recover in an appropriate time period might induce a necessary forgetfulness both of a life experienced in the past but also of the present experience of grief. The degree of speed in which one is encouraged to recover might mean painful memories are not allowed to be pondered, that is to say dwelling in loss is discouraged or considered contrary to recovery.

I want to end with some thoughts on Maurice Bloch’s ‘The Blob’ which I found very instructive in terms of thinking about the self as both a continuum and a relational self, and included many other points to think through. Bloch also made a useful distinction between the narrative self and the self that narrates, and the way the blob might present a narrative to others is not the same as exposing themselves or their personhood. Thinking about this in terms of the ideas of recovery discussed above, recovery is often very much a narrative that is interpreted and presented. The people featured in the recovery film for example were carefully selected as being articulate and able to answer questions coherently. Though the film was designed as a way to get to the ‘reality’ of personal recovery it offered only the expected narratives of new identity and rebirth etc. For no recovery has no language, it is only the underside of the positive language of recovery. As Kauffman and Rose described recovery is only a demonstration of the ability to live whatever is considered to be a normal life. But underlying this perhaps is the idea of the impossibility of recovery, and that none of us actually recover, only some are better at demonstrating it than others. What makes some better at recovering than others is then not so much a personal matter of individual will and resilience but the ability to find certain narratives of recovery meaningful, of the ability to adjust to social life – get a job, be on Facebook etc as Rose outlined. Something else that was also repeated in the film on recovery was the importance of hope to recovery. There had to be a continual belief and hope in the possibility of recovery else recovery would fall apart. Hope was then the object that kept them tied to an identity of recovery that acted as a reminder that recovery was only a transitional state. In no recovery there is no hope. Yet I think it would be more fruitful to not end there by saying no recovery disallows hope but rather that focussing on recovery disallows no recovery as a possibility and thus reduces the different ways to live a life. When relapses also become part of recovery, recovery becomes a limiting narrative to live by. This is arguably not a very hopeful way to live a life. That is not to reject recovery as a possibility, but to say that neither recovery nor no recovery should be our talisman, or what fills our hopes and dreams. Rather it is to suggest ways of recovering inappropriately or not recovering successfully; ways of living that expand the possibilities of what is considered a life worth living.

References

Ahmed, S. (2010). The Promise of Happiness. Durham and London: Duke University  Press.

Bloch, M. (2011) ‘The Blob’, Anthropology of the Century, Issue 1.

Butler, J. (2004). Precarious Life: The Powers of Mourning and Violence. London: Verso.

Kauffman, K. (2008). What is “No Recovery”?. Death Studies32(1), 74-83.