By VLADIMIR SAFATLE*

The greater the scope of clinical diagnostics, the less chance there is of mobilizing psychological suffering as a basis for social revolt.

Almost ten years ago, we began developing the research at the University of São Paulo that resulted in the book Neoliberalism as a management of psychic suffering (Authentic). This research was carried out by the Laboratory of Social Theory, Philosophy and Psychoanalysis (Latesfip/USP), which brings together professors and researchers from the Department of Philosophy and the Institute of Psychology at our university.

During the worst moments of the Brazilian public university, we fought to carry out this research as a way to begin to analyze the mutations that subjects were going through within the new economic order with its own structures of social brutalization and violence.

This research on neoliberalism and contemporary forms of psychological suffering was the first step towards drawing conclusions from an epistemological question that seemed central to us, namely: what, after all, is a clinical category? What kind of entity are categories such as “histrionic personality disorder,” “obsessive neurosis,” “schizophrenia,” “anxiety disorder,” among many others? Could such categories be the expression of natural species discovered by the technical development of medical knowledge?

“Natural species” is a species corresponding to the grouping of facts and elements that would reflect the structure of the natural world, rather than reflecting the systems of interests and actions of human beings. In this sense, a natural species would be a grouping endowed with two fundamental characteristics: epistemic accessibility (they can be known) and metaphysical autonomy (they are not reduced to conventional constructions produced by my structures of knowledge). The question was then: are our clinical categories endowed with natural structures, with regular natural laws that can be identified and verified through empirical research?

What would happen if we were to start from the hypothesis that clinical categories are not natural species, that there is nothing in the natural world similar to perversion, schizophrenia, obsessive-compulsive disorder, or histrionic personality disorder, since the same biological markers can describe distinct mental states? Could we then affirm that clinical categories are, in a certain way, arrangements produced by the very impact of medical knowledge on the objects they describe? Can the configuration of medical knowledge, with its classification structures, produce effects on subjective experience? In other words, can our regime of knowledge compose the problem, and not the solution?

These were the basic questions. They seemed relevant to us because many of our clinical categories not only do not yet have precise biological markers. In fact, they never will, and there is no possibility that they ever will. After all, just to give a pedagogical example, would it be possible to find biological markers for the aforementioned histrionic personality disorder? Its diagnostic criteria are, among others, “discomfort in situations in which he or she is not the center of attention”, “constant use of physical appearance to draw attention to oneself”, “self-dramatization, theatricality and exaggerated expression of emotions”.

Such criteria cannot be assessed as an expression of specific biological markers, but as behaviors of refusal, unconscious or not, to socialization patterns that, by the way, are quite imprecise. Because if we are talking about “exaggerated expression of emotions”, we have to ask ourselves where the definition of an “adequate standard” of emotions would be if not in the subjectivity of the doctor. In other words, the clinical category is clearly based on a disciplinary standard of conduct that has nothing to do with biology or some other system of knowledge apparently independent of the observer’s value system.

Thus, it becomes clear that this problem did not only concern general epistemological questions linked to the field of psychiatric-psychological knowledge and its categories. Rather, we were faced with a political issue linked to medical knowledge as a fundamental sector of the technologies of power. For it was a question of understanding how societies reproduce themselves by defining not exactly the norm, but the deviations.

Governing is defining the possible forms of deviation, it is telling those who do not adapt (but who actually adapts?), those who suffer due to the restrictive weight of social norms: “These are the places of possible deviation available to you.” A bit like Franz Kafka’s famous parable of the door of law. The same parable that reminds us that this door prevents you from entering, but it was created for you.

In this sense, the forms of inscription of suffering in pathologies that will be the objects of clinical intervention technologies were fundamental political problems. The more extensive these forms of inscription, the more societies denounce their fragility in relation to the belief in the norms, in the normality that they themselves enunciate.

For everything happens as if the structures of social domination needed to get ever closer to the subjects, as if they were fighting against a form of insubordination, a malaise, a refusal that seems to come from every pore. If we want to understand how clinical categories and technologies of clinical intervention are constructed, we must not only have a historical perspective that shows development as something that seems to follow the rhythm of the mere deepening of discipline and control. We need an agonistic perspective that shows “against whom” such regimes of knowledge and intervention are created. What insubordination they try to silence. Establishing these questions in the midst of a Brazil taken over by the rise of the extreme right and national fascism seemed to us to be something more than a mere intellectual curiosity.

Neoliberalism as the name of a psychic crisis

Jacques Lacan once understood, with his usual precision, that the multiple modalities of psychic suffering were deficits of recognition. This was a way of remembering that our symptoms, inhibitions and anxieties were organically linked to problems of social recognition or, rather, to the limits of the possibilities of social recognition historically constituted for us.

It was not, therefore, a question of the subjects' inability to make themselves recognized, but of the objective limitations of society itself that divided, divided, and created contradiction within the subjects. Let us always remember this: social norms do not create subjects, they divide them. If norms had this creative force ex nihilo, we would hardly be able to explain why they make us suffer, why we are so unadapted to them.

I make this observation only to say that the Lacanian perspective opened an avenue to be explored. Hegel, when he understood the structures of recognition as the basis for the formation of consciousness, understood that work, desire and language, as fundamental fields of social interaction, were the material axes of the emergence of consciousness.

However, it took someone like Marx to complete this shift away from transcendental philosophy, away from the illusions of the supposed ahistorical and timeless determinations of consciousness, by insisting on the idea that we needed a concrete analysis of the current configurations of work. An analysis that started from the fact that we do not work in the same way inside and outside capitalism.

For if we did not work in the same way inside and outside capitalism, then the structures of social domination were distinct, social suffering was distinct, and the problems of recognition needed to be inflected based on such distinctions. More than that, actions aimed at emancipation could not be thought of in a generic way; they would need to be inflected taking into account the specificity of the material conditions of historically constituted social work.

We can say that the same is true of Lacan’s understanding of the problems of recognizing desire that we deal with in the clinic. One does not desire in the same way inside and outside capitalism, nor even inside and outside its most current configuration, namely neoliberalism. However, more than the historical mutations of the endorsed forms of desire, we must pay attention to the historical mutations of the endorsed forms of deviations in relation to the social norms of desire.

I say this because the rise of neoliberalism as the final stage of capitalism implies a new configuration of the structures of social domination. It implies, above all, a deepening of the forms of psychic subjection and subjective construction.

This deepening involves not only the extension of the social norm, which in this case means the extension of the corporate form to all the intricacies of the social spheres of values, the extension of the competitive and warlike violence of entrepreneurship as a model of relationship with oneself, with others and with the world, the extension of a notion of freedom as property of oneself that explodes all possibility of constituting a social body based on solidarity. It involves, above all, the indefinite extension of psychic suffering and its categories, as if it were the case of providing an almost unlimited authorization for psychiatric intervention.

Let us think, for example, of the explosion in the number of clinical categories that occurred precisely after the rise of neoliberalism in the late 1970s. When it was first published in 1952, the DSM (Diagnostic and Statistical Manual of Mental Disorders) contained 128 categories for describing types of mental suffering. In 2013, in its latest version, it presented 541 categories. In other words, in approximately 60 years, 413 new categories were “discovered”.

There is no branch of science that has experienced such an anomalous and impressive development since the end of the ice age. Of course, this does not indicate any “technological leap.” We had not neglected 413 clinical categories for centuries. Rather, we gave ever more extensive permission for medical intervention in areas of life that until then had not been seen as possible areas of pathological behavior. We allowed psychiatric knowledge to enter our lives to a degree that was hitherto absolutely unimaginable.

I would insist on the idea that this occurred because I believe it is correct to say that we live in an era of psychic crisis. That is, an era of increasing psychological suffering as a normal outcome of socialization processes. Let me emphasize this point: we are talking about a “normal outcome,” that is, there is no way that our processes of socialization and social recognition cannot produce such an increasingly exponential increase in psychological suffering.

To give you an idea, in Brazil alone, this global laboratory of authoritarian neoliberalism, currently 13,5% of the population has been diagnosed with depressive disorder, and 9,7% with anxiety disorder. One way to interpret this data is to say that it shows how being a self is currently unbearable.

We know that there is no subject without symptoms, that is, there is no subject without marks of a socialization that is confused with forms of alienation. But there is something else today that gives the process of social formation of the Self an even more unbearable character. The demands for initiative, for individual responsibility, for “doing one’s own thing”, which the absolute precariousness of society and the implosion of elementary relations of solidarity produced in neoliberalism, have in fact generated a deepening of psychic disintegration.

In an era of extension of economic rationality to our private life and spheres of intimacy, in an era of strengthening of individual decision-making forums due to the affirmation of a freedom that is only conjugated in the singular, as freedom of individual interests, the Self can no longer hide social anguish for itself.

That is, by expanding economic rationality to the spheres of private life, something that Adam Smith, for example, never did, given the difference in approach between The wealth of nations (based, among others, on the recognition of the social function of selfishness) and the Theory of Moral Sentiments (based on the need for empathy), neoliberalism has made the price of being a Self something unpayable. In this social horizon, the Self is constantly under self-evaluation based on the vocabularies of yield, performance, accounting, and quantifiable interest in relation to one's own person.

And increasingly subjected to imperatives that produce not the revolt of knowing oneself under a repressive law, but rather the depressive implosion of being called to athletic performances, subjected to injunctions of unrestricted enjoyment that are never fulfilled. Therefore, the Self gradually becomes less capable of mediating that which does not submit to this logic of extended economic rationality. Everything that does not conform to it appears as a risk to its functioning, to its freedom, in short, something to be pathologized. Then all that remains is the increasing use of narcissistic, aggressive, violent and segregating defenses. This may help to understand the current extent of anxiety disorders.

In other words, we are aware of the emergence of the now classic definition of subjects as “entrepreneurs of themselves.” But let us ask ourselves what must happen to society for subjects to be able to perceive themselves in this way. Was this the result of an “individual choice,” of a decision to see themselves preferentially as entrepreneurs of their own abilities, of their “human capital,” as even the contemporary left irresponsibly advocates?

Or is it the result of brutal social violence carried out with fire and sword, a bit like Marx’s description of the transformation of workers emotionally tied to the land into individuals who have nothing but an abstract and quantifiable “labor force”? For “entrepreneurship” is not a form of freedom, but of violence, of an even greater elimination of any rootedness. It is not a way of producing wealth, but of the violence of reducing every social relationship to the figure of competition and rivalry. Reducing every other to the condition of a competitor to be eliminated.

This is a way of organizing society based on the logic of war, an endless war in which no solidarity is possible. In this situation, the neoliberal call for the strengthening of individual decision-making and deliberation forums can only produce the panic of finding oneself in real social isolation, always balancing against the economic death that lies in wait. The psychic crisis then appears as the result of the complete implosion of a social body that predates individuals. Something that only neoliberalism has managed to do in a rigorous and extensive way, since it is a destruction linked to moral calls to make us “free”, more supposedly responsible for our own lives.

Let us also note that calls to strengthen the Self’s capacity for decision-making and choice are not only illusory, but unrealistic. The Self is not the center of decisions and deliberations. The Self never decides, because real decisions are not made as a result of choices and the exercise of a supposed “free will” mobilized by the Self. They are imposed on the Self in unconscious dimensions. No one “chooses,” for example, a sexual orientation. It is imposed on the subjects, and it is up to the Self to recognize or not what appears to be unavoidable.

And non-recognition will necessarily be paid for with enormous amounts of psychological suffering and self-violence. The decisions that fall to the Self are only those that are organized as representations of consciousness, as objects of consensuality, as expressions of personal “interests.” Which means an extremely limited number of decisions regarding our lives. This is a way of remembering that strengthening the Self as an instance of decision-making is just a form of ideological ignorance.

Something that only deepens the inability of the Self to deal with real decisions, with unconscious and depersonalized processes that determine us. The result can only be the even greater rigidity of a psychic instance that feels constantly invaded, traversed by alterities that are internal to it. The helplessness of perceiving oneself in such a situation is, in moments of crisis, transformed into appeals for support by narcissistic images of oneself embodied in instances of power and in bellicose discourses.

In other words, the psychic crisis is the result of the complete implosion of a social body that predates the illusion that subjects are individuals, entities in continuous competition and competition with each other. We know the suffering resulting from the inability to individualize oneself from the social body, but now we have the suffering of being just an individual, without any generic social body to come, capable of transforming, in its own movement of emergence, our social identities and their limitations.

Added to this is the fact that subjects have always been required to make an enormous effort of repression and restriction in order to be social subjects capable of performance and recognition. This even implied sexual repression, the constitution of oneself as a rigid gender identity, as this was a fundamental element of guarantee to escape social violence and exclusion.

However, with the flexibilization of gender identities, including in the central sector of corporate capitalism (there is no company that does not currently want sexual “diversity”, that does not celebrate “diversity” in its campaigns), this self-violence necessary for the constitution of the Self has become something obsolete, which causes enormous anguish. For everything happens as if the subject has not only submitted himself to a violence that is currently unnecessary, but has also shown himself incapable of reading new trends, anticipating the new.

The violence he has inflicted on himself no longer has any value now. Hence the anger that is directed at those who remind him of this because they were able to deal with their gender dissidence and divergences in another way.

In all these situations, we see an increasingly brutal psychic crisis, with predictable social explosions. Against this, psychiatric knowledge raises the indefinite extension of clinical categories, the pathologization of all forms of discomfort and uneasiness in relation to the normal processes of socialization and individuation, the use of diagnosis as a form of self-preservation (“if I have a diagnosis, I deserve some form of care”) that exacts a high price, as it paralyzes the subject in a position of impotence and exclusion.

The greater the scope of clinical diagnoses, the less chance there is of mobilizing psychological distress as a basis for social revolt. In this sense, it is towards understanding this crisis and its consequences that we currently need to move. It is a greater challenge for those who understand the clinical treatment of psychological distress as a necessary sector of the processes of social emancipation, since this psychological crisis will deepen before our eyes.

*Vladimir Safatle He is a professor of philosophy at USP. Author, among other books, of Ways of transforming worlds: Lacan, politics and emancipation (Authentic) [https://amzn.to/3r7nhlo]

Originally published on the website Other words.

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