social pathologies

Image: Elyeser Szturm

By Matheus Capovilla Romanetto*

book review Social pathologies: archeologies of psychic suffering, organized by Vladimir Safatle; Nelson da Silva Junior and Christian Dunker.


There is a peculiar difficulty in reviewing a book written — as one of the organizers reminds us — by “more than 50 master's, doctoral and post-doctoral students”, in addition to the three professors who coordinated the research. If the work is taken immediately as a whole, in spite of the authors, we risk losing sight of the eventual contradictions and internal differences between the chapters, and even neglecting the uniqueness of the various intellectual and life projects that meet each other here. others.

On the other hand, if we are concerned with differentiating the authorship of each portion of the complete text, we do not see ourselves in a better situation: the very structure of the work induces a certain inequality between some chapters — written by a single researcher — and others, in which the handwriting of each student appears next to several colleagues, without us knowing whose text is in each part, nor the exact way in which the research, writing and revision took place.

Finally, there is a third difficulty: a book of these dimensions, which “summarizes and covers almost ten years of research”, having been prepared in “collective work” that lasted “three years”, certainly exceeds, at least in some points, the competencies of any specialty. Thus, in the variety of references, which gives this book one of its main qualities, the reviewer (or at least this reviewer) is faced with a double task: he must consider not only the content of what he has read, but also the way of producing knowledge implied in the very form of the work, without being able to claim a fully qualified apprehension, neither of one aspect nor of the other.

Because of all this, the text that follows refrains from discussing in detail the various stages of the argument, focusing instead on its more general premises and conclusions, as I was able to understand them. Now: the subtitle of the book promises to develop certain “archaeologies of psychic suffering”, based on the “detailed analysis of clinical categories mobilized to deal with social pathologies”, and also of “social categories constructed to describe modalities of social suffering”.

The conceptual apparatus

We are not dealing with “archeologies” in the style of Michel Foucault's first works — in which case the already impressive volume of sources consulted would need to be multiplied even more, and with a slightly different framework —, but with what we could call an exhibition of certain conceptual “lineages”, to whose writing the concern with the social process and history is presupposed — or juxtaposed — to an uneven extent throughout the book.

The effective permeability of the prose to the story varies according to the case and the chapter: sometimes we have a simple description of the meaning that was given to certain categories at a time, then at another, and at another; in other parts, the link between certain general forms of nosography and the social processes underlying their genesis is fully explained, but without specific attention to the meaning given to this or that term.

On other occasions, we jump to the singular event, whether in the presentation (or review) of the clinical case, or in the reflection on certain historical events. Eventually we find mixed cases between these general forms of the argument, without it being possible to say that “the conjunctural historical value of the object in its relation with other objects” (p. 236) — as one of the chapters promises — is clarified in the same terms in everywhere.

As, on the one hand, the discussion of the theoretical foundations of the research is more concentrated in some chapters than in others; and, on the other hand, the exposition method is not always consistent to the same degree with the premises of the research, the book is stronger as a whole than in the parts of which it is composed. The reader who keeps in mind the more general categories presented, above all, in the introduction, in the first chapter and in the epilogue, can complete the exposition of the chapters in a sense that the writing itself does not always guarantee. All these, however, are formal losses — and understandable, when writing involves such a large number of people.

From the content point of view, the repeated allusions to the central categories that organize the argument, as well as the common orientation of its conclusions, guarantee it a real coherence, certainly more than nominal: apart from some singular cases, the text is well -successful in presenting his “archaeologies” (or “lineages”) from a consistent clinical, sociological and political orientation.

From the point of view of clinical and social thought, social pathologies it represents the continuation of at least three major theoretical struggles: the conflict between organicist and psychodynamic conceptions of suffering; the struggle between totalizing and non-totalizing claims to knowledge; and also the conflict between two distinct ways of referring to social theory and norm, which we can discriminate, somewhat unsatisfactorily, as 'positive' and 'negative'.

Naturally, it is not true that these aspects always appear strictly apart from each other in the history of thought: in general, even the most rigidly organicist postures have to face the world of meaning, if only to reduce it to incomprehensible causes, and also those who claim the comprehensibility of psychic suffering face the task of giving a place to the organic element in their expositions.

The book itself is aware of this, and gives us good historical examples — for example, when recalling the initial relationship between psychoanalysis and psychiatry, different from the one that prevails today (cf. p. 264). The same goes for aspects of generalization and particularization, of “affirmation”, “denial” and “position” in the construction (logical, psychological, political) of the works, which can be combined, subordinated, repressed in different ways. assorted. We will see to what extent singular passages of the text contradict or form compromises between these denominations.

At the level of generality, however, the book's stance is explicit and unequivocal: it intends to exercise an “ontology of the negative” (cf. the ear), and it directs itself with a firm profession of psychodynamic faith against the latent organicism in the forms currently present. hegemonic, allegedly a-theoretical views of psychiatric knowledge.

As recurrent contemporary opponents in the various chapters, we have the Diagnostic and Statistical Manual of Mental Disorders (the DSM) — representative both of that latent organicism and of a “total psychopathology”, as opposed to the “non-whole psychopathology” (p. 317) that the book advocates —; social theories that authors consider to vulgarize the meaning of the studied categories, such as Christopher Lasch and Richard Sennett; and Axel Honneth, of whom it is not expressly stated that he takes the side of the “positive” against the “negative”, but that — by attaching himself to “individual models of self-realization” (p. 21) inseparably linked to certain “discipline processes” (p. 22), and therefore the corresponding forms of suffering — ends up arriving at a “rather deflated version of immanent criticism with low potential for structural transformation of social realities” (p. 24).

With what weapons, therefore, does the book intend to deploy its fight against these, and many other opponents? — Borrowing a constant image in the first chapter, we can say that the argument is structured in a “bicentric model” (p. 50), having as central nuclei the works of Jacques Lacan (especially from the categorical point of view) and Michel Foucault (mainly from the point of view of the claimed method).

No less important, in a certain way, are the thoughts of Theodor Adorno, Gilles Deleuze, Félix Guattari (especially philosophically) — and, as a kind of universal mediator, that of Sigmund Freud, common reference to all the names already mentioned. Without a negative dialectic like Adorno's, with his attention to the singular and the non-identical; without a concept of schizophrenia like Deleuze's, there would hardly be the stimulus and the spirit — the “reading perspective” (cf. ear) — that organizes the appropriation of other conceptual repertoires.

If one takes into account only the categories expressly necessary to produce meaning in the reading, however, it is Foucault's archaeological and genealogical procedures that structure — at least nominally — the process of investigation and exposition, and it is Lacan's teaching (accompanied by his interpretation of Freud) that provides the content against which other psychoanalyses, psychologies and psychiatry are preferably measured.

Em social pathologies, in any case, theoretical affiliation and loyalty matter less than the willingness to bring different theoretical perspectives into dialogue. Even more than the expressly professed method, what gives unity to the text is the conduct, the intention with which it is written. Here we have, condensed into a single aspect, one of the greatest merits of the work, as well as one of its deficiencies. The effort to confront a plurality of traditions is remarkable, and is done in a genuine spirit of openness and willingness to synthesis — indeed, successful, in my opinion, whenever it actually happens.

social pathologies nor is he willing to set aside contributions, even from those strands of thought most contrary to his own, without openly examining them. We see thoughtful analyzes from Freud, Lacan, Adorno, Horkheimer, Deleuze, but also from Heinz Kohut, Melanie Klein, Émile Durkheim, Carl Jung, Lasch, and a variety of contemporary names, ranging from Judith Butler to Mario Perniola, to Giorgio Agamben to Claude Lefort, and find at least moderately friendly reception in the middle of the text.

In a certain number of cases, however, the conclusions of the chapters do not absorb the consequences of their development. There is not always a full “critical” relationship with the historical movement of the examined categories — in the sense of an explicit remission of their limitations and potentialities to such and such conditions of origin, of a conscious appropriation or reformulation of their content. Especially when it comes to examining the unique cases and events to which the book refers, the tendency is to assume, without further ado, the theoretical and political party of the authors, without making explicit their relationship to the variety of different positions that were previously presented. .

Naturally, every work must start from certain assumptions; but, in a text that intends to refer the forms of clinical conceptualization to their social conditions, the price of this partial isolation between assumption and object is twofold: first, it protects the theories that support the argument from a reflexive extension of its method to itself, despite the formal recognition, in some more candid passages, that psychoanalysis is also part of the broader dispute between regimes of different diagnostic rationality (cf. p. 329); later, it ends up producing a push — certainly not realized at all, but present as a secondary tendency — to what we could call a “return of naturalism”, to the detriment of the naive realist naturalism against which the “dynamic nominalist” perspective (cf. p. . 12) of the book polemicizes.

The points at which this detachment takes place between theory and method, on the one hand, and object and form of exposition, on the other, also have consequences from the point of view of the uses of the book, both for the lay public and for specialists and scholars. . Readers familiar with psychoanalysis, psychiatry and social theory will find an interesting and rich source of material for the history of the categories covered by the text: anomie, narcissism, fetishism, schizophrenia, paranoia, hysteria. The chapters on these categories are accompanied by others, on ways of writing and conceiving the clinical case, on the body as a place of suffering, and on the constraints and corollaries (social and scientific) of the book.

Two complementary characteristics enrich the book from this point of view: first, the use of historically more distant psychiatric sources, of lesser circulation in Brazilian training, such as the works of Bleuler, Kretschmer, Pinel, Jaspers, Kraepelin and others (although not always from the original text). Then, the use of other contemporary research on the subjects dealt with — texts published, let's say, in the last 30 years —, not always known to the general public.

Taken together, these two qualities contribute to making a more complete picture of both the development of psychiatry and psychoanalysis, and also to indicate the alternatives that have been explored contemporaneously. Problems of method aside, the prose is generally lucid and—to the best of my knowledge—adequate to the notions discussed. In passages where the style recedes into a more obscure form, however, the difficulties in the relationship between presupposition and object of analysis become more sensitive. The text does not always guarantee a sufficient elucidation of the categories that it claims. Some prior knowledge, especially of Lacan, is desirable in most cases, and in some of them indispensable.

In the worst passages, the reader may have the impression that the unconscious is structured like language, but scientific writing is not always structured like language. On the whole, however, the purpose of clarification weighs more than problems of style, and the text serves - sometimes as a good introduction, sometimes as a good continuation of knowledge on the subjects it deals with. In addition to this use as a source in the history of clinical categories, the book also has an interesting philosophical and scientific arsenal to deal with, either the general conceptualization of the relationship between suffering and society, or its specific aspects — forms of nosography and symptomatology, forms of casuistry, modalities of suffering. That is to say: elements for a continuation of the research carried out so far are developed throughout the book, which not only intends to expose the results obtained up to the moment of its writing, but also to point out “the path to be followed for the consolidation of models of social criticism up to the challenges of the present” (p. 29).

Part of the problems I pointed out earlier can be mitigated if we read the book in this way, more as a starting point or as an intermediate station than as a definitive arrival point. In fact, the text only claims to “start” from the already known uses of clinical categories in social theory in order to “evaluate them, understand their strategies and their impacts” (p. 26).

If, in terms of method and theory, the task of relating what the exposition merely juxtaposes is shifted to the reader in some cases (theory against theory, clinical category against social process...), there is also a certain form of generosity in this, such that the exhibition prefers to preserve, as part of a broad repertoire, the instruments that it may be able to use again in the face of other objects and circumstances, instead of summarily discarding them.

For a book that values ​​the indeterminacy of human conduct so much, it will perhaps not be its demerit that it leaves its relation to the bodies of thought it studies indeterminate in a certain number of cases. The reader — especially when previously familiar with the major themes of the book — find in this a space and starting point to formulate their own impressions, and also a stimulus to continue accompanying, in the individual production of the authors of the volume, the particular fusions between the elements that are here analyzed and arranged side by side, but not yet gathered and synthesized.

The substance of the argument

Having considered the formal aspects of the book, let us now proceed to the substance of its argument. As a starting point, we have the idea that the real basis of social bonds is found, not so much in the norms (explicit or implicit) that society erects and seeks to inculcate in its members, but in the affections that it reproduces and puts into circulation. preferably (p. 8, 26-7). However, these affects refer to certain modes of interpretation of experience, themselves “normative”: they are mobilized from determined discourses, whose production is found in the intersection of a series of institutions (or fields), with their respective “modes of reproduction of life” (p. 11, 26, 236).

Summarizing the stages of this reasoning, we have the notion of modes of subjectivation — inspired by Foucault, but occasionally enriched by arguments from other matrices. They are language structures according to which the subject places himself as an object of certain knowledge and powers, and thus acquiring his character as a “subject” properly — that is, the peculiarities of his way of thinking and desiring. The subject's experience is then “organized” and “constituted” by certain categories and the respective games of truth (cf. p. 36, 44-6, 275), with their rules for validating and falsifying what one thinks and does.

What appears at the visible end of singulars, with their ways of acting and experiencing life — and even what is “invisible” to them (that is, unconscious) — leads, therefore, to a more abstract process of inducing these practices. and experiences, having in certain specific configurations of language one of its major instruments, and in institutions (or “fields”), its most visible objective support.

At some points in the text, subjectivation appears as a result of the intersection between desire, language and work (cf. p. 235-6). The dominant tendency in the book, however, is to leave “work” aside, devoting more detail to the relationship between the other two terms. It is clear that the review of some of the categories discussed throughout the work incorporates reflections by certain authors on the world of work, and even on exchange and the capitalist mode of production in broader terms. Especially when Marx is the subject of some chapters again, the book shows a greater permeability to his style of reasoning: categories such as “material reproduction of life” (p. 10) are not absent at all.

As, however, the central links that make the passage from “affects” and “experience” to “institutions” and practices continue to be “language structures”, the most natural inclination of the text is to present “dispositions of conduct” ( p. 26) as the fruit of the word, not the word as the fruit of conduct. This has the at least heuristic benefit of giving a more than purely descriptive meaning to the “lineages” of categories that the book outlines, while sparing authors (and readers) a lengthy ad infinitum dthe work of historical review.

On the other hand, the greater emphasis of the word in relation to the act, so to speak, makes way for the act to occasionally be forgotten, or understood only as an instance and actualization of the discourse. But the world of the act could represent, compared to the abstraction of language, the possibility of rediscovering the concrete richness of singular things and ongoing experience. It could at least serve as a reminder not to lose sight of this. Hence the tendency to keep “history” as an assumption that does not always color the prose, as well as some consequences for the central problematic of the book — the relationship between “determination” and subjective “indetermination” — which we will discuss later.

Thinking in those terms leads authors and authors to a very broad formulation, which allows framing the scientific and philosophical literature studied — and especially the categories thematized in the book — in terms of its “social function” (p. 56): if subjectivation happens in the subject's relation to certain discourses and respective forms of knowledge, with their rules for deciding what is true and what is false, then it is possible to refer the effect on the subject to great regimes of rationality (cf. p. 318) — and, particularly in the case of medical knowledge, certain social grammars of suffering, such that affections, expectations, experiences in general, are understood in this or that way, with this or that possibilities of legitimation (p. 9, 46).

Now: these rationality regimes will produce a series of categories — among which those that interest the book — that are imbued with the “cultural ideals” (p. 309), the “values” (p. 22) of a given society or institution .

But in social pathologies, “every normative assumption” is “necessarily producing suffering” (p. 8-9). Thus, the “collective work of language” (p. 37) with reality is far from being an indifferent process, but appears as an essential part of certain “disciplinary processes” (p. 9). There, the subject, exposing himself to the normative content encapsulated in the discourses, at the same time enters certain regimes of suffering (cf. p. 308) and finds the repertoire of categories from which he will weave the “narratives of suffering” ( p. 10) with which he tries to understand himself or name himself (cf. p. 45). This self-naming can even result in “social identities” guided by the “symptom” — which can serve processes of “identification”, but not of “recognition”, according to the book (p. 9, 45, 328, 333).

social pathologies demonstrates quite clearly how the “forms […] of naming suffering” presupposed to these narratives are “historical” forms (p. 342). Even where, according to the form, the text does not make explicit the connection of meaning between the transformation of clinical categories and the historical experience presupposed to them, knowledge of the symptomatologies and alternative nosographies studied by the authors already contributes a lot to inform the reader of the how susceptible to change are the forms of suffering - as well as the respective ways of understanding them.

The history of suffering appears, in short, as the history of responses (symbolic and experiential) that humans give to the circumstances they face in each era, culture, place (cf. p. 323).

The text also has a very sophisticated handling of the way in which these changes are combined, eventually, with continuities and co-pertinence between the various eras: it admits both the possibility of historical transversality (cf. p. 323) of clinical and social categories and that of its overthrow or essential transformation (cf. p. 35, 306, 338-9).

Another strength of the argument is its sensitivity to the differentiation between suffering in general and two of its specific modes of expression — “pathology”, or “suffering socially considered excessive” (p. 9), and “discomfort”. ”, or the suffering “that cannot be symbolized by a certain mode of existence” (p. 328), with its historical varieties of delimitation and mutual differentiation (cf. p. 328). This allows a more rigorous control of the literature studied and serves as a guarantee — at least a formal one — that the interpretation is not restricted to what this literature presents immediately, but always presupposes that, where a certain discourse brings together certain phenomena, it is possible to return to separate them; there, where one time points to normality, another can point to pathology. At the end of the argument, we extract the figure of societies as “systems that produce and manage pathologies” (p. 8).

“Producers of pathologies” — because the very existence of certain discourses that distinguish acceptable from “excessive” suffering is a moment of their existence and effective reproduction. From this point of view, no nosographic class can be understood in realistic terms, as a discovery of a natural species, but the very verifiability of this or that symptom in clinical practice has to be thought of — at least in part — as an effect of the knowledge that informs this clinic, with its pretension (tacit or explicit) of “reorientation of actions and conducts”, “modifications […] of the subjects” (p. 12, 43).

“Pathology managers” — because these discourses are linked to certain “practices with a transformative intention” (p. 321), of healing, treatment and intervention, whose hegemonic forms enter into that circuit of disciplinary processes to reinforce the subject's dependence on certain institutions — certain ways of living and being in life, yeah. Hence the ultimate conclusion: the “pathologies” are all necessarily “social”: they represent “modes of social participation” (p. 10, 12) induced and effected in the subject from the respective discourses.

This is the premise from which the title of the work derives: the “pathologies do social” are understood — at the suggestion of the text itself —, sometimes as pathologies arising from excessive socialization (assuming the process of subjectivation according to the rules that we summarized above), sometimes as pathologies from the social—that is, as a result of “unrecognized contradictions in social bonds” (p. 324).

This second formulation points to some of the conceptions of “criticism” that the book rejects, such as Honneth's; but it would also be possible to read it as a return, a little weakened, of that dimension in which practice does not (only) appear as an effect of discourse, but also as constitutive of it, and which the “archaeological” procedure tends to omit.

The text is not always firmly aware of its own premises. The more or less indifferent use of the expressions "social pathology" and "pathology of the social" (eg, p. 185) serves as a subtle symptom of this theoretical vacillation.

If, in general, the text fights against the idea that it would be possible to speak of a “pathological society” (p. 327) or one that is sick, in the manner of the old functionalist analogies between social body and organism, the idea that a determinate "form of life" - that is, by reference to what we have been discussing: a It is made, among other things, of language structures — has, in itself, a “pathological character” (p. 282).

the modern individuality

We will see that, above all, “modern individuality” is accused several times of having a “pathological nature” (p. 26). Now: resorting to this type of denomination does not have the intended “critical” effect if the vocabulary of normal and pathological does not recover, at least in part, a little bit of “realistic” pretense. As a more visible expression of this, we will have, especially in two points of the discussion, not the conviction that all “pathology” — being an effect and object of certain knowledge, etc. — is, in itself, as a knowable and recognizable entity, “social”, but the doubt about the framework that should be given to this or that clinical categories.

“[Is] fetishism a social pathology?” (or “of the social”?) (p. 185, 229), asks one of the chapters. “[Is] narcissism a valid category to think about social pathologies?” (p. 180), asks another. If schizophrenia is “one of the social pathologies” (p. 235), isn't there a “group of social pathologies” (p. 142), as opposed to others, of perhaps “non-social” pathologies?

Formulations like these partially weaken the radicalism with which that “dynamic nominalism” wanted to strip the modes of suffering of all natural features. In fact, the text is, in general, very successful in extracting from nature (that is, from the organism considered in isolation) the essential determination of the forms of suffering that it addresses. But he does so at the occasional cost of having to lend back the “normative” weight of “pathology” conceived in naturalistic terms, whenever his predilection for one “form of life” among others appears.

Regardless of how the questions I transcribed above are interpreted — with an emphasis on the problem of knowing whether “they are pathologies or not”, whether they are “social or non-social” pathologies — they fall, according to the form and spirit, in the same type of problem that the book perhaps blames on its opponents in psychiatry: the tendency to get involved in problems of classification, of contrast between certain formal criteria and the actually observed case.

By free confession, one of the chapters I alluded to ends precisely by rediscovering the notion that, in order to affirm positively whether or not such a phenomenon would be a “pathology of the social”, it would be necessary to account for the “difficulties regarding the very criteria that would define a pathology” (p. 230) — difficulties that, in another passage, the work recognizes as inevitable for any diagnosis (cf. epilogue), but which are certainly uncomfortable (although not insurmountable) for a text that has, in its distrust of “normative criteria” ” (p. 230) in general, one of his vital organs.

This same contradiction is expressed a little differently when, in some passages, the text falls back on topos arguments that he himself treats — if not with outright rejection, at least with hesitation and reticence. One of the most suggestive passages in the book deals with what would be four theoretical synthesis strategies between subjective and social aspects — functional analogy, normalization, anchoring and unity (cf. p. 160-3).

If, of the “functional analogy” between society and the individual, it is said that it is not problematic per se, but which requires very special care (since formal similarity does not necessarily mean consubstantiality — cf. p. 161), it did not take us long to find in the same chapter — as well as in other points — an explanation of the ideology in the years of the Brazilian military dictatorship in which “society acts as if it should exclude […] any and all forms of threat” (p. 176), by comparison (hardly differentiable from a simple “analogy”) with the identityist procedure of individual paranoia.

If small deviations like these do not set the general tone of the text — much less invalidate or render useless the discussion they circumscribe —, we cannot help wondering why they even appear in the final essay. Perhaps in part this is due to the immense number of hands that were put to work to write the book, which naturally makes an absolute conciliation of all the parts that were written difficult. I feel inclined, however, to see in this more than a consequence of the way the text was produced, thinking that this should also express a difficulty inherent to the theoretical framework that the book privileges.

If, in fact, by your free admission, every clinical category (or one that intends to describe social suffering) — and, above all, a category such as the “pathological” — contains determined value judgments, pointing to the corresponding forms of life, so here, too, the insistence on a category such as “pathology of the social” — even considering all its transmutations in relation to previous meanings of the term — needs to raise the flag of at least one type of experience, at least one “form of life” against existing ones.

And it has to value the aspects of this anticipated form of life, even though it does not intend to describe itself exhaustively, nor to “prescribe” itself to anyone, nor to delineate itself except by “denial” of what, in the here and now, gives the conditions of suffering already known. But “value” and discipline, “ideal” and imperative, are not easily distinguished in the text.

social pathologies tends to experience all affirmative expressions of “norms” — or at least a certain set of them — as a risk of relapse into submission, conformism, deceit: the text expressly wants to escape treatment guided by “normative ideals” (p. 77). In fact, these are all real risks whenever we are talking about “ideals”. But then we don't have space to clearly distinguish the "ideal" itself, with its prescriptive, imposing behavior, from the "ideal" as an expression and anticipation of what - to speak a vocabulary close to that of the book itself - would perhaps be closer to the desire .

A critical theory can do without the first meaning, perhaps, but it cannot do without the second, if it does not want to fall back into a purely abstract determination of what it means to “deny” the present — by way of simple “refusal” (p. 287). , or by the “impulse” to “subtract oneself” from the “current modes of determination” (cf. p. 25) of subjectivity and experience. That this refusal or this impulse exists, can happen in the simple attempt to deny the present suffering; but that they are directed towards something more specific and actually constitute a “raised challenge” (p. 25) against the conditions that originate suffering, taking on the character of a “determined” negation, demands something more.

As the difficulty persists in differentiating, in the “ideal”, what is the result of desire and what is the result of discipline, social pathologies it must avoid discussing the form of experience (or anticipation of possible experience) that serves as the basis for its opposition to today's dominant ways of life.

We will see that this does not happen at all, and we have good indications of what the book, so to speak, would like to be able to live. But it is a sufficiently extensive “repression” for those mismatches to occur between the assumptions of the book — the distrust of values, the fight against nosographic realism — and its concrete procedure, which ends up reincorporating — if not the values ​​as such, at least one effect of valuation, or its theoretical mode of expression: the “classificatory […] concepts”, which in a certain part the text wants to differentiate from its preferred “psychodynamic concepts” (p. 294-5). This leads us to the two main groups of arguments that remain to be considered: the relationship between organicism and psychodynamics, and the relationship between affirmation and denial in criticism.

Against the prevailing trend in psychiatry

The authors extract from the conceptual apparatus that we have exposed a very firm basis to face the current dominant trend in psychiatry, based on organicism, whose best-known literary representation is found in the aforementioned DSM. If there are certain “rational regimes”, with determined effects on the subject; if the discourses pertinent to these regimes participate in the ways of narrating suffering and self-naming — then it is because there is something like a series of diagnostic rationales (cf. p. 318), capable of identifying, naming, legitimizing and delegitimizing, recognizing and sanction certain sufferings and pathologies — and, with them, certain forms of life (cf. p. 36, 40, 235, 320, 328).

Two vital organs of any diagnosis are the clinical type and the clinical case, as well as a semiology that allows identifying and understanding the symptom. But the text clearly notes that, in a certain “welfare industry” (p. 41) consolidated in recent decades, the emphasis falls less and less on the clinical case — that is, on the narrative of a singular suffering, entangled with the social life—and increasingly on the clinical type, which by its very nature configures a generalization from what (of course) was a series of observed cases (cf. p. 307, 319, 335).

The suppression of casuistry corresponds to a broader tendency, also correctly evaluated by the book, of seeking to arrive at a form of nosographic knowledge that is totalizing, exhaustive and atheoretical — that is, that gives up understanding, or even finding the causes of pathologies, to refer them to the procedure that, in another passage, the book describes as statistical “normalization”. Without the reference to singularity, what is so dear to the authors also disappears, and which we wanted to value more above: the understanding that suffering — and particularly “pathological” suffering — is also a historical phenomenon, socially conditioned (cf. p. 318-9).

Criticism of this model is very welcome, especially due to a phenomenon that the text is also very aware of: if medical knowledge unfolds in a series of discourses that access the subject and start to participate in his ways of acting and thinking, then it is understandable that the ahistorical type of psychiatric discourse has also become widespread among the “lay” public, who come to understand themselves and act from the psychiatric diagnosis.

The book presents a number of clinical cases that bring this form of narrative to the psychoanalyst's ears; but the reader will have no difficulty in coming into contact with similar occurrences in everyday life and will thus be able to convince themselves that raising resistance and critical awareness against the naive naturalization of suffering is an important social task today.

This is one of the other reasons that make the work relevant for non-specialized audiences as well: as it draws attention to the element of disclaiming responsibility (cf. p. 45) for the suffering that certain diagnoses imply, since it suppresses the connection of meaning between the symptom, suffering and its causes — that is, it suppresses the properly subjective relationship with suffering and, with it, also the “enunciative potentiality” on which psychoanalysis would like to base itself to treat its analysands (p. 43, 45) .

Equally welcome is the proposal that closes the book, of a “not-whole psychopathology” (p. 222), as opposed to the “psychopathology of totality”, which has one of its cases in the DSM. In reality, what is at stake is not necessarily the intention of conceiving a manual like this in “final”, “total” terms: the classificatory procedure can be interpreted as infinite and susceptible to empirical “correction”.

But there is in fact a logically fundamental difference between what a text like the DSM proposes and the type of diagnosis that it proposes. social pathologies defend. If the interest is in recovering the possibility of accessing the singular case and suffering as singular, there cannot be a categorical structure that simply reduces the case (or even certain syndromes) to particularizations, specifications, of a more general framework; who treats the general as hierarchically superior to the particular and the singular, because.

The text is also careful to identify the possibility that this tendency infiltrates the very clinical management of Lacanian psychoanalysis — in the hierarchy that leads from the great clinical structures to clinical types, then to certain subtypes, and even to symptoms (cf. p. 333 ). The main effort of the text, at this point, is to extract, above all from the inheritance of Lacan's last teaching, alternatives that — without proposing themselves as excluding the properly “structural” clinic — are capable of approaching a model more receptive to the singularity and that they weaken the trend pointed out by some critics to both “neurotic-centrism” and “androcentrism” (p. 334, 342) in diagnosis. The aim is thus to achieve a model that includes neuroses, psychoses and perversions indifferently, and measures in an identical way the distinct economies of jouissance that we face in the clinic and in everyday life.

This effort to shift the logical form of diagnosis — from an emphasis on the general to an emphasis on the singular — is accompanied by a second proposal, now more directly linked to the use of clinical categories in work with social theory. The text wants to avoid what it recognizes, according to a very witty expression, as a “critique of small claims courts” (p. 321), limited to contrasting the empirical case with a norm (explicit or implicit) and drawing hence the accusation that, after all, things are not as they should be.

There is something consubstantial between the naive “totalizing” procedure, which confronts the observed case with a series of pre-set criteria, to see if one thing corresponds to the other, and the naive “normative” procedure, which discovers each time that things do not. correspond to its criteria, to then “demand” its “realization” (p. 321). The only difference is that the sign is reversed from one case to another: the psychiatrist measures what, from his point of view, should not be, while the critical theorist points to what, in his judgment, should be.

In this sense, the gesture of distrust towards one of the models is the same that leads to criticism of the other and gathers in the same complex of determinations, which we have already identified under the figure of “negativity”.

social pathologies he thinks that there is a “negativity inherent in every subject” (p. 95), which carries within itself a certain constitutive lack, and was itself “constituted” in its relationship with the indeterminate. Therein lies the supposed subjective basis for what the theory should express in a series of particular behaviors.

In the first place, assuming that the effective social cement is not in fact the “norms”, but the circuits of affections — then it is to them that the criticism should be directed, and not to the ideals and their fulfillment (p. 8 ). Suffering should be seen as evidence of the effects of the social order on the psychic economy, as a starting point for analyzing the real forces of social ties, and not as a mark of a deficit in relation to imagined ideals (p. 26, 95).

It should be understood that “political utopias and totalizing visions of the world” have “deleterious effects on human life” (p. 51), thus avoiding any properly prescriptive discussion, which could fall into a “moralization” ( p. 226) and thus deterring the denial movement from its most genuine impulse.

This conception unfolds in what is perhaps the most interesting contribution of the book: its presentation (and taking sides) in relation to what would be a “bifid” metadiagnosis (p. 236) of modernity, which recognizes, as a source of suffering, two distinct forms of “loss of experience” (p. 329): on the one hand, the excess of unproductive experiences of determination and, on the other hand, the deficit of productive experiences of indetermination.

That is: if some strands of interpretation and criticism of modernity recognized as a source of suffering what would be a kind of saturation of social determinations, others thought that the possibility of experiencing indetermination, lack of self-knowledge, was lacking. These two formulations appear in contrast to another classification, also “bifid”, but now “non-complementary” (p. 236): the simplest difference between suffering from determination and suffering from indeterminacy, without taking into account the determinations of “productivity or unproductiveness”, “exaggeration or deficiency”.

social pathologies usually gives preference to the first conception: that what causes suffering is not that we cannot “determine ourselves”, moving towards certain ideals of individuality and self-realization (cf. p. 209), but, on the contrary, that we suffer precisely because we were too determined at the outset, without the possibility of a variation or differentiation that competes with the type of egoic synthesis characteristic of our time.

Any attempt to continue in this direction — represented by values ​​such as autonomy, reflective unity and authenticity (cf. p. 96) — would only serve to reproduce what is supposed to egoic individuation and, with it, also the sufferings that it entails ( see p. 19).

With that, those (general) ideals would be doomed to failure (cf. p. 279), and in their place it would be necessary to seek a way of thinking and acting that recognized “multiple individual models of self-realization” (p. 21) — singular, therefore — and that determined the normal and the pathological by reference to the “experience” of each person, which would then have “normative” value for its own subject, and only for him (p. 78).

Now, it is “a-normativity” and “indetermination” that have to become “indices of the human” (p. 95): of which the text gives its own “indication” whenever it shows love and interest in the mimicry of the human. inorganic, due to the fetishist relationship with things, and also in other analogous points, which radically distance it from what appears in some passages as “humanism” (eg, p. 20).

But the book does not in fact leave its notion of “indeterminacy” totally undetermined, nor does this “normless” activity that inspires its devotion. His main interest, compared to Honneth's “minor claims court”, would be in “releasing the experience of life in his unsubmissive figure” (p. 25). And what figure is this then? — We have a preliminary image of it in the “prepersonal dynamics of life” (p. 28) — above all in categories, such as that of partial drives, insubordinate to the Ego, which point to another form of economy of pleasures (cf. p. 95 , 227).

To be indeterminate is not, therefore, here, in fact, just to “subtract oneself” from determination, to fall back into an unknown quantity or emptying, as indicated by a passage we have already quoted, but to enter into another mode of determining the act — a mode that it is experienced, from the point of view of the I still in force, as a confrontation (or transitory unit) with a fragment: something partial, non-identity, but still in reference to identity.

It is not only nominally that the “partial” drives are opposed to something “total” (or non-partial): the validity of this totality — which Freudian-inspired psychoanalysis recognizes above all in the Ego — is the effective presupposition that they are experienced as partial.

The “force of indetermination of the drive” (p. 23) appears as indeterminant in relation to this known mode of organization, but not as indeterminacy (or as indeterminate) “in itself”, so to speak. In the same way, the I appears as "determined" from the point of view of its relative stability and unity, when compared with the mobility of energy arrangements in the unconscious; but he himself is (even for Freud, and even for Freud as represented in some of the chapters of the book) subject to a process of his own, which does not consider him finished, “determined”, all at once.

Furthermore, it can represent a force of “indeterminacy” for the drive: for example, in repression itself, when it subtracts from it the possibility of developing itself in a concrete act, and thereby takes away the instrument it would have to enrich itself. from contact with real objects, and even with language. (The richness of the human, reminds us of the german ideology of Marx and Engels, is the richness of their relationships, especially those that actually develop.)

What I am trying to draw attention to is the following: deep down, “determination” and “indetermination” do not appear in the text as simple markers of what has a definite or undefined quality, more specific or more general, more differentiated or more confused. . They are truly the terms that carry a specific experience of life — or even a reaction to it, to speak like the book itself — and, with that, they are beyond the purely logical “determination” with which the formality of terms seems to invest. them.

Se social pathologies rightly points out that “immanent criticism” cannot be attached to the “current forms of life” (p. 25) — and, therefore, that the “norms” currently in force or recognizable do not constitute a sufficient basis for the criticism: then it also has to recognize that the current forms of desire can only serve as a starting point, a preliminary anticipation of what would be its effective unfolding in modified social conditions.

Basically, it is only a matter of taking radically seriously an expression found in the work itself: whether a different “experience” of “libidinal organization” is “possible” (p. 227); that is to say: if the “libidinal organization” is, not only as a conjectural category, properly underlying the I, but also as something that one can experience (whether in itself or in its reflections) — then we cannot restrict this experience to what would be perhaps its first figure, the occasional perforation of the ego by what was previously repressed, or even the partial suspension of resistance.

If we become too attached to this figure, we will certainly escape a court of minor causes, but we run the risk of entering into a legislation of minor resistance, which always presupposes the strength and validity of what we would like to transform. So long as we feel the weariness of being as we are, and so long as we apprehend what we are by reference to what we have to give up in favor of the 'norm' - then the aspiration to reach a new form of subjectivity must really appear as an immediate process. (albeit arduous) of “dissolving norms” (p. 287).

It would not be unreasonable to recall, in this regard, the judgment that Lacan himself makes, in the seventh book of the Seminar, about the experience of debauchery: because of her passionate profanation, she ends up finding God again in the end. Denying the I as a form of subjective synthesis without worrying about developing (in concept, yes, but above all in experience) what other type of determination we imagine finding in the subsequent process does not weaken criticism any more than the abstract contrast between ideal and reality. There is no need to want to predict or prescribe anything for this to be a living task for us: it is not embodied in the figure of a despotic brain, but in the figure of an experimenting body with the points where — despite everything — flexibility still exists. and alterity possible in each one's routine.

For this to be accompanied by a corresponding theoretical reflection, however, it would be advisable to take the implicit dialectic further to the terms that the book already brilliantly recognizes: in what, openly or tacitly, the work identifies the element of “determination”, there is also indeterminacy; in what represents “indetermination”, there is also determination, or at least the intention of determining oneself. If — to do justice to a formulation of the text itself — experience has its internal dialectic (cf. p. 226), also the experience of the unfolding of desire towards the real has to inform the horizon of our possibilities. Fixing it in the type of fragmentation and partial otherness implied in the most passionate passages of the text is to fix it, not exactly as a “negative”, but as a denied by the "positive". Regaining its strength as properly “negative” would require us to also recognize in it what is affirmative in itself.

The work itself does not fail to recognize this in one of its most candid passages: “it is a fundamental task to define with greater precision which types of experience of indeterminacy are the ones we designate as healthy or positive” (p. 287).

Clarifying this issue would help, not only to avoid the minor logical lapses that we discussed earlier, but, above all, it would guide researchers, male and female readers to a properly experimental conduct with the “forms of life” that we assume — certainly, a task of the most relevant to the political moment in which we live.

* Matheus Capovilla Romanetto is a master's student in sociology at USP


SAFATLE, Vladimir; SILVA JUNIOR, Nelson da; DUNKER, Christian (eds.). Social pathologies: archeologies of psychic suffering. São Paulo: Autêntica Editora, 2019 (

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