Of unhoused minds and the ‘personality disorder’ fallacy

“So Koestler condemned himself to homelessness. All that remained were the ideas he dragged around with him like Job…Home finally was mind; home was homelessness; Koestler was the homeless mind.” David Cesarani, Arthur Koestler: The Homeless Mind (1998)

“The sufferer who frustrates a keen therapist by failing to improve is always in danger of meeting primitive human behaviour disguised as treatment” (Tom Main, 1957, ‘The Ailment’)

Recently, Barrelman gave a talk at the launch party of a book, in which he and a fellow Cynic have a chapter published. The book’s called Psychoanalytic Thinking on the Unhoused Mind. It’s put together by another comrade of ours – and a very fine volume it is too (this is the weblink if you’re interested).

Now, I get why the various chapters were collected under the rubric of ‘psychoanalytic’ and when I myself started off down this trail I admit that I hadn’t yet quite got over a lingering infection of Kleinitis that very briefly even threatened to develop into the rabid form of that ailment… However, as that other wandering Cynic once sang, ‘I’m younger than that now’ – and I find myself altogether more in the ‘psychosocial activism’ line these days.

Coming back to the main current of the whole ‘homelessness and ‘unhoused minds” project got me thinking about Cesarani’s famous rhetorical ending to his biography of Arthur Koestler – and also about another great twentieth century Central European Jewish author in the high literary tradition… Franz Kafka’s The Castle, as many of you may know, tells the story of K, whose profession ironically is that of land surveyor. K gets himself a gig in the eponymous castle – but no-one seems to know anything about it and he can never find the tradesmen’s entrance, nor can he find acceptance in the nearby village; and yet neither can he cannot go home.

As the following excerpt begins, K has been lying in wait, in the snow, in the yard outside the village Inn, to accost a fellow named Klamm: suspected to be a Castle official who could unravel K’s Gordian knot of longing, bewilderment and annihilation. K’s plan is derailed by a shaming encounter with a mysterious young gentleman (and accompanying flunkey) who orders him to move along and advises K that whether he waits or leaves, he will miss Klamm just the same…

“Then I’d rather miss him waiting’, K. said defiantly… K saw himself being left behind alone…both of them going very slowly, though, as if wishing to show K that it was still in his power to fetch them back.

Maybe he had that power, but it could have done him no good; fetching the sledge back meant banishing himself. So he stayed where he was, the only one standing his ground, but it was a victory that brought no joy…it seemed to K then as if all contact with him had been severed and he was now freer than ever before, no question about it, and might wait in this otherwise forbidden place for as long as he liked and had fought for and won this freedom as few others could have done and none might touch or banish him, barely even address him, but – this conviction was at least equally strong – as if at the same time there was nothing more futile, nothing more desperate than this freedom, this waiting, this invulnerability.”

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My ancient ancestor, that homeless, wandering, Cynical-with-a-capital-‘C’, manic street preacher of ancient times, Diogenes the Dog, was once found, (down on his dodgy knees) begging before a statue. The townspeople asked him what he was up to (for this is their more or less bemused role in all such stories: they are the Chorus). ‘Oi! Diogenes!’ they cried. ‘What on earth are you doing down there? You’re not going to get very far with that statue, now, are you?’ Diogenes replied: ‘Can’t you see? I’m practising disappointment’.

Now, for K, permanently displaced and snowbound, outwith the Castle walls, disappointment in the ordinary sense is a practice in which he will become very well versed. He can’t come in from the cold, in any direction. The more hopefully he travels, the more disappointedly he doesn’t arrive. But what I especially appreciate about the story is the hint of possession and constancy about K as he makes his stand and stakes out his resistance. It’s the only place he can stand – and in a moment of autonomy and self-possession, he comes to a realisation about this, however fleetingly. He could be understood as refusing the ride he is ambiguously and ambivalently offered by the mysterious stranger…the stranger certainly experiences him as having chosen not to take up the offer…but it now seems to me that, for K, it’s not a question of refusal. It’s more that the ride just does not compute. It’s a wagon he can’t imagine jumping onto.

When we started riffing off of the story of Diogenes and Alexander, we constructed Diogenes as refusing Alexander’s offer of accommodation, in an expression of what Zizek called Bartlebian politics – ‘I prefer not to’. According to this way of seeing things, K is saying: ‘I prefer not to catch a ride on any sledge commanded by you, Mister’. He ‘prefers not to’ cede any power or to banish himself – or to draw upon the example of Antigone, whose position in relation to Creon, the tyrant of Thebes, is very similar: ‘I decline to recognise your secular, public authority in any domain that pertains to my private and personal values and allegiances…’.

I celebrate anyone who can take and articulate such a stand but I now think that this reading is not quite right – that K’s resistance is more important than his refusal. I think where K takes his stand and stands his ground (K and Diogenes and Antigone and Bartleby and, say, Greta Thunberg) is in the only place he can stand. He resists the force that would drag him away from his moment of autonomy into what would in essence be someone else’s idea of how his narrative should read. The ‘Bartlebian’ moment is then the realisation of this – not the practice itself, but the reflexive consciousness of the power of the practice. Nobody can twist his arm into banishing himself.

The idea of ‘refusal’ remains significant – but its significance lies in the experience of the offerer, when he feels that the offer of accommodation is refused. It feels like refusal to the offerer, when his offer is not accepted. But the object of the offer may or may not have refused it. We know only this much: that the offer has not been taken up – at least, not on the terms in which it was made. The object of the offer isn’t ‘failing to improve’: it’s more like they’re resisting ‘improvement’.

One of the things that got me thinking about this was being part of a treatment team, being party to an offer that was constructed as having been refused. This was on an inpatient ward where the ‘objects’ of the offer were malnourished or starving people (mis?)constructed as or (mis?)understood to be suffering from ‘eating disorders’.

An entry would go on the progress notes: ‘food was refused’. Such was certainly the experience of the offerer – the nursing staff, for example, who have walked down the corridor with a tray in their hands and set it down beside the ‘patient’ – and then found themselves walking back down the corridor again, still carrying on their tray the untouched plates of food.

But I began to understand – and in fact, the ‘patients’ very patiently took my education in hand, in this regard – I began to understand that sometimes the sufferer, out of sheer terror, or bewildered and bewildering and circular rumination, hadn’t been able to come to a decision. The offer just did not compute. Like K in the snow, they had been able neither to move towards the offer or away from it. They had simply stood the only ground they knew how to stand upon in that moment. The offer – the offerer, even – had been resisted. It had not necessarily been refused.

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I think it does also behove us to resist. By ‘us’ I generally mean everyone, when it comes to pernicious discourses of any kind, but I particularly mean, for present purposes, those of ‘us’ who do the offering in such settings (or the writing about the offering). It may be, that as our practice develops, we may risk losing our compass – fluidity is our friend and rigidity our enemy, but fluidity is not the same as going with the flow.

For my part, as I get older (and older – or, remembering Bob Dylan again, do I mean younger?), I realise there’s stuff going round that I just can’t be doing with any longer. I don’t think that I mean this in self-deluded ‘heroic’ identification with some Wilsonian constructed outsider; but rather because it simply won’t wash and I decline to be aligned with it any longer. The lies and venality of our political classes, to give a pressing example: but the list is long, and I’m not here to have a rant. However, the one I particularly wanted to end by mentioning, by way of publicly correcting the record, is the deployment and weaponisation, within the system of care, of the contested diagnosis – the fallacious concept – of ‘personality disorder’.

Now the record needs correcting, because although those early papers were written in ‘critical’ mode, nonetheless, I’m sorry to say, the reader would possibly have come away imagining that there really was such a thing as ‘personality disorder’ and that all it needed was a spot of reframing. But it needs to be said very clearly that it just will no longer do to be telling people that the problem with ‘them’ is that ‘their’ personality is ‘disordered’, and that the remedy for this is a little more of that much-evoked and apocryphally ‘containing’ secular deity, Laura Norder. There is, in particular, and by logical extension, no such thing – no such illness entity – as ‘borderline personality disorder’. Note carefully that it therefore can’t be meaningfully researched, such as to test possible treatments for said non-existent ailment.

This is a blog and not a book (note to self: must write a book some time!) and so I can’t give you the whole lowdown as to why in the not so distant future the whole concept of personality disorder will only be found lurking in dusty box files in mildewed archives tagged ‘pseudo-scientific colonialist claptrap of the Industrial Age’. But a little history goes a very long way…

So next time someone uses the term ‘personality disorder’ about someone else, recall, if you will, Prichard’s 1835 definition of ‘moral insanity’, in which a diagnostic entity is inferred from a judgement on presenting behaviour and ‘the individual is found to be incapable…of conducting himself with decency and propriety in the business of life’ (this was before the present Conservative government was even a twinkle in the eye); and recollect that the formulation of ‘moral insanity’ was the medical ticket into expert witness status in the criminal justice system as psychiatry emerged as a distinct profession at the beginning of the nineteenth century (here I am greatly indebted to another fellow psychosocialist, David Jones, for illuminating some of this in his own comprehensive history of the development and deployment of the term…).. Remember the 1938 pronouncement of the psychoanalyst Adoph Stern that ‘it is well known that a large group of patients fit frankly neither into the psychotic nor into the psychoneurotic group, and that this border line group of patients is extremely difficult to handle effectively by any psychotherapeutic method’ – for this is the moment when the term ‘borderline’ came into the frame.

Fast forward then to 1980, amidst the tsunami surge of the neoliberal turn, when suddenly there was no such thing as society, the jobless we created were either ‘feckless’ or ‘on their bikes’ and only ‘hard-working families’ were beneficiaries of government policy: and the American Psychiatric Association published DSM-III with the caveat and proviso that its system was so imprecise that it should never be used for forensic or insurance purposes (and then fast forward to the sales figures for DSM-III, which very quickly persuaded those august gentleman of the APA that there might be mileage in more classifications and more disorders).

Pinch yourself on the cheek, therefore, next time you hear the term ‘borderline personality disorder’ and remember that it’s not yet forty years old and has been more or less discredited for at least half the duration of its (non-)existence. Remember Main’s warning about the risk of ‘primitive human behaviour’ being disguised as treatment. And ask yourself if this might not be a Bartlebian moment after all.

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I’ve stopped going along with the whole ‘there is such a thing’ discourse (as far as I can: I’m sure I can still be called out on this) and I’ve started actively resisting it. It’s kind of a liberating feeling (and I sincerely hope that it’s not only me that gets liberated, of course). You know how the way to negotiate the perilous web of a supermarket is consciously blinking, so that you don’t get stoned on the sounds, scents and settings spun by the marketing spiders as they pre-plot your purchases for you? It’s the same with all that stuff about borderline personality disorder. Once you start to resist, you’ll start to wonder how you ever got taken in. If there’s a single discursive practice we can pick out and say, well, no offence to Diogenes, but that old Dog has surely had its day, it’s what Edward Said in Orientalism called ‘othering’: by which he meant ‘disregarding, essentialising, denuding the humanity of another culture, people or geographical region’.

To which I would add the prefix: ‘toxic’.

Toxic othering: there’s much too much of it about. It’s like air pollution: you get so used to it, you don’t even know you’re dying. The only remedy is a zero emissions policy. When it comes to the homeless, the displaced, the dispossessed, let this new book, and maybe in some small way also this blog, be some part of the process, not so much of psychoanalytic reformulation, but of a psychosocietal process of resistance and realisation – I hope that a range of emergent practices may coalesce and cohere and crystallise (but not solidify) around it, as did K’s awareness in the snow – let’s all, indeed and after all, prefer not to go along with it a moment longer.

“Hit the ground!” On the (im)possibility of exhaustion

 “In German, Erlebnis … can also refer to an intense disruptive episode, one that makes an indelible impression, changing a life course, the kind of experience not so much integrated into a life but which relegates the old life to the past and inaugurates a new sensibility…”

(From Defiant Earth, Clive Hamilton, 2017 p. ix)

“The problem is that the problem is us.”

(From Learning to Die in the Anthropocene, Roy Scranton, 2015 p. 68)

“…this other Great War about which we are learning, stunned, that it has already taken place – and that we have probably lost it…”

(From Facing Gaia: Eight Lectures on the New Climatic Regime, Bruno Latour, 2017 p. 10)

 

On the evening of Friday January 18th a massive fireball killed scores of people as they sought to fill makeshift containers from a leaking oil pipeline in Tlahuelilpan, in the state of Hidalgo in Mexico. Incinerated corpses littered the fields around the place where the leak was being exploited. On the webpage of the news article (Guardian 19/1/19) you can watch video footage from earlier in the afternoon as people gather eagerly and purposefully around the fuel fountain, covered in petrol as they jostle for position to fill their containers. The news article goes on to report that “screams could be heard later as a fireball shot into the sky. ‘Hit the ground,’ one person yelled at those fleeing.”

Such pipelines are notoriously and dangerously vulnerable to leakage but in parts of Mexico there is also an established practice of intentionally rupturing pipelines in order to steal the fuel – those who lead such practices are known as huachicoleros. President Andrés Manuel López Obrador leads a governmental initiative to eliminate fuel theft, deploying the army to guard Petróleos Mexicanos (Pemex, the State-owned oil company) installations and to lead the fight against the gangs that have developed to exploit the availability of stolen fuel. Pemex reported 42 ruptures of pipelines daily through 2018.

It is perhaps quite tricky to ascertain whose goods have been stolen; who here is the ‘joker’, or who the ‘thief’. Does the oil belong to the Earth; to Gaia? To humankind? To the Mexican Government? To Pemex? To the Mexican people? Is the thief in the story the impoverished peasant risking his life to fill his jerrycan? The gang member profiting from the trade in fuel? The oil company executive (and/or shareholder) profiting from the trade in fuel? The government guarding its supply lines in order to ensure its own income streams? Or perhaps your correspondent, the horrified petrol consumer across the Atlantic Ocean, reading the news on his multi-plastic laptop in his centrally heated but indifferently insulated London flat…?

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On January 29th (to arrive at my second story) it was announced that a consortium of carbon speculators (Total (French), Edison (Italian) and CNOOC (Chinese)) had identified a new gas field under the North Sea with potential for the extraction of the energy equivalent of 250 million barrels of oil (both these stories, by the way, prompted me to ponder the potential bathos inherent in writing this blog under the name ‘Barrelman’). The Glengorm field is the eleventh largest find in the UK in the last thirty years. The article reports that the gas is in a reservoir with high pressure and high temperatures, meaning it will be more costly to produce than other gasfields (this rather glibly glosses the escalating ecological costs of extraction in hard to access fields).

A spokesperson for Total Oil said the find was evidence of the company’s “capacity to create value in a mature environment” (make pretty much whatever you will, of the use of the words ‘value’ and ‘mature’ in this phrase). Then a Mr Andy Samuel, the chief executive of the UK’s statutory regulator, the Oil and Gas Authority (OGA), said that this was “very exciting news” and added that since the UK continental shelf is still estimated to hold a further 10bn-20bn barrels of oil and gas, there is therefore “every chance of yet more significant finds”.

You can check out the OGA here: https://www.ogauthority.co.uk/. You may even wish to drop them a line…You will find that the statutory task of the OGA is “to regulate, influence and promote the UK oil and gas industry … The development of a series of strategies represents a key step in setting the strategic direction of how the OGA and industry will work together to maximise economic recovery (MER) from the United Kingdom Continental Shelf (UKCS)”. (Observe, if you will, that capital letter ‘M’, for ‘Maximise’, in the rather conveniently euphemised acronym ‘MER’ – in case you were wondering, it doesn’t stand for ‘Minimise, in line with the Government’s obligations drastically to reduce emissions, as signatory to the 2016 Paris Agreement’…)

Those OGA people sure do have themselves a strategy, folks, and it has to do with something they like to think of as ‘asset stewardship’: “The MER UK Strategy underpins our work and came into force in March 2016. It describes how MER should operate in practice, setting out a legally binding central obligation to take the steps necessary to secure the maximum value of economically recoverable hydrocarbons.” You may possibly be more alarmed than chuffed to hear that the OGA professes to have “strict controls in place to ensure that operators manage the risk of induced seismicity from such operations” (high pressure, high temperature reservoirs, anyone?).

Well: frack me sideways!…I hope that my own weatherworn old barrel can survive a spot of drilling-induced seismicity – and yours too, dear Reader – but no doubt we are in capable hands…all those earthquakes we in the UK have recently been having are no doubt nothing much to fret about… (see the ‘fracking’ references below, including OGA gloss on the possible harm, and also Naomi Klein’s extensive analysis in This Changes Everything, eg pp. 213-17).

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Sadly, there’s no shortage of news items touching on ideas about climate change and the ways in which carbon-fuelled capitalism and its projected consequences damage or threaten to destroy the biosphere. So why these two particular stories, Barrelman, I hear you ask? I have two responses; one is to say that in a moment I have a story of my own that I want to add to the picture.

I want first of all to observe that both these news stories subliminally proclaim the inexhaustibility of those resources in pursuit of the plunder of which we organise ourselves: either societally, in corporations, or in other kinds of sociopathic gangs.

It’s often suggested or assumed (or maybe that’s just Donald Trump I’m thinking of here) that there is something peculiarly American about the American Dream and the American idea or ideology of ‘Manifest Destiny’ that emerged into public discourse in the mid-nineteenth century. The journalist John L. O’Sullivan coined the term in an article published in 1845 in which he was arguing for the annexation of Texas to the Union, in pursuit of “the fulfillment of our manifest destiny to overspread the continent allotted by Providence for the free development of our yearly multiplying millions” (see my 2014 essay on the ‘Evangeline Oak’). Much later on, in 1992, President Bush proclaimed in similarly emphatic and entitled tones that “the American way of life is not negotiable” (cited in Latour 2017).

The westwards expansion towards the Pacific of the nation State that emerged out of the war of independence of the New England colonies of the eastern seaboard – and the genocide of the indigenous peoples encountered along the way – can be understood not only in the particular historical, geographical, socio-political, technological, ethnic and demographic context of the wagons rolling west (the American population nearly doubled in the two decades from 1840 at the same time as the printing presses and the railroad tracks multiplied). O’Sullivan’s words and the ideology they articulate also stand for an imaginary manifesto of imperialism generally and of Western imperialism and carbon-fuelled capitalism in particular (and it is but a very thin veneer that separates his portentous phrase from the speeches of Hitler on the rightful claim of the German people to its lebensraum, only ninety years or so later).

In the age of Trump, Bolsonaro, Putin, Orbán, Erdoğan, Assad and Brexit – of neoliberalism run rampant and off the rails – it is still the imperialist ideology of manifest destiny that drives the impulse to drill in Alaska or to frack in the great National Parks of the Western United States or derogate from the Paris Agreement – or has the Canadian government calling in the Mounties to disperse First Nation protests against the systematic desecration that is the exploitation of the Alberta tar sands – or that opens up the Glengorm field or the Cuadrilla site at Preston New Road near Blackpool for exploitation, or causes us to export our used rubber tyres to India for burning (Guardian 30 January 2019) – or (a quarter of a century ago, but nothing much has changed…) that saw Ken Saro-Wiwa and his eight colleagues hung in 1995 by the Nigerian government, at the behest of or with the connivance of Big Oil, for their activism protesting Shell Oil’s pollution of his homeland of Ogoniland in the Niger Delta – or that (at the time of writing) drives Theresa May and her Churchill-worshipping cohort-in-cahoots to believe God is on the side of a no-deal Brexit that will restore Britain’s imperial ‘glories’ [sic] (see also my barrelblog last month on this theme).

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One thing we can learn from this overview is that the Western, whether in film or in literature or song, may be a significant genre for understanding the relationship between capitalism and the Earth System. John Wayne riding shotgun for the stagecoach (or for his platoon in the south-east Asian jungle in The Green Berets) embodies manifest destiny and slaughter in the service of capital, be it buffalo or Native Americans (the actor himself is on record as stating ‘I believe in white supremacy’) – whereas the revisionist Western, from Robert Altman’s McCabe and Mrs Miller onwards, tends to be suffused with melancholy – what Renee Lertzman calls ‘environmental melancholia’ – for the loss (the destruction, in fact) of that sense of clear limitless immensity you might yet perceive a vestigial trace of in Monument Valley at sunset or along the high passes into Yellowstone or Yosemite. Henry Fonda’s enforcer in Sergio Leone’s Once Upon a Time in the West is the amoral gun for hire for what Bruno Latour calls ‘globalization minus’ or Pope Francis called ‘the globalization of indifference’ – we’re pushing the railroad through and we recognise no boundaries and know no limits and no suffering shall deflect us from our purpose – whereas Clint Eastwood’s rebel drifter in The Outlaw Josey Wales, gathering about him his motley ragtag multicultural crew of fellow wanderers, respecting the land and the land’s custodians, represents ‘globalisation plus’ in all its creative potential.

In John Williams’ (may we say?) ‘revisionist Western’ novel Butcher’s Crossing (spoiler alert!) a young man, Will, quits his studies at Harvard and heads west ‘to see as much of the country as I can’. He bankrolls a party of hunters who head out on a long trek in search of a remote Colorado valley where are reputed to roam a vast herd of buffalo who have avoided the hail of bullets that have decimated their brethren of the open plains. Will’s innocence is washed away in blood as a season of slaughter ensues: the entire herd is massacred and the buffalo hides pile up but the hunters are then snowed in for the winter – as though the mountains protested the carnage and exacted their own tax upon the ‘produce’. The following spring many of their prizes are lost on their arduous journey back to the ‘buffalo town’ of Butcher’s Crossing – whereupon, they discover that the bottom has fallen out of the market in buffalo hide they had been so sure would outlast the animals themselves. It was all just a craze – their wagonloads of animal skins are worthless.

I have yet to see this novel referenced when the literature of climate fiction is being catalogued and yet it vividly and harrowingly captures and illuminates this ‘Western’ dialectic between, on the one hand, the pure jouissance of techno-industrialist capitalism, and what Naomi Klein calls ‘extractivism’ (that which drives the OGA, it would seem) run rampant; and, on the other hand, the melancholy of devastated ecologies left in its wake (for a pellucid exploration of the impact on the Crow Nation of the loss of the buffalo, see Jonathan Lear’s 2008 text on culture collapse and radical hope). By jouissance I here intend to evoke what Žižek elaborates as the Lacanian ‘superego’ injunction which is covertly the very opposite of the Freudian ‘civilizing’ prohibitory force within the psyche. Jouissance has to do with ‘enjoy yourself’; ‘get it while you can’; ‘you can’t take it with you when you go’; ‘the best thing about the Earth is if you poke holes in it oil and gas come out’ (the aptly named Republican Congressman Stockman in 2013, quoted by Klein); or, notoriously, ‘the only good Indian is a dead Indian’. This last quote is apocryphally attributed to General Philip Sheridan, the veteran commander of the American Civil War who instigated ‘scorched earth’ warfare in pursuit of Robert E. Lee. Sheridan later presided over massacres both of the bison and of the Native Americans of the Great Plains – and then only partially redeemed himself, in later life, by defending the lands that would eventually become Yellowstone National Park against the claims of agents of capitalism and extractivism even more rampant than he.

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My other reason for picking out those two news stories? My father died in the very early hours of Boxing Day morning, 2018 – just about six weeks ago. He’d had a long illness – he had a degenerative neurological condition and had been first restricted in his movements and then immobilised and then bedbound in a nursing care home while Alzheimer’s Disease had taken his memory of us and, in some sense, our memory of him. In early December he seemed to simply stop eating (did he somehow will this, in some deep internal nook or cranny of remaining consciousness? Did he simply kind of forget? Did he get frightened of being fed? I have no idea…). He contracted pneumonia and (perhaps) this brought a mercifully rapid end to what might have been a very miserable and extended long haul (but who am I to say?). I beg permission to set out a few thoughts about what passed between us, as another way to illuminate my theme.

After about the first twelve years of my life, I was not close to my father – if by ‘close’ is meant, able to manage and savour a mutual sense of intimacy, enjoy each other’s company, pick up where we left off, know each other’s minds. We were close in the sense that he was my father and half of me is him – close in the sense that we couldn’t bear to be ‘close’ with each other. So I don’t want you to think of me as grief-stricken or overwhelmed – not exactly, anyway. It’s been unexpectedly an upheaval – I know this to be an expected thing, in other people’s lives – but not in my own. I find myself not at all knowing what this event is doing, taking place in my life. It’s somehow not supposed to be there, but somehow, precisely because of this illusion, nothing is ever going to be quite the same again, now that it has revealed itself as having been in prospect all along. My Erlebnis, perhaps, to borrow the word from the quote that opens this piece…

In my latency years –  from, say, 5 to 11 – I don’t recollect all that much but I do seem to remember that he was pretty much my hero. What he said was right (and what he said was law, even if it might transiently have felt unfair). My Dad was stronger and cleverer and wiser and lovelier than anyone else’s Dad, and that was that. In public – at school, at family gatherings – I modelled myself on him and worked hard at my studies because that was what he expected and I’m sure it never occurred to me that there was any other option. There’s pictures of me in blazer and tie and side parting, aged about eight going on eighty, looking not one little bit like I live in a barrel – a miniature version of him that if anything I believe I was looking to perfect, rather than reject.

Around the age of thirteen, the Adolescent Spring surged its way along the southern Mediterranean seaboard of my familial bonds. Like many an old school Arab tyrant, my father had not ever heard of such a thing as adolescence among his people; had not prepared for it in his own mind and was therefore utterly ill-equipped and confounded when it exploded into life before him. It’s maybe a measure of just how high were the pedestals on which the statues of the nation’s hero had been placed, in the hierarchical structures of my mind, that their plummet into pieces on the ground was so precipitous. Violent was the revolt, then – and violent, too (but ineffectual), the reciprocal early attempts to quash the uprising.

I repudiated my father – damning was my disdain of him. For a couple of years I could scarcely look at him. I elected to remake myself in my own image – a grandiose project! – or at any rate, to cast myself in the mould of new masters. He never repudiated me, although I’m sure he was less than well pleased with his unexpected usurpation. Later tentative and awkward olive branches from my father-in-exile (to extend the analogy) were, I am ashamed to say, pretty much scornfully rebuffed and rare indeed were my own equivalent moves to make peace – was I not after all the wronged party? I was prodigal and proud – perhaps I should say arrogant, since in retrospect I have no idea what I was so proud of. I strayed far from the pathway that had been set out for me and on occasion, disoriented in the gloom, wandered perilously close to the cliff-edge. From time to time I was not so proud as to rule out coming home to ask for help, which was always made available. But by then there was no longer any shared language with which to process or metabolise any moment of rapprochement.

I know on one level I’m giving myself a hard time here and that we are all allowed life crises in adolescence (and even in adulthood!). I also don’t want to say that this rupture was the ‘end of history’ for the two of us. Conflict drifted into wary circling and then gradually towards a surface geniality that suited us both well enough for our different reasons. At some point along the way I was helped to the realisation that maybe not everything was his fault and he was living by his own lights and steering his own path as best he could; that after all he was my father and half of him was me. Those deeper longings of father and son went largely unavowed and unmet, but diplomatic relations were restored, even if there was no talk of a return to power.

It saddens me to think that by the time things had settled down into this unsatisfactory but mostly peaceful accommodation, the early signs of neurodegenerative illness were already upon him – he knew something of his doom, even if I was unconscious of it. There’s always another time for the Great Conversation, but the seasons flourish and fade and the years fall away and ‘suddenly’ it’s too late and there was my father, first wheelchair- and then bed-bound, incontinent, not knowing who I was or remembering anything much at all about me except a nagging feeling that at some point I had disappointed him. I think he was revealed to me on his deathbed, almost more than he was in life – naked and vulnerable – my father, in his own right – and (selfishly speaking, of course) a unique and irreplaceable resource, exhausted.

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You can see where I’m going with this. Many voices have spoken to their own Erlebnis in relation to the climate crisis (one such story that you can find in the public domain is told by Paul Hoggett, right at the start of this clip: https://vimeo.com/tavistockandportman/review/307462685/dc2ea10c46). For is not this new and familiar story of mine the very quintessence of environmental melancholia? Did my practice in relation to my father not in essence embody a kind of grim extractivism in which both the internal and external resources he represented (the father-in-my-mind as well as the father-on-the-end-of-the-phone) were indifferently available to me either to be tapped or to be squandered? Do I not deny both my parentage in Gaia, my Cosmopolitan species-membership (Diogenes would turn in his grave!), and the finite mortality and exhaustibility of those parental resources, every time I turn my key in the ignition of whatever real or metaphorical piece of carbon-fuelled technology most powerfully excites my transient fancy?

Slavoj Žižek, in his own analysis of what he calls the primarily ecologically-driven ‘apocalyptic zero-point’ of the global capitalist system, observes that “the limitation of our freedom that becomes palpable with global warming is the paradoxical outcome of the very exponential growth of our freedom and power, that is, of our growing ability to transform nature around us, up to and including destabilizing the very framework for life” (2011 p. 333). Neil Young (that great if erratic songwriter of Westerns both revisionist and, on occasion, decidedly old school) proclaims that we “got a man of the people/says ‘keep hope alive’/got fuel to burn/got roads to drive”. Do not we as a nation or a species, find ourselves ‘destabilizing the very framework for life’ every time that we plunder a pipeline – or build one? The men in suits celebrating the ‘find’ in Glengorm are more responsible for the plunder of the Earth System than those impoverished desperate people who burned to death at the end of that petroleum-fuelled Bacchanale in Tlahuelilpan, but the ailment is surely the same and I know my own complicity: my own carbon footprint remains indefensibly in the general category of ‘wanton’.

Have we not all been guilty of prodigally postponing that Great Conversation with our planet-parent that might have offered redemption, back in the day, only to discover (as we did yesterday) that (for example) fully one third of the Hindu Kush-Himalaya icecap, the greatest concentration of ice outside of the two poles, is already lost? Is not climate disaster the very thing that somehow was not supposed to be there, and is it not precisely because of this illusion, that nothing is ever going to be quite the same again, now that it has revealed itself as having been in prospect all along…? The only difference between the personal and the eco-political in this rhetoric is the crucial one: that human beings really are mortal, whereas the human species and the global climate, as two parts of the Earth System whole, are only being destabilized into crisis or collapse, because of the irresponsible abuse of accelerating power by the human species – which is of course why we have now got ourselves a whole geological Age, the Athropocene, named after us…

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Žižek arranged the five chapters of Living in the End Times to accord with the five stages of grief set out by Elisabeth Kübler-Ross: denial, anger, bargaining, depression and acceptance. Lertzman (2015 p.6) writes about environmental melancholia as unresolved mourning, “wherein one may be ‘frozen’ or otherwise arrested due to lack of acknowledgement or recognition of what has been lost”. She adds that the sense of loss can be ‘anticipatory’ and that melancholia can then be all the more frozen and disorienting and unresolved. This goes to the question running through all of the stories in this piece, which I think has to do with the varying difficulties in knowing about loss at the emotional-thinking level (rather than in a split off way, either cognitively or affectively) according to whether the loss is foreseen, perceived, experienced or remembered. Severe emotional trauma can cause disruptions in the field of time – perhaps this is somehow true at the species and Earth System level also. Maybe this is how it comes about that, as Latour points out, we can be sleepwalking into a war we’ve already lost.

There are certainly powerful voices now to be heard, mobilising the available empirical evidence in the service of grim analyses and dark forebodings of the possibility or even probability of exhaustion. Hamilton asserts that “we must concede the material possibility of our own extinction, or at least the collapse of civilized ways of life, as a result of our own actions” (2017 p. 37). Jem Bendell’s text on the necessity of ‘deep adaptation’ (2018 p. 11) argues that “the evidence before us suggests that we are set for disruptive and uncontrollable levels of climate change, bringing starvation, destruction, migration, disease and war…When we contemplate this possibility, it can seem abstract…But when I say starvation, destruction, migration, disease and war, I mean in your own life. With the power down, soon you wouldn’t have water running out of your tap. You will depend on your neighbours for food and some warmth. You will become malnourished. You won’t know whether to stay or go.” The full text, available online but not in published print, comes with a health warning just about the consequences of reading it. We are hitting the ground and hitting it hard.

Roy Scranton predicated his book Learning to Die in the Anthropocene upon his own Erlebnis as a soldier in the 2003 Iraq war and his conclusion is succinct: “We’re fucked. The only questions are how soon and how badly” (2015 p. 16).

I think I may be finally starting to have a sense of how badly.

 

References/weblinks

Adlam, J. (2014) ‘The Evangeline Oak: of Lost Loves and Found Objects.’ Free Associations, 66, July 2014.

Bendell, J. (2018) ‘Deep adaptation: a map for navigating climate tragedy.’ http://www.lifeworth.com/deepadaptation.pdf

Francis (2015) Encyclical Letter Laudato Si’ of the Holy Father Francis on Care of our Common Home. https://laudatosi.com/watch

Hamilton, C. (2017) Defiant Earth. Cambridge: Polity.

Klein, N. (2012) This Changes Everything. London: Penguin.

Kübler-Ross, E. (1969) On Death and Dying. New York: Simon and Schuster.

Latour, B. (2017) Facing Gaia: Eight Lectures on the New Climatic Regime. Cambridge: Polity.

Latour, B. (2018) Down to Earth – Politics in the New Climatic Regime. Cambridge: Polity.

Lear, J. (2008) Radical Hope: Ethics in the Face of Cultural Devastation. Harvard: Harvard.

Lertzman, R. (2015) Environmental Melancholia. London: Routledge.

O’Sullivan, J.L. (1845) ‘Annexation’, The United States Magazine and Democratic Review 17: 5-10. http://web.grinnell.edu/courses/HIS/f01/HIS202-01/Documents/OSullivan.html.

Scranton, R. (2015) Learning to Die in the Anthropocene. San Francisco: City Lights.

Williams, J. ([1960] 2014) Butcher’s Crossing. London: Vintage.

Žižek, S. (2011) Living in the End Times. London: Verso.

https://barrelblog.org/2019/01/01/on-migrants-climate-change-doublethink-and-brexit/

https://unfccc.int/process-and-meetings/the-paris-agreement/the-paris-agreement

https://www.theguardian.com/business/2019/jan/29/discovery-of-biggest-uk-gas-field-in-a-decade-glengorm-north-sea

https://www.theguardian.com/commentisfree/2019/jan/30/worse-than-plastic-burning-tyres-india-george-monbiot

https://www.theguardian.com/world/2019/jan/19/mexico-explosion-deaths-burst-pipeline-gasoline

https://www.theguardian.com/commentisfree/2019/jan/30/worse-than-plastic-burning-tyres-india-george-monbiot

https://www.theguardian.com/environment/2019/feb/04/a-third-of-himalayan-ice-cap-doomed-finds-shocking-report?

On fracking:

https://www.theyworkforyou.com/wrans/?id=2018-12-18.203198.h

https://www.theguardian.com/environment/2018/dec/11/fracking-blackpool-tremor-cuadrilla

https://www.independent.co.uk/news/uk/home-news/earthquakes-tremors-fracking-site-lancashire-cuadrilla-a8592956.html

On ‘migrants’, climate change, doublethink and Brexit

“Even a Diogenes has the right to a barrel…” (Bruno Latour, from ‘Down to Earth – Politics in the New Climatic Regime’)

“I think Europe needs to get a handle on migration because that is what lit the flame…I admire the very generous and compassionate approaches that were taken particularly by leaders like Angela Merkel, but I think it is fair to say Europe has done its part, and must send a very clear message – ‘we are not going to be able to continue provide refuge and support’ – because if we don’t deal with the migration issue it will continue to roil the body politic.” (Hilary Clinton, November 2018)

“Doublethink means the power of holding two contradictory beliefs in one’s mind and accepting both of them. The Party intellectual knows in which direction his memories must be altered; he therefore knows he is playing tricks with reality; but by the exercise of doublethink he also satisfies himself that reality is not violated.” (George Orwell, from 1984)

 

Two articles occupied the front page of The Guardian on Saturday December 29th (alongside a picture of Twiggy…). “Councils pay for rough sleepers to leave town”, the first of these announced (or muttered…you could tell it had been tricky to strike the right note…). 83 councils had purchased 6810 travel vouchers for purposes of ‘reconnecting’ street homeless people to their ‘areas of origin’. Local authorities said the policy was pursued on a voluntary basis only – rough sleepers felt they had no choice and reported being sent places they had never been before.

‘Experts’ apparently ‘advised’ that “without support and accommodation, the policy does not resolve homelessness, but moves it to another area”.

Well, yup, o experts, that is indeed pretty much the nub of it.

The second piece bore this headline: “[Sajid] Javid declares migrant boats a ‘major incident'”. 106 ‘migrants’, many of them reported to be Iranian, had been detained in the Channel since Christmas Day and the Home Secretary had curtailed his Christmas holiday in South Africa.

This was not (you might fondly have imagined) to make sure there was ‘room at the Inn’ for these desperate wayfarers, but rather to appoint a ‘gold commander’ (take that, annoying unwanted ‘economic migrants’!) to deal with the growing crisis (ie get them back across the Channel and deter them and others from attempting the crossing) and to ask the French interior minister Christophe Castaner for an urgent (pre-Brexit?) chat about the situation.

On New Year’s Day it was announced that two extra Border Force cutters would be deployed pour décourager les autres. Javid made various noises about the nautical perils involved in the crossing and then got to the point he is there for: “I want to send a very strong signal to people who do think about making this journey – we will do everything we can to make sure it is not a success, in the sense that I don’t want people to think that if they leave a safe country like France that they can get to Britain and just get to stay … our job here is to make sure this doesn’t turn into a new route for ever-increased illegal migration [note: migration is not illegal!], so I want to stop it now as much as I possibly can.”

It was thus clear that the cutters had been deployed because the treacherous waters of the English Channel were no longer doing their job of being the ‘Border Force’ well enough.

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These two stories are connected by underlying individual and collective tragedies in human lives and indeed it is striking how little sense of tragedy gets communicated in the news stories or in the responses of the various authorities. But the particular point I want to pick up here is that in both stories, the responses of the authorities are located in a deeply-rooted piece of system or societal doublethink.

This doublethink is contained not only in the idea, common to policymakers in both stories, that there might be ‘somewhere else’ for displaced people to go – it is also inherent in the idea that there are people in these stories who somehow or other are not displaced.

The housed are still constructing themselves as the housed in relation to an outgroup who are unhoused and feeling better about, more securely housed in their housedness, as they always have done. At the level of the nation state, this is located in the idea of a border, over which the nation state has control and therefore the final say on who can cross the border and who must stay outside – or, to put it the other way round, who can stay inside the border and who must leave. At the level of the borough council, it is this idea that drives the policy of paying to send rough sleepers ‘somewhere else’.

This idea of a controlled border was never an absolute truth but we could perhaps nonetheless think of this as the defining construct of the Holocene age – that age of relative climatic stability that for ten millennia has framed and enabled that phenomenon we call ‘human civilisation’ – that age which eventuated and reached its dénouement, over the last three hundred of those ten thousand years, in the Enlightenment, the Age of Empire, the Industrial Revolution and the great drive of carbon-fuelled capitalism towards what Latour argues was the chimerical horizon of ‘globalisation’.

In the Anthropocene age now upon us – the age in which human beings are understood to be the main agents acting upon the climate and in which, perhaps more importantly, the climate – the behaviour of the Earth – is understood to be the main agent acting upon humankind’s chances of survival – in the Anthropocene, this idea no longer has any ground left to hold. Carbon particles observe no boundaries.

Here is Latour again, worth quoting at some length:

“Most of our fellow citizens…understand perfectly well that the question of migrants puts their dreams of a secure identity in danger…The climate crisis is forcing people they do not welcome to cross their frontiers; hence the response: ‘Let’s put up impenetrable borders and we’ll escape from the invasion!’

But…the New Climatic Regime has been sweeping across all our borders for a long time, exposing us to all the winds, and no walls we can build will keep these invaders out.

If we want to defend our affiliations, we shall have to identify these migrations also, migrations without form or nation that we know as climate, erosion, pollution, resource depletion, habitat destruction. Even if you seal the frontiers against two-legged refugees, you cannot prevent these others from crossing over.

‘But then is no one at home any longer?’

No, as a matter of fact. Neither State sovereignty nor inviolable borders can take the place of politics any longer.”

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So then: welcome to 2019, and Fortress Britain, the ‘armed lifeboat’ with its Border Force and its threats and posturing, battening down the hatches and affecting not to worry who gets caught in the incoming hurricane. It would seem that the British government is of a mind with Hilary Clinton in her finding that the lesson to be drawn from the rise of populism is that Europe should have been less hospitable to climate change refugees (for this is what ‘they’ are…).

And this of course is the whole point of Brexit, right? Climate migrants are understood to be a plague, and Brexit the quarantine strategy. ‘Bad luck, our erstwhile European friends, but you’re already contaminated and there’s no saving you now. So long – it’s been real, but we gotta go…’

When the Referendum was first called, I believed that the case for Remain lay squarely in the necessity of maintaining solidarity with the European project that had bound together the major Powers since the post-WW2 reconstruction – that George Steiner’s Europe was a Europe worth preserving. In the wake of the vote and the accelerating disarray of the last year, I became convinced that the central issue and the overwhelming argument for Remain was the Irish Border and the honouring of the post-imperial compact that had brought a tenuous but creative peace to those troubled lands.

But it’s now clear to me that I have been underestimating the catastrophic consequences of Brexit. Brexit is nothing more or less than a desperate flailing and utterly doomed exercise in climate denial and doublethink.  If Britain (and indeed the rest of the English-speaking world) pursues the ‘logic’ of Brexit and fixes machine guns to the rails of the lifeboat rather than distributing lifebelts, the waters will rise and consume us all.

The last word goes to Fred, a voice of reason on the streets of Dover, reported in the follow-up to the ‘lifeboat crisis’ story we began with.

Numerous voices complained that the wrecked lifeboat was an eyesore and that the desperate travellers were ‘economic migrants’ and ‘benefits scroungers’. Now, this is the language our masters and our media have promulgated and it’s not for me to judge people for their fearful responses to the incoming storm. But here’s Fred, and he has a point to make that I think we all urgently need to grasp and understand and take on board:

“If we were in a similar situation, from a war-torn country and trying to make a better life for ourselves, we would do the same thing…But people don’t think about that. In a way, we are all migrants…”

 

References/weblinks

For factual correction of official and media commentary on the crossings, see this from the Refugee Council: https://www.refugeecouncil.org.uk/latest/blogs/5459_channel_crossings_-_time_to_set_the_record_straight?fbclid=IwAR203v_yObIJG_fUXjilkZl-iJPu2lNEM0YEzQOZV19WakTTJW9smwCOxYI

Latour, B. (2018) Down to Earth – Politics in the New Climatic Regime. Cambridge: Polity.

Orwell, G. (1949) 1984. London: Penguin Modern Classics.

Steiner, G. (2015) The Idea of Europe. London: Overlook Duckworth.

https://www.theguardian.com/world/2018/nov/22/hillary-clinton-europe-must-curb-immigration-stop-populists-trump-brexit

https://www.theguardian.com/uk-news/2018/dec/28/channel-migrant-crossings-a-major-incident-says-sajid-javid

https://www.theguardian.com/uk-news/2018/dec/31/two-border-force-cutters-redeployed-to-english-channel-says-sajid-javid?CMP=Share_AndroidApp_Email

https://www.theguardian.com/uk-news/2018/dec/31/we-are-all-migrants-dover-divided-by-wave-of-boat-arrivals?CMP=Share_AndroidApp_Email

 

 

 

On violent states and creative states

Violent States and Creative States – From the Global to the Individual

John Adlam, Tilman Kluttig and Bandy X Lee (eds) – Jessica Kingsley Publishers (2018)

https://www.jkp.com/uk/violent-states-and-creative-states-2-volume-set-1.html/

Violence often feels like it comes ‘out of the blue’. This contention might almost be intrinsic to any account of the experience of any individual who finds themselves ‘on the receiving end’ of an act of violence. Repeated violence, almost by its very nature, risks ceasing to be perceived or experienced as violence at all – think of patterns of domestic violence or self-injuring practices – or the tweets of the President of the United States – or the newspaper columns of the United Kingdom’s recently-resigned Foreign Secretary.

And yet: human behavioural violence is not random. It involves an agent – the doer of the violent deed. In turn, the violence of this agent emerges out of the self state, the state of mind, of the agent: an act of violence is the external expression of an internal state of mind. James Gilligan, who contributed the epilogue to these volumes, has argued that all interpersonal human violence comes down to feelings of shame and humiliation and feeling disrespected.

From a psychodynamic perspective we might characterise such states of mind as unstable states in which a ‘bad object-relation’, a node or nexus of tension and aggression and ambivalence, experienced as intruding upon the self, has to be evacuated in pursuit of the unconsciously hoped-for restoration of equilibrium. Put (much!) more simply: I feel shamed or ‘dissed’ – there’s then a relationship in my mind between ‘me-who-is-dissed’ and ‘he-who-dissed-me’ – the feelings associated with this are increasingly difficult to tolerate – eventually I lash out at someone else ‘out of the blue’ – at least momentarily, I am powerful and someone else has the bloody nose or the black eye – the feelings associated with ‘me-who-was-dissed’ are no longer available, they belong now to the person I have humiliated in turn.

It was ‘out of the blue’, for me, when, working a cold weather shelter one winter’s night (if the reader will accept testimony from my own experience), I was suddenly attacked from behind and thrown to the ground by a homeless man who had taken refuge there. But it wasn’t ‘out of the blue’ for my assailant – I suspect his violent state of mind had been building and bubbling a while – and so might mine have been, if I had been out and about that freezing night on the streets of South London.

What finally did it for him (I have many times since reflected) was probably when I happened to turn my back towards him (in order to go fetch something, as I recall). His violent act emerged out of his violent state and was ignited by his experience of the violent, humiliating or shaming disregard that I (inadvertently) performed for him. And then we must imagine the kind of life experiences that had led this man into this particular predicament – and reflect upon the violent State that might be understood to obtain, when the sixth largest economy on the planet can’t quite manage to meet the basic housing and social care needs of its vulnerable populations.

This two-volume set of essays on violence and creativity has at its centre the observation that even individual or behavioural violence occurs within an ecology that encompasses not just immediate family and community but society as a whole. We hope to show that, just as an individual can be in a violent state of mind, societal structures can take on ‘violent states’ – not only in the political construct of the ‘rogue state’, but in the sense that anti-Semitism or Islamophobia or misogyny or neo-liberalism or biosphere destruction might be understood as ‘violent states’ that effect harm to the body politic (and also give rise to individual violence).

Those who lost their lives in the Grenfell fire, on this view, died not ‘simply’ of smoke inhalation ‘out of the blue’; they died of an ongoing slow-boiling ‘structural violence’ – just as the victims of Hurricane Katrina in New Orleans did not die of drowning, so much as they were killed by structural violence at Federal and State level: by the failure to repair the Mississippi levees and by racial segregation pursued in public policy by covert means (which latter factor is explored in the first contributor chapter in these books, on the violent State of racial segregation in the housing policy of Baltimore).

Throughout the thirty-two chapters of these two volumes, we invite the reader to position herself in the liminal spaces between two pairs of concepts: in the interplay between violent states of mind and violent States of society; and across the subtle distinctions or the mysterious fine line that may separate a violent state, of mind or society, from a creative one.

Violence begets only violence. This book project is first and foremost an activist project: we are looking to contribute to violence reduction, not only to the theory of violence reduction. We also hope that our authors may have helped to shed light on the wellsprings of human creativity: how a destructive death impulse and the healthy, creative life impulse, may be inter-related; how to divert the flow of human destructiveness into more creative channels, at the level of the nation State and the global community as well as in individual states of mind.

In a creative state of mind, unbearable experience can be integrated into the psyche instead of needing to be got rid of; likewise in a creative State, the feared or hated ‘other’ is not expelled, be it an idea or an individual or a people – the ‘other’ instead is received, engaged with, respected, accepted, even celebrated. In these dark times, that’s not just a project and a book worth launching – that’s more like an urgent and overriding imperative.

Violent States & Creative States Freud Museum authors group photo

Book Launch at the Freud Museum, 6 July 2018

(Some of the authors – from left to right: Gina Donoso; Wayne Martin; Tilman Kluttig; David Jones; Sarita Bose; Lucy Neal; Alex Maguire; Maggie MacAlister; John Adlam; Gerard Drennan; Anna Motz; Estela Welldon; Tamsin Cottis)

 

On the occasion of the tenth anniversary of the closure of Henderson Hospital Democratic Therapeutic Community

Alexander     Dost thou not know that I am able to give thee a kingdom?

Diogenes      I know thou art able, if I had one, to take it from me; and I shall never place any value on that which such as thou art can deprive me of. …

Alexander     … for which purpose thou hast forsworn society, and art retired to preach to trees and stones.

Diogenes      I have left society, because I cannot endure the evils I see and detest in it.

From “A Dialogue between Alexander the Great, and Diogenes the Cynic” by Henry Fielding (1743)

Henderson April 2008 005

On 23 April 2008 at 2.00pm, a certain NHS Mental Health Trust closed the Henderson Hospital Democratic Therapeutic Community on a ‘temporary’ basis – pleading or otherwise peddling the usual piddling managerialist alibis and nostrums.

Even if you weren’t there, you can guess the sort of thing they said. What’s a fellow to do, we were – and are still – invited to consider, when he runs a big business and he can’t secure his cash flow? Our hands are tied. It’s no longer financially viable … and so forth … (if you can bear to look, some of it is laid out in the southwark.gov weblink listed at the bottom here). It’s been the same old song, for many years now, and it never lets up (or lets on) (or lets anyone off) and at some point you just know you’re going to hear those two dread words – ‘luxury flats’ – and another expanse of the Attlee/Bevan post-WW2 welfare settlement will have gone down with all hands on deck and the officers in the lifeboat, to the sound of cash tills singing ‘ker-ching!’ and developers popping corks – and also, somewhere at the edge of audibility, the continuing suffering of the marginalised and traumatised and dispossessed and excluded …

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I was there. A bit player: not one of the residents, or the residential team; not one of the potential candidates for admission suddenly denied an opening – but I was there through the death-throes of the community and I was there the day it was finally evacuated and boarded up. I was working for the Henderson Outreach Service team: it was my first NHS job. I started there in April 2001 and was there for seven eye-opening, humbling, almost overwhelming years that educated and moulded me as a person, as a citizen, as a mental health practitioner and as a psychotherapist. I then joined the massed ranks of the redeployed – an ongoing upheaval still playing out its consequences a decade down the line, in a minor but nonetheless sharply-pointed echo of and parallel process to the upheaval endured by those residents and candidates.

This is not all about me – but I do want to say how vividly I remember my first contact with the Democratic Therapeutic Community (DTC). As part of the interview process I was invited to attend the 9.15 community meeting. I was intensely anxious. Staff and residents congregated in this long rectangular space, dark in my memory but lit by windows and glass doors all along the long side facing the garden and full of assorted faded and shabby but snug and inviting furniture and fittings of the sort that nowadays would have the corporate drones diving for their alarm buttons on about 57 grounds of violation of health and safety edicts (NB this and other photos in this blog were taken the day the hospital closed, by the way) …

Henderson April 2008 006

Visitors were participant observers in the community meeting but active verbal participation was strictly limited to stating one’s name and business when asked and otherwise to remain silent. It’s an old cliché of the DTC, but it was not an easy matter – and why should it have been? – to distinguish staff from residents by any visual cues, and this is one of the things I remember so well: the disorienting (transformative) almost visceral experience of stepping out of the world of vertical hierarchy and rigid structure and into a liminal space where everything seemed to be up for negotiation in a flattened (not entirely flat, but flattened) hierarchy. And the other memory I retain is how excluded I felt: I was wrong, somehow, wrong to the very core of me; I did not understand, there was a language and vocabulary whose key I did not possess; I felt received but not welcomed.

I quickly came to perceive that in this way some fragment of the experience of the residents had been located in me, or I had identified with, as though this community had a sign above the door that said “do not abandon hope, all ye who enter here, but check your privilege, interrogate the quality of your own hospitality and get your head around what it’s like to feel excluded and outcast, and that right speedily, because this is the emotional work we do here and it matters very much” – or something like that, and I’m sure that anyone who lived there for the allotted year would be able to come up with something decidedly more pithy and concise…

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This is not about me and it is also not about recording a formal history of the unit: plenty of other places where that can be researched. But in case you don’t know what all this is about, I’d want to include you in! The Henderson DTC was in its sixty-first year of existence when it was closed. It therefore just pre-dated the inception of the National Health Service. It opened in 1947 essentially as a trauma unit, for ‘shell-shocked’ soldiers struggling to reintegrate back into civilian life after the end of World War Two. It went through changes of identity and changes of location over the years – and changes of funding, especially in the wake of the advent of the ‘internal market’ but if you want to know what people remember and mourn, when the Henderson DTC model is evoked, it is this:

  • Staff had no control over admission and discharge of residents inside the maximum stay of one year
  • Admission was by majority vote of a group of nine residents and three staff members – early departure from treatment depended on the vote of the whole community (in which residents always outnumbered staff)
  • There was no use of psychotropic medication permitted or prescribed
  • There was no coercive psychiatry or medico-legal technologies involved – no use of the Mental Health Act (or Probation Orders or conditions of residence or restriction orders of any kind) – no curfews, no restraints – as far as is possible to sustain in the UK of the late twentieth and very early twenty-first centuries, residents entered and stayed of their own free will
  • There were no ‘one to one’ psychological therapies available but a range of therapy groups, work groups and community meetings, which latter could be called at any time, day or night, if an issue affecting the whole community demanded the community’s whole attention

The American social anthropologist Robert Rapoport studied the Henderson Hospital in the 50s and in 1960 reported that four key characteristics defined the therapeutic milieu of the then twelve-bedded unit (when I joined in 2001, there were 27 beds as well as two other ‘replicated’ communities of similar size, in Crewe (Webb House) and in Birmingham (Main House)). These four characteristics Rapoport identified as democratisation, communalism, permissiveness, and reality confrontation. Transposed to the late period Henderson DTC model, these four ideas relate to major decisions all being taken by majority vote; to the ethos (‘communalism’) of staff and residents sharing with one another all the tasks and processes of daily living in a flattened hierarchy, with conventional roles consciously blurred; to the principle (‘permissiveness’) that there were no transgressions but only enactments, in that there were plenty of ‘house rules’ prohibiting all kinds of violence but it was understood that residents were not expected immediately or magically to relinquish safety practices (such as practices of self-injuring) that had got them to the door; and finally (‘reality confrontation’), to the principle that permissiveness did not preclude challenging the individual to understand that within the communal frame his or her actions had an impact on the rest of the community – and that by engaging in a given safety practice (slamming a door in frustration, for example) it was understood that distress had been expressed but that the individual had still placed themselves thereby outside the (conceptual) boundary of the community and would need to ask the community’s blessing to ‘come back in from the cold’ and to continue their emotional work (again, others may be able to put this into words better than can I who worked mostly at the edge of this system).

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Elsewhere, I have written in perhaps more moderate and balanced tones about the demise of Henderson Hospital and looked at some of the ways in which the DTC  in its defiant persistence may ultimately have contributed to its own dénouement:

“The Henderson DTC … not only represented an affront as well as a reproach to the over-use and abuse of medico-legal technologies deployed by the conventional psychiatric services for trauma and social exclusion that surrounded it: it also rather enjoyed actively poking its thumb in that system’s eye and should not perhaps have been so surprised when it eventually got thumped for its pains.” (Adlam, article in preparation)

“The Henderson’s own fraught relationship with the system of care … perhaps meant that it found itself too closely identified and ‘damned by association’ with the troubled, anti-social outsiders and misfits who were its client group.” (Adlam and Scanlon, 2013)

But what is a blog for, if not for engaging in familiar safety practices – which, in my case, right now, may well mean slamming a door, or even breaking a window or two? In the permissive culture of the therapeutic milieu, it’s understood one can’t be, would not want to be ‘reasonable’ all the time. Confront me, o reader, with reality – but not just yet, if that’s okay … because it’s ten years since Henderson was closed, and I am still influenced and shaped and inspired by my experience then and in the aftermath of its closure and I’m still mourning its loss but most of all at this the tenth anniversary (give or take a week or two of assembling my thoughts) I am really very deeply furious that it was shut down. I read through contemporaneous accounts of the closure process (some of which weblinks I’ve included as references below) and it still makes me furious. And I’m furious to feel that, provocative, even Diogenesque, though we may have been, nonetheless, some of the Alexanders of the field (not those many allies who stood alongside us, but those arbiters and authorities who stood by) did not come to our aid, or came too late, or came with weasel words, when eventually they rocked up outside our barrel…

Most of all, I’m angry because I keep encountering people who I feel would have found hope in the idea of the availability of the Henderson Hospital Democratic Therapeutic Community as a national specialist resource for traumatised and dislocated souls – and for whom that hope has simply not been available. That door has closed – like so many other doors.

People have died.

Who knows if they would still be alive, if they’d made it into the DTC? No-one can know this. And not everyone who did spend time at Henderson felt helped by it. But austerity and managerialism are violent and mendacious discourses and so let’s not get confused. Of course we could afford to keep the Henderson open. We could then and we could now. Spare me all that crap about cross-subsidies. The annual budget of the Henderson was about a third the cost of a Challenger tank (well, I’m approximating this detail off the top of my head, but that’s the joy of a blog, and you get the point I’m making).

In 2001 the Taliban dynamited the Buddhas of Bamiyan in central Afghanistan. They felt, so it seems to me, that the Buddhas constituted the wrong sort of evidence base and they hated how much those giant artefacts were revered by those whose hearts and minds they were determined to dominate. The closure of the Henderson was, on a much smaller scale, an analogous act of irrevocable cultural vandalism. I sympathise then with Fielding’s Diogenes, who forswears society because he cannot abide the evils he perceives in it.

We can’t just start up a campaign to re-open the Henderson. It’s gone. It leaves a hole in the fabric of the body politic that can never be repaired.

References/weblinks

Adlam, J. & Scanlon, C. (2013) ‘On agoraphilia: a psychosocial account of the defence and negotiation of public/private spaces’, Forensische Psychiatrie und Psychotherapie, 20 (3), 209-227.

https://www.researchgate.net/publication/261759145_’On_agoraphilia_a_psychosocial_account_of_the_defence_and_negotiation_of_publicprivate_spaces’

https://en.wikisource.org/wiki/A_Dialogue_between_Alexander_the_Great,_and_Diogenes_the_Cynic

http://moderngov.southwark.gov.uk/Data/Health%20and%20Adult%20Care%20Scrutiny%20Sub-Committee/20080227/Agenda/Closure%20of%20HendersonHospital.pdf

https://www.independent.co.uk/life-style/health-and-families/health-news/mental-hospital-closure-plan-is-condemned-as-inhumane-765690.html

http://www.communitycare.co.uk/2008/05/27/henderson-hospital-staff-and-residents-fight-to-reverse-closure/

https://www.leighday.co.uk/News/Archive/2008/April-2008/Henderson-Hospital-closes-today—a-failure-by-the

http://news.bbc.co.uk/1/hi/health/7144686.stm

https://www.theguardian.com/society/2008/apr/16/mentalhealth

Henderson April 2008 007

On ‘consultation’

“It is too often forgotten that the gift of speech, so centrally employed, has been elaborated as much for the purpose of concealing thought by dissimulation and lying as for the purpose of elucidating or communicating thought” Wilfred Bion (1966)

“To know and not to know, to be conscious of complete truthfulness while telling carefully constructed lies…” (George Orwell, from 1984)

“…there is a ‘symbolic’ violence embedded in language and its forms, what Heidegger would call our ‘house of being’ … this violence is not only at work in the obvious – and extensively studied – cases of incitement and of the relations of social domination reproduced in our habitual speech forms: there is a more fundamental form of violence still that pertains to language as such, to its imposition of a certain universe of meaning.” Slavoj Žižek (2008)

“He lit a lamp in broad daylight and said, as he went about, ‘I am looking for a man’.” Diogenes Laërtius (early third century AD)

 

Recently Barrelman and his colleagues have found ourselves being (apparently) consulted. There was a ‘Service Review’ in Athens and when its findings were announced, the thing that was proclaimed to follow was a ‘thirty day consultation period’. And when that was done, we were all unceremoniously turfed out of our barrels.

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It all reminded us very strongly of the last time the elders of the city conducted a Service Review. On that occasion, it was to consider the possibility that Socrates, late of this parish, had been ‘corrupting the youth of Athens’. Instead of a consultation, there was a trial – as you may have heard; and at the end of the trial there was a cordial invitation to come by for a cup of something strong.

Socrates could have done a runner at this point, but he elected to drink the hemlock and of course it terminally disagreed with him. In this way, the outcome of the review came to pass exactly as it had been planned and intended when the review was begun – which makes us Cynical types wonder, naturally enough, what on earth was the point of all that window dressing in the first place?

So when the local bigwigs announced a Review, last Spring, our thoughts turned to all those dreary preparations that would eventually turn out to be necessary: like rolling our barrels over to some shady olive grove; finding someone to look after the dogs; writing our wills; that kind of thing. But they were very clear with us that it was not about, you know, ‘jobs’ and such, or clearing undesirables out of the city – and the summer was long and hot and there was plenty to be getting on with, so we just kind of let them get on with it really.

Conceive, if you will, of our discombobulation, when the findings of the Review were announced and they were exactly what had been predicted. It was indeed all about ‘jobs’; and those wandering undesirables (Barrelman in particular, it must be said) were indeed, after all, to be shunted off into the suburbs.

So much for the legendary hospitality of the agora towards the maverick and the marginal!

But it did raise a dilemma: because there was this thing called a ‘thirty day consultation period’. What could they possibly mean by this? If we were being consulted, did this mean what it said on the tin? Or was it something a bit more like ‘insulted’? Or ‘assaulted’, even?

Well, the Cynical response seemed clear: we’d question the ‘findings’, whether or not anyone was interested.

And of course, no-one was.

At least, none of the city elders were interested. Plenty of people in the demos had some very strong feelings about it, being somewhat partial to the itinerant philosopher community and having come to rely upon us for a good old-fashioned harangue when times were tough (which was pretty much always, as the city elders tended to keep all the good stuff for themselves and the people could go hang…)

Still, it left a bit of a puzzle all the same: what was meant by ‘consultation’?

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When in doubt about something like this, there’s worse moves to make than to go down to the library at the Metröon and look it up! And what we found is that ‘consultation’ derives from the word ‘consult’, meaning ‘seek information or advice from’ (someone who knows something). This in turn derives from the French verb ‘consulter’, from the Latin infinitive ‘consultare’; which in its turn derives from ‘consulere’, meaning ‘to take counsel’.

We also looked up ‘consultation’ and found that this is ‘the action/process of formally consulting/discussing’. Here is a definition that makes more sense if you are an Athenian elder – because if you take that definition and you stretch the word ‘formally’ just as far as it will go and then some; and if you then compress the term ‘consulting’ within that definition down to the smallest scrap or iota of meaning that you can manage; then you’re somewhere in range of what they meant when they said there’d be a ‘consultation’ period.

To put the matter succinctly: when you hear an ordinary human being, with a mind of their own and no tail, use the word ‘consult’, what’s going on is that someone doesn’t know something and is seeking counsel from someone who does (like consulting the oracle at Delphi, for example, a thing Barrelman once did, and never looked back…)

But when you hear the word ‘consultation’ being used, especially by officials of the Metropolitan City-State, what is meant is ‘the formal process of NOT seeking information or advice or enlightenment of any description from anyone at all …’.

To which one might add ‘… whilst nonetheless indulging in a piece of transparently cynical (with a small ‘c’) and spurious virtue-signalling to an imaginary constituency of people, presumably all born yesterday, who might be supposed to be capable of imagining or believing that a decision of such import had been taken with meaningful and dynamic and interactive reference to the views and experiences of those who knew something, from lived experience and expertise, about the processes being discussed’.

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So look – Barrelman is not one for special pleading. I don’t want you thinking he’s got a personal beef and he’s just using his platform to vent it. Not that much of a platform, let’s face it. But Barrelman did feel at home in his barrel in the agora and he loved his interactions with the townsfolk and passers-by and as far as he is concerned the Metropolitan City-State and all its works can shove it where the sun don’t shine.

That’s the thing about a barrel – you can always just up and roll it to some other parking place.

But there’s two things stick in his craw. The first is that he has a hunch that the good people of Athens, if asked, would have had other ideas. It’s not comfortable or pleasant to see people being trampled upon in the service of ideologies to which they are not subscribed. But I don’t want to say too much more about that here – not least, because those people are very well able to say it themselves and probably say it better than Barrelman ever could.

No: the main thing to say here is this: there’s a violence done to language in this use of the word ‘consultation’. It’s a symbolic violence but it’s no less lethal for not being a contact sport. Lies and doublethink begin with expedience and end in totalitarianism. ‘Consultation’ is a phenomenon of epidemic proportions, reach and spread, in these post-truth times.

Language is an infinitely versatile but also unwieldy technology. Fiddle with its very basis and you mess most dangerously with minds and souls and systems. This is why Barrelman carries a lamp even in broad daylight – hard to spot an honest man about the place…

To borrow from a joke that’s even older than Barrelman: that ‘consultation’ was no bacon tree – that was an ‘am-bush’ …

 

References

Bion, W.R. (1966) ‘Catastrophic change.’ Bulletin of the British Psychoanalytical Society, 1966, N°5.

Orwell, G. (1949) 1984. London: Penguin Modern Classics.

Žižek, S. (2008) Violence: Six Sideways Reflections. London: Profile.

Dariusz Galasinski writes beautifully about corruptions and collapses of language and communication in mental healthcare systems, including difficulties in psychiatric/clinical consultations – see his blog at http://dariuszgalasinski.com/blog/?stc_status=success&stc_hash=04835e4cdee77914d0112b0a133fe20e

Diogenes Laërtius’ account of the life of Diogenes is at https://en.wikisource.org/wiki/Lives_of_the_Eminent_Philosophers/Book_VI#Diogenes

Janeway’s dilemma: coercive treatment and human rights in ‘eating disorders’ inpatient units

In 2017 the UN Human Rights Council published the “Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health”. The secretariat prefaces the report by observing the Rapporteur’s call “for a shift in the paradigm, based on the recurrence of human rights violations in mental health settings, all too often affecting persons with intellectual, cognitive and psychosocial disabilities” (p.1).

The report goes on to say that “Informed consent is a core element of the right to health, both as a freedom and an integral safeguard to its enjoyment” (p.14). The right to consent to treatment includes the right to refuse treatment but “the proliferation of paternalistic mental health legislation and lack of alternatives has made medical coercion commonplace” (p.14). Justifications for using coercion based on risk and dangerousness and medical necessity are subjective and “exclusive to psychiatrists, who work in systems that lack the clinical tools to try non-coercive options” (p.14).

The report continues:

“Coercion in psychiatry perpetuates power imbalances in care relationships, causes mistrust, exacerbates stigma and discrimination and has made many turn away, fearful of seeking help within mainstream mental health services. Considering that the right to health is now understood within the framework of the Convention on the Rights of Persons with Disabilities [CRPD], immediate action is required to radically reduce medical coercion and facilitate the move towards an end to all forced psychiatric treatment and confinement. In that connection, States must not permit substitute decision-makers to provide consent on behalf of persons with disabilities on decisions that concern their physical or mental integrity; instead, support should be provided at all times for them to make decisions, including in emergency and crisis situations.” (p.15)

The report acknowledges the radical nature of these proposals and the concerns of stakeholders including medical practitioners and proceeds nonetheless to invite States to move towards an “absolute ban on all forms of non-consensual measures … Instead of using legal or ethical arguments to justify the status quo, concerted efforts are needed to abandon it. Failure to take immediate measures towards such a change is no longer acceptable” (p.15)

The implications of this report have been seized upon by service user and survivor groups (see for example Point 7 of the Executive Summary of the Kindred Minds BME Manifesto at https://www.nsun.org.uk/news/bme-mental-health-service-users-launch-manifesto) but mental health services are not perhaps falling over themselves in their haste to catch up.

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The reference to ‘psychosocial disabilities’ includes the contested diagnostic fields of ‘personality disorder’ and ‘eating disorder’ and my business in this blog is with the latter category. For more than fifteen years now I have been working as a psychotherapist on an inpatient ‘adult eating disorders’ unit and for the last seven or so of these years I’ve been leading the psychological therapies team there.

The ‘symptom’ being treated is starvation and the treatment being enforced is refeeding. Psychological therapies are understood to play a central role in supporting this process and/or in supporting the sufferer to undergo the intervention. In my role I am therefore unambiguously party to and implicated in this enforced treatment. This treatment is possibly often life-saving and life-restoring and yet is experienced as a terrifying intrusion, one to be resisted at times by any means possible, by many of the individuals who receive it – and now it has been proclaimed to be part of a widespread and endemic abuse of the human rights of those same individuals.

When I first arrived on that ward, more than fifteen years ago, coercive treatments under the Mental Health Act were very rare (I emphasise here that it is adults I am thinking of and the particular dynamics of adolescent units, although of course also covered by the Rapporteur’s findings, are outside my authority to comment upon). Adult patients in those days were on some psychological level ‘volunteering’ to undergo the intervention, in the hope of making a full medical recovery from malnutrition and from the distress that drove the troubled or troublesome food practices to begin with.

Nowadays 30-60% of patients at any one time are detained under MHA s.3 for compulsory treatment for their ‘disorder’ (specifically, anorexia nervosa, for other manifestations of eating distress are very rarely funded for this kind of unit). Coercion is therefore more explicitly medico-legal than it used to be, even though refeeding was always carried out across a power differential. And according to the Special Rapporteur, the coercive aspect of ‘eating disorder’ treatment is therefore more explicitly in contravention of international law.

In this blog I do not propose to argue for or against the findings and recommendations of the Special Rapporteur. I propose to treat them as a given and to look at the treatments I have been party to and the ethical issues they have always raised in this particular new light. Historic moments like the publication of the report to the Human Rights Council do and must give pause for thought and one question in particular has been niggling away at the back of my mind:

What can the fourth season of Star Trek: Voyager teach us about the ethical limits and excesses and the psychosocial dynamics of coercive treatment for ‘eating disorders’ on inpatient units?

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Well, I know you’ve been asking this very same question … and I don’t mean at all to be flippant about so deadly and deathly serious a subject. But sometimes material from literature and popular culture may serve as useful analogy or parable and I don’t want to blog about a ‘real life’ case study – for reasons I hope are self-evident.

So I hope you’ll bear with me, Trekkies and non-Trekkies alike, while we journey into the 24th century and the Delta Quadrant, 70,000 light years away from Earth, where we find the crew of the starship Voyager, under the command of the intrepid Captain Janeway, stranded far from home, making their way through unknown swathes of space and hostile predators, of whom the most significant for our purposes is The Borg, a hive of drone organisms who anthropophagically assimilate the technologies of alien species via enforced assimilation, turning enslaved individuals into cybernetically and surgically transformed fellow-drones within the Collective in pursuit of an idealised technological and socio-political perfection.

Now when I describe them thus, they don’t sound like a very sympathetic bunch, but you have to remember that the Borg drones have been subjected to coerced medical procedures in order to become Borg. They are already traumatised, colonised, subjected: made abject. They are victims-turned-predators, like a conscripted child army brainwashed into the massacre of alien villagers.

In their predatory and compassionless nature, they are very different indeed from the sufferers and survivors who pass through the door of the ward on which I work. But nonetheless I crave the reader’s indulgence not to be offended if I ask you (why? well, please bear with me a moment) to understand them not as the super-bad guys of the Star Trek mythology but as traumatised subjects with complex post-traumatic stress disorders; to imagine them as life forms with inalienable (although not conceptually individual) rights of their own – to see that they are fearfully perceived as ‘other’ in the sense of ‘belonging to an out-group’ – to see them as fiercely loyal to their sisterhood – in general to note that ‘their’ groupishness is different to ‘ours’ but that groupish they certainly are, chasing mirages of perfection together as one …

I ask you to allow, in short, for purposes of relating my parable, that this image might serve, in translation, as playful but respectful representation of the out-group in the Delta Quadrant of ‘severe and enduring’ eating distress …

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As our story begins, a drone has become isolated from the Borg Hive and taken into inpatient treatment in the Voyager Sickbay. The drone’s appellation is ‘Seven of Nine’. In our story there are no junior psychiatrists – but there is an Emergency Medical Hologram (EMH) (a long story!) and he is presenting a tricky case to the Captain/Consultant Janeway …

EMH: I’m afraid we have a decision to make. A difficult one. Her human immune system has reasserted itself with a vengeance. … Her life is in danger. I have little recourse but to remove the Borg technology.
JANEWAY: Which is the last thing Seven of Nine would want.
EMH: Hence the difficult decision. If a patient told me not to treat them, even if the situation were life-threatening, I would be ethically obligated to honour that request.
JANEWAY: This is no ordinary patient. She may have been raised by Borg, raised to think like a Borg, but she’s with us now. And underneath all that technology she is a human being, whether she’s ready to accept that or not. And until she is ready, someone has to make the decisions for her. Proceed with the surgery.

Here then is the central ethical dilemma. Seven of Nine is being held to ‘lack capacity’. Janeway is acting paternalistically, on behalf of the Federation, in what she feels is a construction of Seven of Nine’s best interests – even though the Voyager MDT is clear that Seven of Nine would not want this. Her junior doctor evokes the CRPD – ‘we must respect the wishes of the patient’ – but Janeway feels she has to ‘hold the hope’ of a full recovery for her captive/patient. Seven of Nine cannot be allowed to remain (cybernetically) disordered – she is at risk of organ failure – a radical intervention is mandated, whether or not in compliance with Intergalactic Law … [I hope by now it’s clearer why I pleaded with the reader to bear with me]

In post-operative recovery, Janeway does a bedside visit …

JANEWAY: I’ve met Borg who were freed from the Collective. It wasn’t easy for them to accept their individuality, but in time they did. You’re no different. Granted, you were assimilated at a very young age, and your transition may be more difficult, but it will happen.
SEVEN: If it does happen, we will become fully human?
JANEWAY: Yes, I hope so.
SEVEN: We will be autonomous. Independent.
JANEWAY: That’s what individuality is all about.
SEVEN: If at that time we choose to return to the Collective, will you permit it?
JANEWAY: I don’t think you’ll want to do that.
SEVEN: You would deny us the choice as you deny us now. You have imprisoned us in the name of humanity, yet you will not grant us your most cherished human right. To choose our own fate. You are hypocritical, manipulative. We do not want to be what you are. Return us to the Collective!
JANEWAY: You lost the capacity to make a rational choice the moment you were assimilated. They took that from you, and until I’m convinced you’ve gotten it back, I’m making the choice for you. You’re staying here.
SEVEN: Then you are no different than the Borg.

Janeway here is channeling Creon in Sophocles’ tragedy, seeking to persuade Antigone that she would be making the pro-social choice in choosing life and conformity over autonomy in death (I write about this a lot in other places). She tries to soothe Seven of Nine with the wisdom of her experience – she has seen others recover. Seven of Nine, from this particular perspective, is a serious case – the disorder took her over at a very young age – but in time she will learn that it’s worth coming in from the cold on Federation terms, even though she doesn’t see it that way right now.

But Seven of Nine, still using ‘we’ in her Borg identification with the Hive, has a perceptive question: if you get me better, so that I am then able to exercise my free will, will you allow me to return to the disordered out-group? Janeway is boxed in by the logic of her own position: she upholds the full recovery model and reasserts Seven of Nine’s lack of capacity. No change to the care plan, sorry, it’s all in your best interests, says Janeway … and Seven of Nine sees it clearly in the moment: I recognise you – you are my abuser.

A little later on, it’s time for Seven of Nine to start therapy – her body is restored somewhat towards a standard of normal functioning – her sense of panic has subsided – she is more compliant, although still held in seclusion – she has entered cautiously into a relationship with her treating team …

SEVEN: … I cannot function this way. Alone.
JANEWAY: You’re not alone. I’m willing to help you.
SEVEN: If that’s true, you won’t do this to me. Take me back to my own kind.
JANEWAY: You are with your own kind. Humans.
SEVEN: I don’t remember being human. I don’t know what it is to be human.
(Janeway picks up a [tablet] and lowers the forcefield.)
SEVEN: What are you doing?
JANEWAY: I’m coming in.
SEVEN: I’ll kill you.
JANEWAY: I don’t think you will.
(Janeway enters the cell, staying out of arm’s reach. She shows Seven the picture from the Personnel File [of Seven of Nine as a human girl] on the [tablet].)
JANEWAY:  Do you remember her? Her name was Annika Hansen … There’s still a lot we don’t know about her. Did she have any siblings? Who were her friends? Where did she go to school? What was her favourite colour?
(Seven looks at the picture for a while, then slaps it out of Janeway’s hand.)
SEVEN: Irrelevant! Take me back to the Borg.
JANEWAY: I can’t do that.
SEVEN: So quiet. One voice.
JANEWAY: One voice can be stronger than a thousand voices. Your mind is independent now, with its own unique identity.
SEVEN: You are forcing that identity upon me. It’s not mine.
JANEWAY: Oh yes, it is. I’m just giving you back what was stolen from you. The existence you were denied, the child who never had a chance. That life is yours to live now.

In a scene that seems to me to evoke forensic psychotherapy settings and seclusion facilities across many pathways, Janeway seeks, within a custodial frame, to engage Seven of Nine’s ambivalence and her repressed memories of her ‘pre-morbid’ condition before the trauma of assimilation by the Borg. Janeway is offering recovery but Seven of Nine not only can’t imagine what that might be like but is not at all sure there’s anything wrong with her that she needs to recover from. The emotional temperature goes up: Seven of Nine is aroused and agitated and distressed and confused but she can still clearly discern Janeway’s agenda, pressing upon her an identity that once was hers but with which she does not and cannot at present identify.

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There’s lots more where this comes from, as Seven of Nine’s ‘recovery journey’ continues and Janeway and her crew gradually increase her privileges and reward her progress with initially fearful and reluctant but gradually more trusting processes and mechanisms of social inclusion. As time goes on, Seven of Nine’s expertise by lived experience will come in handy, when Voyager comes across the Borg again …

But for now, it’s time to leave them to their travels and to come back to the Special Rapporteur and his recommendations. Where does this report leave the coercive framework for inpatient eating disorders treatment? The Rapporteur acknowledges the intense ‘stakeholder’ anxieties stirred by the prospect of radical change. Where would these units be, after all, without their medico-legal technologies?

I have seen people in Seven of Nine’s situation (by allegory and analogy) who, like her, came to feel grateful that their lives were saved by coercive interventions. I have seen others whose lives were saved in the strict (and short term) sense of the word but blighted at the emotional and existential level by the horror of the treatment they received ‘in their best interests’.

Obviously, I have no authority to make an ethical ruling here. The Rapporteur says that “instead of using legal or ethical arguments to justify the status quo, concerted efforts are needed to abandon it”. His position appeals to me and scares me in equal measure. But the point of this blog reduces to one question that inches its way into consciousness, in various different guises:

What if Janeway had wrestled a little deeper with the question of Seven of Nine’s fear of losing everything in treatment? Janeway makes a case for the ‘special patient’ – she pursues a justification for the excess of forced treatment by saying that Seven of Nine is ‘no ordinary patient’. But what if there are never ‘special’ reasons for using force? This is the axiom that we are being required here to accept.

The Rapporteur says we “lack the clinical tools to try non-coercive options”. What if the increasing power and potency and even sophistication of our medico-legal technologies (the Mental Health Act; the Mental Capacity Act; Community Treatment Orders; naso-gastric feeding; PEG feeding; pharmaceuticals and so forth) has deskilled us in some simpler forms of intervention? Suppose our coercive muscles are so well developed, that our engagement skills have become rather flaccid and feeble with disuse?

Suppose we invested in developing those skills in what Judith Herman called ‘existential engagement’, instead of falling back in relief, behind our coercive medico-legal redoubts, away from the stresses and strains of open debate? Suppose as many or even more lives might have been saved in creative ways, as have been lost to mishap or suicide under more coercive regimes?

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I don’t know; but I wonder …

 

References

Adlam, J. (2015) ‘Refusal and coercion in the treatment of severe Anorexia Nervosa: the Antigone paradigm’. Psychodynamic Practice, 21 (1), 19-35.                  https://www.researchgate.net/publication/265685587_Refusal_and_coercion_in_the_treatment_of_severe_Anorexia_Nervosa_The_Antigone_paradigm

Herman, J. (1997) Trauma and Recovery: The Aftermath of Violence – From Domestic Abuse to Political Terror. New York: Basic Books.

‘Star Trek: Voyager’ screenplays from http://www.chakoteya.net/Voyager/401.htm