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.

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