Late Modern Subjectivity and its Discontents

Anxiety, Depression and Alzheimer's Disease

Kieran Keohane, Anders Petersen, Bert van den Bergh

• Publisher: Routledge
• Year: 2017
• ISBN:
  9781315447186
• Edition: 1
• Topic: Social Sciences
• Subtopic: Sociology
• Index: Social Sciences

This book analyses three of the most prevalent illnesses of late modernity: anxiety, depression and Alzheimer's disease, in terms of their relation to cultural pathologies of the social body. Usually these conditions are interpreted clinically in terms of individualized symptoms and responded to discretely, as though for the most part unrelated to each other. However, these diseases also have a social and cultural profile that transcends their particular symptomologies and etiologies. Anxiety, depression and Alzheimer's are diseases related to disorders of the collective esprit de corps of contemporary society.

Multidisciplinary in approach, the book addresses questions of how these conditions are manifest at both the individual and collective levels in relation to hegemonic biomedical and psychologistic understandings. Rejecting such reductive diagnoses, the authors argue that anxiety, depression and Alzheimer's disease, as well as other contemporary epidemics, are to be analysed in the light of individual and collective experiences of profound and radical changes in our civilization. A diagnosis of our times, Late Modern Subjectivity and its Discontents will appeal to a broad range of scholars with interests in health and illness, the sociology of medicine and contemporary life.

1 Introduction to a series

Kieran Keohane, Anders Petersen and Bert van den Bergh

The series: The Social Pathologies of Contemporary Civilization

In The Sociological Imagination, C. Wright Mills famously claims: ‘Neither the life [or, we would say, the health] of an individual nor the history of a society can be understood without understanding both’ (1959: 3). In this spirit, the overarching theme of this book series is that the social sciences as well as the humanities should thoroughly investigate the ways in which contemporary malaises, diseases, illnesses and psychosomatic syndromes are related to cultural pathologies of the social body and disorders of the collective esprit de corps of contemporary society. Hence, focus should be directed at understanding contemporary problems of health and well-being in the light of radical changes of social structures and institutions, extending to deep crises in our civilization as a whole. Problems of health and well-being have hitherto been considered chiefly in isolation; both in isolation from one another and in isolation from broader contexts. This path has shown to have severe limitations. Instead, one should explore the fruitfulness of not just locating health and well-being at the level of the individual body, but within a trans-disciplinary imagination that takes into account the integral human person’s situatedness within collective social bodies, particular communities, entire societies, or even whole civilizations, encompassing the health of humanity as a whole and our relationship with nature.

Social pathology was once a mainstream concern of the social sciences, but over the years it has become associated with conventional, ‘old-fashioned’, or normatively conservative standpoints. For instance, the social science focus on social pathologies of the early and mid-twentieth century was on specific topics, such as alcoholism, crime and delinquency and (what was seen at that time as) sexual deviance. More recently, professional clinicians and medical doctors have provided a great number of books in a ‘self-help’ genre oriented to both a specialist readership and to a broad audience. There is a wide variance of quality in the genre. Some are ‘best-sellers’ because their authors hold positions of authority and their readers are looking for authoritative guidance. However, the weakness of most books in this genre is that they concern themselves with one discrete problem – depression, or eating disorders, or stress – and/or that they are focused at the level of the individual subject.

Conscious of this problematic antecedence and its narrowly ideological and moralistic legacy, the Social Pathologies of Contemporary Civilization book series breaks decisively from this anachronistic context, as indicated by its three distinct emphases: the series focuses on the social – that is, historical and cultural as opposed to reductive psychological and biomedical – sources of contemporary epidemic pathologies; and, extending beyond the urgency of the new pathologies and beyond the immediate and particular context(s) of the present society(ies) in which they occur, the analysis extends to encompass principles and processes of global western civilization as a whole.

The social pathologies of contemporary civilization – depression, stress-related illnesses, eating disorders, suicide and deliberate self-harm, to name just a few – are the subject of much discussion today, and they are the problems recognized and targeted by mental health professionals and in public health campaigns promoting mindfulness and well-being. While sympathetic to these problems and while aware of these developments in public mental health promotion and appreciative of them insofar as they are well-intentioned, this book series is concerned with understanding more widespread social pathologies than fall within the conventional remit of mental health and well-being.

As well as these illnesses that are at least recognized as such, there are more general, diffuse social pathologies that have so far not even been formulated as being problematic. On the contrary, they have come to be seen, broadly, as the normal conditions of life in contemporary society, so much so that, echoing Sigmund Freud, ‘to be sane in a sick society is to be sick relative to the society’ (Freud 1961/1930: 102f). For instance, under the auspices of the neoliberal revolution whereby the norms of society are eclipsed by the principles of the market, a corresponding new type of subject has been emerging. Shaped by the experiences of hyper-individuation and the political-economic and cultural-ideological emphasis on the purported rationality of utility-maximizing individual self-interest we can see a florid symptomology of egoism, conceit, greed and narcissism that, in many ways, approach new forms of psychosis. Moreover, the amorality of the market and the relativization and dissolution of collective ethical frameworks and ideals (whether traditional-religious or modern-secular) under conditions of global post-modern culture, results in an amplified and intensified anomie and loss of meaningfulness, a moral vacuum experienced individually and collectively. One of the characteristic aspects of this social pathogenic milieu is a generalized experience of liminality; a morbid interregnum wherein we are ‘stuck in a moment’ as it were; living in a interminable present, with a lack of sense of history on the one hand and lack of a sense of a future – other than an extension of the present – on the other. Characteristic social pathologies of this condition of ‘permanent liminality’ (Szakolczai 2000: 220) include an acceleration and intensification of sensations (rather than meaningful experiences); a proliferation of choices (rather than significant decisions) and individual and collective amnesia/aphasia corresponding with loss of historicity, and of despair/hopelessness corresponding with loss of futurity.

Hence, social pathologies are treated as multiple and as being related to one another, and as not merely problems to be understood and addressed at the level of the individual sufferer but rather as to be understood in social and historical terms. Instead of addressing these conditions as though they were discrete pathologies, specific diseases suffered by private individuals as ‘cases’, the starting point is thus that the sources of these problems are social, cultural and historical: that they arise from collectively experienced conditions of social transformations and shifts in our civilization. This diagnostics of social pathologies of contemporary civilization suggests also a corresponding therapeutics. When we consider the challenges of recovery we realize that our individual and collective health and well-being will require more than changes at the level of the discourse of professional medicine, or at the level of the contents and forms of health services and policies, but, more fundamentally, a revitalization of our social, political, cultural and moral institutions.

This book series will solicit contributions of single-author manuscripts and thematic collections that address and explore different aspects of the Social Pathologies of Contemporary Civilization. As the theme transcends disciplinary boundaries, we call for several disciplinary perspectives – philosophy, sociology, social psychology, politics, anthropology and economics; from the humanities and arts more generally, and, of course, from medicine, therapies and the healing arts. The readership for the Social Pathologies of Contemporary Civilization series will be similarly trans-disciplinary and diverse, encompassing the particular academic readerships indicated above, and extending too to a readership in professional training for social work, nursing, public health, education, social policy and cognate vocational fields.

The series editors

Social Pathologies of Contemporary Civilization (SPCC) is an international collaborative project led by Anders Petersen (University of Aalborg, Denmark), Kieran Keohane (University College Cork, Ireland) and Bert van den Bergh (The Hague University of Applied Sciences, The Netherlands). The SPCC collaboration encompasses teaching, research and publications with partners in Denmark, Ireland, UK, Netherlands, Sweden, Italy, USA and Canada. The network has organized several international conferences and related workshops since 2010.

The first volume: Late Modernity Subjectivity and its Discontents: Anxiety, Depression and Alzheimer’s Disease

This first volume of the series on the Social Pathologies of Contemporary Civilization, analyses three of the most prevalent illnesses of late modernity: anxiety, depression and Alzheimer’s disease, in terms of their relation to cultural pathologies of the social body and mutations of subjectivity. Usually these conditions are interpreted clinically in terms of individualized symptoms and framed in demographic and epidemiological profiles. They are represented and responded to discretely, as though for the most part unrelated to each other; each having their own professional discourses of aetiology, diagnostics, therapeutics, as well as their taskforces developing health strategy and policy recommendations and interventions. However, these diseases also have a social and cultural profile, one that transcends the particularity of their symptomology and their discrete aetiologies. Anxiety, depression and Alzheimer’s are diseases related to disorders of the collective esprit de corps of contemporary society.

Multidisciplinary in approach, the book addresses questions of how these conditions are manifest at the level of individual bodies and minds, as well as how the ‘bodies politic’ are related to the hegemony of reductive biomedical and psychologistic perspectives. Rejecting such a reductive diagnosis, the central research hypothesis uniting the book is that anxiety, depression and Alzheimer’s disease, as well as other contemporary epidemics, are to be analysed in the light of individual and collective experiences of profound and radical changes in our civilization, of corresponding mutations of subjectivity and of the social hegemonization of the biomedical and psychiatric perspective.

First, before we focus on the three above-mentioned concrete malaises, the broader cultural context is explored by discussing the anthropological mutation of the subject which has taken place in the transition from modern to post-modern (or late modern) times. This mutation entails the emergence of an isolist precarious subject faced with the task of creating a self, though deprived of the conditions of possibility of successfully undertaking such a project under conditions of the neoliberal revolution. The presentation of the essential hypothesis of the mutation of subjectivity under conditions of neoliberalism by one of the world’s foremost proponent of that diagnostic, Dany-Robert Dufour, sets the scene for the analyses that follow, namely those of three major ‘epidemics’ of our time: anxiety, depression and Alzheimer’s disease. We choose these three conditions because not only are they key disorders of our present age, but also they correspond roughly with stages of the life course, anxiety being the fastest-growing malaise among youth and adolescence; depression being an affliction especially of young adulthood and mid-life; and Alzheimer’s dementia as the coming ‘epidemic’ of an aging population.

So first, in Chapter 2, the French philosopher Dany-Robert Dufour outlines the context of late modern social pathologies by focusing on the transition from modern to post-modern (or late modern) subjectivity. In the last 15 years Dufour has undertaken an extensive, multi-volume investigation into what he terms the ‘liberal cultural revolution’, a cultural transformation the heart of which consists in a gradual, longlasting liberation of the human passions, leading to the emergence of a Sadean, isolist type of subject. ‘Isolism’ is a term De Sade used to indicate his ideal type of individual: narcissist and hedonist. According to Dufour, it is this type of subject which is propagated, stimulated and constituted by late modern capitalism, or, in other words, by the ‘Divine Market’. Here, in this second chapter of this first volume of our series, Dufour’s analysis of the ‘anthropological mutation’ proceeds in in four steps. First, he reveals his psychoanalytical sources by defining the subject-as-such as the being that because of its neotenic nature is the ‘most-low’ (or the little subject) who is subject to the ‘Most-High’ (or the big Subject, or the Other). Second, while working within the Lacanian psychoanalytic paradigm Dufour critiques and develops that paradigm by presenting what the latter fails to take properly into account, namely the different historical, anthropological, sociological and political figures of the big Subject: these include totems, spirits, immanent gods, transcendent gods; sundry kings and absolute monarchs; and, more recently, modern iterations and incarnations of the big Other such as the nation, the people, the great leader; or abstractions such as reason and science; and, finally, today, the market, which – in Dufour’s account – purports to be a big Subject, but it fails to be such. Third, Dufour separates modernity, which he presents as the space in which the subject is defined by several figures of the big Subject, from post-modernity, in which the grand narratives have collapsed and no other presentable figures of the big Subject can be proposed. The market is inadequate as a new big Subject, Dufour states, because it doesn’t function as a ‘grand story’ – that is, not as an encompassing collective narrative – but as a fragmented whole of ego-oriented ‘small stories’. Therefore it has nothing to offer to the subject considering the basic problem of foundation. It only offers dual relationships and does not acknowledge the third. In this way it confronts the subject with the impossible task of founding itself. The subject henceforth is defined auto-referentially instead of hetero-referentially. The result of this is a mutation of subjectivity: the modern neurotic and critical subject makes way for the post-modern ‘psychotisizing’ or borderline-like subject, which is no longer functioning primarily symbolically but libidinally. This dynamized insecure auto-referential subject is an easy target for the powerful apparatus called the market. ‘Neoliberal’ times are therefore the era of a new servitude. Lastly, Dufour discusses briefly ways of compensating for the absence of the big Subject: 1) groups and gangs, 2) sects, 3) dependence and addiction, 4) omnipotence and 5) depression.

After this, in Chapter 3, Anders Petersen presents the thesis of a return of the ‘age of anxiety’. Since the end of the 1980s we have lived in what Jerome Wakefield and Allan V. Horwitz have referred to as the ‘age of depression’. Their claim is based on two facts: first, that during the last 30–40 years, more and more people have been diagnosed with depression; second, that western countries particularly have witnessed a steep increase in the number of people who use antidepressant medication. Although depression is still a very common diagnosis – and medicalization of mental illnesses such as depression has not come to an end – there seems to have been a development towards anxiety as becoming the more precise signifier of our contemporary mental malaise. Empirically, this is backed by recent statistics that show that anxiety has dethroned depression as the most commonly diagnosed mental disorder in Denmark (and elsewhere). Now, W.H. Auden famously proclaimed in the 1950s that this was ‘the age of anxiety’ – so one should perhaps talk about the return of that particular age. But, one cannot equate Auden’s age of anxiety with the one that seems to haunt contemporary life. The general claim in this chapter is that there are different types of anxiety at stake today than in Auden’s age and that anxiety should be seen as a particular social pathology that reveals particular aspects of contemporary society.

In Chapter 4 Bert van den Bergh discusses a phenomenon that only since 1980 has been formally separated from anxiety, namely depression. On the basis of, among other things, Dufour’s analysis of the ‘liberal cultural revolution’ and his identification of a ‘Sadean subject’, the focus in this chapter is on the so-called ‘depression epidemic’, which is said to be haunting late modernity. According to the World Health Organization (WHO), depression is ‘the leading cause of disability world-wide’. Within the dominant Diagnostic and Statistical Manual of Mental Disorders (DSM)-based conceptual and practical framework of mental health care this disorder is taken as a universal condition which particularly hits our contemporary society. In this chapter this presupposition is questioned by taking a cross-cultural perspective. The leading thesis is as follows: the phenomenon which we have termed ‘depression’ is not only interpreted but also constituted differently across cultures because of the ‘work of culture’ – that is, culture-specific narratives and practices. This thesis is explored via a discussion of the critique that has been formulated from different theoretical angles on the concept of depression as it dominates western mental health care discourses since the ‘neo-Kraepelinian revolution’ of DSM-III in 1980. The chapter moves from a critique from the (biopsychiatric) ‘inside’ to one from the (phenomenological) ‘outside’. Taking the dominant DSM-based interpretation of depression as a culture-specific and historically determined understanding of a universal underlying phenomenon leads to the twofold question of what this underlying phenomenon might be and how we may get access to it. A preliminary answer to these questions is that we need to ‘bracket’ our dominant understanding of ‘depression’ in order to get to the Sache selbst – that is to say, this ‘mental disorder’ understood on the level of (a disruption of) a primal process of pre-conscious attunement by a presubject and its ambiance. Bracketing our dominant understanding of depression means turning away from the ‘neoliberal’, (hyper)individualistic interpretation of subjectivity and getting back to the human being as basically a ‘social animal’. From a phenomenological, non-individualistic angle depression then comes to the fore as a social affect and as a disruption of a basic attunement. The depressed individual, in other words, is above all not sad but isolated or distuned.

The third concrete malaise that is discussed by Kieran Keohane in Chapter 5 is Alzheimer’s disease. The general hypothesis is that what has come to be known as ‘Alzheimer’s disease’ arises from the unfulfilled deep need for life to be coherent and meaningful. Alzheimer’s disease and the dementia reputed to it are formulated in terms of transformations of late modern society, the disintegration of individual consciousness from the conscience collective and fragmentation of the symbolic order resulting in generalized asymbolia (loss of meaningfulness). The analysis is developed by re-examining the findings of the ‘Nun Study’, the most famous longitudinal epidemiology of Alzheimer’s disease to date. These empirical materials are ref...