The Weariness of the Self: Diagnosing the History of Depression in the Contemporary Age – Alain Ehrenberg
This period’s psychic trauma would involve train accidents. These were no simple mishaps as, during the nineteenth century, the train represented modernity, the Bête humaine whose imaginary effects on material and spiritual life were immense: “The railroad fixed the very idea of an accident with its modern meaning.” For the first time in human history, it was not only nature or war that caused catastrophe but also the human inventions of technology and industry. From this stems the issue of reparations and responsibility. Beyond the broken bodies, another phenomenon appears: uninjured people complain of headaches, backaches, partial paralysis, or amnesia. These injuries were not caused by lesions. John Erich Erichsen, a London doctor, in one of the first studies published on the subject in 1866 invented the term “railway spine” to name the “spinal shock” that caused such headaches. Another London doctor, Russell Reynolds, suggested that the symptoms of these disorders were comparable to those of hysteria and underscored that they were produced by ideas, though still far from the realm of madness.
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A second difficulty stemmed from the patient’s constitution. What if the patient’s disposition or character were built in such a way that he had little capacity to enjoy his existence? “Modifying an inexorable predisposition to mood and psychological instability… is an illusion for those who believe in the total irreducible nature of constitutions and who assign the fixed nature of a histological lesion to morbid behaviours.” What could be done about nature? Very little, although psychological analysis gave us the means to examine these fragile constitutions, the better to strengthen them. Medicine was easily impressed by nature’s bulwark. When the constitutional state dominated, hopes for healing were slim. Doctors knew quite well how to diagnose anxiety neuroses that expressed themselves through short panic attacks, keeping the patient in a permanent state of fear of their return. If the diagnosis was easy, the therapeutic options were not, since “the basic predisposition that escapes the effects of medicine often gives sway to the occasional causes on which it is easier to act.”
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Mental disorder must be understood and treated on a double basis: (1) by acting on the centre of the lower functions (i.e., the thymia) and (2) by integrating the higher functions (as expressed in the patient’s personal history). We could say that the sick self is affective: her emotional life is the meeting point of her thymic illness and her erroneous judgment.
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In 1985, it was acknowledged that “depression remains… a concept with blurred boundaries. What is known is that it is ‘what antidepressants cure.’” Therefore, “the most common approach in treating depression is an empirical one.” In 1996, the same observation: “The concept of depression remains vague.” What is more: “the adage according to which we know better and better how to treat it, but less and less what we are treating, remains valid.” But what do we treat better when we do not know what we are treating? What are the criteria for a cure? Some fifty years after the discovery of antidepressants, psychiatry, in the face of all that is vague and heterogeneous, is still struggling to produce a theory of depression.
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Distinguishing two main categories of depression, “neurotic” (or simple) and “endogenous,” the authors went on: “Our greatest diagnostic difficulty occurs when endogenous depression takes the form of a simple depression.”
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I could no longer submit to Fate. My wish was not to be good, in the way of our tradition but to make good. But how? What did I have to offer? …
This anxiety began to eat away at me.
V.S. Naipaul, A Bend in the River, 1989.
Sexual liberation has replaced the fear of sin with a desire for normality.
Augustin Jeanneau, “Les risques d’une époque ou le narcissisme du dehors,” 1986.
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Why force patients to face up to their conflicts when medical assistance can compensate for feelings of inadequacy? […] At the same time, the therapeutic status of psychotropic medications began to be questioned: were we drugging people or really treating them? The disconnect between the two models of illness, along with the erosion of the regulating functions of the forbidden, led to a questioning of the boundary between the normal and the pathological. The land of the permissible would be subordinated to the land of the possible.
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In the social realm one could make up one’s own rules, while clinically, the measures taken served less to encourage a state of equilibrium for the individual than to remove his inhibitions and enable him to widen the scope of his own possibilities.
According to Philip Rieff, what the new therapeutic age had to offer was the collective determination “not to pay the high personal costs of social organization.” Not to pay? This glorious innerness went hand in hand with different ways of expressing our private anxieties. Mental pathologies where intrapsychic conflict was not present but where, on the other hand, a sense of one’s valuelessness prevailed were an object of concern that did not exist in France during the 1960s. A lowering of self-esteem, feelings of inferiority: these bore a strong resemblance to deficit. If conflict was linked to guilt, deficit was bound to narcissism. This was the great lesson that depression would impose on the individual who thought he could set himself up as his own legislator.
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Beyond melancholia, two situations could present themselves. In the first, sadness and helplessness were neurotic symptoms in the same sense as were obsession or hysterical paralysis. But there was a second type of depressive emotion more difficult for psychoanalysis to classify: it was not a symptom but, rather, a pathological system characterized by the loss of an object, and it was much more tenuously related to the idea of the forbidden. In this case the conflicts were pre-Oedipean. That indicated that these patients had stalled at a stage preceding their identification with parental images, which were the first objects presented to them. The patient had remained at a phase where he was still one with the mother. If neurosis was a pathology of identification, then the borderline condition, because the individual had not been able to develop relationships with objects, was a pathology of identity. Indeed, he had great difficulty identifying himself. He was, one might say, his own impotent sovereign – which was the source of the “extraordinary diminution in his self-regard: his delusion of inferiority.”
Depression, then, was not a neurotic symptom because the personality structure associated with it was different from that associated with the neurotic. Psychoanalysts called it “the depressive personality.” “The depressive personality,” wrote André Haynal, “seems unable to free itself from the problem of loss, unlike various neuroses that will bring to bear defensive strategies in order to control the negative inner states it creates … With neurotics, depression is the indicator of a particular loss…; but depressive structures live chronically in the shadow of an unresolved problem of constant loss, of being always the loser, the disappointed.” The borderline condition was not a vague catch-all, it was a structure with the same legitimacy as neurosis, psychosis, or perversion. The great difference between a neurosis with depressive symptoms and this pathological system was that, in the first instance, the individual managed to construct stable defences, while in the second, her identity crisis was permanent and often manifested itself in chronic depression.
And so psychoanalysis found itself face to face with a depression that was not melancholic and that did not play itself out in the one realm where this therapy had the most success – neurosis – leaving it with an impassable conflict that made the individual ill. This type of patient attracted the attention of British psychoanalysts in the 1930s and became the focus of much attention in North America in the 1950s and 1960s. These patients first turned up in psychiatry at the end of the nineteenth century, at a time when the boundary between psychosis and neurosis was being established. They had character disorders stemming from their constitution but did not suffer the implacable destiny that led to dementia. Twentieth-century French psychiatry was very familiar with such patients. Henri Claude talked of schizomania; Eugène Minkowski of a schizophrenic character with no habitual dissolution of identity, as in schizophrenia; Henri Ey of schizo-neurosis. The patients lived in a state of permanent psychic disequilibrium. These pathologies were called “narcissistic.”
This narcissism was not that love of self that was one of the products of joie de vivre but, rather, the experience of being captive to a self-image so idealized that it led to impotence and paralyzed the individual, who had a constant need to be reassured by others and could easily become dependent on them. One can see how group therapies might compensate for this fragility. The psychoanalysts had a tool to define their pathology, which was the Ego Ideal. The phenomenon was defined variously in Freud’s thought, but we could say schematically that it was linked to narcissism just as the Superego was linked to the forbidden; the feeling of inferiority was to the first what the feeling of guilt was to the second. In fact, if the Superego told one not to do, the Ego Ideal urged one to do.
In narcissistic pathologies, the Ego was so invested that any frustration was hard to endure.
The patient never derived any satisfaction from her impulses; she felt empty and reacted aggressively, impulsively, or by acting out. If the neurotic was defined by her psychic conflict, the borderline personality was not able to enter into conflict: she was empty. This type of patient posed very special problems for a cure because it was difficult not only for her to work through her psychic conflicts but also to negotiate a transference with the analyst, which was a precondition for successful healing. She was not open to analytical “influence” because the identifying processes had not been instilled in early childhood. The prognosis for these depressions was poor.
[…] Psychoanalysis would more and more be faced with cases that, traditionally, were outside its purview, “where emptiness, absence, […] were particularly acute.”
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The interesting point about these nosological debates for the problem that concerns us is that neurosis was seen as the consequence of a conflict that rendered one guilty (including when depressive symptoms were dominant), while depression was experienced as a shameful flaw. Narcissism clouded the issue where the forbidden was concerned; the neurotic personality’s illness was one of wrongdoing, whereas the depressive personality’s sickness was one of inadequacy. It seemed to lack a well-developed Superego, and it was subject to very few conflicts. “Whereas potent individuals easily acquire anxiety neuroses,” wrote Freud, “impotent ones incline to melancholia.” The depressed individual was immersed in a logic where inferiority was dominant, while neurotics were involved in a dynamic of transgression: they wanted, as Freud said, to be nobler than their constitution allowed. Did the disappearance of the regulatory force of the forbidden and the strait jacket of conformity open the way to depression? The depressive personality remained fixed in a permanent state of adolescence and was unable to become adult and to accept the frustrations that were the lot of every life. The result was fragility, a permanent feeling of precariousness or instability. […]
These depressed individuals, whose Egos were characterized by inadequacy, underestimated the value of their experiences: “The feeling of not being as strong as one would like was often expressed in terms of ‘fatigue,’ as well as the sense of being less stimulated than one would prefer.” That is why this type of depression manifested itself less through guilt than through shame. It “is the prime emotion in the narcissistic realm … What is more, it implies that the individual feels himself to be responsible …, as if, like a god, he thought he had created himself on his own. The depressed individual feels shame because, in his fundamental megalomania, he cannot admit to his inadequacies; he does not admit to feeling limited by reality, and in particular by the constraints imposed on him by his personal history and his affiliations.” Guilt was related to law, while shame was related to the “social gaze.” The success of group therapies doubtless resided in a process of “shame removal.” In fact, when the reference was no longer a fixed precept, when the impersonal law no longer counted, the other became the only means to having one’s choices validated. This often pathetic quest for the other could, in the most extreme cases, turn into a dependence, an insatiable need.
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The craving for drugs appeared, in the eyes of psychoanalysts, like a choice equivalent to that offered by group therapies: a means of defence against depression. “The path leading from depression to different forms of drug addiction is being travelled more and more frequently,” noted André Haynal in his report on depression. The depressive individual, in fact, could not cope with frustration. Alcoholism or addiction to narcotics or medication was a way to compensate and could be considered as a form of self-medication for depression. The addictive input was the other side of the coin to the depressive void.
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The pathology was often hidden behind a façade of good socialization and professional, even domestic accomplishment. The personality could be a “false self,” an “as if.” The addictive behaviour betrayed the contradictions of this type of pathological individuality, which involved “an opposition between the inflated idea they have of themselves (excessive self-obsession and a constant need to be admired), and their unusual state of dependency.”
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“The individual does not construct a symptom, as in neurosis, nor a delirium, as in psychosis (which already presupposes a high degree of mental processing), but acts out the conflict [behaviourally],” through addictions, compulsions, suicides, and acting out itself. These “acts” fill the depressive void; they are a way of compensating for it.
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The depressive implosion and the addictive explosion were from now on inseparably linked: the impotence void and the compulsion void were Janus’s two faces. In the case of depression, it was not sadness that dominated the picture but impotence – the difficulty of acting – and the inability to cope with frustrations (does not choosing imply being able to renounce?). This led to the new face of depression, which was dependency – the unbalanced action produced by the absence of self-control.
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In French psychoanalysis in particular, depression was regarded as a symbolic collapse: the difficulty in experiencing conflict weakened the identifying mechanisms needed to structure an identity that could live with such conflict. The style of despair changed along with the style of hope. The anxiety of being oneself morphed into the weariness of being oneself. This was the guise our inner constraints now assumed as a new age for the individual was taking shape.
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In fact, as many studies noted, at least since the beginning of the 1960s many patients had been complaining of a variety of symptoms that had no organic foundation: they were masks for depression. These changes involved a wide spectrum of somatic symptoms, ranging from headaches to cardiovascular and gastro-intestinal problems.
[…] “its immense practical impact, above all for non-psychiatrists,” all the more so in that the somatic manifestations of depression were extremely diverse (constipation, palpitations, hair loss, sensitivity to cold, etc.), which made the pathology even more elusive than was thought.
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(on DSM-III)
The alliance between deficit and conflict enabled the psychotropic drug to be only a medication. Their separation raised the question: drug or medication? “Very often the depressed individual does not have to actively seek out the help of a drug; his doctors take the initiative in making him a ‘passive’ addict. Is that really necessary? Is that therapeutic progress, in the sense that the patient’s true personality finds itself hidden from the outside world and led along a path that severs the affective connection making a psychological approach possible?”
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Depression is not a subjective state, it is a style of action.
Daniel Widlöcher, “L’échelle de ralentissement dépressif: Fondements théoriques et premiers résultats,” 1981.
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The second instrument of turn-of-the-century individuality was that of individual action.
The gospel of personal fulfilment was backed up by the commandments of individual initiative. The questions of identity and of action came together in the following way: on the normative side, individual initiative joined forces with psychic liberation; on the pathological side, a difficulty in initiating action was associated with identity insecurity. […] At the same time, psychiatric thinking was more and more convinced that the fundamental problem in depression was psychomotor: what had been a mood disorder was now a dysfunction in mental activity. To violate the norm was less a matter of disobedience than of being unable to act. This was a new concept of individuality.
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Chapter 7 shows how depression became a chronic identity pathology. This resulted from the migration of the neurotic terrain, with its long-term personality disorders, into the continent of depression. Now the distinction between a mood disorder that one had (in the course of a depressive episode) and the troubled personality that one was lost its former meaning. The chronic nature of the condition jeopardized the idea of a cure. The result was the emergence of a persona with wide implications: the valid invalid. It is not so much that it provided added evidence for the over-publicized crisis of the self as that it signalled a shift in the experience of subjectivity, a reorganization of the relationship between private and public that defined the arena in which modern intimacy would be played out.
The reactions to the crisis of the cure suggested that curing something was no longer the issue; what was important was to be accompanied and modified more or less constantly – by pharmacology, by therapy, and by socio-political means.
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“Depressed people,” the authors write, “are old before their time.” They have three times more digestive, urinary and genital, and cardio-vascular disorders; twice as many cancers, endocrine system diseases, osteo-articulatory problems; and so on.
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His [Peter Kramer’s] is a practical reflection on the type of self demanded by «today’s high-tech capitalism»: “Confidence, flexibility, quickness and energy… are at a premium.” Let’s just say that these attributes let us stay in the race longer. Because it was effective with people who were not “really” depressed, the product called Prozac got the reputation of being able not only to improve mood and to facilitate action but also to transform personality in a favourable manner. The patients described by Kramer were able to “be productive” with Prozac.
[…] “The issue cannot be contained within the medical world alone,” an author wrote in L’Encéphale in 1994, and this we have forgotten: “Patients need results depending on the time they have and their other obligations. Not to take this into account might expose them to socio-professional difficulties that would turn into depressive complications.”
[…] Jonathan Cole and Donald Klein, for example, thought that a number of people taking Prozac were waiting in vain for the miraculous effects of the product – either that or its supposed effectiveness depended more on wishful thinking. A sociological study conducted via interviews with people taking antidepressants showed that Prozac’s effect was quite variable and that disappointment was not rare at all. SSRIs are exactly like all other antidepressants: their effectiveness varies.
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The ideal antidepressant is the modern version of such myths. It carries us into the magic of miracle powers, the power of “the shaman who could cure us with a simple breath, a potion, a mixture, an incisive destructive force.” “Now we must,” he wrote, “reject that senseless belief that could … take root: that a pill could straighten the soul, give back the taste for living, create sudden and utter joy.” No medication, psychotrope or not, is an all-powerful potion that can be applied to an illness (or any other sick entity) and so cause it to end.
Please forgive me, but I have bad news: the supposed all-curing properties of antidepressants are simply band-aid solutions to an incurable illness, as we are now beginning to see. Everything becomes depression because antidepressants act on everything. Everything can be treated, but we no longer know what can be cured. The conflict is hidden as life becomes a chronic identity illness. That is not necessarily a bad thing, for our individualities are perfectly built to stand such “diseases,” but we’re better off knowing what they are hiding.
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SSRIs created the fear of a chemical abrasion of the dilemmas that make our subjectivity. Insofar as we possess medicines that can be applied as much to serious pathologies as to small cuts and scrapes, the loss of the need for a diagnosis would mean that the nightmare of a society of “pharmacohumans” would finally come to pass. I hope I may be allowed to use that expression to speak of a category of persons who would no longer be subject to the usual condition known as limits.
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From the 1980s onward, psychiatric epidemiology began to realize certain things about the difficulties of treatment – for example, resistant depression and chronicity were the rule. Cure entered a crisis.
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The crisis of cure and the decline of the reference to conflict suggest that contemporary individuality is simply no longer part of cure; it is accompanied and transformed in all sorts of ways as it moves through time. Simultaneously, from the political point of view, our societies have left behind the idea of the right solution (this accounts for the breakdown in the traditional French left-right divide). Conflict no longer seems to structure the unity of the person with his or her social world, and its messages no longer seem to provide adequate guideposts for action.
The two levels of the crisis of cure in psychiatry and the “deconflictualizing” of the psychic realm (as well as the social zone) lay down the main lines for our new collective psychology. The subject does not emerge from this process moribund, just changed.
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Three-quarters of patients who have experienced an episode of depression will not recover the psychological equilibrium they possessed before. […]
The consensus on these proportions leaves no doubt: most patients do not recover their past equilibrium, a good minority will experience only partial remission, and a large majority will fall into relapse and depression as a chronic condition.
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Though the emphasis on the necessity of associating psychotherapeutic help with the antidepressant cure remains a constant, it “does not appear to lessen the risk of relapse. It may simply lead to the patient sticking to the cure in a better fashion.” Psychotherapy becomes an enabler for chemical therapy. Besides, the psychotherapies most recommended today are behavioural or cognitive. And they are based on an exclusively deficiency-based model.
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The distinction between the DSM’s Axis I, which lists pathologies, and its Axis II, which lists pathological personalities, was challenged insofar as the long duration of the disorder seems to indicate that the patient’s personality is at the heart of the matter. These types of depression create consensus on one point: their prognosis is very bad. Therapy is a long-term affair, and its objective is “to maintain remission through disallowing the symptomatic expression of a process that is presumed to still be active.” Yet there has not been any evaluation of prescriptions over such long durations, and the long-term effects are not known, as is pointed out from time to time. Since we cannot cure, as in the case of madness, we can at least support.
Comfortable molecules represent ideal products for these pathologies not because they are more effective but, rather, because they are more adaptable to chronic disease than are the old antidepressants.
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On the deficiency front, the tendency towards chronic disorder pushed psychiatrists into using the theme of patient quality of life instead of the idea of cure through the therapeutic encounter.
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Antidepressants leave the category of medication the way depression leaves the category of illness.
Antidepressants more or less diminish the identity insecurities of individuals who feel chronically inadequate, and they regulate action for as long as they are ingested – at least when the depression does not resist them. Long-term treatment takes over from cure because, indeed, antidepressants are antineurotic medications: they place conflicts at a distance.
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Antidepressant abuse, difficulties in stopping, and risks of dependency are all linked to the weak therapeutic results in the progress of the neurosciences. Pierre Pichot pointed out this fact: “The work produced by the neurosciences is extremely impressive. I’m not contesting that, but for the time being, very little of anything useful has emerged in terms of concrete clinical applications for psychiatry.” He added: “This brings us back to the definition of the concept of illness and its limits. There is no truly satisfactory definition.”
Such comments – and they are not rare – point to the weakness of theory in contemporary psychiatry. On the one hand, insofar as it has no autonomy in relation to them, psychiatry is a satellite of the neurosciences; on the other hand, insofar as it is obliged to respond to social demands, psychiatry is faced with the need to rethink its references. How can it define and conceptualize the notion of mental pathology in today’s world?
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The ill individual is a self who is suffering and who can recognize her own cure only through integrating illness into her experience and self-history.
The idea of cure would then be characterized not through a return to some former time (i.e., before the illness) but, rather, by the fact that the doctor, psychotherapist, or molecule would no longer be necessary. That moment is of course difficult to isolate, and it presupposes a kind of practical wisdom, a compromise in which the self participates along with his or her therapist.
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[…] the role of the doctor is to practise a pedagogy of cure: “This pedagogy should work to help the subject understand that no technique, no institution, present or future, can provide him with the guaranteed integrity of his relational powers with other people and things.” Canguilhem adds that this limit is inherent to every living being and is its natural law: “Health after recovery is not a past state of health. The lucid awareness of the fact that cure does not mean returning to the past will help the patient in his or her search for the least amount of renunciation possible, by freeing him from a fixation with a former state.” There is no cure without work, without development, without a story – a fiction in which the person is involved through the use of the I.
One thing seems certain in the conflictual model: well-being is not a cure. This is because being cured involves the ability to suffer and to tolerate suffering.
From this point of view, being cured is not at all the same thing as being happy. It means being free, recovering a power over the self that will let us “decide if we want this or that.” If we accept the idea that health is the ability to go beyond our own norms, we need to distinguish between happiness and freedom, between well-being and cure. If an individual in good health is up to the various bumps and bruises of existence, and able to go beyond his norms, I would also add that, in terms of psychic disorder, he can do so only because he is conflictual. Conflict is both engine and brake.
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Cure seems reduced to an “initiation into the mysteries of the unconscious.” The patient remains dependent on the therapist, a dependency similar to that experienced by those who ingest a certain molecule on a long-term basis. The chronic mode is certainly not the monopoly of biological psychiatry. As François Roustang remarks, in his ferocious way: “If analysis has no limit in time and space …, analysis will not only last as long as life does, it will absorb all of life.”
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Is standard therapy relevant to those who live in economic insecurity and exclusion – and to the many wage-earners who use and abuse tranquilizers and antidepressants (not to mention alcohol, the great French taboo) in order to face the increasing constraints that act upon them as they wait for the storm to pass? Is it necessary – and, if so, in the name of what principle – for all of us to face our conflicts? Are there not countless cases in which the cure is worse than the disease?
If conflict is the honey that feeds psychoanalysis, it is obvious that new demands are always being made of it. These demands don’t have the open face of conflict but, rather, the more slippery visage of the void. […] These days, they are phrased in vague terms of a sense of malaise arising from new economic and social constraints and the insecure nature of private life.
[…] after the preliminary interviews, analysts do not know how to define the references to these patients’ suffering: “We don’t really know where it hurts, how and when.”
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In psychoanalysis, it is suspected that acquiring greater lucidity does not necessarily lead to cure, whereas in psychiatry, it is believed that abandoning conflict in favour of well-being would make cure impossible.
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Today’s individual is neither ill nor cured; rather, he has just signed up for one of the many maintenance programs on offer.
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The prescribing of molecules with a wide spectrum of effects responds to an increase in today’s normative demands; the difficulty of confronting them can be costly to an individual caught up in a world where professional, family, and emotional failure can add up quickly. Such failures can lead to social rejection much faster now than in the past.
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Instead of calling molecules “antidepressants,” we could simply opt for the word “tonic” – since tonics don’t treat a disease.
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Dependency, like depression, is both an illness and a state of mind. It covers territory that goes far beyond psychotropic medication and illicit drugs. The innocent techniques of self-improvement that were popularized in the 1970s have, today, turned into a mistrust of cults whose marketing is centred on personal transformation: at the horizon of personal liberation is the dependency on a master. The fear of cults is to psychotherapy what the fear of drugs is to psychotropic medication. And it does not matter, as far as that point is concerned, whether we are talking about chemistry or organization.
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The neurotic individual suffers, then, from too large a load of the forbidden. His Superego is too harsh, and what is usually a condition of civilization turns into a personal defect. In a culture of performance and individual action, in which energy breakdowns can cost dearly, and in which we always have to be running at top speed and efficiency, inhibition is pure dysfunction, an inadequacy.
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Yet there is a relation between melancholia and depression: both are the unhappiness of self-consciousness heightened to the extreme, the awareness of being only oneself. If melancholia was the domain of the exceptional human being, then depression is the manifestation of the democratization of the exceptional.
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When, in 1887, Nietzsche announced the arrival of the sovereign individual, “with the help of the morality of customs,” he saw in him a strong being: “The proud knowledge of the extraordinary privilege of responsibility, the consciousness of this rare freedom, of this power over himself and over fate, has sunk right down to his innermost depths, and has become an instinct, a dominating instinct.” “But there is no doubt about it,” he added, “the sovereign man calls it his conscience.”
The individual, free from morality, creating herself by herself and aspiring to the superhuman (acting upon her own nature, surpassing herself, being more than herself), is now our reality. But, instead of possessing the strength of the masters, she turns out to be fragile, lacking in being, weary of her sovereignty and full of complaints. She does not inhabit Nietzsche’s gay science and laughter. Depression, then, is melancholia plus equality, the perfect disorder of the democratic human being. It is the inexorable counterpart of the human being who is her/his own sovereign. We are not speaking of the human being who has acted badly but, rather, of the human being who cannot act. Depression is not conceived in terms of law, what is allowed and what is forbidden, but in terms of capacity.
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Madness was the underside of reason, Freudian neurosis was the underside of the conflictual self, and depression was the underside of an individual who is only himself and, as a result, is never enough himself (as though he were always running behind his own shadow, on which he is dependent). If depression is a pathology of a consciousness that is only itself, then dependency is the pathology of a consciousness that is never enough of itself, that is never adequately filled with its identity, that is never adequately active – too undecided, too explosive.
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A double movement ensues. First, technological excitement over the definitive restructuring of the self, a cyberhuman wave, as pointed out in the catalogue of the “Post-Human” exhibition in Lausanne, Switzerland, in 1992: “More and more people are understanding that there is no longer any use in trying to ‘cure’ a personality disorder. On the contrary: it would be better, it would seem, to try to modify rather than treat the personality.” In parallel fashion, a sense of moral excitement has arisen. We can see this in the overinvestment in penal law concerning the “limits” that the subject must not transgress in order to remain a subject. What, then, is the “limit” between a little bit of plastic surgery and [an] android creation […]; between the wise management of one’s moods through psychotropes and the excesses of the “chemical robot”; between seduction strategies that are just “too much” and sexual abuse. The borders of the person and those that divide people, one from the next, have preoccupied us to the point where we no longer know who is who. Is not incest, like dependency, “a short circuit with oneself?”
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These methods are certainly no panacea. The demands they make on more fragile individuals, when it comes to the social integration contract, can have disastrous results. A recent report on mental health among financially insecure groups pointed this out: “The effort demanded of people who need to integrate is in general much greater than that demanded of those who are already part of society.”
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The institution of the self enters at this point. This notion, it seems to me, will help us understand that individualism cannot be reduced to the privatization of existence and that it presupposes “a world that is shared and public.”
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The convergence of the State, the professional sectors, the educational system, and private enterprise on personal initiative, combined with unprecedented moral leeway and a growing numbers of openings, gives the psychic realm a social, and therefore personal, signature that is completely new. The types of responses to the new problems of the self take on the form of helping relationships offered to individuals, sometimes all through their lives. These relationships become a sort of maintenance system that can be administered in a myriad of ways – pharmacological, psychotherapeutic, and socio-political. Products, persons, and organizations can be their avenues. These various actors, who come from public health or private services, all refer back to the same logic: produce individuality that can act by itself and transform itself based on its inner resources. This logic can serve as an instrument of domination as much as a pathway to reintegration and therapeutic care-giving. The confrontations, strategies, and judgments of these actors take place in this imaginary field and not in the classic “class struggle” model or the one provided by life insurance. Part of our lives and our ways of acting, having created a vocabulary we all use on a daily basis (“motivate,” “facilitate,” and “company”), this logic is part of our very being. It has instituted itself. These new shared forms of the production of individuality are our new institutions.
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Today we are involved in the second wave [of emancipation], that of personal initiative and submission to the norms of performance. Individual initiative is necessary if people are to remain in the social group.
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At the end of the 1960s, “liberation” was the word that brought young people together. Everything was possible. These movements fought institutions. The family stifled you, school was another form of barracks, work (and its product, consumerism) was alienation, and the law (the bourgeois variety, of course) was an instrument of domination that had to be thrown off. Unprecedented moral freedom united with improved economic conditions, and the opening of lifestyle choices, always upwardly mobile, became a tangible reality during that decade. Madness did appear in the landscape of public debate at the beginning of the 1970s, as a symbol of modern oppression rather than mental illness, but only because everything was possible. The madman wasn’t sick, he was simply different, and he suffered from the non-acceptance of this difference. Nearly fifty years later, quite another message is often heard: nothing is possible. People feel as though they have collapsed into the present. The shutting down of the economy and the dropping out of a segment of the population reinforces this feeling.
[…]
It is no use yearning for a return to the forbidden, or endlessly repeating that limits have to be placed on subjects that have never known any. We can’t go back in time. We need to understand that the unknown being within us is changing, and the costs, just like the gains, are moving house.
In the end, the story is very simple. Liberation might have gotten us out of the drama of guilt and obedience, but it has taken us straight into the demands of responsibility and action. And so the weariness of depression took over from the anxiety of neuroses.
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Without family, without a name, the Cronenberg hero tries to build himself… an essence through technological incantation alone.
Serge Grünberg, David Cronenberg, 1992.
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Depression threatens the person who resembles only herself the way sin haunted the soul turned towards God or guilt gnawed at the person torn by conflict. More than a source of mental pain, it is a way of life. (ed. «Plus qu’une misère affective, elle est une façon de vivre.»)
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In this movement we find what is at stake in our own collective psychology. No doubt we are still too psychologically caught up in a rigid perspective of the conflictual self. For we certainly don’t lack ways of reflecting on the new issues of the self and illuminating our pathway, inventing our future instead of regretting the good old days when borders were clear and progress could be counted on.
[…] the unknown is part of every person – and that it always has been. It can change but never disappear: that is why we never leave the human realm. That is depression’s lesson. The impossibility of completely reducing the distance between us and ourselves is inherent to any human experience in which the person owns herself and the individual origin of her action.
Also see Umberto Galimberti.