The pipeline!!!!! (pt 1)

They told me, after the visit, that he was a sportsman in his youth. They told me that he golfed like a champ, a proper champ.

Where did it go wrong, then?

They told me on his 18th, he had a swig of beer. They told me he couldn't stop drinking since.

When we saw him, he sat there behind a glass window. He was handcuffed. He had been arrested for hurling verbal abuse at the staff of a bottle shop. He had been drunk.

He sat there, handcuffed. He posed no harm to himself, he posed no harm to us. But still, he sat there in handcuffs, telling us how he got there in the first place.

The psychiatrist asked him if he saw things. He said yes - he saw the devil, and the devil would harangue him for drinking. He heard voices - those of the devil - berating him for drinking.

He drank, and he saw and heard, and he drank, and he saw and heard. And he drank.

He swore off drinking in that cell.

He'd go back to drinking the moment he left that cell.

We knew he'd be back. The jail knew he'd be back. He'd been back so many times that the jail kept a box of his things with his name labelled on it.

Let's see another patient.

A poor little broke girl.

She broke down into tears in front of us.

Crying about how she was afraid of being kicked out by her dad - an affable gentleman, gray hair tied back in a bun, clad comfortably in a Hawaiian shirt and clutching a cane.

He reassured her that he would never kick her out.

She wept about how she couldn't work - that she was useless - that maybe she should find some work with horses - that she couldn't work.

There she was, that poor little broke girl.

She was getting better.

***

Psychiatry in Crisis. The two fold argument of that book is that psychiatry is in a crisis of epistemiology and ontology. That it is in a crisis of knowledge and being. Of the two arguments, Dr Di Nicola's, the one of ontology, is more convincing.

Psychiatry, as it exists in the present day, is caught between the intentions of wider society - that is to nullify madness, to keep it at bay, and to ensure either the working capacity of the ill or to rid them from the public eye - and that of a duty of care towards patients.

Fatefully, in the 18-19th century, psychiatry entered a sort of compact with law (and as with all structures in society, a compact with the burgeoning economic system of capitalism and imperialism). That is to say, psychiatry was legitimised by what it offered to the state.

Psychiatry thus served as a tool used to discern who could be punished, and who couldn't. Now, this isn't to say that madness made you impervious to the law, rather, it excluded you from society.

This followed in the trend of the enlightenment - to distinguish and to categorise, to separate what would otherwise lie on a spectrum into discrete forms. Man became rational or irrational, of the metropole or of the periphery, burdened by race or burdened by the need to uplift races.

It should be no surprise then, when psychiatry and psychiatrists were at the forefront of the eugenics movement. One of the primogenitors of the T4 program, after all, was a psychiatrist.

This modern incarnation of psychiatry carries within it the hallmarks of the modern century, the racial centuries, and the imperial centuries. Far from a deviation, the principles of separation and annihlation has always existed within modern psychiatry, as it has within modernity.

On the other side of this crisis, lies the psychiatry of the living. More concerned with the lives of those who experience mental illness, it is concerned with the obliteration of such discrete categorisations. This too stems from the logic of modernity – that of a common man, and that of the radicalism which had informed revolutions past.

Psychiatry thus has set itself against itself – its purpose as an institution marking and condemning those with death, and one set to return madness to society. It is a reflection of the tension within modernity. The universalisation of values held against the drive to marginalise and define an other, one to whom such mutualistic values do not apply.

This crisis therefore does not exist to haunt psychiatry solely. Perhaps it is more obvious in psychiatry, with its tumultuous history and its sharp ideological divisions, but it persists in other fields.

It is a crisis that has been generated alongside similar crises in medicine - that of the conflict between economic interests and healthcare.

Of course, such interests are not always in conflict: preventative medicine decreases the cost of healthcare such that investing in a general practitioner (GP) is much more worthwhile economically than investing in any specialist, states the world over initiated lockdowns in part to prevent system collapses, and a healthy population tends to be more productive.

Despite the apparent virtuous circle at hand - funding preventative healthcare drives down healthcare costs, allowing for more relative funding, the drive to operate healthcare systems at a profit throws a wrench into this affair.

Certainly in Australia, the rate at which GP practices are closing, or moving away from bulk billing (bulk billing is where the cost of a visit is covered by public health insurance), speaks to healthcare's inability to escape its wider context of privatisation and deprivation.

Ultimately, the people most impacted by these changes will be those who need it the most. Those who cannot afford to see a GP or a specialist may need it more - such are the deprivations of poverty and inequalty.

But these crises are changing, undergoing a metaplastic change. Where such deprivations were once limited to the periphery - that is to say, the racialised, the criminalised, the cast aside - such forces are returning to the metropole.

In Achille Mbembe's Necropolitics, he describes an age of paranoia and security - one that is deathly afraid of half-formed images of an irreconcilable threat growing in the bowels of society. This all-consuming fear of the other is a reflection of the relationship between the metropole and the periphery, with the advent of globalisation forming a sort of mania formed when those once considered alien or otherwise irreconcilable with the notion of personhood, are intermingled with the metropole.

At once, those consigned to the periphery exist in a state of waiting for death in what Mbembe deigns "necropolitics".

Yet, there may be another force, whereby capital, having plundered the periphery, now seeks to plunder the metropole. That is to say, the metropole is in a state of contraction, with those left behind in its absence joining the ranks of the periphery.

The formation of sacrifice zones, and the consigning of such environs and its peoples to collapse marks an escalation in the return of colonial modes of consumption to the metropole.

It should be noted that even as migrant workers cross the US-Mexico border to pick fruits for the benefit of the US, breaking their bodies in the process and hounded by state apparatuses all the way, these conditions could only have been made possible by the contraction of the state and hence the metropole.

Certainly, NAFTA broke the backs of Mexican farmers, but it also shattered the working conditions in the metropole. Whilst Mexico was flooded by cheap, subsidised grains, the US saw its economy shift to that of a service economy. The newly unemployed were thus cast aside, consigned to the periphery.

For those newly transported to the periphery, or those at risk, such events inform the Zivilisationsbruch, or civilisational rupture. It is not mass murder that informs the Zivilisationsbruch - the West (and other states) have a long history of such activities. The rupture is that when those in the metropole suddenly wake up one day and find themselves donning the garb of the periphery. It occurs when those of the metropole find their lives to be nothing more than one that awaits death.

This form of separation naturally brings with it a yearning to return to the metropole, to what was once normal. But this cannot occur. Those jobs, now lost, will never be returned. Those social bonds are severed. The rupture has occurred and it cannot be mended. People are aware of this. And so the tension between that desire and the knowledge of their current situation informs a will to break from reality.

There is some similarity between this and Laing's double bind. The difference is, of course, that this is not pathogenic. The double bind does not force schizophrenia into being, it forces fascism into being. Once confronted with these incompatible desires and realities, the mind does not sunder, does not conjure up bizarre notions. Rather, there is a pseudo-ironic distance.

Fascism operates beyond the fourth wall. Fascism is the politics of theatre. Fascists are Heroes, overcoming all before them, invoking emblems of myths and legends, grounding the rootless.

The audience knows that this cannot be true - the curtains will drop, the fascists will become powerless once more, their symbols shown to be nothing more than paper mache. Yet it is an intoxicating belief, and so they allow themselves to believe that myth.

As Jeff Sharlet notes in the Undertow, quoting a Trump voter, "don't it feel good, at least, to believe?"

What is more, fascists grant their followers the ability to bring about death. Instead of a life awaiting death, life searches for death. The destruction of the other, along with the destruction of the self, as Mbembe notes, is a break from any form of reconcilliation.

At the same time, the ability to bring about death marks the a sort of return of the metropole. This biopower, the sovereign ability to choose who lives and who dies, is granted to the followers of fascism. This biopower salves no wounds, repairs nothing, but is a powerful intoxicant. He who would otherwise perish in the periphery brings into himself the metropole, and in that moment, the moment of the shooting, the suicide bombing, acquires for himself what was taken from him.

Our politics has no answer for this. And indeed, it must be like this, for these acts are an inversion of our politics. The violence, the refusal to communicate anything but death, is a matter of our politics revisited upon us.

The West was borne of the plunder of the periphery, its rise to greatness as much a consequence of the slaughter of the peripheries as the strength of its industries.

Those in the peripheries cannot be reasoned with. They are beyond the rationality of the metropole, a mad other that defines our reason. It is no wonder, then, when those in the metropole, upon slipping into the periphery, take up the arms and rhetoric of the metropole and seek to bring it upon the centre.

And the centre cannot hold.