Monday 6 December 2021

anxiety





Why are you standing on hot coals?



So called civil society is hostile to every form of life. It's not just genocidal, it's geocidal. It's the modality within which the world is being liquidated, in which earthly life is placed under the severest possible distress and duress.

      Fred Moten


Behind the powerlessness of God peeps the powerlessness of men who continue to cry "May that never happen again" when it is clear that 'that' is, by now, everywhere.

      Gorgio Agamben


It may be that we are puppets puppets controlled by the strings of society. But at least we are puppets with perception, with awareness.

      Stanley Milgram


I felt, at times, that my head was being violently shaken and that my thoughts and feelings were being thrown out of my skull; it was as if I was nailed to the spot, helplessly watching them shatter as they hit the ground. You can become too aware of your own actions, you can start to watch yourself watching yourself, you can quickly spiral into a kind of paralyzing hyper-awareness. Watching watches watching…An artwork portraying panic focuses on a panicking figure with arms outstretched pushing at the frame of the image. There is another, smaller, but otherwise identical version of him trapped in the first versions head and the two figures are surrounded by eyes, seemingly trapped by their gazes. In an article titled: 'I feel I might die any waking moment: can I escape the grip of PTSD?' a journalist named Rhiannon Lucy Cosslett described the panic associated with PTSD as follows: 'I am not on a plane nosediving into the sea, but my brain is...It’s firing off terror signals like a wonky catherine wheel'. I described panic, less well, as feeling like Roman soldiers were crawling into my ears, an event made all the more painful due to the large rectangle shields they carried and because the soldiers would then proceed to crucify my brain. I described feeling, at times, as though my brain was being hung drawn and quartered - sliced up into ice-cube's which then melted at the faintest warmth and trickled helplessly through the apertures that held my senses. On rainy nights, for a while, when I encountered someone in the street, my heart and mind would race as I sprinted home, I ran as fast as I could and yet I felt as though I was barely moving. I found my way back to my room and my head swam, it was as if a malevolent sorcerer had conjured a swarming chemical stampede; my whole being felt liquefied but I was also super alert, so alert that awareness seemed to have escaped into the air where it shone and shimmered and billowed below the ceiling. I think the first person I passed was a jogger - she ran around a corner and passed me by so quickly that I didn’t have time to cross the road or duck down a side-street and my brain didn’t have time to enter panic mode. Causes or 'risk factors' are said to be numerous; to grossly simplify, somebody I listened to in therapy said that her friend had been stabbed to death while she sat next to him, perhaps it was after that that going outside became a life or death struggle. When I was about 7 my mother smashed my fathers window at night, lost a lot of blood and was hospitalised. I was, as it turned out, vainly, seeking refuge because my mother was drinking a lot and things were getting pretty bad at home. It would be far too simplistic to say that I ended up with a cluster of symptoms similar to PTSD as a result. The ability to communicate astonishingly complicated processes and perceptions in plain or schematic ways seems to be important; Cosslett writes: 'Dr N draws me pictures of the brain, showing me the amygdala and the hippocampus. The amygdala is responsible for my fear responses, and you could say that it’s hyperactive. This is why I startle so easily, because it is going into stress mode unnecessarily. The hippocampus is in charge of the storage and retrieval of memories, and helps you differentiate between past and present events. Put simply, mine is damaged, so the past and the present blend together, the attack elbowing its way into my everyday experience without warning or invitation.The pragmatic psychoeducation 'Dr N' offered is an aspect of cognitive behavioural treatment, Aaron Beck (amongst others) laid the foundations for cognitive behavioural theories which are, in turn, grounded, in part, in cognitive science. A discipline the early development of which is often said to have been influenced by Noam Chomsky's paper: 'A Review of B. F. Skinner’s Verbal Behavior'. Trains crash into the brains memory filing system (the hippocampus) and files fly out of the filing cabinet. Barely readable descriptions of trains crashing into the cabinet are written on them. Put very simply, symptoms, at least of this kind are, in this view, compressed or scrunched up memories or emotional flashbacks, they consist, in a sense, in an identity which is being crushed and scattered. In her essay: 'In Defence of De-persons' Johanna Hedva describes a 'dissociative panic attack' in the first person as follows:

'It was in the Copenhagen aquarium called Den Blå Planet, which has been designed to make one feel as though underwater - stupid of me to forget my meds, especially because for twenty years I’ve had the recurring nightmare of being underwater in an ocean of black...One enters Den Blå Planet as though being submerged into a sea cave. Inside, there is only dim, blue light. Silhouetted shadows of fish, sharks, and whales are projected onto the ceiling. One can peer up at them circling overhead. The lapping, sloshing sounds of water stream from hidden speakers, but they are mostly drowned out by the voices of children running around, darting like little fishes...I waited for the attack to pass, the only thoughts in my brain were “thing, thing, thing”...There was blue - blue paint on the wall of the stall? - which equaled “thing.” Each time the door slammed, it was with such ferocity that “my” body felt ripped - into two things, then three, then many. The sound of the hand dryer, even more ferocious and splitting - thing, thing, thing'.

Somebody with combat PTSD said that its as if a wolf pack is hunting you, when the lead wolf tires another wolf takes its place and if you stumble for a second the wolves catch up with you. 

Generalized anxiety - or near constant 
dread and intense worry about anything and everything - can feel like being locked in a small room with an incessant and extremely loud and unpleasant noise, or like being stuck fast in a very high-g centrifuge.

The philosopher and mathematician Blaise Pascal would have met the diagnostic criteria for a panic disorder, he wrote: 'The eternal silence of these infinite spaces fills me with dread.' Infinity phobia is called apeirophobia.

There is, sometimes, much more dissociative anxiety, depression and panic than there is person or world, pathology becomes very loud and normality quiet and neither are being stored or retrieved or (chronologically or spatially) differentiated as they should be, instead, both explode their innards all over the shop as Cosslett put itOr, as Andrew Solomon put it, anxiety feels like a constant need to vomit while lacking a mouth with which to vomit. Or, as Amanda Stern (talking about her panic disorder) put it, like being dragged by the ankles into hell, or else, anxiety might be analogized to a jet engine excruciatingly sucking up thoughts and feelings and spewing them out as cinders - losing your identity to an anxiety disorder or to any other psychological disorder/injury is horrific and often unnecessary and often horrific because it's unnecessary. See, also, Maria Popova's essay about Stern's book: 'Little Panic: A Literary Laboratory Exploring What it is Like to Live in the Stranglehold of Anxiety and What it Takes to Break Free' and her essay on Dr. Esther Sternberg's work and, of course, anything by Dr Claire Weekes.

I was endlessly moving around in circles like a stick caught in a whirlpool. ‘I could not become anything; neither good nor bad; neither a scoundrel nor an honest man; neither a hero nor an insect.’(Dostoevsky) Life went on all around me and, although I was right next to it, I might as well have been on the opposite side of the universe or at the bottom of the Mariana Trench.

Terror can turn a millimeter into a lightyear.

And rage can reach apocalyptic heights; it was as if I felt that the whole of civilization was misbehaving so egregiously that it needed to be told off using several tactical nuclear weapons - the fight in the fight or flight binary.

Or in the fight, flight, freeze, fawn or collapse non-binary. And if its a case of kill or be killed, if you fight (or if panic fights) then, in one way or another, the world tends to fight bac
k. And if you're incapacitated the world tends to put the boot in, when there is blood in the water sharks circle, the more blood there is the more sharks there are and the more sharks there are the more blood there is.

In her paper: Freeze for action: neurobiological mechanisms in animal and human freezing Karin Roelofs writes: 'Freezing is activated at intermediate levels of predator threat. It is a state of attentive immobility serving to avoid detection by predators and to enhance perception...Freezing differentiates with the sympathetically dominated fight-or-flight response activated during imminent predation threat. Especially, upon threat, both sympathetic and parasympathetic branches of the autonomic nervous system are simultaneously activated and only in case of parasympathetic dominance do we observe defensive freezing'. To simplify a great deal there is a sense in which depression, derealization and depersonalization are, in this view, examples of severe freeze responses while panic, anxiety and rage are, of course, manifestations of the fight-or-flight response. For Plato, ideas rooted in an eidetic world stabilize us more than our innately lacking earthly roots - our roots are in the sky so to speak but Roelofs take, and the fact that the broca's area tends to go offline when distressed, might lend credence to the perspectives of people like Peter Levine and Weekes and to notions like co-regulation and to an initial focus on intero and proprioception along with procedural and emotional memory. Episodic and declarative memory are, in this view, secondary or less elemental. 

Severe relational dysregulation in early childhood would, of course, increase the risk of developing an affective disorder. Unsurprisingly, unexpected negative events, involving, for example, familial difficulties like conflict or abuse are said, by academics, to increase the risk of developing GAD (and other affective disorders). As is having a relative with an anxiety disorder, as is role inversion/parentification, often as a result of having parents who were struggling to hold things together, generally and, more to the point, emotionally. Exposure to chronic stress-inducing situations in childhood, a lack of social interaction/capital and poor life satisfaction are also said to be risk factors. Parentified children, by definition, have little guidance and few adults to consult with and for such children, the centrality of a parents, demanding and attention grabbing, troubles and their own consequent marginality may feed into depersonalization.

Growing up around parents or guardians with unpredictable, disorganized 'attachment styles' (which, oftentimes, consist a breakdown of attachment) is also said to increase the likelihood of developing various disorders, including GAD, social anxiety and DPDRD. There may be attempts to compartmentalize and to control these, sometimes troubling, interactions (and to monitor and compartmentalize and to over-control oneself) in order to reduce harm; excessive (self)monitoring can involve or feed into sensorimotor, 
existential, awareness, harm, MS and other forms of primarily obsessive OCD, as such, thinking about reality becomes, so to speak, more real than reality and thinking about acting more active than acting. Internal compartmentalization, of this kind, consists in forming models of attachment and, to some degree, 'self-states' which are segregated and at odds with one another, or within themselves, and which may have been generated as we alternated between avoiding and approaching unpredictable or dangerous guardians or as we avoided and approached at once.

We need guidance and emotional support and we need to consult with others when under a great deal of stress and, as such, stress activates the attachment instinct. When this happens defensive/controlling strategies, all of which inhibit attachment, start to collapse and panic, depersonalization and derealization kick in as a second line of defence because, in short, attachment is 'disorganized' or
'anxious and preoccupied' and meshed with an overzealous fight-flight or freeze response.

Disorganized attachment is a complicated subject, see for example: The Dissociative Mind by Elizabeth F. Howell, Trauma, Dissociation and Disorganized Attachment: Three Strands of a Single Braid and A model of dissociation based on attachment theory and research both by Giovanni Liotti and see Judith Herman, Van Der Kolk, Adriano Schimmenti and Vincenzo Caretti's work for appropriately (or over) complicated accounts. In the latter paper Liotti lists four implications of this model, the first three of which are: '(1) pathological dissociation should be viewed as a primarily intersubjective reality hindering the integrative processes of consciousness, rather than as an intrapsychic defense against mental pain; (2) early defenses against attachment-related dissociation are based on interpersonal controlling strategies that inhibit the attachment system; (3) dissociative symptoms emerge as a consequence of the collapse of these defensive strategies in the face of events that powerfully activate the attachment system'. In addition, put very simply, by way of symptom amelioration the attachment theoretical view focuses on attachment security and trauma processing.

Blaise Pascal described panic and what a psychologist might call 'existential primarily obsessive OCD' as follows: '...when I survey the whole universe in its dumbness and man left to himself with no light, as though lost in this corner of the universe, without knowing who put him there, what he has come to do, what will become of him when he dies, incapable of knowing anything, I am moved to terror, like a man transported in his sleep to some terrifying desert island, who wakes up quite lost and with no means of escape.' This kind of sensitivity is terrible but it's also, for want of a better word and depending on how it's received, humanizing. Put simply, one way that primarily obsessive OCD (and several other disorders) can be treated is through controlled exposure combined with self-talk or being talked through exposure. In other words you activate or lean into, for example, an over focus on awareness instead of being blind-sided by it and avoiding it. Positive compartmentalization might be another factor, in the sense that time can be set aside to, for example, consider philosophical questions (such that they don't swamp other considerations) or for controlled exposure.

As Rhiannon Cosslett points out, the causes, in this instance of post traumatic stress and panic, cast long shadows: 'The amygdala knows no sense of past or present, and so, when faced with a perceived threat, it responds how it sees fit, unbeholden to logic, in the form of blind panic'. We may often phase in and out of the here and now or seldom out of the then and there into the here and now, we may feel injured, tremendously diminished and surrounded by a 'hard shell of fury' as Cosslett put it. Put simply, when anxious or panicked, the amygdala is said to 'hijack' the prefrontal cortex leading to ego-dystonic and overwhelmingly fearful and clouded thinking, impaired
 working memory, executive skills (including speech) and capacity for attention shifting and self-regulation.


About post traumatic stress Dr Judith Herman wrote: 'Equally as powerful as the desire to deny atrocities is the conviction that denial does not work. Folk wisdom is filled with ghosts who refuse to rest in their graves until their stories are told. Murder will out'. She says that remembering and telling the truth about terrible events are prerequisites for healing. Combined with medication and a few other things Cosslett found cognitive exposure therapy to be a life saver, put very simply, it entails systematic desensitisation through talking about (in a structured way) and, more to the point, re-living a painful experience until it loses its sting and the memory of it, and of the 'sane' memories that are tangled up with it, are defragmented. How can we lead what we do not control? She bought a great deal of determination to the table but she also said: 'How strange and capricious our minds are, how deluded we must be, to purport to be in control of them'. Control might be more of a conceit than a fact or else it consists in the attainment of certain socio-economic positions.

She writes: 'In therapy, I learn that the trauma of the attack means that my brain’s usual mechanisms for storing memories have been corrupted. Dr N, the therapist, uses the analogy of cardboard boxes on a conveyor belt, being knocked off one by one, so that they never reach their storage facility. Instead, they have exploded and their innards are all over the shop (this part of the analogy is mine)'. It should be noted that most cannot access this kind or quality of treatment, as Mia Mingus says: 'Oppressed communities have had long and complicated histories with the MIC'. These histories, she says, include 'humiliating, lacking or flat-out denial of services to poor communities'.

Judith Herman also said that: 'It is very tempting to take the side of the perpetrator. All the perpetrator asks is that the bystander do nothing. He appeals to the universal desire to see, hear, and speak no evil. The victim, on the contrary, asks the bystander to share the burden of pain'. In this view, when a ghost's story is supressed and murder does not out, it's more likely to out as PTSD, secrecy about the disorder is lethal. The belief that we can't harm others or that we are incapable of wrongdoing is thread that runs through many types of gratuitous systemic and inter-personal (or systemic-inter-personal given that they work on a continuum) abuse, while believing, collectively and individually, that we can harm might at least reduce the likelihood that we will. The belief that we can't is related to trivialization, to the implicit belief that, as in a Warner brothers cartoon, we can drop anvils on peoples heads to no lasting effect. Hiding behind official or social sanction makes trivialization and the adoption of a false sense of irreproachable harmlessness all too easy.

In a press interview Bessel Van Der Kolk said: "The assault on people who have been traumatised has been relentless – to this day, almost."

As per the interviewers interpretation: 'psychiatry is simply society in a white coat, the medical end of the norm-enforcement and denial of reality that drives individuals to suppress their trauma in the first place'. In Brent Potter view: 'A superficial (or no) sense of consequences is near to the essence of much contemporary psychopathic hallucinosis'. By hallucinosis he means a cultural malady that has been normalized and generalized. Judith Butler restates a stance taken by Hanna Arendt, then takes a stance which adds to points made above, and, more to the point, made by Emmanuel Levinas, she writes: 'The possibility of whole populations being annihilated either through genocidal policies or systemic negligence follows not only from the fact that there are those who believe they can decide among whom they will inhabit the earth, but because such thinking presupposes a disavowal of an irreducible fact of politics: the vulnerability to destruction by others that follows from a condition of precarity in all modes of political and social interdependency'. In some social orders and cultures, in this view, we often attempt to position ourselves as invulnerable, or as close to invulnerability as possible, and attempt to displace precarity and vulnerability onto others, in doing so, we refuse to inhabit the earth with them and we (always hypocritically) disavow the fact of  a vulnerability that inevitably goes along with an equally inevitable interdependence. If we co-exist or encounter then we can harm and be harmed and so pre-theoretical morality arises with being in the world. But, in that precarious others are, as Butler puts it, ungrievable they are understood, often tacitly, not just to be insensitive brutes without a heritage or a history but as not counting as life at all and so we can harm them and banish them without consequence.

I fainted in class. I dug a Biro into my hand as a distraction in class. My joints ached. I woke up to find a lake of diarrhea by my bed. When relatives came round at Christmas I pulled clothes out of a cupboard and attempted to hide in it. I couldn't sleep. I watched a programme which dramatized job interviews to demonstrate how best to be an interviewee and was sick with anxiety which increased because, if merely watching a make-believe interview was as sickening as a cut elevator cable, then what chance would I have when confronted by the real thing? I lay in bed for a couple of weeks due
, in part, to an allergic reaction to something. A teacher called me up to her desk and asked me if I wanted to go home; I had something similar to a fever, which she must have noticed somehow. I attempted to complete mock exams, which felt more like mock executions, while coping (or not coping) with brutal stomach pain. And while blood and diarrhea trickled down my leg - anxiety is, in every sense of the word, shit. If the parasympathetic 'rest and digest' branch of the nervous system is inactive or 'dysregulated' then digestion (and anything else that rests on not being anxious) is likely to be. Stomach cramps, irritable bowel syndrome, constipation and vomiting are common. Is it surprising that something as seemingly simple as anxiety and dread (and the fearful) can destroy so many people? It can destroy morally, as Martha Nussbaum indicates in: The Fragility of Goodness, and in just about every other conceivable way. Think of panic as a snow drift in a cowboy film, you are trapped in a log cabin for the winter and so a lot depends on who and what you are trapped with and what is outside; sometimes the snow drift reaches as far as the door and sometimes as far as your eyeballs and, sometimes, you become a snow flurry or a blizzard or as static as an icicle.

Amanda Stern notes that transitions (from here to there, day to night, awake to asleep, now to then, loud to quiet and so on) are extremely difficult for people with anxiety disorders. The anxious, she says, need to know what’s going to happen. 

And, as Viktor Frankl said, a fear of a given outcome can make that outcome more likely; anxiety attacks throw up a plethora of imaginary horrors and they can make them happen. Aaron Beck makes much the same point in his book: Anxiety Disorders and Phobias: A Cognitive Perspective. In any case, the world might collude in this process; if someone is, for example, afraid of flunking exams and ending up in a remedial class then fear might make failure more likely, and they might then be placed in a remedial class. If such a failure leads to a fear of consequent failures then anxiety might, again, cause them to mess-up and so factor into bringing these fears, this panic or these terrors to life. This might be the least of our worries given that anticipatory anxiety can make the worst of our worries - the worst things that we can imagine - happen.

The further you sink the more you panic and the more you panic the further you sink. You might know what you should do but you must do what you should do under your own steam, even if you are running on empty you must make rational decisions in the market place or suffer the consequences. There may be an overwhelming fear of never achieving or becoming anything at all or of simply existing or of becoming something awful or of failure and of success.
 
A nervous fire-walker hesitates before running across hot coals and making it to the other side of terror where he joins those who crossed before him. The next fire-walker panics and stops a quarter of the way; he watches the triumphant fire-walkers relax, none of them look back at him, burning. There might be a sense in which anxiety disorders are care disorders - animals tend to be cared for when they first appear and anxiety disorders seem to extend this care anxiety, in the beginning there is care, care for beginnings.

He who dares wins but, as Winnicott said, home is where we start from.

Making it to an appointment was a fire-walk, following through on anything was. Everything was a life or death fire-walk.

I described myself as feeling somewhat like an undeveloped roll of film that needed the right concoction of chemicals to be added in order for something to then emerge from the potential hidden in transparency.

Anxiety involves an inability to be there.

Concerns grow, there are growing concerns over such and such and, by way of analogy, if enough space stuff gathers together then it collapses into itself and nuclear fusion makes for a sun. If yet more more space stuff gathers (if the star is large or, rather, dense enough) then space-time itself collapses which makes for a black hole. As a journalist who has bipolar named Hanna Jane Parkinson said in an article about mental health: time melts and slips away like a Dali clock when you are ill.

(What are now called black holes were, for a while, called frozen stars. It was thought that a black hole would, when detected from the outside, appear as an unmoving star stuck in the state that it had been in an instant before its collapse).

Our desperately inquiring perplexity concerning things that are second nature to others might seem, to them, like being asked how it is that we can drink coffee or write a sentence; they mightn't know exactly how they do these things but such capacities seamlessly and incrementally developed and it doesn't occur to them that it could be otherwise - not taking part in things was never an option anymore than stillness is an option for a boulder rolling downhill, there was no break that gave them pause to question.

And so they ask: "Why are you standing on hot coals?"









Mental anguish can also manifest as derealization and depersonalization, which can, sometimes, feel like dissolving into the background or like arcing or being wrenched out of yourself and viewing a waxwork version of you, or like a translucent and razor sharp and slicing kaleidoscope of perception, or like being hyperaware of being aware and being trapped in optic nerves, unable to exit out into the world or to retreat into thought. It can feel like realizing that reality is real or like shaking a snow-globe in which a static facsimile of your life does not play out behind glass without you; about DPDR, Jane Charlton said: "Imagine you’re holding a snow globe in your hands. The world is in the globe, but you feel like you’re on the outside of the glass. Somehow, you are unable to connect the ‘I’ looking in with the world in the globe. That connection and its absence makes all the difference to whether or not I feel I am alive. If I quieten my mind, I can almost taste the colour and richness of life as I knew it before. It comes with a sense of expectation, a feeling of being an agent in changing and plotting a course through the world. This is, I think, the very act of ‘living’, which I bear witness to in others, all day, every day. I still understand it academically, but I can barely remember what it feels like. These days I’m in a constant state of grief; I feel as if I’m grieving for my own death, even if I seem to be around to witness it''. The wait becomes a wake. See Anna Ciaunica's Aeon article: When the Self Slips, from which Charlton's description was excerpted. (Ciaunica also co-authored several paper's about DPDR one of which is titled: 'The Transparent Senses and the “Second Skin”: Implications for the Case of Depersonalization'. See, for example, 'Dissociation and the Dissociative Disorders: Past, Present, Future' for a more thorough academic discussion).

Cosslett also describes DPDR (as it co-occurs with PTSD) well: 'Strangest of all, though, is this ghost-ship feeling of not being really there. A floating sensation of being outside yourself, like when you are a child and someone tells you about the universe, or you think really hard about how strange humans look, objectively: our noses, our slender, tapering fingers...My self is in splinters, basically. I’m a simulacrum, a carboard cut-out trudging woodenly through the city'.
 DPDR can throw you into a semi-permanent Twin Peaks like state.

There is a loss of proprio and interoception when we decamp into, or are shocked into, our heads. DPDRD is sometimes characterized as escaping when there is no escape, escaping from a world that you do not want to be in, from a life that you don't want to lead but are stuck with, from a self which you don't want to be or from events or states which are unbearable, however, the escape itself often becomes even less bearable. 

The novelist Kingsley Amis was loath to allow himself to be left alone because he suffered from this disorder, when he had dissociative attacks at night his partner would bring their small children to him to remind him that he was still connected to the rest of the world.

By way of analogy, in war films, when a bomb explodes, its impact on adjacent soldiers is sometimes portrayed through a high pitched tone which appears as all other audio disappears, a deafened soldier looks around and, though the mouths of others move, he cannot hear them speak.

Or else depersonalization is like being a flame which you desperately and vainly cup with one hand to protect it from a never-ending storm, vainly because the flame always blows out.

A large bell is rung but it removes sound rather than creating it.

An immediate trigger seems to be reality, it might make sense to say that DPDRD involves a kind of existence (and non-existence) phobia including a fear of oneself and that, as such, everything is a trigger and, on some level, everything leaves you flabbergasted, you are astonished by and you question an unraveling social and natural reality that most take for granted. 
Most but not all, the physicist and mathematician Edward Witten doesn't find nature to be normal. For some it's astonishing, for example, that the ratio of a circle's circumference to its diameter is π and that π crops up so frequently in nature. Reality is strange through and through.
 
It's as if you are an irresolvable quantum superposition or in a coma, or as though thoughts were in one glass box, feelings a second and the world a third and it's as if the last two boxes had been thrown to separate corners of the universe. As per Schauer and Elbert, in '...general, dissociation can be understood in three distinct ways: (1) as a lack of integration of mental modules or systems, (2) as an altered state of consciousness, and (3) as a defense mechanism'. Depersonalization and derealization are said to create inner distance from overwhelming experiences by dampening pain and unbearable emotions or moods and by 'tricking' the sufferer into, to varying degrees, perceiving what is happening to them as not happening to them. In a paper (Feeling unreal: a depersonalization disorder update of 117 cases) Daphne Simeon, Margaret Knutelska, Dorothy Nelson and Orna Guralnik note the findings of their study, a few of which were as follows: 'Negative affects, stress, perceived threatening social interaction, and unfamiliar environments were some of the more common factors leading to symptom exacerbation. Conversely, comforting interpersonal interactions, intense emotional or physical stimulation, and relaxation tended to diminish symptom intensity...In this sample, depersonalization tended to be refractory to various medication and psychotherapy treatments'. DPDRD is often associated with relatively moderate accumulated or 'complex' or 'strain' trauma, if nothing that you say or do reduces the likelihood of mistreatment or hardship then learned helplessness or a persistent freeze response kick in as emotional states are jettisoned and you detach from those of others, both of which are associated with threat and the like and, threat notwithstanding, both of which knit us into the fabric of the world. The Diagnostic and Statistical Manual briefly points to, what are colloquially called, causes: 'There is a clear association between the disorder and childhood interpersonal traumas in a substantial portion of individuals…In particular, emotional abuse and emotional neglect have been most strongly and consistently associated with the disorder'. E.g. when I was about 7 or 8, while my mother twisted my arm behind my back, she whispered in my ear that I would get gangrene in my shoulder, that the gangrene would spread and that my arm would have to be amputated. But people are complicated and some people have devils on one shoulder and an angel on the other so to speak. This is often the case when alcoholism and limerence are involved. At around the same time I opened random pub doors at night and shouted her name into them because, without a front door key, going home was not an option - I grew up with someone who was too often either drunk or hung over or comatose. Without going into detail, my father was also intermittently extremely emotionally abusive so, in my case, there was likely some truth in the manual entries aetiology although many other possible 'causes' are described in authoritative texts and by sufferers.

Johanna Hedva notes that the entry focuses on interpersonal and neglects inter-generational, institutional and societal origins. We pay others to take out the trash and take our share of blame. Or to engage in guilt washing for us such that blame disappears altogether. Generals outsource direct violence to soldiers in much the same way that people with a relatively high social status tend to outsource as much violence and pain as they can to those with a lower status. When I was is primary school I was dragged downstairs, dragged upstairs, bundled into a car, observed through a one way mirror and dragged out of my room etc. mainly by 'officials' of various kinds. I was skipping school, in part, because I could not cope and because I had early onset depression and an anxiety disorder - this was read as insubordination and met with force. The people who interviewed me while someone else observed through a one-way mirror and took notes were educated, well spoken and full of hot air. The people who burst into my room and dragged me out were far from well spoken. In her essay: In Defence of De-persons, Hedva says: 'We can see the state as a mechanism that creates depersonalization. It is a device that simultaneously produces and perpetuates de-personhood while negating the possibility of self-control. How about that for a cause?' This same device, or these same agencies, then insist that 'de-persons' accept the 'personal responsibility' which they often want and have been robbed of. It might be the case that most of us fully identify with the symbolic order and that most (whether we conform or not or agree with or oppose it) are entirely unaware that we do so; many, including the world itself, are placed under the severest possible duress by this same order. 

Similarly, Ann Cvetkovich writes: 'What if depression could be traced to histories of colonialism, genocide, slavery, legal exclusion, and everyday segregation and isolation that haunt all of our lives?'

In her paper: 'Mental health, resilience and inequalities': Dr Lynne Friedli wrote: 'Socio economic position (SEP) refers to the position of individuals in the hierarchy and is inherently unequal, shaping access to resources and every aspect of experience in the home, neighbourhood and workplace. SEP structures individual and collective experiences of dominance, hierarchy, isolation, support and inclusion. Social position also influences constructs like identity and social status, which impact on wellbeing, for example, through the effects of low self esteem, shame, disrespect and 'invidious comparison'. For parents and children alike, childhood poverty can be particularly brutal, every bit as brutal as a car crash but, while car crashes are sudden, leaving us injured in an instant, the injuries that excessive inequality often involves accumulate as if in a slow motion crash or through a death by a thousand, mostly hidden, cuts. In the paper quoted above Friedli asks: 'What difference does it make if discomfort and difficulties are shared by everyone?' Epigenetics and gene environment interaction is relevant here, see, also, research into adverse childhood experiences or ACE's, Robert Sapolsky's work on stress and Michael Marmot, Kate Pickett and Richard Wilkinson epidemiological work. In an essay titled: Disablement, Prison, and Historical Segregation Jean Stewart and Marta Russell write: '...not only are poor children exposed to lead and other toxins, resulting in high rates of developmental and learning disabilities; they also drink poisoned water and breathe poisoned air, leading to extreme prevalence of asthma and other respiratory illnesses and cancers. Poor people often live in neighborhoods plagued by drug and alcohol abuse, leading to physical and psychological damage, including fetal alcohol syndrome, and marked by violent crime, leading to spinal cord injury, traumatic brain injury, and other disabilities'. Being poor is a cause of illness. Illness is cause of poverty and they reinforce one another.

In his essay: Going Astray, Will Conway wrote: 'Those who have gone astray, whose lives are in error, become a risk that warrants their confinement, correction, and, often, their liquidation'. And in his essay: Echoes of Utility he writes: 'Tobin Siebers described disabled bodies as a legion of flesh belonging only to “the nation of the abandoned and the dead”. (See Siebers' essay: My Withered Limb). With reference to Henri Stiker's book: A History of Disability, David Mitchell and Sharon Snyder write: 'The “success” of integration can be based upon a variety of assimilation strategies, from legislative policies to segregation to eradication, but Stiker argues that there is a disturbing ideology underwriting each action along this continuum - the social ideal of erasure'.

Joe Perkins said that "the lack of help is the most difficult thing" and that living with DPDRD "...is hell but the grind of dealing with mental health services is often worse". His point can be easily neutralized, for example, by leveraging and playing on survivorship bias and by promoting poster boys. According to the World Health Organization 2 out of 3 people with mental illnesses are undiagnosed and untreated. In the U.S. just over half go undiagnosed and untreated and when people do receive treatment the average gap between 
symptom onset and treatment is estimated to be about 10 years. A researcher interviewed by Andrew Solomon said that 6 percent of people with depression get adequate treatment and about 1 to 2 percent get optimal treatment. For most, there are no mental health screenings, there are no assessments, no diagnostics and no treatment. 

In her essay: What My Brother Taught Me About Science and Social Justice, Alexis Takahashi writes: 
'By giving scientific legitimacy to ableist ideologies, neuroscientists are implicated in upholding oppressive institutions such as the special education and mental healthcare systems that lead to mass incarceration and homelessness'. Other resources created by Takahashi and the scientists she collaborates with as a part of the Free Radicals Collective are also worthwhile. As is work which seeks to unmaskcharity and medical industrial complexes, the essay: 'Medical Industrial Complex Visual' by Mia Mingus is a good example.

Dana Francisco Miranda notes that iterations of the manual have indicated that depression is, sometimes, linked to stressful social, educational and occupational environments and with stressors related to housing and finances. But he also indicates that the models underpinning such lists fail to meaningfully connect distress to structural oppression and violence, in this instance, of a racialized kind, or to a disordered world and, in short, he attempts (in his paper: The Future of Alienation and the Possibilities of Fanonian Sociodiagnostics) to strengthen this tie by combining Fanonian sociodiagnostics with Heideggerian phenomenology. While, in Dr Coni Kalinowski and Pat Risser's view, in the mental heath system: 'The separation of the facilities for "staff" and "clients" mirrors the conditions in the Southeastern US prior to the civil rights movement of African-Americans, where racist beliefs led to the separation of all public facilities for "whites" and "non-whites”. And (in the same paper, titled: 'Identifying and Overcoming Mentalism') they say that: 'As painful as it may be to consider our role as perpetrators...clinicians must come to grips with both our personal mistakes and our participation in a profession that historically has done much to abuse the people who came for care'.

In a Time magazine article titled: 'Trauma Rupture You in Two' Rhiannon Cosslett wrote: 'As if living your life in a fragile state of fear and hyper-awareness weren’t enough, additional problems come when outside observers try to impose their rational view of the world on trauma victims. Friends and family, police officers, prosecutors, college counselors and...journalists, will view your trauma within their own, undisrupted, rational frameworks...Few people seem to realize that a muddled, incoherent account of a traumatic incident is almost humdrum in its predictability.' In the same article Cosslett says that survivors are often re-victimized by a system that demands that they provide an unassailable narrative when events themselves are hazy, fragmented, and unspeakable. Cosslett was, by her own admission, paranoid but if you are in a 'fragile state of fear' then you are a prime target for exploitation and so a paranoia makes sense to a degree, predators tend not to target the strong.

In an interview former Surgeon General of California Dr Nadine Burke Harris said: "I think our government really has to be thoughtful and careful because when we enact policies that we know we have the research, the science and the evidence that demonstrates puts people's health and people's lives at risk then there's a certain amount of responsibility and liability".
 
Achille Mbembe describes new and increasingly sophisticated forms of necropolitical government which now govern through abandonment or negligence, abandoned subjects are, he says, 'relegated to the role of a “superfluous humanity.” They are trapped human subjects 'caught in the various death management systems that saturate the contemporary world'. In this view, it is through wielding the capacity to kill and to injure and through killing and injuring that we emancipate ourselves from our fear of them and become, in a perverse sense, courageous. These 'death management systems' aim to barely maintain people in states of injury. (Also see Professor Ruth Wilson Gilmore's work, in particular as it relates to what she calls 'organized abandonment' and to what she sees as the relentless enforcement of inequality).

Then there is the Aktion T4 programme, the Verdingkinder or contract children, the forced sterilizations, the Tuskegee syphilis study, the lobotomy programmes, the medieval practice of locking people in ‘idiot-cages’ in town centres and the various other (acknowledged and unacknowledged) crimes against humanity that constitute the terrorization of whole peoples; the metamorphoses of the Beast are, as Mbembe says, various. 



About major depression, John Folk-Williams wrote: 'Thought pushes one word at a time into speech like boulders uphill. Then each sound rolls slowly across tongue and teeth. My jaw’s like lead.' Or else, words franticly jump and flip like cats on a hot tin roof. You do not say what you intend to say when your mind feels like molten metal or the sun's surface. I answered questions with: "I don't know" when I knew because forming, what felt like, complicated sentences was impossible, simple interactions  became missiles hitting 
planes which then careened towards the ground.

When I was about 15, I described thought somewhat more luridly – I pictured letters as buckshot slowly clawing through my brain, taking a sadistically circuitous route to my mouth, then spilling into it along with globs of blood.

What you say or don't say feeds back into what you think, you think about what you say or don't and about what you do or do not do and so thoughts miss-fire almost as much as you misspeak and miss-act and, soon, the injury becomes a synonym for the person who is injured - i
n the short story: 'The Planet Trillaphon as it Stands in Relation to the Bad Thing' David Foster Wallace wrote: 'I don't know how apt it is to say it's like being underwater, but maybe imagine the moment in which you realize, at which it hits you that there is no surface for you. That you're just going to drown in there no matter which way you swim; imagine how you'd feel at that exact moment...then imagine that feeling in all its really delightful choking intensity spread out over hours, days, months...Some people say it's like having, always before you, and under you a huge black hole...a black, black hole, maybe with vague teeth in it. And then your being part of the hole, so that you fall even when you stay where you are (maybe when you realize you're the hole, nothing else)'. How much of this is related to motor system impairment is unclear, be that as it may, motor and premotor impairment or agitation can factor into communicative bottlenecks such that thoughts accumulate like an ever increasing number of increasingly horrific rejected scripts, social and other kinds of anxiety may be compounding factors. If motivation and interest are lost then the direction they provided is lost and so thoughts (and much else) become haphazard 
or random, as such, some people with depression describe being animated while they interact with others and then staring into space, as if they'd been unplugged, the second the interaction ends. Folk-Williams writes: 'Even my vision slows down. Rapid movement is a blur...I want to catch one frame at a time, like old-fashioned film editing. You crank the film one frame at a time through a small viewer, stop, back up, cut several frames, splice the ends together. Edit out the confusion'.

To simplify way to much, depression can be viewed as involving a lack of emotional ‘capital’ and because you get what you give, you can’t get. You can't get far on a thimble full of petrol and if you misuse it then you will likely end up stranded. There is a sense in which depression is despair at what we have lost and anxiety is a fear of future loses.

In depression it takes all of your strength
and will power just to exist which is excruciating and exhausting and so you want to lock yourself in a dark room and never come out. Referring to his persistent or 'dysthymic' depression, Wil Wheaton said that he felt like he'd been shot. Depressives might be in moods that feel like a bucket of squirming black and red or black and yellow poisonous frogs; this might be what being radically de-situated or being outside of all 'stimmungen' or moods feels like - the stripping away of the earths atmosphere and biosphere, an absence or complete absorption of visible light, darkness in other words, or darkness visible. Or, as Mikkel Krause Frantzen put it: a '...feeling of nothing...definitely felt. Or to put it another way: the feeling of not feeling anything is itself a feeling. This is...the ultimate – affective – horror of depression'. Or else, depression involves an inescapable and endless feeling of nothing definitely felt. Or else it's what unfelt pain feels like or unfelt grief or unfelt feeling in general.

In his paper: 'Depression, Intercorporeality, and Interaffectivity' the psychiatrist and philosopher Thomas Fuchs writes: '...moods are atmospheric in nature, radiating through the environment like warmth or cold, and conferring corresponding expressive qualities on the whole situation'. The Doldrums can be located on a map – just north of the equator. In the same paper, he writes: 'Of course it may occur that one’s mood is in contrast to the atmosphere one encounters in the environment...but usually there is at least a tendency of mood and surrounding atmosphere to converge. Thus, interaffectivity is not merely a particular section or application of our emotional endowment. Rather, it is the encompassing sphere in which our emotional life is embedded from birth on'. Moods are multilayered and coextensive with environments, including past environments in the broadest and in the narrowest sense of the word past or historical and their deepest layers are very deeply ingrained and so very difficult to shift.

Rates of depression are high in Greenland and Greenland is barely habitable. These high rates have much more to do with modernization and the destruction of traditional Inuit societies though
- they have more to do with the political climate than the weather, hence, between 1970 and 1980, the suicide rate saw a catastrophic threefold increase. Modernization bought wealth for some and death and disempowerment for others. There is also an interaction between harsh climactic and cultural conditions - between climate, culture and various moods which are within us and which we and our ancestors and contemporaries are also in or have been in. In a depression affective desynchronization disrupts or halts interaffectivity, as such, we are severed from surrounding atmospheres - atmospheres which have at some point conferred expressive qualities which sever and disrupt. Depression is a lack of atmosphere, it is asphyxiating, it is a northern Siberia of the psyche, it is also, often, social erasure and social murder.

They have better access to mental heath treatment now but this has not made much of a dent in the dire statistics, given that mental health work, social work and the like are, inevitably, harbingers of the very same, often crass, modernity that wrecked their culture this should not come as a surprise. The apartment blocks that some Inuit were moved into: 'were symbols of progress, the authorities told them, luxurious examples of modern Greenland, with heat and power and plumbing and paved sidewalks outside'.(Hersher) For many of the people who were moved into them: 'the apartments didn't feel luxurious
- they felt foreign and lonely' as one Inuit put it.
 Though, as far as I can tell, most think that a better compromise with modernity is needed rather than rejecting it outright.
































Heidegger is probably beside the point, with that said, poiesis (or primitive/pre-modern technē) brings forth in a world related to us and to ideas and inventions, while modern technē challenges forth in a world ordered entirely as 'standing reserve' or as a calculable and manipulable means to our ends, and both occlude as, and more than, they reveal. In the shift from knowing as poiesis to knowing as modern technē, aletheia becomes correctness of vision, as in the correspondence theory of truth.

Stated crudely, navigation, orientation and attunement and, therefore, engagement with the ontic or factual (and with ethical reasoning and so on) are grounded in stimmungen (more specifically in sorge or care of various types - in anxieties, anger, interest, angst, attentiveness, hatred, concern and so on) which are, at once, internal and external so to speak - a degraded mood and degraded 'pubic feeling' are coterminous, and, as ever more is confronted and placed within technē's frames less is to be found beyond them, these gesteller or frames are like an uplit billboard above a broken streetlight at night, or at least they are when they are totalizing. Or else, stimmungen (and, ultimately, the life-world and beings themselves) are vivisected as we attempt to reveal all, in a singular way, and to instrumentalize all. Sorge is, so to speak, a necessary condition for being there, being-in-the-world and for the doorway to more fully taking ownership or to the more open (in the sense that truths about things are disclosed when we are both open to them and when things are in the open) way of being-in-the-world that is sein-zum-tode; nothing happens without actively taking care, without active concern for the precepts that we adopt and that we are surrounded by and for whatever exists within them, the sien of da-sien manifests as sorge. Therefore, to reiterate, engagement with the factual is grounded in being, more precisely, as Heidegger put it: '...an ontic knowledge can never alone direct itself ‘to’...objects, because without the ontological…it can have no possible Whereto'.

Because dasien is a being for whom its own being is in question, to be a human being involves being or being in doubt - involves being, to varying degrees, decreated. Ontological questioning and the beginnings of ordinary anxiety distance dasien from itself and its surroundings such that we can see innumerable possibilities but, without being fixed to itself and to a specific context, we are none of them - we cannot be and so we feel unheimlich, not at home, anxious or unreal. Or canceled-out because anxiety is also, as it were, nothing definitely felt; nothing '...comes to the fore when da-sein...realizes its staying away from the being of beings as a whole'(Ryuichiro Taniguchi) then foregrounds the, usually backgrounded, world in general or being as such and backgrounds specific beings. In that dasien is never fully itself, and is never fully affixed to its surroundings, low level anxiety is always present and possibilities possible - there is empty space on the shelf on which new objects can be placed hence parousia and apousia, meaning presence and absence, form a binomial. While, anxiety which forces us to take a very close look at the structures which compose Being is rarer as per Daniel Lehewych's reading.

Contemporary technē is, by definition, a useful way of knowing or revealing and making and it seems to be inevitable but if we lose sight of its roots in poiesis and if we are unable to think (to know, or reveal and make) beyond its frames at all then we can no longer dwell, in other words, we can no longer be in and with the world, which is to say that we are, ourselves, nihilistic, ordered and ordering, in use, waiting to be used or useless and invisible standing reserve, at which point, if Heidegger, at his most pessimistic, is to be believed, only a God can save us. We suffer, Jonathon Porritt said, from a lack of being, while our doing is destroying the world. The injured, the slain, silence, pain, impairment, and all other aspects of nature for which we have no use, do not count and are barely present when we view the world through the lenses of modern technē, which is one way in which this, near all pervasive, way of knowing and organizing can become excessively violent. If we don't get this then it might be because we can't see the wood for the chainsaws (or computers) we wield, it might be because we annihilate whatever we can't count, sell, measure, enclose, use or rationalise. It might be because we treat smart phones very well while brutalizing much of humanity who, as Achille Mbembe said, can only dream of being treated as well as phones are. (See, for example, Dana Francisco Miranda's paper: 'The Future of Alienation and the Possibilities of Fanonian Sociodiagnostics', Achille Mbembe's lecture: 'Algorithmic Reason and Planetary Humanities', Byung Chul Han's work and, more to the point, Brent Potters book: 'Elements of Self Destruction'). 

In any case, when in a depression your mood crashes. Your mood is a car crash.

You grieve bitterly and violently about grieving. 

Being killed in a car crash that takes you entirely by surprise would be preferable to being killed in an ultra slow motion car crash in which you know precisely what is happening and what will happen.

I picked up a graphic novel about 'concrete man'. For the most part, concrete man was, as his name indicates, made of a copious amount of featureless concrete; his eyes, however, were human and expressive, they were pleading and they expressed pain - the pain of being trapped in unexpressive concrete.

I was given appointments with the school nurse/counselor. She asked me whether I enjoyed going to school and placed some cards on a desk and numbered them. She said that the cards represented varying levels of intelligence, then varying levels of happiness at home then at school. I was asked to pick cards which corresponded to my level of intelligence or happiness or popularity and so on. I picked cards with low numbers, she said: ''You don't think much of yourself do you?'' As for her focus on intelligence, I assumed that she was trying to figure out whether my self-esteem was low - low self-esteem is an indicator of depression. She asked me if I wanted to speak to a psychiatrist. I declined. I felt that I was being singled out and I hated it because I desperately wanted to fit in. I shed a few tears at some point during the appointment which surprised me because I rarely cried and because I met her questions with indifference, my expression remaining neutral as emotions stealthily broke rank and betrayed me. She was sympathetic and I think that I felt angry and I felt embarrassed at my weakness, I wasn’t looking for sympathy. Not long after that meeting, I placed school books into my rucksack and watched the clock in the corner of the television screen slide passed 9am and
, instead of making my way to school, I sat on the sofa all day feeling exhausted to the marrow and, in a way, relieved to have given up on existence. I stopped going to school and didn’t leave the house for several years.

Things got worse.

Panic disorders/GAD and agoraphobia are near difficult to disentangle, they are much the same thing. 


Depression involved the kind of pain that would melt linoleum if you spilt it on the floor. It and anxiety are, sometimes, like walking around on two broken legs indefinitely, the broken ends of the bones scraping into one another. Every move made and every word spoken becomes a sledgehammer. From a biological standpoint, depressive disorders, anxiety disorders, bipolar disorders, chronic pain and toxic stress are similar. Unsurprisingly, some studies show that people with depressive disorders are more likely than average to have suffered from, and to suffer from, chronic physical pain. Pain exacerbates depression and depression exacerbates pain but the line between physical and mental seems to be tenuous, as Dr Madhukar H. Trivedi put it: 'Physical pain and depression have a deeper biological connection than simple cause and effect; the neurotransmitters that influence both pain and mood are serotonin and norepinephrine'. Of course, Trivedi's paper (The Link Between Depression and Physical Symptoms) and others like it paint a more complicated picture than this quote suggests. In any case, fewer but larger neuronal clusters than average seem to be a feature of physical pain, depression and highly abstract thought. Neurons in the anterior cingulate activate when we are in pain and when we see that someone else is in pain and, typically, this part of the brain is overactive in people suffering from major depression. Gray matter volume is reduced in the insula and medial PFC in people with major depression, anxiety and in people with chronic pain syndromes and the neuropeptide/hormone substance-p is released by nociceptors and immune cells in all three instances. In short, physical pain and depression are said to share some of the same biological pathways, Dr Stephen Ilardi writes: 'Depression lights up the pain circuitry of the brain, to such an extent that most clinically depressed individuals, if you talk to them and they let their guard down, they will tell you as they’ve told me hundreds of times. It’s torment, it’s agony, it’s torture'. Or else we could say that whatever causes depression 'lights up pain circuitry' in this way. I felt like my skull was being smashed in with a rock. This kind of pain is muted and it comes from, and is sent, everywhere and nowhere which is inherently confusing, the short story: 'The Depressed Person' by David Foster Wallace opens with the sentence: 'The depressed person was in terrible and unceasing emotional pain, and the impossibility of sharing or articulating this pain was itself a component of the pain and a contributing factor in its essential horror'.

Knowledge is readily available to some and yet, in general, they don't know. Perhaps they don't know, as James Baldwin said, because they don't want to. 

If generalized anxiety feels like being locked in a small room with an incessant and extremely loud and unpleasant noise then, as William Styron wrote, major depression feels like being locked in a fiercely overheated room. Boxed in moods, feelings and emotions seem to heat up and so you wilt
, melt and drift beneath the door, it might be the case that DPDRD is the only way to escape from both rooms and, in that it entails pulling realities ripcord, from everything else or almost everything.

In his book: The Noonday Demon: An Atlas of Depression, Andrew Solomon said: 'Whatever time is eaten by a depression is gone forever'.






 

In essence, what we want is to share the burden of being, to have some external element; a person, a community, a culture or set of values; some form of shared meaning, to alleviate our fear, our anxiety, and our suffering, and to allow us to...rediscover some center within, something that we can hold on to, and from which we can orient ourselves without being overwhelmed by the onslaught of infinity.
                        Like Stories of Old

And no amount of rhetoric and no amount of idealism...none of this reasonable talk changes the fact that you have millions of people in this country who have...no future and who are trapped in what for them is a concentration camp and who have concluded that the country intends to destroy them. I have no evidence to offer them to the contrary.
                       James Baldwin

…the personal tragedy theory of disability...suggests that disability is some terrible chance event which occurs at random to unfortunate individuals. Of course, nothing could be further from the truth.
                         Mike Oliver



In her paper: 'Pain and the Creative-Critical Memoirs of Anne Boyer and Sinead Gleeson' Cat Chong writes: 'Within a condition of illness or pain Gleason asserts that the body is made vulnerable as it is made public. This is not an inherent category - the diagnosis and the necessity of convincing are enacted within a construction of unequal social relations. To be wounded is not a disadvantage but produces one in response to this site, which is to say: it is not my body which included the world, the way power is structured produces bodies at its mercy'. When Chong mentions the necessity of convincing she means, mainly, a repeated need to prove to medics that you are in pain.

I met someone who was raped by ten people everyday in the residential he grew up in, and I knew someone who was sedated and raped by a psychiatrist when he was 15 who, he found out later, had raped over one hundred people. The person who was sedated and raped drank rat poison (he said that he felt like a rat) and when I met him he still coughed up blood after he ate because the poison had damaged his stomach. U.S. Department of Justice data and World Health Organization data shows that disabled people, generally, are approximately three to four times as likely to be the victims of a violent crime (e.g. assault, rape and murder
) than average and that rates are significantly higher than this amongst some subgroups - among those with emotional or cognitive disorders for example. More precise statistical breakdowns are available from, for example, the DoJ and the WHO; findings differ but they all seem to point in the same direction. Data collated by the Ruderman Family Foundation shows that one disabled person is killed by a relative or a professional each week. The unwell are often assumed to be lazy or irresponsible and the like, especially when they have conditions that can't be seen and are undiagnosed or difficult to diagnose, this is just the tip of the iceberg. Sometimes they suffer psychological abuse, often at the hands of relatives, for many years. 

The way that power is structured produces bodies at its mercy. 

Fear throws up a plethora of imaginary horrors, it can make them happen and the world helps bring them to life. My treatment involved being 'placed' in a bed and breakfast hotel in which the other residents were refugees, my room there was the size of a double bed. Toxic stress has been shown to be a cause of several physical and mental illnesses/injuries, apparently, some people respond to intense stress by shitting blood, I responded by ripping at my clothes, punching myself in the face and banging my head against walls. At a crisis drop-in center a guy who said that he was hearing voices told an employee that the voices were telling him to kill me, the employee then phoned a taxi to have him taken to hospital. This event wasn't a one off, one of my neighbors told me that he might stab me; predictably, these settings did little to lessen the panic that had, in part, led me to become involved with them in the first place. It cuts both ways though - we trouble troubled others and they trouble us, as Hannah Jane Parkinson wrote: 'How do I tell you that it is horrible being an inpatient, because there will be people there who are crazier than you, and you do
 not want to be around those people? Sometimes the situation will be reversed'. In the first mental health hostel I stayed at, I lived with someone who often self harmed, I walked to the kitchen one night and noticed him standing by the kitchen door, he heard me coming and turned to face me. I noticed that there was blood on his arm and then I saw the blood smeared door – he said laconically that he seemed to have made a mess of it. Later, at the dinner table, he managed to injure himself more severely and someone grabbed onto his wrist attempting to stop the blood from spurting, another neighbour at the same place hung himself offsite.

With that said, abandonment and the weaponization of time are infinitely more damaging than the sporadic and mostly petty dramas sketched. As Achille Mbembe has it: 'Bodies that should not move...are...kept shifting between invisibility, waiting and effacement, trapped as they are, in fragmented spaces, stretched time and indefinite waiting'. 'Bodies that should not move' are subject to a kind of white room torture.

In any case, I was helped into environments where people smashed televisions and windows; in one hostel I lost hundreds of pounds due to aggressive begging, people would come to my door and plead, sometimes they would 
spin implausible sob stories aimed at parting me from money that I could ill afford to give and sometimes things would turn nasty. Their quest for free money became particularly threatening when they were drunk. You could say that being in these kinds of environments was a culture shock. One morning I walked into the bathroom to brush my teeth and there were a few guys in there that I had never seen before, partway through the process of injecting heroin. They were completely unfazed by my intrusion and so I left and let them get on with it. A flat mate in a mental health hostel frequently knocked on my door in the middle of the night and shouted at me (or, more accurately, in my general direction) for hours. Much of what he said was gibberish and he would shout so loudly that the security guard two or three floors below us would often hear the noise and come up to quieten things down. He sometimes shouted about how mental health workers had driven him crazy but I had to face his anger not those who were, or who he thought were, responsible for his awful condition. I lived with alcoholics who drank twenty cans of 'white lightning' cider a day. People who worked in this hostels office were attacked a couple of times and 'clients' also occasionally attacked each other – on one occasion a client stabbed a visitor in the room adjacent to mine and one morning I woke up to the sound of a scuffle which ended with another client stabbing someone in the hostels forecourt. Understandably the office workers decided to keep the office door locked for a few months, later the policy was relaxed and the door was only locked when a worker was alone in the office. It’s a good idea to keep car doors shut when on safari, I suppose. I was in group therapy with someone who took an overdose, his corpse was found sprawled on the pavement outside of the hostel he stayed at, it was naked because it had been stripped by people living there. Hanna Jane Parkinson also wrote: 'How do I explain that, sometimes, I doubt the professionals know what they are doing?'

I didn't know what I was doing either. In the same article, titled: It's nothing like a broken leg: why I'm done with the mental health conversation, she says: 'I used to blame the system. Mostly it is the system...But sometimes, that system gets inside the staff, too'. The 'system', in one way or another, gets to everyone. Her antipathy didn't lead her to disengage with it completely. No one chooses to have bipolar or any other illness and, because we live in societies, we have little choice but to engage with them and to engage, largely, on their terms. Similarly, regardless of whether we like or dislike the socioeconomic orders in which we find ourselves we have little choice but to go along with them, this is the case even when they are lethal. Civil disobedience (and the like) isn't open to many and if you bite the hand that feeds you then you starve.

Hydraulic prejudice is concrete
- it is instantiated in 'micro and macro-juridical, bureaucratic and institutional apparatuses'.(Mbembe) While nano prejudice is cultural, it manifests in the way that we habitually speak and act and think, it goes without saying, it is metronomic, boring, anodyne and narcotic but, paradoxically, it is also a frenzied manifestation of a genocidal unconscious. It involves a tacit desire to wipeout outgroups or to evict them so that, in both instances, not only do you owe them nothing, you do not have to share the earth with them at all. Nano prejudice is not a person or an apparatus, it is particulate and molecular, it is as pervasive as air and it has the 'capacity to infiltrate into the very pores and veins of society'. We can't turn screens off but they can turn us off because if we don't adopt and adapt to the norms represented and generated by mass media (through its form as much as its content) then we are likely to be excluded. To reiterate, this kind of culture and its spores, for Mbembe, consist in the tactical destruction of reciprocity and in taking pleasure in wallowing in ignorance and claiming a right to stupidity and to the violence that it institutes.(Mbembe) It consists, also, in the silent and horrifying indifference which Cornel West, Elie Wiesel and many others are right to place so much emphasis on. 

At the level of apparatuses and culture, individuals are not taken to be rights bearing by default or even to be living by default, as such they may or may not be killable objects. 

Though it seldom sinks in, it's commonly noted that the holocaust must be understood, primarily, in terms of social rather than individual psychology
- in terms of group dynamics rather than individual traits. Speaking about the holocaust, and about genocides in general, Dr. Wendy Lower said: 'Genocide is a social practice, an entire society is mobilized - men, women and children'. The terrorization and the liquidation of many impaired and injured people is, similarly, non-local - no one person or organization is the sole culprit. Echoing Sarah Ahmed, Lennard Davis, meta-humanism, Conway and Hedva, it might also be worth considering the hegemonic figure (and organizing principle) of a mythic human, which not everyone can match up to, and whose qualities not everyone can possess or perform, and which we are castigated (or killed) for failing match up to. 

If such a human exists then so does the in or sub human, and vice versa
If Christopher Browning was right to suggest that: 'Evil that arises out of ordinary thinking and is committed by ordinary people is the norm, not the exception' then being an ordinary person might not always be such a great idea.

See, Christopher R Browning's: 'Ordinary Men: Reserve Police Battalion 101 and the Final Solution in Poland', Robert J Lifton's: 'The Nazi Doctors: Medical Killing And The Psychology Of Genocide', Giorgio Agamben's: 'Remnants of Auschwitz: The Witness and the Archive' and, of course, Hanna Arendt's: 'Eichmann in Jerusalem: A Report on the Banality of Evil'.



With reference to slavery, Achille Mbembe posits a thoroughly dishonored body which: "...has been immobilized, it has been subjected to a whole set of rituals, the aim of which was, first of all, to take it away from its natural 'owner' so that my body does not really belong to me any longer. I embody my body as that which can be taken away from me at any given moment and used as equipment by somebody else". 

Those growing up in pressure cooker situations, those who are being squeezed like lemons until the pips squeak, need escape routes, they need some of that pressure to be removed, achieving this would, I think, require the generation of social, cultural and economic capital; in G.K. Chesterton's words, we should confess the error and try to restore the wealth. Similarly, Martin Luther King said that a radical transformation of the social order is necessary and called for a radical redistribution of political and economic power; retributive, restorative, interactional (including informational) and transformational justice are all vital. If people have been thoroughly devalued then, according to Ruth Wilson Gilmore, they should be valued and anti-abandonment organization is, she says, a necessary corrective to organized abandonment. I listened to someone whose daughter drowned herself. To someone whose father murdered his mother and to someone whose wife was killed when he crashed his car. I listened to someone who told us about how she was raped by several of her male family members when she was growing up, whose best friend was stabbed to death while she sat next to him on a sofa and who was locked in a room for nine years by her husband. She wore a T-shirt which had the words: 'Funky Junk' written on it and she said that she felt like junk or funky junk, its worth remembering that much of society views people like her (people like 'us') as parasites and the like, as playing the victim or, at best, we expect them not to grumble and to be 'good victims'. Because she didn't pay her rent she was threatened with eviction and so she attempted suicide, after which, she was in and out of surgery. Society has a debt to pay that it will not pay and which it cannot pay completely and, instead of incompletely paying that debt, it sends in bailiffs.

We extract from those who have already been over exploited, terrorize people because they have been terrorized or feel terrorized and quarantine those who are already segregated and who (as is the case with 'traumatic isolation' and the like) self-segregate. Humanity is evil. How does the boot taste? Better than the curb that the injured are thrown to. Signs of attritional damage tend to be viewed as signs of illness which, in turn, signal a need for further stigmatization and attrition. The fact of injustice tends to lose all meaning and injured parties are left to, or made to, carry the can when causes are severed from effects. Effects are focussed on, in as much as they function as identifiers, and they are individualized, while causes are mostly left alone, as such, pathogenic or unjust individuals, cultures and structures are disregarded or promoted.

Marta Russell and Jean Stewart noted that in the US people labeled “mentally ill” have increasingly '...become a part of what Christian Parenti calls "a growing stratum of" surplus people’ [who, because they are not] being efficiently used by the economy must instead be controlled and contained and, in a very limited way, rendered economically useful as raw material for a growing corrections complex.” Thus the old “snake pit” mental institution is being replaced with yet another institution, the prison, where incarcerated “social wreckage” contributes to the GDP by supporting thousands of persons associated with expanding and maintaining the prison industry'. In several countries facilities which were not overtly punitive were degraded, run into the ground or closed such that many thousands of people in distress were, by design, impoverished, untreated and, often, subjected to something along the lines of a slow and sadistic genocide. The homelessness industry is, for example, in the main, a front for an extermination programme despite what the volksempfänger says. And aRussell has it: '...necessary new structures and solutions...designed and run by disabled individuals themselves, were never put in place'. Concomitant with these closures attitudes shifted and, as knowledge was discarded, stigmatization and superstition increased, after all, barbarism is not barbaric if it's aimed at those considered, and constructed as, less than or worse than - barbarism is not barbaric if poverty and illness are criminalized (There are many papers with titles like, White Paper on the Criminalization of Children with Non-Apparent Disabilities which detail what this entails) and if people in distress are re-cast as malingerers or radically misunderstood: to borrow Mbembe's phrasing: 'We are not sure who they are, they might be human but they are not human like us'. The rug was pulled out from under peoples feet and they were told that it was in their nature to fall. A patchwork of small organizations remained or were put in place and, typically, they are, to use Henri Stiker's phrasing: '...content with weak resources, very loose coordination, and minimal rationality'. They are often staffed by money grubbing scammers.

In his paper: Going nowhere, slow, Mikkel Frantzen notes that several phenomenologists emphasize the relationship between time and depression and he writes about feeling stuck and stagnated – about feeling that the race is run. And about how, when in a depression, '...the present – which is hell – becomes all there is and all that can ever be imagined to be'. 

In the same paper he cites: ‘Melancholia as a desynchronization: towards a psychopathology of interpersonal time’ by Thomas Fuchs:

'[T]he depressive suffers the loss of sympathetic resonance; he gets ‘out of synch’. While dialogues are normally accompanied by a continuous synchronization of bodily gestures and gazes, his expression sets and loses its modulation...affect attunement with others fails'. Weaponized time is aimed at those who are being, or have already been, destroyed, so to speak, by time - in a circular or spiraling fashion, depression consists, for some and to some degree, in the internalization of the kinds of practices and subject positions or socio-economic positions (SEP's) described well by Mbembe, 
Friedli and by Kelly Oliver, Orlando Patterson and many others. 

In the US, in the antebellum and in the Jim Crow eras, black Americans were, sometimes, said to be intellectually disabled, always tired, easily frightened and sensation seeking. These descriptions are similar to the symptoms of mood disorders and the like; however, the connection between the way they were treated and their state was seldom sufficiently made. European American elites 'discovered' states which could be, and were, used to justify continued mistreatment which, in turn, amplified these states.

Similarly, the killing of the poor often happens by first disabling them then using, nowadays often crypto, eugenicist logic (mixed with prejudice and malevolent political and economic ideology) to justify letting them die or to justify actively contributing to their deaths. Phossey jaw, tuberculosis, syphilis, rickets, infantile paralysis, 
radiation poisoning, measles, mumps, rubella and scarlet fever often first disabled people, a disproportionate number of whom were poor, orthopedically and/or intellectualy, before killing them, if various other forms of social murder or murder by omission didn't get to them first. Also see, for example: Victoria Brignell's article: The eugenics movement Britain wants to forget, Mike Davis' book: Late Victorian Holocausts: El Niño Famines and the Making of the Third World and Sunaura Taylor's: Age of Disability: On living well with impaired landscapes. Not everyone falls or fell into line, for example, in his essay: 'Eugenics and Other Evils': G.K. Chesterton said: 'The modern poor are getting to be regarded as slaves in the separate and sweeping sense of the negroes in the plantations. The bondage of the white hero to the black master was regarded as abnormal; the bondage of the black to the white master as normal. The Eugenist, for all I know, would regard the mere existence of Tiny Tim as a sufficient reason for massacring the whole family of Cratchit...The poor are not a race or even a type...for they are not a breed. They are, in cold fact...a dustbin...of damaged dignity...' Weltschmerz, or world pain, will always be invisible to those immersed in a hedonistic, shallow and money grubbing culture and the fact that we can be injured and incapacitated by terrible things happening to us will be misread.

Neurotypical spin always requires a feigned collective amnesia involving the removal of centuries of context in order frame the neurotypical and physiotypical majority and the privileged minority as victims of their victims. The actions of their victims are framed as happening in a vacuum without any cause and effect beyond them, by implication, being naturally injured, incapable, unwell, poor, hateful and so on. It should be expected that, in populations that have been oppressed on the basis of, for example, their poverty, ethnicity, mental health status and/or impairment for centuries, some might be driven to take desperate and extreme measures.(Stanopoulos) The claim is not that outgroups are good, instead, the claim is that outgroups are human and therefore as capable of being bad as anyone else.  It might be the case that people are fickle not, strictly speaking, good or evil. When a member of an ethnic or religious minority does something good then, often, they will be called by the name of the majority. When a member of a minority does something bad then they are more likely to be called by the name of that minority. We include and take ownership of what is good and reject what is bad - we prefer to believe that we are not involved at all in generating anything bad. What is bad is understood to happen in a vacuum in which history and the laws of cause and effect are suspended, and it belongs entirely to those individuals who lack the power to reject it.

The capacity to deprive, to make ill and to inflict injury rests on disconnection and this disconnection tends to consolidate at, and travel down from, the higher levels of society where people are much less likely to feel the adverse consequences of their actions. Achille Mbembe points out that the lives of black and white South Africans were entwined regardless of the vast spatial and psychological distance opened up between them by apartheid. To be disentangled is to imagine yourself apart from the imperatives of, and from the fact of, entanglement. It is to be outside, to be outside of trouble and intervening in that with which you are not complicit in creating and have no shared history with at all. Those who buy blood diamonds are connected to those who mine them no matter how well the buyers cover their tracks. Apartheid means separateness and separateness is often a wish more than a reality. It might have been the case that the more separate black and white South Africans were, the more they impacted one another though the advantaged group is impacted less and impacts moreIn any case, there is merit, I think, in the notion that we support individualist ideologies that both produce mass individual suffering and enable mass healers to sell cures for states that, at least in part, they produced in the first place.(Hans-Georg Moeller) Hyper-individualism and the Individual Model help mask this circular process. Anne Boyer makes much the same point with more urgency in her book: The Undying.

We tend not to notice that we need supportive infrastructures (including emotional and cognitive infrastructures) until they are removed - until the rug is pulled from under our feet. Individual, interpersonal, micro-social or helper/helped framing can lend itself to this same inattention, to disowning, to being inattentive to our intrinsic vulnerability and to our precarity - to our dependence on various social norms, institutions and (infra)structures. And can lend itself to ‘...the posture of control over the property that I have and that I am...’(Judith Butler) To conceiving of ourselves as sturdy and self-centered and to routinely hiding any fault-lines in ourselves that we can’t overcome.(Butler) Secure in the knowledge that the rug is firmly beneath our feet, we can say that we are not interdependent and we can foist an anti-interdependence slant on the terminally precarious, thus amplifying their insecurity, but not without performative contradiction and not without hypocrisy; even the most virulent attack on the fact of interdependence and dependence rests on their preservation.

Those without the means to be ‘liberal subjects’ are expected to be, those who can’t maintain the posture or cloak fault-lines are expected to. Neoliberal discipline and the imposition or superimposition of neurotypical subjecthood onto those who can’t perform it might give them something to aim for or counter, or
 it might render them as obscure and as socially dead as Ralph Ellison’s Invisible Man. For disability studies founder Mike Oliver it never, however, meets the demand for: ‘...acceptance from society as we are, not as society thinks we should be’ because putative assimilation and just membership are incompatible. See Oliver's paper: 'The Individual and Social Model Of Disability' and see explanations, developed within disability studies, of the civil rights, the affirmation, the charitable help, the interactionist, the money, the medical and other models. There are criticisms, sometimes strong criticisms, that can be and have been levelled at each but it does not follow that any should be rejected entirely.

Achille Mbembe speaks of the erasure of the living substance of the face 'that gives the enemy his humanity' - he speaks of the task of disfigurement and erasure, the completion of which is a precondition for banishment and execution in accordance with the logic of contemporary hatred.

Mbembe equates the face with language - language is our face.

Where does this leave the non-linguistic? What if the face transcends, or is other than, language? 
Mbembe, sometimes, navigates such questions by calling for a de-monopolization of language. Language isn't the exclusive property of humans or alphabets. Language as such, does not sever us from them (or nomos from physis and so on) rather, it is a refusal to acknowledge the language of human and non-human others which contributes much to their erasure. Similarly, Anne Boyer suggested that '...pain is widely declared inarticulate for the reason that we are not supposed to share a language for how we really feel'. The subaltern, the thoroughly disempowered and the voiceless are often forced to turn to a politics of viscerality and emotivism. Seen through the lenses of this culture, for the most part, signs are a semblance of smooth pebbles substituted for a complicated, agonistic and struggling inwardness or outwardness - this feeds into the crushing of, and into the 'disfigurement' and 'erasure' of, others and into their imprisonment in dungeons of appearance, semblances of smooth pebbles or shells, or the pebbles smoothness without the pebble. No one wrote this and no one writes or does anything, the non-human is also widely declared inarticulate, a plurality, in Mbembe's sense of the word, is declared inarticulate in favor of one true voice, or in favor of many false voices, of '...an endless racket of words and gestures, symbols and language, delivered with increasing brutality like a long series of blows to the head'.(Mbembe) The elliptical character of modernity and the destitution of language, an endless racket of words and a war on thought give us an invisible mountain of distortion, emptiness and deceit to climb or to reiterate. When contemplation is barred and allotted spoonful's of hellfire rejected we destroy in the same way that a tsunami destroys, indiscriminately - without a second thought or a first. Without dubious institutional windbreakers provided by a corrupt academy thought is butchered by a wider culture and a social order which, like disruptive pupils, spill ink on your work or break your jaw. These windbreakers help generate 
broken jaws, disruption and spilt ink and the thought they help generate is often one and seldom all-terrain. When we build ivory towers we also, inadvertently or not, build a pale and whatever is beyond it, as Michael Sandal indicated in his book: The Tyranny of Merit: 'the highly educated harden into a hereditary aristocracy'.(Hochschild)

And, paraphrasing Baldwin, they barricade themselves behind this curtain and inside their history.

See, also, Johanna Hedva's essays: 'In Defence of De-persons' (in which she argues, for example, that governance was invented to govern de-persons) and: Sick Woman Theory, from which I want to excerpt one important insight: “Sickness” as we speak of it today is perceived through its binary opposite, “wellness.” The “well” person is the person well enough to go to work. The “sick” person is the one who can’t. What is so destructive about conceiving of wellness as the default, as the standard mode of existence, is that it invents illness as temporary. When being sick is an abhorrence to the norm, it allows us to conceive of care and support in the same way. Care, in this configuration, is only required sometimes. When sickness is temporary, care is not normal'. Nature contains deserts and Arctic ‘wastes’ and culture contains equally inhospitable locations; as inhospitable as they are, it would be remiss of a geographer to exclude deserts from their work. Organizational design, culture, financial incentives, regulation, protocol and law all reflect a gross lacunae in skill and soul where affliction is concerned. What if we asked, along with Eduardo Galeano: 'What happens when we integrate rather than refuse the pain, toil, and doom of surviving?' Everyday sorge or support for everyday discomfort and for everyday difficulties is continuous and taken for granted. While support for those, like Johanna Hedva, whose pain is persistent, is absent or intermittent and conspicuous. And often, to use a bland term, inappropriate, she speaks in visceral terms of violence and terror.

Giving a shit is not normal in as much as we go-along-to-get-along rather than taking the rough with the smooth and challenging all forms of unjust division and binarization. Hedva indicates that productivism or market fundamentalism and crude economic utility, as a catch-all ethic, are ideological lynchpins that this violence and this terror now revolve around. The ill are, so to speak, often framed as rogue or substandard industrial robots on a post Fordist production line, as are the well, albeit to a lesser degree. Injury, mental pain and disability are useless and, in a crudely utilitarian society, whatever lacks utility is waste or lebensunwertes leben/life unfit for life.

Or vice: 'Usefulness is virtue, incapacity - burden - is its corresponding vice'.(Will Conway)

One way, as per Foucault, that 'authorities' exercise control over individuals is through 'binary division and branding' - the sick/well binary described by Hedva is one example, there are many others. And, as Hedva has it: wellness now '...stands in for “life,” but life in terms of wealth, race, power, and, primarily, ability...' As such, our conception of '...wellness is soaked in ableism'.

There is also a gearing up for crisis and emergency and not for the more common, less exciting but no less agonizing, quiet desperation. By defining problems we shape solutions and so defined, we might be inclined to rush unnecessarily; provisional or stop-gap measures and short termism might be favoured and thoughtful deliberative democracy might yield quickly to, faster and simpler, managerialism and the managerial drivel which accompanies it. Charles Eisenstein talks about this inclination to rush in terms of an artificial scarcity of time; a notion that might, usefully, be connected to the idea that there is a limited supply of virtue: Michael Sandel cites the economist Kenneth Arrow as saying that: ‘We do not wish to use up recklessly the scarce resources of altruistic motivation.’ Time and 'altruistic motivation' are money.

He says that Arrow conceived of virtues as like fossil fuels which are depleted with use; this view leads to virtue (or a facsimile of virtue) being carefully metered with a frugality appropriate for a scarce resource – as is often the case when it comes to our treatment of various forms of distress. Sandel suggests that virtues would be better analogized to muscles that get stronger the more we exercise them, as such, it would be preferable to normalize or institutionalize the practice of virtue and altruism. (Achille Mbembe would, in part, agree, see his EGS talk: 'Technologies of Happiness in the Age of Animism'). While, Gilmore Wilson's analysis of crisis can, at a push, be synopsized as follows: anti-state states manufacture crises in order to impose new modes of governing on populations with the intention of resolving, managing or hiding underlying crises of capitalist accumulation. See Wilson's: 'Golden Gulag. Prisons, Surplus, Crisis, and Opposition in Globalizing California'. And the 'No Natural Disasters' campaign. It might also be the case that insecurity is generated and threats made in order to sell security.

Sandal also speaks of a eugenics sensibility dovetailing into a readiness to drop all projects geared towards moral and political improvement and economic and social reform. And says that we, too readily, concede that we are helpless when confronted with such imperatives; we conclude, then, that it's better to repair ourselves so that we may better '...fit the world, the social roles, that are beyond repair or reform'. This, he says, ‘...represents the fundamental concession to the moral and political disempowerment of humanity’. Knowledge about prejudice and about the subjects which we are prejudiced about can reduce prejudice - 
mythical versions of a subject along with stigma appear in the social imaginary whenever absent knowledge makes space for them or whenever we are taught to see circles and find squares and continue to see circles. And stigma is lethal. In addition, the social psychologist Gordon Allport wrote: ‘Prejudice (unless deeply rooted in the character structure of the individual) may be reduced by equal status contact between minority and majority groups in the pursuit of common goals. The effect is greatly enhanced if this contact is sanctioned by institutional supports (i.e. by law, custom or local atmosphere), and if it is of a sort that leads to the perception of common interests and common humanity between members...’ The Jewish and Palestinian 'Standing Together' movement might be an example of a worthwhile template. In as much as morality originates in, and is sustained by, reciprocity and interdependence anything which diminishes them will, in turn, increase the likelihood that anyone expelled from reciprocal loops will be harmed and increase the potential for retaliation, moreover, such expulsions are, themselves, disastrous in that they strip others of moral status and, therefore, of humanity. Of a culture, a set of values and of shared meaning. Orlando Patterson called this state: social death.

If we isolate, segregate, stigmatize, trivialize, alienate, monitor, spirit break, concentrate, Other, withhold knowledge, starve, abandon and team up on then the likely result will be that targets are isolated, segregated, stigmatized, trivialized, alienated, monitored, spirit broken, concentrated, othered, dumbed-down, starved, abandoned and teamed up on. If vast swathes of people are systematically stereotyped and stigmatized then that is what will happen, for an academic discussion of mobbing, including well thought out suggestions on how to address it, see: 'Mobbing and Psychological Terror at Workplaces' by Heinz Leymann and for an academic discussion of scapegoating see René Girard's: Violence and the Sacred and the pages on scapegoating in 
Ernest Becker's: Escape From Evil.

The psychotherapist Peter Levine noted that pack animals become stressed and panicked when separated from the pack, whether as a result of injury or otherwise, and so, if I remember correctly, he didn’t want patients to speak to him alone which is, at least, a tokenistic gesture in the right direction. One obvious reason for this increase in panic is that a herd animal without a herd is easy prey, temporary panic would make sense in such instances but persistent and severe stress is more likely to be lethal than useful, as Levine, Robert Sapolsky, Nadine Burke Harris, Gabor Maté and many others note. It might make sense to say that, just as active volcanos appear to be dormant and then erupt, so it is that persistent toxic stress can surface as panic or derealization or depression and so on; there is a sense in which these conditions consist in being buried under a mountain of stress.

The medium is the message, or else mediums (protocols, tools, screens, organizational forms and so on) have a strong influence on, and are enmeshed with, the message, with characters, identities, lived experiences etc. There is a cognitive bias which involves attributing causes to individuals where situations and 
underlying political philosophies have been, and are, causal, social psychologists call this the 'fundamental attribution error.' The simple truth of this finding shouldn’t be mistaken for simplicity, as the psychologist Paul Bloom said in a lecture, it “...is one of the core ideas in psychology”. Bloom illustrated the idea via comic exaggeration, saying that, through-out a lecture, you could throw Smarties at the lecturer and at the end conclude that they were the nervous type. We are, as David Rosenhan said, ‘…much more sensitive to an individual's behaviors and verbalizations than we are to the…contextual stimuli that often promote them.’ To simplify, one explanation for this bias is that our culture emphasizes individualism of various kinds, another is that we don't like to think that we lack control or are easily manipulated and, more significantly, we are also 'hardwired' to focus on individuals, characters and identities. It might also be the case that simple good guy/bad guy moral narratives can offer a kind of narrative comfort that more complicated and more troubling explanations undermine.

Moreover, over focusing on individuals helps quell anxieties stemming from an awareness of injustices which inhere in society and of the exclusionary nature of social orders, and helps us to remain unaware, also, of our own involvement in such formations. This focus lends credence to feeling ourselves immune to mental distress or breakdown and other experiences or qualities which are, or are perceived or created as, negative; such experiences or propensities are viewed as inhering in others not in us and an unbreachable (material and ideological) line between the two is drawn. In as much as this line is inscribed in the bodies-minds of Others, to patrol and police it, is to police them. Or else, as Jaques Semelin said in: Purify and Destroy: The Political uses of Massacre and Genocide: The community of 'us' is '...constructed at the expense of rejection of some 'Other', perceived as a profoundly different 'Them'. In this way, institutional inertia is cemented and reform killed in the cradle, along with the hopes and, often, lives of those who need reform, development, transformation or abolition; we want to belong, in other words, we want to be accepted and protected by a group, a team or a tribe and this want can be exploited. See the philosopher, Stacy Simplicans: 'The Capacity Contract' from which the thoughts above were adapted and, for example, work undertaken at the Othering and Belonging Institute and Robert Sapolsky's thoughts on othering, reciprocity, ingroups and outgroups, hierarchies, disparity, prejudice and related subjects.

In much the same way, the negative stereotyping of outgroups functions as a safety blanket reinforcing the comforting belief that ingroups (sane, normal and law abiding citizens) are inherently good. Outgroup status may be imposed when anyone questions the basic goodness of a social order or, even, of nature or God or humanity. Questioning the social order may consist in being harmed by that order, being harmed in this way contains within it an implicit accusation and an implicit condemnation - the greater the harm the stronger the condemnation. That which, through its mere existence, condemns the ingroup is then condemned by that ingroup. See, also, the just-world hypothesis: it has been shown experimentally that uninjured controls are less likely to be judged adversely than injured parties. Injured parties serve as a disturbing reminder of the fact that we live and are complicit in a brutally unjust world, a reminder that can be avoided if we turn the tables and judge them negatively, as having gotten what they deserve or as merely being unlucky, as in personal tragedy theory.

Deep tensions are indicative of deep divisions and deep forms of oppression inhering in the material practices of societies - divisions and forms of oppression that have been allowed to worsen. The expression of these tensions can be taken as a call to change and to improve material practices or it can be taken to be the problem and if it is taken to be the problem - if we shoot the messenger - then worsening material practices will continue to manifest as various kinds of catastrophe.(McManus) 

The most elementary lesson that social psychologists (like Fritz Heider, Stanley Milgram, Thomas Pettigrew, Elizabeth Levy Paluck, Solomon Asch, Susan Fiske, Elaine Hatfield, Leon Festinger, Kenneth and Mamie Clark, Lee Daniel Kravetz, Bruce K Alexander and Sherif Muzafer) have taught us is, perhaps, that the ways in which societies are arranged, social norms, protocol and organizational design have a strong impact on 'behavior' or action and that they should, therefore, be a primary focus. The Britannica Dictionary has it that: the most common meaning of the word protocol is: 'A system of rules that explain the correct conduct and procedures to be followed in formal situations'. In his anecdotal TED talk, Aaron Stark emphasized the fact that what turned things around for him was "...not the kind of overbearing kindness where they say: "Is there anything I can do for you? Is there a programme I can get you in? Can I do something to make you better? How can I help you?" Instead, talking about the impact that a friend had on him, Stark defined a version of, what might be called, informal correct conduct as follows: "He treated me like it was a Tuesday. He treated me like I was a person. When someone treats you like a person when you don't even feel like a human, it'll change your entire world, it did mine". He said that he had, for a long time, been treated like either a project or a monster and that both approaches were dehumanizing. From Stark's perspective normality was special and mistreatment was normal, so normal that adjusting to being treated like it was a Tuesday was no mean feat for him or his friend. His conclusion is reminiscent of Lilla Watson's maxim: “If you have come here to help me, you are wasting your time, but if you have come because your liberation is bound up with mine, then let us work together.” Indigenous Action warn of self-styled a
llies who may use anti-oppression principles and values (like those expressed in Watson's maxim) as window dressing. 'They are keen to posture, but their actions are inconsistent with their assertions...self-proclaimed allies have no intention of abolishing the entitlement that compelled them to impose their relationship upon those they claim to ally with'. Indigenous Action argue for the criminalization of support and solidarity. See their essay: 'Accomplices Not Allies: Abolishing the Ally Industrial Complex'.

The maxim is, in turn, reminiscent of the following thoughts, activist and educator, Mia Mingus wrote: 'I want us to be able to be understood and to be able to take part in principled struggle together - to be able to be human together. Not just placated or politely listened to'. Or offered '...a quick fix, an add on or a “just tell me what to do and I'll do it” type of angry/guilty shuffling. I want us to not only to be able to be part of spaces, but for us to be able to fully engage in spaces'. Self-referential discussions which are ostensibly about others do not constitute full engagement in spaces. If you have to Oliver Twist to them then they are not your organizations, if you are expected to say: “please, sir, I want some more” then then they are for you, for the most part, in name only. I'm reminded of a conference held in Saudi Arabia on the subject of women’s status in Saudi society; a photograph of the attendees showed that not a single woman was present. Think of a fish pond in which no fish are allowed. The fish flap around on the banks and, at best, a few splashes here and there reach them.

And, though I don't think that Stark, Watson or Mingus saw or see themselves as victims or adhere to a simple victim/perpetrator binary, Judith Herman makes a somewhat compatible point: 'To hold traumatic reality in consciousness requires a social context that affirms and protects the victim and that joins the victim and witness in a common alliance. For the individual victim, this social context is created by relationships...For the larger society, the social context is created by political movements that give voice to the disempowered'.

Robert Sapolsky concluded an article about depression and anxiety (titled: Taming Stress) with the following: 'such insight carries with it a social imperative: namely, that we find ways to' improve the world such that fewer 'people learn that they must always feel watchful and on guard or that they must always feel helpless'. And, in the same article, he says that '...it should be self-evident that something is wrong when a society is so unequal as to teach some of its members that life consists of menace and that they are fundamentally helpless; the incidences of anxiety and depression soar among the lower rungs of the socioeconomic ladder'.

Jean Stewart and Marta Russell also emphasise the creation of better social orders and values: 'We must create a social order based on equality, an order...that does not make “work” the defining measure of our worth, and that offers counter values to the prevailing productionism which only oppresses us all'. Similarly Dr Sally Wicher says that until “work” is no longer the defining measure of our worth not everyone will be viewed as equally human and not everyone will have human rights. She says that until then '...the holy grail of equality will never be attained. Until then all we are ever likely to get is the reframing and rebranding of oppression'. And that 'the very unequal distribution of power is, at root, what the problem is'In an interview, with reference to her post doctoral work, Michelle Ciurria calls for a coalitional movement, transformational justice and a re-visioning of the social order involving inclusive world building which, drawing on Garland-Thomson's work, she contrasts with eugenic world building or design plans made for the “ideal citizen.” She says that: 'Eugenic world-building constructs a society for the privileged and tries to “eliminate” everyone else through techniques of genocide, assimilation, medicalization, and so on'.

Paraphrasing Abigail Thorn's suggested solution to the mistreatment of trans people by health services: inquiries or truth commissions should be set up in which the people who were denied healthcare or who were harmed and the families of those who died have a chance to tell their story. Inquiries of this kind tend to involve investigating ourselves and concluding that we did nothing wrong and so there should be a majority of sufferers on the governing bodies of inquiries. The reports from such inquiries would then give us a starting point to talk about material changes - apologies, resignations, changing the system, memorials, damages and so on. To simplify, she indicates that bad system design and segregation are the main sources of mistreatment, it's a question, primarily, of organizational forms and of infrastructures and the inertia that all but guarantees that the way that things are traditionally done will be the way that things continue to be done no matter the cost.

To cut a long story very short, Dean Spades thoughts on mutual aid are also relevant here, as is the work of Mingus and Elliott Fukui on transformational and disability justice and Judi Chamberlain's writing on democratization and on mutualist ways of organizing, in particular as they relate to various kinds of pain. In The Fire Next Time, James Baldwin wrote: '...it is not permissible that the authors of devastation should also be innocent. It is the innocence which constitutes the crime.' Baldwin understood that he was complicit and therefore responsible to the extent that he was able to be - the enemy is always in the mirror and the mirror is always, also, a window; he said: 'I know you didn't do it, and I didn't do it either, but I am responsible for it because I am a man and a citizen of this country and you are responsible for it too, for the very same reason'. People who are not distressed have a lot of thinking to do. But, often, if you try to appeal to their better natures you will get run over because their better natures are non existent, for the most part they will do very little thinking - jackboots don't see the boot prints they leave in other peoples faces - their faces, their words in other words, are viewed as theirs and theirs alone. There are a few people who will and who have, some of the people cited here have, Carol Bacchi has. How are problems represented? Who or what are problems represented to be? There are several iterations of the following six questions which, as per professor Bacchi's Foucault inspired approach to policy analysis: 'WPR', can be used to analyze problem representations/policies; these questions are then aimed at any problem representations generated by the analysis: ‘Question 1: What’s the problem represented to be in a policy or set of policies? Question 2: What deep-seated propositions or assumptions underlie this representation? Identify binaries, key concepts and categories. Question 3: How has this representation come about? Question 4: What is left unproblematic in this representation? What are the silences? Can the problem be reconceptualised differently? Question 5: What effects (discursive, subjectification, lived) are produced by this representation of the problem? Question 6: How/where are dominant problem representations produced, disseminated and defended? How could they be contested/disrupted? Explore contradictions and discursive resources for reconceptualisation(re-problematization)'.





To be honest, it fills me with deep shame and rage. Shame at having to represent this brutality and because I know how much better it could be. Rage because of the indifference and ignorance of so many of my colleagues and bosses and because of how powerless I can feel. I have to own that I thought it was a resource issue. Of course I’ve seen the bigotry...However I don’t think I realised how much I relied on the resource problem as a screen to hide the fact that the system functions as it does...this is not about me showing...that “I’m not like those other nasty doctors” (although I can see the angle of perceiving my response as “white man tears” - emotion without action) because I believe the problem is systemic and beyond whether I am a good person or not, only collective action and a recognition of the political can change that. Every post on any form of systemic oppression gets a bunch people responding to simply show that they are one of the good guys, and of course it totally misses the point. I thought it was more important to own the very real harm that my profession is causing.

If you knew me, and if you really knew yourself, you would not have killed me.

                           Felicien Ntabengwa  

          

 At some point, a point we have not quite reached but will, I think, reach soon, the level of damage will begin to be more terrible than the advances we buy with that damage.
                   Andrew Solomon




The figure in Eleanor Davis' painting: 'Anxiety: My Monster, My Self' looks cold, rigid and scrunched up. Behind her transparent eyes is another figure. The viewer merely glimpses this small second person trapped within the first, holding her (perhaps its would be a better description given that it is barely identifiable as a person) arms aloft, calling, waving or drowning. But the blue figure is inhuman, is the monster, and the yellow the person. About her anxiety disorder and her painting Davis wrote: 'Everyone thinks this monster is you. But your trapped inside it...All you can do is watch while this monster lives your life.' If there isn't a semblance of a match between you and the you that appears in the world, then the worlds interactions with you might get lost in the post leading to a kind of locked in syndrome.  It would take an uncommon or impossible effort for the person in the painting to be heard at all, there might be a tremendous struggle to convey some of the you that appears in your head to the world and to unlock the trap - the anxiety or monster that scrambles your words and world. If the trap remained locked then what chance would you have? Davis wrote: 'you try to call out to your loved ones they can’t hear you. When they think they’re holding you, they’re only holding the monster'.

‘Eighty percent of success is showing up’. I stopped showing up for anything and when I did I was often so panicked that I wasn’t entirely present. Composer, Allen Shawn called his book about his anxiety, panic and agoraphobia: ‘Wish I Could Be There’ and I wished that I could be there also. He threads neurobiological and psychoanalytic perspectives into a work that is primarily autobiographical; his descriptions of his parents are particularly detailed. He didn’t seem to have been conspicuously mistreated, there was one incident in his upbringing that can be viewed as plainly traumatizing but the seeds of his phobia can, perhaps, be seen in the details of his parents way of relating to the world. A kind of ‘death by a thousand cuts' rather than by some incredible and obviously terrible misfortune. Of course, not everyone would find it easy to identify with Shawn's story. He grew up in a family who travelled around in chauffeur driven cars and he grew up to be a successful composer. These are uncommon experiences. The book opens with an account of him being mugged. He says that what bothered him about this event was that the muggers held him in place. Its other unpleasant aspects faded into the background as his phobic fear of restriction took hold and overwhelmed him. When I was a child I remember going to a fair and getting on a ride, the ride involved being swung upside down at high speed – this didn’t bother me but, in order to hold us in place while we were upside down, machinery pushed a pad onto our chests, in turn pushing us back into our seats. I began to panic at being restrained and the ride attendant offered to reverse the machine and free me. Similarly, I remember canoeing once and feeling something like vertigo at the thought of having to paddle through a metal tunnel that had been placed in a lake as part of some sort of obstacle course. I was disconcerted enough to lose concentration and turn the canoe such that it was wedged sideways against the sides of the tunnel, becoming an impassable obstacle for people behind. 

A nuclear power plant melts down and everyone is fleeing the city. Air raid sirens blare. You arrive at a vast train station. People are panicking and rushing around. You see your cousin in the distance. He joins a gaggle of people who seem to know what they are doing and were they are going. He disappears from view. You glance up at the departures board. It has short circuited and is quickly cycling through random numbers and letters. It comes to an abrupt halt.

When a relative visited I crouched behind a wall in the garden on what seemed to be the coldest day that winter; I stayed crouched for hours. When I could no longer withstand the sub-zero temperatures, I crept back into the house and exchanged a few simple words with the visitor.

Once, when I was at school, most of my classmates left the classroom to watch a film that was related to what we were studying and I and a couple of others stayed behind to finish working on something. I completed the work and left the classroom to watch the film that was being shown in another room. I came across a door that was ajar and assumed that it was the door to the classroom I was looking for. The thought of being mistaken and walking into the wrong room seemed to be a cause of anxiety and I couldn’t shake the seemingly nonsensical feeling that I was about to walk into a trap. I felt very sick. So I walked round the corridor and tried to pluck up the courage to enter. But I was still unable to open the door and ended up walking around the corridor for about an hour – stressed by the knowledge that, had a teacher crossed my path, I would have some explaining to do and that I didn’t have an explanation; I don't have much of an explanation now other than that my cerebellum was playing fear Scalextrics. The film that was being shown was: 'One Flew Over the Cuckoos Nest'.

There were many other occasions early in my childhood that indicated that something was going awry. There were other occasions when I would feel crushed or panicked while in enclosed spaces or at the prospect of being confined but why list them all? I was also hospitalized when I was about ten due to psychosomatic pain caused by irritable bowel syndrome and anxiety.

I walked around a block a thousand times rather than enter a house party when I was about eight - I associated such things with alcohol and I associated alcohol with my drunk mother smashing the house up or injuring herself. I was angry. It was a warm day. I was exhausted. And so I went to the party. It wasn't what I expected. The adults were pleasantly drunk. It was a common or garden 'bohemian' house party. I sat on the polished wood floor with the daughter of my mothers friend while she played rough with a kitten and talked the kind of spirited gibberish of which five year olds are fond. I was much less angry but I did not adapt to being there.

If you stop showing up at all then you're liable to become stir-crazy
- cabin fever is added to a cauldron of terrors.


Cosslett's article: I feel I might die any waking moment starts with a description of cognitive exposure treatment“Tell me what you can smell, what you can hear.”

“I don’t know,” I say. “Normal plane smells – that stuffy, dry smell. Coffee breath. Chemicals.”

“Sounds?”

“The roar of it moving through the air, I guess. Someone rustling a newspaper. Tinny hip-hop through headphones. A baby crying. Conversation. The glug of wine in a plastic cup.”

“Then what happens?”

I become very aware of my heart. “The man stands up and he is shouting.” My voice shakes. “He’s standing behind my husband. He gets out a knife and he slits his throat, there is blood everywhere, it’s all over me. Rusty smell. People are screaming. My husband is looking at me. He is dead.”

“Then what?”

I am crying now. “They have taken over the plane. It starts to nosedive and everyone is screaming. And I know this will be the end.”

“Then what?”

“Then nothing.”

I am not on a plane nosediving into the sea, but my brain is on that plane. It’s firing off terror signals like a wonky catherine wheel. My palpitating heart is also on the plane. I imagine that it is as visible in my chest as the tiny unborn hand I once saw high-fiving the wall of my friend’s womb, protruding. And my shaking body’s on the plane, as I sit there, in the therapist’s office, the sunlight streaming through the windows and the gardeners outside mowing the lawn, and I think: I am about to die. Not for the first time, either. Not even for the first time that day. I feel as though I’m about to die almost every waking moment'.



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