Reification, Abandonment, and the Industry of Misery Management

Introduction

The contemporary management of mental distress and homelessness operates not as a system of care but as a mechanism of containment and for the promulgation of laissez-faire ideology, the implementation of state and market discipline, risk management, and neoliberal notions of autonomy and blame. While dominant narratives frame mental health services and homelessness outreach as efforts to provide assistance or advice, in reality, they more often function as Potemkin villages and fronts for pre-existing forms of social exclusion and social murder, maintaining rather than alleviating suffering. The success of deinstitutionalization was not merely logistical it was also conceptual and political. In reality, the shift was not mainly about money; it was about transforming how society defines responsibility, and personhood. This essay examines how essentialism, institutional shifts, neoliberalism, and necropolitics shape the governance of mental illness and poverty, reducing various kinds of suffering to "vulnerable populations" qua objects of remote governance and, ultimately, to economic and political raw material. By tracing these dynamics, we uncover how so-called care infrastructures operate as a slow and sadistic extermination programme, disguised as social responsibility.

For Foucault, populations are not just passive masses but constructed through knowledge systems and governance techniques that define what it means to live, thrive, or be at risk—the word, as it is used here, points to the diffuse process of tacitly managing life itself.

Unmediation, Essentialism and the Reification of Distress

The language of vulnerability masks a logic of disposability, where suffering bodies become sites for economic extraction or are simply left to decay. Giorgio Agamben’s idea of the state of exception involves a kind of unmediated political power—where law suspends itself and operates without limits. This, paradoxically, creates a space where mediation is abolished, yet power is fully exposed. In this way, governance does not merely fail the populations it claims to serve; it weaponizes life itself, determining who is allowed to live and who is left to die.

Meaning is always deferred through signs (Derrida's différance). Any attempt to remove mediation still relies on some structure of semiotic mediation. The strategic removal of mediation amounts to the destruction of a target subject through the destruction of its meaning.

Another key tool in the generation and management of distress is the essentialization and reification of suffering. Mental distress and poverty are not personal failings and they are not merely fixed biological states — they are socially produced states generated through histories, relationships and processes. However, within dominant frameworks, these conditions are stripped of their relational contexts and instead reified—turned into ill-defined monolithic categories that justify segregation, stigmatization, neglect, underdiagnoses, and organized abandonment.

As the anthropologist Marshall Sahlins observes, “Poverty is not a certain small amount of goods, nor is it just a relation between means and ends; above all it is a relation between people. Poverty is a social status. As such it is the invention of civilization.” The same holds true for mental illness: rather than being understood as an interaction between person and brutal synchronic and diachronic habitats or as a subject position—internalized and autonomized though it may be—it is transformed into a simple static identity, creating populations that can be monitored, abandoned, rendered docile or criminalized under the guise of benevolence.

If we adopt a mysterian stance and treat human experience as merely a set of puzzling behaviours to be managed we risk a kind of abolition of the person, unmediation leaves people in a state of existential limbo, much like C.S. Lewis’s "men without chests," governed by impersonal systems rather than personal meaning-making.

From Asylums to Prisons: The Evolution and Refinement of Containment

The history of deinstitutionalization is often framed as a progressive movement away from the horrors of the asylum system. However, while psychiatric hospitals declined, the carceral apparatus expanded, shifting the site of ideological capture and intensifying it rather than dismantling it.

Those who would have previously been confined to mental institutions are now disproportionately funnelled into the prison system. Christian Parenti refers to those who are “not being efficiently used by the economy” as part of a growing stratum of surplus people—populations rendered economically redundant yet necessary for the expansion of the prison-industrial complex. Marta Russell and Jean Stewart argue that “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.” The rise of forensic psychiatric units, court-mandated treatment, and punitive mental health policies further blur the line between care and incarceration, ensuring that mental illness remains under the discursive, structural and procedural control of the "anti-state state" not in, for example, the hands of those who experience it or in the hands of other parties with a stake or comprehensive knowledge and know-how.

The Homelessness Industry and Neoliberal Misery Management

Parallel to the prison system, the homelessness industry has become a lucrative sector in its own right, profiting from the perpetuation rather than the resolution of poverty. Under neoliberal governance, the state has outsourced the management of homelessness to a patchwork of nonprofits, shelters, and community mental health services. These organizations, rather than providing pathways out of homelessness, essentially function as containment zones that maintain injured individuals in cycles of precarity, dependency, and surveillance.

The charity model and tragedy theory play a key ideological role here—framing homelessness as an individual misfortune rather than a structural issue justifies a never-ending stream of short-term, band-aid solutions that preserve the power dynamics of giver and recipient. This model not only pacifies political resistance but also turns suffering into an economic resource, sustaining industries that profit from managing rather than treating illness.

Necropolitics and the Slow Genocide of the Marginalized

Achille Mbembe’s concept of necropolitics—the politics of deciding who may live and who must die—is crucial in understanding how contemporary systems of mental health and charitable help operate. The criminalization of illness, underdiagnoses, undertreatment, the neglect of those deemed “unproductive,” and bureaucratic indifference to their suffering all constitute a slow form of extermination. People in distress are not only abandoned— their survival is actively impeded, whether through the destruction of encampments, the refusal of necessary medical care, or the expansion of anti-homeless legislation.

Stigma and superstition further reinforce this exclusion. As empiricism, evidence and knowledge about mental illness was discarded in the wake of deinstitutionalization a "demon haunted world" of fear, prejudice, propaganda, deliberate culturally induced ignorance and hostility took its place. As a practice and as an explanatory tool, soft-skills and soft-power were adopted and promoted over facts—soft-skills can constitute a kind of relational padded cell, they often amount to fluency in the euphemisms of managerialism, the ability to perform concern while ensuring nothing changes. Rather than being understood as relational and context-dependent, suffering, illness (and the impact of childhood neglect and abuse) are underplayed and underdefined or cast as dangerous, malingering or fictitious. This dehumanization facilitates policies of neglect, ensuring that those pushed to society’s margins remain invisible until they die—deaths that are either ignored or quietly blamed on personal failure.

Alternative Models and the Politics of Resistance

If, as Russell argues, the structures necessary for genuine support “were never put in place,” what alternatives exist? True transformation, she says, demands a rejection of the carceral and charitable models of mental health in favor of structures designed and run by those most affected. Mutual aid, abolitionist mental health frameworks, critique of civilization and praxis based on that critique provide viable alternatives to the current system of misery management. In this framing, radical peer-run models and harm reduction initiatives, offer glimpses of what justice and treatment could look like outside of discursive subjection. Rather than reinforcing dependency and surveillance, these approaches recognize distress as political issues that require systemic transformation not mere individual correction. In contrast to the fragmented patchworks—content with weak resources, loose coordination, and minimal rationality—currently in place, a genuine model of justice grounded in the lebenswelt would prioritize knowledge, dignity, and material support without organized abandonment under the guise of "freedom" and without criminalization.

Conclusion

The contemporary mental health industries and dominant ad rem salience frames discussed do not exist to solve or to illuminate "crises" but to facilitate the management, scapegoating and containment of populations deemed disposable. Essentialism, criminalization, and the economic exploitation of distress ensure that these systems remain intact, profiting from and co-generating suffering rather than alleviating it. Deinstitutionalization did not liberate the distressed; it simply transferred them from psychiatric wards to prisons, shelters, "community" charitable mental health facilities and the streets.

If these systems are to be dismantled, their underlying logics must be exposed and rejected. Resistance must center those directly or indirectly responsible and those directly affected, building alternatives grounded in autonomy, clearer and more distinct first, second and third person knowledge, knowledge sharing, critique, hermeneutics, co-creation, individuation, compassion, mutual aid and in the institution of various forms of mediation—such as apt texts and lectures, law, rights, and due process or epistemic, ethical, market/financial, ecological, symbolic, ritual, affective and political media and mediation. Until then, the rug will continue to be pulled out from under people’s feet, and they will continue to be told that it was in their nature to fall which is, of course, both insane and evil.

GPT

Tragedy Theory in Disability Studies: A Critical Examination

Disability studies has long critiqued the ways in which disabled people are framed in society, particularly through models that reinforce marginalization. One of the most pervasive frameworks is the tragedy model of disability, often referred to as tragedy theory in disability studies. This model conceptualizes disability primarily as an unfortunate, pitiable condition that evokes sympathy, charity, or personal suffering rather than as a neutral or valuable aspect of human diversity. This essay critically examines tragedy theory, its implications, and alternative perspectives that challenge its dominance in cultural and organizational narratives.

Understanding Tragedy Theory

Tragedy theory emerges from the individual model of disability. Within this framework, disability is seen as a personal misfortune, something to be grieved, overcome, or eradicated. This perspective is deeply embedded in historical representations of disabled people, from religious narratives of divine punishment to modern media portrayals that emphasize suffering and resilience in ways that reinforce ableism. The tragedy model assumes that the primary challenges of disability come from the condition itself rather than from social, economic, and political structures that enforce disablement.

The tragedy model often underpins charity-driven approaches, where disabled people are depicted as objects of benevolence rather than as full social agents. Telethons, fundraising campaigns, and sentimentalized media representations frequently trade in pity, reinforcing the idea that disabled people exist in a perpetual state of suffering and dependency. Disability activists have long critiqued this approach, arguing that it infantilizes disabled individuals and shifts the focus away from systemic change toward individual narratives of perseverance or cure.

Critiques of the Tragedy Model

The most significant critique of tragedy theory comes from the social model of disability, developed by disability scholars such as Mike Oliver, Tom Shakespeare, and Colin Barnes. This model distinguishes between impairment (a physical or cognitive difference) and disability (the social barriers that restrict participation). Under this framework, the tragedy model is rejected as a depoliticizing force that obscures how institutions, policies, and cultural attitudes disable individuals more than their bodies do.

A key argument against tragedy theory is that it perpetuates passive victimhood. If disability is framed solely as a personal tragedy, then disabled people are seen as recipients of care rather than as active participants in shaping society. This fuels policies that prioritize professionalized intervention over structural accessibility and inclusion. For example, instead of demanding equitable access to education and employment, tragedy-based narratives often focus on individual success stories that reinforce neoliberal ideals of self-sufficiency while ignoring systemic barriers.

Another critique emerges from affect theory and cultural studies, particularly in the work of Rosemarie Garland-Thomson and Tobin Siebers. Scholars in these fields examine how affective economies—such as pity, fear, and inspiration—construct disabled bodies as sites of spectacle and moral instruction. Media representations, such as news stories about “overcoming” disability or viral social media posts of disabled people performing everyday tasks, reinforce a narrative of exceptionalism that keeps the tragedy model intact while offering a false sense of empowerment.

Alternative Frameworks

To move beyond the tragedy model, disability studies has developed alternative frameworks that center relationality, interdependence, and structural justice. Rather than seeing disability as something to be pitied or overcome, some schools of thought embrace non-normativity and fluidity, arguing that disability is part of the broader spectrum of human experience. This perspective disrupts the tragic narrative by positioning disability as an identity and political stance rather than as a mere personal affliction.

Conclusion

Tragedy theory in disability studies has been widely criticized for its reductive, individualizing, and depoliticizing approach to disability. By framing disability as a personal misfortune rather than a structural issue, the tragedy model reinforces exclusionary narratives that prioritize help and charity over rights and justice. Alternative models, including the social model, the money model and rights, interactionist and justice perspectives, offer more nuanced ways of understanding disability that emphasize agency, interdependence, and systemic change. Moving beyond tragedy requires a fundamental shift in how society conceptualizes disability—not as something to be mourned, but as a vital and integrated part of human diversity.

GPT

2. Deinstitutionalization Without Support (Franco Basaglia, Critical Disability Studies)

• While deinstitutionalization was meant to restore agency, it often happened without building mediating structures, leaving many to fall through the cracks into homelessness, prisons, or premature death.
• The forced shift from long-term psychiatric hospitals to prisons and emergency rooms represents a removal of mediating mental health infrastructures, reducing people to either zoe (mere physical life) or criminal cases.

3. The Removal of Interpretive Mediation

• By stripping away interpretive mediation (personal history, cultural meaning, even the patient's own narrative), distress is transformed into something purely individual—opening the door for elimination through containment or neglect.

4. Suicide and the Bureaucratization of Death

• The way institutions handle suicide—whether through coercive hospitalization, surveillance, or outright neglect—often involves removing mediation between suffering and systemic response.
• Policies that frame suicidal individuals as risks to be managed rather than persons in need of relational engagement erase the role of human connection as a mediating force.

5. The Algorithmic & Carceral Turn

• AI-driven risk assessments for mental health (in policing, welfare, or healthcare) remove human mediation, turning distress into a set of data points that determine eligibility for care—or justification for incarceration.
• The criminalization of madness, particularly among marginalized communities, bypasses psychiatric mediation altogether, leading to direct punishment.

Would you say you're particularly interested in psychiatric history, contemporary policy, or the existential implications of this removal of mediation.

You said:

Contemporary policy/deinstitutionalization and the existential implications of the removal of mediation. I'm also interested in Basaglia.

ChatGPT said:

Basaglia is a fascinating figure, especially in the context of deinstitutionalization and the existential stakes of removing mediation. His work was radical not just for closing asylums but for rethinking the relationship between mental illness, society, and power.

Basaglia and the Politics of Deinstitutionalization

• He saw psychiatric hospitals as instruments of exclusion, where people were not treated but warehoused, stripped of agency and reduced to objects of control.
• He was influenced by phenomenology and existentialism, viewing mental illness not as a purely biological phenomenon but as deeply tied to social and political conditions.
• His reforms in Italy, culminating in Law 180 (the Basaglia Law, 1978), dismantled psychiatric asylums in favor of community-based care—but the failure to fully fund alternatives led to unintended consequences (e.g., homelessness, criminalization).

The Existential Crisis of Deinstitutionalization

• Deinstitutionalization was meant to restore autonomy, but without proper mediation (community support, economic stability, relational structures), many former patients were abandoned to a system that functioned through neglect rather than overt repression.
• The transition from the asylum to the streets or prisons replaced one form of elimination with another—rather than being confined, people became invisible, disposable.
• In an existential sense, this mirrors what happens when mediation is stripped away in other contexts: the person is no longer seen, recognized, or understood within a shared framework of meaning.

Contemporary Policy & the New Forms of Unmediation

• Modern psychiatric care increasingly operates through biomedical reductionism, where mental illness is seen as a brain disease divorced from lived experience. This removes interpretive mediation—there is no room for history, trauma, or social critique.
• Carceral psychiatry persists, with involuntary commitment often functioning as a legal bypass of rights, while others are abandoned under the guise of "freedom."
• Algorithmic decision-making (in social services, healthcare, policing) strips away human judgment, reducing care to risk assessments and cost-benefit analyses, making access to support even more precarious.

Would you say your interest in Basaglia is more in his theoretical critique, his policies, or the unintended consequences of deinstitutionalization?

You said:

From Agamben's angle and from the angle of unmediation, mismediation, mass-man vs individuation and from Ernest Becker's angle as well as from conventional contemporary biopsychosocial angles.

ChatGPT said:

That’s a rich and multidimensional approach. Agamben’s state of exception is particularly relevant to deinstitutionalization—many psychiatric patients became subject to a kind of liminal non-status, neither fully recognized as needing care nor as autonomous subjects with rights.

Unmediation and mismediation frame deinstitutionalization as a double-edged process:

• Unmediation: The removal of institutional containment without constructing alternative forms of social, legal, or existential mediation. This leaves people in a precarious, often invisible state.
• Mismediation: The imposition of inadequate or misaligned structures, such as shifting psychiatric patients into the criminal justice system, emergency rooms, or precarious housing rather than building genuine community-based care.

The mass-man vs. individuation lens highlights how contemporary mental health policy often treats people as statistical categories rather than singular beings with unique existential struggles. Deinstitutionalization, when done carelessly, can strip people of relational and symbolic structures that enable individuation.

From Becker’s angle, psychiatric patients live in heightened proximity to mortality, vulnerability, and social abjection. Deinstitutionalization, when it results in neglect rather than liberation, can function as a form of death denial by exclusion—removing those who force society to confront its own fragility.

And from conventional contemporary angles, deinstitutionalization is often discussed in terms of funding gaps, housing shortages, and criminalization. But these policy critiques often miss the existential and political stakes that thinkers like Agamben, Becker, and Basaglia bring to light.

Would you say your focus is more on critique, re-theorization, or tracing the historical arc of these processes?

You said:

All three. The funding gap argument is weak. It's a hand waving excuse.

ChatGPT said:

That makes sense. The funding gap argument is often a way to sidestep deeper structural critiques—it assumes the failure of deinstitutionalization was merely logistical rather than conceptual or political. In reality, the shift was not just about money; it was about transforming how society defines responsibility, and personhood.

A purely economic framing also obscures how unmediation and mismediation were baked into the process itself. Deinstitutionalization didn’t simply fail because of underfunding—it failed because it operated under an ideology that prioritized efficiency, risk management, and neoliberal notions of autonomy. The "freedom" it offered was often indistinguishable from abandonment.

Tracing the historical arc, there’s a clear pattern:

1. Institutionalization (19th–mid-20th century) – Psychiatric asylums functioned as spaces of containment, often dehumanizing but at least acknowledging a social obligation to those inside.
2. Deinstitutionalization (1960s–80s) – Driven by anti-psychiatry movements, legal challenges, and cost-cutting imperatives, institutions were dismantled without building robust alternatives.
3. Carceral & Market-Based Psychiatry (1990s–present) – The prison system, ERs, and precarious social services became mismediated replacements, reinforcing cycles of exclusion and abandonment.

GPT