872021, issue 2
Normality Proper to the Time is Sickness
Fabian Freyenhagen
Capitalist societies have the uncanny ability to constantly change, and yet remain the same.
An envisaged psychoanalysis of the prototypical culture of mid-twentieth-cen-
tury society – especially as it presented itself in California – was predicted to reveal
that sickness proper to this time is normality (§ 36). Being a regular guy or popular girl
then required blocking all signs of illness, displaying exuberant vitality and cheerfulness
as if one’s soul’s salvation depended on it. In fact, the mechanical nature of the bodily
comportment and the suppression of even as much as a furrowed brow inadvertently
suggested that the hearts had stopped beating long ago; and that what was presented
to us were corpses, skilfully prepared so as to not scare o anyone at the open-casket
funerals that were hidden in plain sight. It was a time when being homosexual was
considered a mental illness, which tells us not only about the sexual mores then, but
also about the stigma – even taboo – that was attached to those not considered normal
in their mental or emotional make-up.
As times have changed, so have mores. Being diagnosed as presenting with
mental illness has become much less stigmatised, especially if the suerers are privileged
and do not have socially unacceptable delusions. Certain conditions are now often
understood as examples of neurodiversity, rather than abnormality. Being neurologically
dierent is sometimes even celebrated, as in the trope of the troubled geniuses of the
world of art, mathematics, or nance that populate the silver screen and on-demand
streaming devices. It has become statistically likely and accepted – even fashionable,
judging by how many princes and other celebrities go public with it – to receive at
least one diagnosis in one’s lifetime, be it anxiety, depression, attention decit hyper-
activity, or autistic spectrum. It is seen as a mark of individuality to be an instance
of a general category, although this absurdity is partly masked by the exceptions and
reasonable adjustments an acknowledged diagnosis might make available to whoever is
prepared to accept it (this quid pro quo can be witnessed in university contexts, where
the rise in mental health problems has been particularly striking). Still, perhaps, so far
so good. Things become more troubling when we consider the open secret that an
ever-increasing number of us are prescribed and take medication meant to address
low mood or anxiety, conceptualised as chemical imbalances in the brain; and the less
open secret that the side-eects might be worse than the (purported) disease. The shift
from the “age of anxiety” to the “age of depression” has been accompanied by a shift of
response, from one of telling people to man up or be locked up to one of popping pills
and exemption badges. What it means to be mentally distressed has changed in a way
that can almost be dated to a specic year: in 1980 a watershed occurred in psychiatry
– inevitably rst in the USA – whereby mental distress became understood as a bundle
of symptoms, for which the aetiology need not be known. The individualisation of
mental distress – something that already worried Adorno about mid-twentieth-century
psychoanalysis’s becoming part of social hygiene – thereby reached a completely new
level. The change in ontology within psychiatry made this distress into an illness of the
brain of yet-unknown origin. The causal nexus of these developments is like a vortex
882021, issue 2
of forces that cannot be easily disentangled. Yes, there have been changes in cultural
and moral – including sexual – norms, but the result we are faced with today also owes
much to the material forces brought to bear by the pharmaceutical companies and the
incentives structures of private and public health-care providers. Destigmatisation, in
our times, has come at the expense of commodication. If only the suering wouldn’t
so stubbornly persist through its normalisation and medicalisation! For while it is a
source of income, it is also a source of inconvenience for the new enterprenerial world.
Plus ça change, plus c’est la même chose.Whether to be normal is to deny illness
to the point of being dead, or to accept illness to the point of dying of the supposed
cure, does not alter in the slightest the aetiology of the individual and social malaise, or
indeed the lack of a real cure. Once again, bringing to light – be it the mid-twentieth-
century hygiene of social adaptability or the early twenty-rst century explosion of
mental illness diagnosis – does not automatically remove but instead can hide, indeed has
hidden, the “secret domain of the faeces” (§ 36), the remaining wretchedness; and more
eectively so. The signs of repression are perhaps no longer repressed at the individual
level, but now at the collective one. Yes, there is increasing recognition that there are
social causes of illness, including mental distress. But even this insight is co-opted into
social control, albeit often in the supposedly innocent and subtle form of changing the
“choice architecture” advocated by behavioural insight teams. Instead of social change,
we get mindfulness and resilience training; and whether the default becomes ‘opt out’
instead of ‘opt in’, will not change this.
When the norm has become for society to be ill, what’s the future for health?
Perhaps there is hope in the thought that no normalising of suering can completely
erase the critical potential suering has as motor of thinking.
Fabian Freyenhagen is Professor of Philosophy at the
University of Essex, UK. His publications include
Adorno’s Practical Philosophy: Living Less Wrongly
(Cambridge University Press, 2013) and articles and
book chapters on Critical Theory. He is investigating
the idea of social pathology, particularly in relation to
mental distress, its conceptualisations and social causes.
Biography
