Tag Archives: psychiatry

Although this post can be read alone, it might make sense to read it in sequence. The previous posts can be found here and here. I have at least two further posts planned in this sequence.

Ecopsychopathology: Pre-Traumatic Stress Disorder

In 2012 a psychiatrist and United States National Wildlife Federation published a study on the psychological effects of climate change. The report is full, considered and features some pragmatic words of advice around “awakening” people to existential threat of ecological collapse and discusses how ‘psychology can help us understand what ignites an environmental consciousness and steers it into action’ (Coyle and Susteren, 2012). It also details how woefully unprepared the US psychiatric system is for the escalating psychological fallout of climate change. Nature is about to unlock all our repressed and hidden madness.

One of the authors of the report, forensic psychiatrist Lise Van Susteren, has coined the term “pre-traumatic stress disorder” to discuss the effects on the psychological state of the scientists, academic and their assistant who are gather, analysing and reporting on the hard data of climate change. In an interview from September of this year, Van Susteren explained the term as ‘what I see. It’s what I live. It’s what I see others living’. In a story in Grist we are told that

“It’s an intense preoccupation with thoughts we cannot get out of our minds,” Van Susteren says. And for some, it’s a preoccupation that extends well outside of the office. “Everyday irritations as parents and spouses have their place, they’re legitimate,” she says. “But when you’re talking about thousands of years of impacts and species, giving a shit about whether you’re going to get the right soccer equipment or whether you forgot something at school is pretty tough.”

What’s even more deflating for a climate scientist is when sounding the alarm on climatic catastrophes seems to fall on deaf ears. “How would that make you feel? You take this information to someone and they say they don’t believe you, as if it’s a question of beliefs,” says Jeffrey Kiehl, senior scientist for climate change research at the National Center for Atmospheric Research in Boulder. “I’m not talking about religion here, I’m talking about facts.

The 2012 report also details the effects that studying climate change is having on these researchers. An example comes from a researcher who has invested 10 years studying one coastal reef:

It’s gotten to be so depressing that I’m not sure I’m going to go back to this particular site again because I just know I’m going to see more and more of it dead, and bleached, and covered with brown algae (Coyle and Susteren).

Climate science as thanatology. The investigation of marine ecosystems become the assessing of a graveyard. Encounters with a dying a ecology: the local material eco-collapse as the causal occasion for the neuropsychological one. You go to work to find your dream job of charting the vibrancy of life revealing to you only death and the promise of more death- of extinctions. Powerless witness to the violence of the demonic will to live,  you are a mortuary attendant and morgue worker for the world. You passively register the dying off the Earth. And no one listens. No one cares.

Another report, this time from Esquire:

Among climate activists, gloom is building. Jim Driscoll of the National Institute for Peer Support just finished a study of a group of longtime activists whose most frequently reported feeling was sadness, followed by fear and anger. Dr. Lise Van Susteren, a practicing psychiatrist and graduate of Al Gore’s Inconvenient Truth slide-show training, calls this “pretraumatic” stress. “So many of us are exhibiting all the signs and symptoms of posttraumatic disorder—the anger, the panic, the obsessive intrusive thoughts.” Leading activist Gillian Caldwell went public with her “climate trauma,” as she called it, quitting the group she helped build and posting an article called “16 Tips for Avoiding Climate Burnout,” in which she suggests compartmentalization: “Reinforce boundaries between professional work and personal life. It is very hard to switch from the riveting force of apocalyptic predictions at work to home, where the problems are petty by comparison.

The despair is easy to understand if we consider that reputable climatologists like Paul R Ehlrich are providing us information that leads them to conclude that

The evidence is incontrovertible that recent extinction rates are unprecedented in human history and highly unusual in Earth’s history. Our analysis emphasizes that our global society has started to destroy species of other organisms at an accelerating rate, initiating a mass extinction episode unparalleled for 65 million years. If the currently elevated extinction pace is allowed to continue, humans will soon (in as little as three human lifetimes) be deprived of many biodiversity benefits. On human time scales, this loss would be effectively permanent because in the aftermath of past mass extinctions, the living world took hundreds of thousands to millions of years to rediversify. (Ehlrich et al. 2015)

At the risk of overloading this post with quotes culled from elsewhere, the same Esquire article manages to report some of the most worrying data regarding my generation, and the kids coming up after me:

A 2007 poll of more than a thousand middle schoolers found that almost 60 percent feared climate change more than terrorism, car crashes or cancer. Roughly the same percentage thought more needed to be done to combat the threat, and more than 40 percent reported that concern about climate change occasionally occupies their minds.

“Unlike adults who can put their heads in the sand … kids are very aware of what’s going on,” said Chris Saade, a North Carolina-based psychotherapist, in a 2014 interview with The Globe and Mail. “Children often ask me questions that we, as adults, try to evade: ‘What is going to happen to the human race?’ ”

Most of the middle schoolers from 2007 are now in their early 20s. For a generation that was born after the Cold War and came of age in the Anthropocene, to what extent does climate fear persist into young adulthood?

In a June 2015 Pew poll, 51 percent of Americans aged 18 to 29 rated climate change a “very serious” problem, compared to 47 percent of those 30 to 49, 44 percent of those 50 to 64, and 41 percent of those 65 and over. Fifty-one percent may seem a slim majority, but in light of what we know about human psychology, it’s actually quite striking. A 2009 report on climate-change psychology by the American Psychological Association explains that people tend to underestimate the danger of events perceived as having a “small probability.” Climate risks, which are believed by many to be uncertain, far off in the future, or occurring in remote parts of the planet, should follow this logic.

Yet a majority of millennials rate the threat as very serious. While polls shed some light on young people’s concern levels, no large qualitative surveys exist to illuminate the depth of their worries or how the emotional impact of climate change influences their life choices.

Gillian Calderwell has listed the symptoms of pre-traumatic stress on her own blog: anxiety and stress, fear and hopelessness, the sense of “living in a parallel universe” – ‘Don’t people see that we are headed straight off a cliff?’- and depression, irritability and anger. It is all too easy to imagine that in these situations people suffer intrusive images of apocalypse: the desertification of the earth, the boiling away of the oceans, a desiccated, husk of a lifeless world. At its extreme edge this is the vision of the future that has led to advocates of near-term human extinction such as Michael Ruppert to kill themselves. The mad black environmentalist suicide-priest of the NTHE movement is Guy McPherson. While McPherson’s data has been the subject of controversy and he is usually painted as an irresponsible hysteric, it seems like spending any amount of time with the psychological literature gives his words an existential weight. For instance, he is quoted as saying:

We’re human animals, and I know animals require habitat to survive…when there is no ability to grow food or secure water, humans will exit the planetary stage. [-It is worth reading the full article, titled “Suicidal Environmentalism”].

Enter the retro-futurist nostalgia of space capitalism and terrestrial escape. Red Mars for everyone!
Speaking from my own first-person perspective, I have been sunk into exactly these symptoms myself. It is impossible to genuinely attempt to cognize the full horror of catastrophic climate change without lapsing into this pre-traumatic despair. I have spent time wilted and enraged and shredding my nerves, unable to float along with daily living, and seriously questioning the sanity of all those whose politics does not or cannot begin to mitigate the worst near-term effects of such an unprecedented disaster of such an enormous scale.

As a final quote I want to take the most basic definition of Post-Traumatic Stress. Here is Wikipedia’s take on PTSD as

a condition of persistent mental and emotional stress occurring as a result of injury or severe psychological shock, typically involving disturbance of sleep and constant vivid recall of the experience, with dulled responses to others and to the outside world.

Driving me onward here is the question- what is it to experience an anticipatory psychopathology in which the effect precedes the cause? In this strange new landscape time itself appears to appear in a psychotic or demented form that defies the typical phenomenology of temporal linearity, contorting the principle of sufficient reason into a hideous and bizarre shape, effectively ruining its organization of experience as such? How can one experience the psychic effects of events that have not yet taken place in that experience? Far from being a simple matter of fear of a wave about to crash is it possible that pre-traumatic stress disorder enacts a psychosis at the very core of human cognition? Is this the outcome of our self-mutilating striving after knowledge we are ill evolved to handle?

These questions are haunted by the image of the scientist who is driven to suidice by her research into that which has not yet happened but is nonetheless happening.

In the next post in the sequence I plan to look briefly at the phenomenology of pre-traumatic stress disorder and a couple ways we have attempted to cognize catastrophe without falling prey to it. I also plan to return to Lovecraft in another post, before concluding the sequence by examining this disturbing psychotic temporality of pre-trauma.

Coyle, K. and Susteren, LV. 2012. The Psychological Effects of Global Warming: And why the US Mental Health System is not Prepared. Here.

Critical psychiatrist Joanna Moncrieff, author of The Myth of the Chemical Cure (2009) and The Bitterest Pill (2013), discusses what psychiatrists do and, more importantly, do not know about psychoactive drugs used to treat mental suffering.

Joseph Kay’s call for an affective politics is one I agree with and have made in other (non-anarchist) circles. For me part of the problem of leaving affect out of the picture is that affect is a significant driver of motivation for active participation in politics. Reactionary capturing of affect is predicated on exactly the point that it is through the stimulation and management of affect that you can mobilise people to a cause (EDL for instance), to a political party or, much more commonly, to a tabloid media witch hunt. The power of this affective expertise is such that non-issues and non-existent threats from a generalised paedophile epidemic to the imminent threat of weapons of mass destruction can quicken the pulse and boil the blood of entire swathes of the working class.Are the affects and the post-spectacular media terrain really things that we want to exclude from our politics and ethics? In what follows I want to discuss the consequences of relieving politics and ethics of the pathos of our corporeal affectivity.

Beyond politics it has been an accomplished fact of advertising since the 1920s/1930s when Sigmund Freud’s nephew percolated his uncle’s theoretical writing (via his experience as a wartime propagandist) into creating the field of public relations. Edward Bernays laid much of the groundwork in the invention of advertising in order to assist the post-Depression drive to increase American consumption by seeking to apply Freudian insights into human psychology. While we might question the validity of psychoanalysis as anything other than an impressive piece of mytho-poetics (my own problem with it is more to do with the idea of it being a symptom of a belief in “deep interiority”), it is nonetheless the case that its application to the manipulation and production of desire has been a resounding success. If we take the example of cigarette smoking. In the 1920s it was uncommon for women to smoke and Bernays wanted to change this, to create a new consumer market who would go out and spend their dollars on Lucky Strike tobacco. In order to do this he orchestrated suffragette-type marches in which all the women symbolically took out and lit their cigarettes on queue.

Meanwhile, Bernays had consulted a psychoanalyst to ask about the potential meaning of the cigarette to the female psyche. The analyst returned what seems to us now to be the obvious and perhaps pat answer that cigarettes represented phallic symbols- the very symbol of masculine privilege, authority and power. In accordance with this Bernays also had stories running that this “suffragette” march was to culminate in the women lighting up and thereby symbolically reclaiming (and destroying) the power and visibility that men held as their own exclusive domain. The papers turned out; the march was a success; the subsequent advertising for the “Torches of Freedom” campaign chimed on the idea that ‘an ancient prejudice has been removed’. Sales of cigarettes shot up. Read More


In this essay I want to discuss suicide from within a Heideggerian perspective as a form of freedom. In doing so I will be making the distinction between suicide-as-event and suicidality-as-possibility. To deepen the discussion I will be drawing on Stoic accounts of possibility and fate, situating suicidality in terms of Baudrillardian seduction, theories of sublimation and briefly connecting the discussion to contemporary psychotherapeutic practice. I intend to open a discussion on the place of suicide and suicidality after the post-nihilist turn and to recognise in it not only the moment of despair but also a path toward the sense of liberation and opening of possibility that a catastrophia inflected post-nihilist praxis sees as the pre-requisite for living after nihilism.


 ‘There is but one truly serious philosophical problem and that is suicide’ (Camus 2005, p.1): this is how Albert Camus  opens his book The myth of Sisyphus. It is a book that forms Camus’s elaboration of his ideas on the Absurd, ideas that have a more readily accessible form in his novels such as The outsider and The fall. At the outset of The myth of Sisyphus Camus is setting up the question of whether we should live or die as the paramount philosophical problem. In this way of thinking about suicide, it is presented to us as a question, a provocation and, at the same time, as an accusation. The question is: what is the status of suicide, and what is the status of life? Camus is quick to state that to treat this question as a purely social phenomenon in the manner that Durkheim did, and that Franco Berardi does today, is to evade the centrality of the question. It is to flee from the intimate proximity of the suicidal person to themselves and to the terrain of their life. As Camus puts it

 An act like this is prepared within the silence of the heart, as is a great work of art. (2005, p.3).

Within the silence of the heart the suicidal act is locked into Beckettian profounds of mind; the urge to kill one self lurks subterraneous and mute, being prepared but without communicating to the one who prepares it. This is a work, ‘like a great work of art’, that writhes beneath the everyday consciousness  in ferocious activity; working itself out, but unknown to the one who will put the gun to their head or tip the pills from their crumpling plastic cup. This is almost like the kind of process that Charles Bukowski somewhere speaks of in the ideal experience of writing poetry: you should not write unless the poem surges from your mind onto the paper, a torrent lashing from the fractured sky. And just like the great work of art there is a sense of culmination, of destiny fulfilled, of the work coming to fruition, as if all preceding acts were merely rough sketches, vague gestures, and preliminary experiments in style. Prepared in the silence of the heart, it is as if Camus thinks of suicide as a great love or a great sadness that can finally confess itself to a world that it spurns, as if suicide were its mode of intimacy with that world, like the cruelty of a rejected lover. As a great work of art suicide may be the smallest act in a vast and cold universe devoid of final salvations or consolation, but it is sublime nonetheless and even perhaps because of it.

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“He whose eyes happens to look down into the yawning abyss becomes dizzy.”


This essay will briefly examine the genetic, evolutionary, cognitive (and behavioural), and psychodynamic approaches to the aetiology of panic disorder (PD). Throughout, this essay will attempt to orient the reader to the centrality of bodily experience to any consideration of PD, and will utilise this as a means to sketch a philosophical as well as psychiatric understanding of the disorder. In order to approach this, the body’s relationship to death will be considered, an approach that will be mediated by introducing existential themes from both philosophic and psychological literature. This essay will provide a modest overview of the ground, and serve as the beginning of an attempt to place existing aetiological theory of PD within an understanding of the human being as ontologically vulnerable to the world.

This is not a disinterested essay, and I will not apologise for excluding certain worthwhile and important dimensions of the rise of the experience of and psychiatric responses to panic. To be complete, I would need a more thorough account of technological, social, economic and political upheavals. I think these have been covered pretty thoroughly elsewhere and so for now (but not indefinitely) they won’t be broached at length. Furthermore, this is not a disinterested essay- although it is more academically styled than most of my writing- because I was once in the throes of an undiagnosed panic disorder (my GP providing me with breathing exercises and a few quips about Sartre). When I entered my training in psychiatric nursing, I went in with this experience and a sense that the psychopathology of panic was on the rise. Experiencing panic acutely, I could see manifestations of it and more chronic anxiety all about me in others and in the social fabric itself- nowhere was this more obvious than in the changing architecture and policing of London in the earliest post-9/11 period. Aspects of this essay may be familiar to readers of my other online work. I tend to agree with EM Cioran’s observation that thought is the product of sensation but I disagree that it is a “descent” or a “failure”: rather, thought is so often the obsessive retrieval and retracing of experiences, often archaeological, always a kind of dangerous play or magical ritual. In this way, this essay itself form part of my own therapeutic work: the attempt to articulate the inarticulate.

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Systems thinker Tom Andersen, in being “a wanderer and worrier” (as he put it), was constantly reflecting on his own practice, on his way of ‘going on’, to further develop and refine it. Each new way came to him, he said, on reaching a ‘crossroads’, a point when he felt unable to continue any longer in the same way. But once he stopped doing what he had come to see as ethically wrong, he found, he said, that the “alternatives popped up almost by themselves”.
It is what the nature of that imaginative judgmental work feels like, looks like, and sounds like that Shotter discuss in this talk.

Beak Street, London, England: 11th June 2013 and two camps cut the capital in two. The heavy black figures,clad in stab-proof vests, weighed down by shining tools of their trade, some seemingly bioluminescent bodies reflecting the dull city lights, form soft, permeable walls of flesh and industrial fibres. Across the tarmac expanse, its broken and uneven surface silent in the summer heat, the masked and black hooded figures of the gathered protesters; their black outfits mirroring their enemy but their bodies more languid and faces more tense, raising an obsidian flag, slashed in half by a diagonal block of fresh blood red. The clash of the police and the protesters at the Carnival Against Capitalism played itself out dramatically: a man seemingly attempting to jump from a roof (or is he fleeing his pursuers?), his body crumpled and crushed beneath the care and security of those of the Met; reports of the laissez-faire use of tasers and rapid Twitter denials; the usual, almost boring when it splashes lurid across the evening news (packaged in easy to digest narratives, troubling no passive constitutions); the press release announcing the number of arrests read out over images of property destruction and hooligans with strange, hyperbolic demands. Days later, the echoes of violence still ringing like some brutal tinnitus, the new logic of urban policing and its attendant open secrets still reverberate in my ears. Again, I see the city of my self-imposed exile convulse with the spectacular rituals of struggle and the accelerated militarisation of the City that forms a central node in the cold global network of finance.

Such scenes are nothing new: we are so exposed to images of protest and police brutality that it is easy to forget that we are not watching some endless dystopian film. The anger as we watch the stream and read the first hand reports is somehow ambivalent- almost as much an automatism as the algorithms of digital trade. It isn’t that the anger isn’t genuine or real but it feels like a cold mathematical rage; almost like that of a cortisol come down, my own anger traces a familiar affective circuit that ingrains itself so deeply into my neurology that it functions almost autonomic. Today, anger and the anxiety that follows it have become affective default settings.

What is new is the level and openness of the police response to a completely legitimate form of democratic protest. As the protesters, assembled anarchists, Marxists and the generally fucked off, opened up a cleavages in the management of public space, and as they disrupted the becalmed tranquillity of the social, those hired hands of the state and of capitalism, the perverse henchmen of Capital (remunerated for protecting the mechanisms of their own exploitation), stepped into perform a sudden, brutal, and unanaesthetised surgery in order to close the wounds in consensuality. What is opened must be shut down; what ever operates without permission must be made permissive; and in the ritualised forms that these clashes take, boredom is a dangerous mood.

Ordinarily the police must justify themselves. Ordinarily, the police respond to a crime. Ordinarily, they must wait for civil disorder before operating as active guardians of that order. On June 11, this logic was abandoned. Riot police are not a new phenomena in London’s streets. What was new was the pre-ordering of London’s iconic red double deckers, a symbol of jolly old London, of tea and scones or the good ol’ Eastender of the BBC and Sherlock Holmes, in order to have bulk mobile containers for those they expected to arrest. Before confrontation the confrontation had already taken place: resistance had been modelled, planned for and effectively co-opted before booted feet had touched the asphalt and the gum-encrusted paving stones.Of course, the precedent of the militarisation of the City was set long ago when, as a response to terror threats, we suddenly saw armed police roaming the Embassy areas, the airports, and now routinely see tasers throughout the UK; the Olympic Games, managed by G4S, were a paramount exercise in the new society of control that functions through a military operating system. Now, protest is treated as anti-social behaviour or terror

What I find most disturbing about this is the way in which it symbolises the wedding of two form of rationality. The site of London buses used to carve up space and to house arrestees is not just a chilling perversion of a brand image, although that is frightening enough when we consider the lack of response to this (as if the public transport network and its materials were obviously always already technologies of repression). More than this, what disturbs me is the way in which the police response, obviously directed by a higher authority, establishes the total normalisation the social as a military space- wherein any contestation, any democratic expression, any identification of wrong, is a priori an act of sedition that the “public” is happy to see put down. Even more than this, it is the marriage of the logic of the pre-emptive strike with the logistical reason of Auschwitz. Let me be clear, I don’t mean that on the existential, political or social registers that the police response to the Carnival Against Capitalism was in any way on the scale   of the Holocaust: what I mean is, that the image of the buses and the rationality that conducted such a scheme clearly resonates with those of the Eichmann run train lines. And all this is taken as normal.

I have read reports that suggest this kind of police action is a response to previous unrest like the London riots of 2011: a vast libidinal discharge that set sections of the city ablaze in a genuine eruption of rage that was no less exhilarating than it was terrifying. What is the new psychology that is taking shape in a city like London and all those other city’s like it across the world? What new psychic co-ordinates are coming into focus after the utter brutality of the Turkish government’s reaction to Occupy Gezi? Is this the emergence of the militarisation of the protester’s consciousness? Surely, given that even those equipped with a theory of class struggle and biopolitical power can’t immunise themselves from the world that they describe. If the city is being militarised then so to are the consciousnesses and bodies that inhabit and are inhabited by it. But in truth, this is merely the city sloughing off its new clothes as cultural centres of commodity exchange. The earliest cities were enclosed by walls and protected by turrets: we might be seeing the return of these siege cities and of siege subjectivities. To speak the language of psychiatry, the city of London is displaying more and more of the signs of a paranoid delusional disorder. Exodus, for the majority, is neither desirable nor affordable. This is an endogenous siege that recalls the schizo-urbanism of China Meiville’s The City and The City: and when the two cities begin to bleed into one another in that novel, the only evidence is a corpse.