A new (dis)order?

I recently posted a piece on depersonalisation and conversion disorders.  The post initially focused on an article in The Guardian which looked at  the phenomena of depersonalisation, and had interviewed three people who had experienced a sense of feeling estranged in some way from their bodies and from the world.  The post then briefly touched on an article in The Independent which reported on the recent decision by British Canoeing to bar the paralympian canoeist Charlotte Wilkinson-Burnett from competing in the 2016 Brazilian Paralympics because her disability was now considered to be ‘psychological’ rather than physical.

Both stories were quick to use the term ‘disorder’ to describe the problems being reported.  The Guardian article talked about ‘depersonalisation disorder’ (DPD) , and noted that although it appeared to be widespread, with as many sufferers as those with a diagnosis of schizophrenia or obsessive compulsive disorder, there also appears to be widespread ignorance of the condition amongst the psychiatric profession.   The Independent  mentioned ‘conversion disorder’ which, according to the article, “causes people to suffer from symptoms such as paralysis with any identifiable physical cause”.  It also mentioned that in the past the term ‘hysteria’ would have been used to describe these kinds of experience.

As I pointed out in the post, the kinds of phenomena being described in both articles have a long history, and in many ways to label them ‘disorders’ was simply a ‘repackaging’ exercise and was symptomatic of a psychiatry which focused on classifying symptoms rather than looking at underlying causes.

However, there is another interesting question here: why ‘disorder’?  ‘Conversion disorder’ and ‘depersonalisation disorder’ join a long list of ‘disorders’ which includes ‘post traumatic stress disorder’, ‘borderline personality disorder’, ‘anxiety disorder’, ‘panic disorder’, ‘obsessive-compulsive disorder’, ‘eating disorders’, and so on.  And the first thing that strikes me about all these ‘disorders’ is that they imply a deviation from a previously existing ‘order’.

But what might this ‘order’ be?  My first thought is that it refers to something that used to be called ‘normality’. It’s interesting to note that if anyone uses the term ‘normal’ nowadays the chances are that either they themselves or the person they are talking to will immediately ask: “but what’s ‘normal’?”   So there is already a recognition in the culture that the term  ‘normal’ is no longer a socially accepted reference point.

So is ‘order’ simply a replacement for the term ‘normal’, and therefore ‘disorder’ equates with ‘abnormal’?  Perhaps, but are they actually equivalent?  Jean-Pierre Klotz makes the interesting observation that for many people, including mental health professionals, the term ‘disorder’ equates with ‘symptom’.1   People who have psychiatric symptoms are disordered, and it the role of psychiatrists (and in some countries I’m afraid to say,  psychoanalysts) to reinstate order into these disordered psyches.  As Klotz goes on to note, psychosis, especially when accompanied by delusion, “.seems to be the apex of disorder.”

The problem here, at least for those psychoanalysts who still take the concept of the symptom seriously, is that symptoms are not  ‘disorders’.  To quote Klotz:

There is a requirement in psychoanalysis to say what a symptom is rather than to simply treat it as a disorder.  To summarise, the symptom is a way for the subject not to inscribe himself into the world’s order but to be part, in his place, of the world’s disorder.2

The aim of analysis is not to ‘reorder’ the subject, but to allow the symptom to speak.  And the reference to the ‘world’s disorder’ is an interesting one, because it suggests that it is not the individual who is ‘disordered’ but that something is amiss in the world itself.  This is perhaps another way to talk about Freud’s discontents of civilisation.   As Freud pointed out, there is a disjuncture between the drive and the social order, between jouissance and human survival.  The symptom is a way to try and circumvent this disjuncture, this contradiction.

To quote Klotz again:

The symptoms of today are more than ever being considered as disorders.  We are in a time that belongs to the current state of the discontent of civilisation in which we are no longer allowed to have troubles.  To be a good citizen your are no longer allowed to be ill, you must be efficient and must be without troubles.  You have to have your piece of jouissance which makes you efficient, not more or less, and it is essential to eradicate troubles.3

But what exactly is the nature of this new order, this brave new world, in which no one is allowed to be troubled, in which everyone has to enjoy – but only up to a point…?

  1. Klotz, J.-P., 2008. Ordinary Psychosis And Modern Symptoms. Psychoanalytical Notebooks, (19), pp.7-19. []
  2. ibid p.24 []
  3. ibid p.29 []