I have completed a 14-hour course on Obsessive-Compulsive Disorder, which defines the malady as a matter of profound doubt. OCD, the creator of the course says, comes down to doubt that produces fear, which then, in turn, drives compulsive or ritual acts and stokes obsessional, often intrusive, thoughts. While I learned a lot and am already integrating insights into my clinical practice, I’m starting to have my own doubts about that founding premise.

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Before explaining, I want to address common misconceptions. OCD has become part of popular jargon. People will off-handedly describe themselves or someone else as “OCD” to connote a basic kind of perfectionism or finicky sense of order and neatness. Clinical OCD, by distinction, is a great blow to a person’s daily functioning. Obsession with neatness, cleanliness, symmetry, or aggression, for example, emerges out of deep fear. This fear spreads through whole personalities, including those of family members and others who are close to the person with OCD. There are certain terms that we work to get out of one’s daily vocabulary because of insensitivity, and I would argue that (casual use of) this term is one of them. Every joke about OCD casts a shadow on someone struggling to lead the semblance of an ordinary life.

Second, “compulsion” is a specific word that people often confuse with “impulsive.” In clinical language, however, they are different and require different therapeutic approaches. Impulsive behavior comes with a sense of risk that pushes into enjoyable or “ego syntonic” feelings. Imagine this scenario. You are in a meeting with colleagues and your phone is on the table. You see it light up with a notification. You know that checking the phone during the meeting can send the message that you aren’t paying attention or that you are disrespecting the speaker or the task at hand. The act of checking the phone is thus checked by a sense of propriety. But the desire to know who texted is so strong that you now find yourself in a battle against your impulse to pick up the phone and look at it. If you pick it up, you’ll feel a little rush, and that’s the pleasure of finding out - but this act of looking is also a need for instant gratification, which suggests a broader problem of phone dependency and dopamine seeking. In short: this episodes highlights thrill of risk, excitement through anticipation, desire for pleasing fulfillment, and generally ego-syntonic behavioral patterns as markers of impulsive action.

Compulsive action is basically the opposite. Compulsive actions seek to end risk and acquire certainty. Doing the action is not pleasurable; it is necessary. We call this “ego-dystonic.” Imagine this scenario. You have left the house in your car, and you’re about a mile from home. A thought occurs to you: did I leave the stove on? The thought pricks you and gains strength. You ruminate on it by chewing it with your thoughts. If you cannot find a sense of relief without going back to check, then you are compelled to go back. People with OCD feel this compulsion regularly, and it is accompanied by great discomfort. Worse, even after checking (or aligning, or washing, or yelling), the sense of fulfillment never comes. The doubt lingers. Without resolution, the compulsive act may take place over and over again. This can, and often does, lead to emotional and/or physical injury (sometimes likened to “self harm”).

Obsessions are easier to understand. These are thoughts that impinge on the thinker. They push in from without. They are often graphic, violent, and most frequently run counter to the thinker’s morality and preferences. These thoughts do not go away. They are the motor for compulsive behaviors. The latter seek to remedy the former. According to the clinical literature, all of this, collectively, can be attributed to doubt. A person doubts (about their capacity to fend off aggression, to keep their eyes averted from people’s body parts, to maintain cleanliness), and what follows is a ritual of ridding the self of doubt. If, for example, my steps always add up to even numbers, then I will be able to prevent a panic attack. Or if I touch the insides of my cheeks with my tongue in a very precise order, then I won’t tell that person that they are an asshole. In other words, I doubt my capacity to function normally or maintain health in the absence of these protocols I have created.

But here’s where I raise a question: are we dealing with doubt or with certainty? These are opposite beliefs…but not always. For example, I can doubt my ability to remain clean outside of my house, but I can also be certain that I will become contaminated outside of my house. Are these the same? Do we treat doubt and certainty the same way? The answer is no, but the nuances of that answer drudge up the gradual institutional shift away from psychoanalytic theories and toward behavioral adjustment. Investigating the difference between doubt and certainty in the context of OCD provides another opportunity to challenge that institutional shift and rethink what exactly we as therapists are dealing with when we meet a client suffering from clinical OCD.

Zwang

The original, Freudian term for this cluster of symptoms was Zwangsneurose (translated, misleadingly, as obsessional neurosis). Zwang is a great word and deserves analysis because of its rich tradition across different fields of literature, history, clinical work, and mythology. Unlike what the English translation of “obsessional” suggests, Zwang means compulsion; constraint. It appears in multiple German words where it consistently modifies the meaning of its partner word. For example, zwangsläufig (meaning “inevitable”) makes meaning by affixing Zwang to läufig, which is the suffixal adjective formed from the verb laufen, meaning “Running, moving, coursing, or tending toward a direction.”

In machine engineering, a Zwangslauf (“constrained motion”) describes a system where the movement of one component deterministically forces the exact, unalterable movement of another (such as gears, pistons, or cams). A mechanism functioning under these physical conditions was described as inevitably running according to a predefined course. By the late 19th and early 20th centuries, the term moved from mechanical engineering into logic, sociology, and political economy to describe events that follow inevitably from prior conditions—e.g., a process moving down a track where no alternative vector is physically or logically possible. Something that is zwangsläufig is inevitable because its trajectory (”running,” “course”) is entirely dictated by the structural constraints (Zwang) acting upon it.

Zwangsläufigkeit is the relentless, mechanical causality that binds the subject to a fixed track. It is the state of being fated, destined to find a certain outcome. Zwang produces the rigidity. If we follow that word back to classical philosophy, it tends to appear beside its opposite, which in English would be clinamen. Zwang is fixed reality, clinamen is the swerve, as Epicurus (using παρέγκλισις), and later Lucretius (translating the Greek into Latin as clinamen), hypothesized. Zwang is universal certainty. Clinamen is contingency. Zwang’s ontological and cosmological status even found personification in the Ancient Greek goddess Ἀνάγκη (Ananke) who expressed inevitability, compulsion, and necessity. She was in fact the Mother of the Fates. Whereas Zwangsläufigkeit constrains the flow of events to inevitable conclusions, Zwansneurose constrains thoughts to repeat obsessional patterns and behaviors to compulsive action.

Freud picks up this thread of Ananke in Civilization and Its Discontents (1930, Das Unbehagen in der Kultur (”The Uneasiness in Culture,” p.140). He writes,

We can only be satisfied, therefore, if we assert that the process of civilization is a modification which the vital process experiences under the influence of a task that is set it by Eros and instigated by Ananke [Ἀνάγκη] — by the exigencies of reality; and that this task is one of uniting separate individuals into a community bound together by libidinal ties.

That is to say, living in a society produces stress and discontent. How did this stressful social environment come to be the norm for human kind? Freud theorizes that it arose from the dynamic power of Eros acting within the constraints of reality. Human culture, not unlike a culture of bacteria, coalesces around the exigency of social bonds tied up artfully with Eros (which is more than erotic love). The key notion here is that there is no individuality without society and these social bonds, which means individuals are constrained within collective life. While that comes with certain benefits, like strength in numbers, it also means that individuals must cede pure autonomy and neuter the impulse to act only according to one’s desire. We are all constrained. As such, it makes sense that some people attempt to resist this civilization- and culture-sized constraint through specific obsessions and compulsions.

From Zwang to neurosis

Recasting OCD as a fitful adjustment to the constraints of social living means understanding “Zwang” not as an ontological certainty but, rather, as a human-made process of assimilation and acculturation. Once we challenge the idea of OCD as a pathological condition linked exclusively to misfirings in the basal ganglia, amygdala, and other regions of the brain, we can reframe the “disorder” as a fit caused by being ordered. Even if one believes that a goddess is producing a fated path, a person still has to deal with all the ways that the dictates of the profane world demand behaviors and compliance from each of us.

What, then, are the “compulsions” linked with OCD? What are the ritual behaviors that follow on the heels of intrusive thoughts that often feel alien to the thinker? Astrid Gessert brings a Lacanian perspective to these clinical questions and asserts that what the DSM calls clinical compulsions and related obsessions are better understood as an “idiom of distress” “that articulates a subject’s particular attempt at resolving fundamental questions of existence” (xvi). Each thought and ritual behavior works to impose an injunction: I must or I must not do these specific things. Why must I? Because I am certain of something that I do not want to be true. To deal with that, I will replace that certainty with another belief, a belief that I have the power to modulate certainty and contingency through my own actions. In a sense, I am certain that my individuality is linked inextricably with others (and that’s unsafe), so I will act as if I am an autonomous individual capable of producing and sustaining other certainties. To act as if is to acknowledge on some level that I must perform in order to belong. Such a recognition of the crucial role of performance in everyday life prepares the the shift away from doubt toward certainty. OCD is less about superficial doubts regarding banalities of everyday life, as in “Did I leave the stove on?” and more about radical certainty regarding the structural exigencies of the social fabric from which I cannot extricate myself.

Psychoanalysis seeks to help the obsessional person confront the truth they don’t want to be true. Theorists and practitioners of this persuasion hold that the fundamental truth is the same for most people. First, I am a body that is defenseless against the entropic forces of the universe. Second, my entire self is structured around a lack, an incompleteness, one that can never be made whole. This “lack” is the missing Other in me, the relational existence I lead that denies any truly autonomous action. Even though there is no wholeness, no completeness, I still desire it. Worse, I am driven to pursue it. Still worse, desire as such cannot be fulfilled because if it were then desire would end and I would cease to have purpose. Drives compel me to seek my desire but also have no intention of fulfilling it. And this is not only my predicament. Others have it, too. I may even find myself standing in as the object of the Other’s desire, which means I run the risk of becoming the end of that person’s existence should they obtain me. The whole situation is thoroughly vexing, maddening. The very worst part is, there is no escape from it.

The only possible way to avoid this play of the self and the Other is to produce a desire that can exist independent of the Other and the social field. This would be a pure desire. Again, there is a truth hiding here, the truth that the Other is indeed the locus of desire as such, and, because of that, the construct of a pure, unadulterated desire is imaginary. The imagination is able to project a version of desire and reality only as long as the self can sustain the compulsive actions and obsessional thoughts. This creates an impossible task and a thoroughly tiring existence. Gessert, writing about Luca Bosetti’s article in Obsessional Neuroses: Lacanian Perspectives, explains the obsessional’s plan:

He attempts to split the Other into an “Other of demand” and an “Other of desire”. By setting up the Other of demand who introduces rules and prohibitions, and who is endowed with rationality and consistency, the obsessional destroys the unpredictable and unfathomable Other of desire. While submitting to the set of rules and prohibitions of the Other of demand he can keep his desire alive as an impossible desire. (xx)

This would be an absolutely ingenious plan if it wasn’t all based on illusion. The illusion only exists because the obsessional person is certain that he is caught in an unfulfilling game of desire conditioned by social rules that predated his existence and over which he has very little power.

Treatment

The goal of treatment is to convince the obsessional person to stop bypassing the certainty of desire’s elusiveness and its imbrication with social living. Here again is Freud’s Eros and Ananke. Due to the fact that humans long ago elected to form social ties and build institutions to promote and sustain those ties, each subject must accept the objective power of such ties and institutions. Repressing Eros, whether we are talking about libidinal urges or evocative drives, only leads to more suffering. This does not mean that each person’s life is fated. Rather, it means that all search for purity and wholeness is based on illusion. Instead, we ought to seek moments when a minimal deviation—the swerve—becomes playable in the field of the social.

Instead of using purely behavioral methods and exposure therapy to exhaust the fear centers of the brain, what would happen if we started to treat OCD as a matter of performance? If each habituated and compulsive gesture is a performance rather than an absolute, fated necessity, the subject introduces a microscopic gap between the impulse and its execution. Awareness of the paradigm to Perform or Else in daily life could be a strong starting point. Each of our actions is compelled of us by structures that appear natural but are entirely fabricated. We feel the injunction to act according to pre-made roles and rules. We know we are being ordered. What we don’t know is that between the bodily cue that announces the social conditioning and the performed action that either represses, plays off, or accedes to the mandate exists a tiny crack through which something new might emerge.

What if doubt is a red herring? If the obsessional is certain that their individuality is compromised by the social fabric, yet creates a ritual to claim temporary agency, then they are using ritual to manufacture a temporary doubt about their own powerlessness. Doubt is not the foundation of OCD, it is the malady’s greatest invention. In Therapy Yet to Come, I argue for a repoliticization of therapy because of this tendency for therapeutic theory and practice to mistake symptoms and what Lacan calls synthomes. The latter is an act of production through which subjects learn to bear the weight of social existence and the status of the self as wanting. In clinical OCD, doubt is conjured negatively through repetition and constant adjustment. If we developed that negative image as one might develop a photographic negative and then printed it, we would see an image of desire.

When I was growing up, PDA meant Public Display of Affection. If you were doing it, you were probably have a good time. If you were watching it, you were grossed out or “over it.” But times have changed and so too language. PDA is no longer a harmless annoyance. It now stands for an autonomic response that can bring parents and teachers to the brink of madness. Let’s talk about the new PDA, what it is, what it isn’t, and how everyone suffering from it can move toward relief.

British clinical psychologist Elizabeth Newson coined the term Pathological Demand Avoidance in the 1980s to identify a subset of behaviors common to autistic individuals. Typical of psychiatric terminology, Pathological Demand Avoidance transforms an immediate, nervous-system-level response into an internal characterological defect. More recently, neurodiversity advocates have attempted to replace the original term with Pervasive Desire for Autonomy, which is a soft-focus reframe that sounds like a heroic, liberal assertion of will. Both names distract from what is actually happening.

My issue with either phrasing of PDA is that each severs the causal link between a person’s environment and their physiological response, thereby framing a protective relational instinct as a private pathology. When we tell parents and teachers that a child has "Pathological Demand Avoidance," we tacitly encourage them to look for a broken mechanism inside the child. We treat the dynamic as a behavioral abnormality to be corrected rather than a lived, relational boundary manifesting in real time without any conscious thought from the child or adolescent.

If we want to support kids, neurodivergent individuals, and ourselves, we need a language that lays bare the actual mechanics of this experience. When I say “we,” I mean therapists, teachers, parents, and other family members. I also intentionally group myself into the “we” because I have a 6-year-old who exhibits this autonomic response several times each day.

What It Is (and What It Is Not)

To build a shared form of life between parents, educators, and neurodivergent individuals, we must first untangle what this experience actually entails.

What It Is Not

• It is not willful defiance or a moral failure. 
• It is not a child deciding, "I don't want to do what you said."
• It is not an "irrational" defect. 
• It is not a static identity. 

What Is Actually Happening

What we see in these cases is a protective, autonomic response to perceived coercion, executive overwhelm, and/or the sudden loss of felt safety. This phenomenon is a dynamic that emerges between a person and an expectation. It is:

• An immediate threat response. The moment an expectation is externalized, the body perceives an erasure of its internal equilibrium and enters a state of fight, flight, or freeze.
• A low tolerance for implicit coercion; an acute, highly sensitive radar for when a social contract is being forced rather than organically built.

Alternative Names for the Live Experience

Shakespeare wrote, “That which we call a rose, by any other name would smell as sweet.” But in the same play, Romeo also laments how his last name positions him socially as an enemy to Juliet’s family, and thus he asks of his beloved, “Call me but love, and I'll be new baptized; Henceforth I never will be Romeo.” So which is it? Does changing the name of PDA actually change anything? I believe the answer is a clear yes. What we call this phenomenon is what gives it currency. Rather than relying on psychiatric taxonomy to categorize this human behavior, I advocate for us to draw on phenomenological, relational, and material language to name what is actually happening during this episode of lived experience. Here are some alternatives.

1. Relational & Somatic Frameworks

• “Involuntary Expectation Shock.” This wording highlights that the reaction is an automatic, somatic disruption triggered by external agendas, rather than a deliberate, conscious choice.
• “Prescription Resistance.” These words capture the immediate, visceral friction that occurs the moment an action is "written out" by someone else before it can emerge organically from the individual.
• “Somatic Boundary Panic” names the neurobiological panic response (fight, flight, freeze) that occurs when an external demand threatens internal equilibrium.

2. Social & Structural Frameworks

• “Systemic Friction Sensitivity” frames the trait as an acute, low-tolerance threshold for coercive, hyper-structured social spaces (like standardized classrooms).
• “Autonomic Non-Compliance” (my favorite) centers the instinct where it actually lives—in the nervous system—framing it as the body's autonomic refusal to be governed by external pacing.
• “Coercion-Triggered Paralysis” identifies the exact catalyst (perceived loss of agency) and its actual outcome (an inability to move or act, even on tasks the person desperately wants to do).

Regardless of the name, the approach remains the same: support over compliance; care instead of punishment; slow wins in the end. Imagine a soldier who has returned from combat with acute PTSD, sitting with her back to a corner, armed to the teeth, and panicked. Would you tell that person to put the guns down or else you’ll call the cops? Would you say, “we don’t have time for this?” Those expressions don’t fit either the situation with the soldier or the situation with the kid screaming at you from the other side of the locked bedroom door. The similarity between the kid and the soldier is that, in both cases, a switch has been flipped, one that indicates, “The World is Not Ok.”

Despite retaining the name PDA, the most-frequented online resources provide some good basic info for parents at their wits’ end. PDA North America is a good place to start. If you’re a parent or a school counselor, and if you want to talk about this or schedule a presentation for your community, send me a message and I’ll be happy to respond with suggestions. As I said above, I have a personal and professional interest in this highly visible contemporary issue that leads to thousands of family systems suffering invisibly and in silence. 

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Treating eating disorders proves exceedingly difficult, partially because of the absence of a strong theory that helps understand the psychosomatic substrata of people suffering from these issues. For me, such a theory would revolve around the fraught relationship between Being and Having a body.

I first came to treat eating disorders at the Partial Hospitalization (PHP) stage of substance abuse treatment where disordered eating qualifies as a “process addiction,” alongside gambling, excessive spending, video-game addiction, etc. I frequently met clients, mostly but not exclusively females, who had experienced prior treatments for both substance abuse and eating disorders, though these treatments were also separate, siloed. This separation comes from at least two reasons. First, the physical toll that the body and mind must pay to support an eating disorder, especially in its most severe stages, marks individuals with such issues as needing a “higher level of care” where medical doctors can supervise organ function, nutrition deficits, and the like. Clinicians in private practice, too, will often identify themselves as unqualified to navigate the somatic and psychological needs of Anorexics or Bulemics, often leading them to encourage clients with such needs to find a specialist. Second, and building on the problem of “scope of practice,” the traditional treatments for substance use and eating disorders call for totally different approaches. For starters, the “total abstinence” approach to early recovery from alcohol and other drugs can’t work with eating. People need food. To permit the need for food while treating an eating disorder (again, typically) calls for a “management” approach that addresses eating and meal preparation behaviors. Simply put: clinicians either specialize in and focus solely on the treatment of eating disorders, or else they stay clear of them entirely. 

This separation between substance use disorders and process addictions merely replays the Cartesian dualism of mind and body. It’s one of the signs of neoliberalism’s territorialization of the psychic terrain that occurs in order to legislate “evidence-based treatments.” By moving away from traditional treatment theories, I have come to understand the phenomenon of eating disorders as a symptom of something else, usually a fraught relationship between the subject and society. By “subject,” I mean not only the “I” whom the patient believes themselves to be but also the “I” that the patient believes they should be. 

I draw upon Lacan’s distinction between the “ideal ego” and the “ego ideal.” The ideal ego is the aspirational self one strives to become. The ego ideal is the socially constructed image of the ideal self, a kind of mold into which one seeks to fit oneself so as to attain all the benefits one imagines comes from attaining this ideal. Both are fantasies, but, again, I use that word in its Lacanian sense. Fantasy is the culmination of the Imaginary and Symbolic orders, both a “figment” and a “filament” of what we normally call the imagination: figment in the sense of “something invented, a myth, a fable;” filament in the sense of the incandescent element that lights the lights and enables sight. Treating eating disorders requires attending closely to the construction and apperception of ideal ego and ego ideal handled daily by the individual I’m working with. 

Understanding the fantasy of the self leads back to a more pressing conflict, that of Being and Having a body. Sam McCormick’s parsing of Lacan’s 21st seminar underscores the connection between Lacan’s late and early work, especially in the formulation of the body’s speculative/fantastical makeup. Early Lacan synthesized what he called “the mirror stage,” a pivotal moment in a subject’s development where the experiences of Being and Having strike at each other discordantly. To summarize: new personhood feels awkward, emergent, discombobulated, alternatively uncomfortable and delightfully comforting, and simultaneously unfolds astride a recognition that others see me, interact with me, care for me (or not). Being seen (which can encompass being neglected) begins to imply a wholeness that is incommensurate with the Being one experiences. Viewing oneself in a mirror strikes the gong. I see there in the mirror a whole body, yet the “I” who sees feels unwhole. How are both true? Which one is “I”? These questions never resolve. Rather, they crater out and carve a canyon, one that I like to represent with the diacritical mark |. Being | Having. That’s the result of this mirror stage: I am, and I have this body (that I am). Being and Having never unite. Or, rather, they “unite” mythically in the fantasy of the self. This fantasy is the irremediable differentiation (|), albeit a | wrapped up in the semblance of a whole. | masquerades as I. 

When I say “wrapped up” in the semblance of a whole, I’m thinking of a specific artistic practice of wrapping. The art of treating eating disorders can borrow from the art of painting, specifically as enacted by the 20th-century Polish painter and theatre-maker Tadeusz Kantor. Of his many contributions to the world of avant-garde art, his “emballages” are the most helpful in this case. 

Here’s an excerpt from Kantor’s “The Manifesto of Emballages” to which I often return:

The object has always interested me. I realized that it is unconquerable and inaccessible by itself. When realistically reproduced in a painting, it becomes a more or less naive fetish. The color that tries to touch it immediately becomes involved in a fascinating adventure of light, matter, and phantoms. But the object remains unfathomable. Is it possible to 'touch' it in a different way? Artificially. Through a negative, an imprint, or by hiding it. By something that conceals it. 

- Wiesław Borowski, Tadeusz Kantor, Warszawa 1982, p. 147-148.

Contrary to the common sense that might understand painting to produce objects upon a canvas ex nihilo through the addition of pigment to the white background, Kantor sees objects appearing negatively. Color can latch on to the object, thereby functioning like wrapping paper covering a gifted bicycle. Emballage means “wrapping”: paint wraps the object and reveals it without ever disclosing the object as such. “The object remains unfathomable,” that is, we can’t tell how deep it is, how its material truly is. The result of painting is a touching of the object through artful wrapping, not the disclosure of the object itself.   

The question for a painter, then, is not “how do I produce an umbrella out of colored pigment.” The question is this: How can I artfully conceal or wrap the object so as to touch it and give it sensibility negatively? In Kantor’s famous “umbrella emballage,” a three-dimensional umbrella-like construction becomes the wrapping that conceals the two-dimensional painted umbrella, which, in turn, conceals the object of the umbrella. Through his choice of concealment, Kantor throws into question the “is-ness” of umbrellas as such. Which is more real, a “naturalistic” albeit broken down umbrella made through various materials, or the material idea of the umbrella concealed through this naturalistic wrapping? Even if we don’t have an answer to the question, we have the sense that we’re truly in the presence of Umbrella, though I must now rethink what I thought an umbrella to be.

Psychotherapy can produce the space in which a client’s emballage art can be interpreted and theorized. The client with the eating disorder has wrapped or concealed an object (perhaps the object cause of desire, le objet petit a) within a practice of overeating or restricted eating or some combination of those. The practice, however, has attained the status of habit, and if left to run in the background like a kernel process on a computer the habit will appear artless. Once out in plain sight, this changes. The concealing practice is quite artful. It is the umbrella on the canvas. Wrapped within it is a desire, a fear, a foreclosed encounter. In many cases, the encounter is between the body one has and the body one is.

Sex is also such an encounter, an event during which one’s subjective activity discloses its intimate relationship with one’s object-ness. “I” have sex, but “I” also am the body that the other is having sex with. Something disquieting dwells in the ecotone between self as subject and self as object. Penetrating and permeating the boundary, according to Lacanian psychoanalysis, produces an encounter with the fiction of oneness. Sex does not merge two into one. Sex reveals the impossibility of that. Disordered eating does not ameliorate the fear of this revelation, but it does forestall the revelation by either warding off the sexual (non)encounter or permitting a subject to fully objectivize oneself. The wrapping that comes into focus in the treatment of eating disorders is motivated in equal parts by the desire for unification between being and having a body and also the refusal to encounter the inaccuracy of that desire. 

Wrapping is a geometric art, and subtending the client's practice of concealment we find a strict blueprint—a defensive geometry utilized by the mind to prevent the horrific realization that I am what I have . If we look at the lines of this blueprint through the lens of Lacanian mathemes, we can see that the formulas are not mathematical computations, but the literal markings on the canvas of the emballage.

When the subject is anticipating the threat of the somatic encounter, the wrapper is sketched as I < I | sex, where the diacritical mark (|) acts as the rigid boundary wall of the wrapper, keeping the fragile, pre-sexual subjectivity (I) qualitatively lesser than (<) the objectified body that will be seen and possessed by another . Post-coitally, when the anticipated unification fails to occur and leaves only a missed connection, the blueprint flips its geometry to sex | I > I. Here, the primary “I" inflates itself (>), masquerading as whole and dominant to push the somatic reality safely back behind the dividing line.

In the heat of the experience itself—the state of I ♢ I | sex—the blueprint utilizes the Lacanian lozenge (♢), which serves as the ultimate friction of the canvas. This diamond is the brushstroke of fantasy: it connotes the desperate illusion of gaining something substantive during the encounter (>) choked by the agonizing certainty that the core of the self is being exposed or stolen away (<) . In every variation of this blueprint, the vertical mark of sex (| sex) remains outside, because the wrapper can never fully enclose the gap; sex never crosses the divide to achieve union.

Being | Having, Sex, Eating

Consider how sex and eating each come to mind when we utter questions and phrases like these: 

• Insatiable appetite
• I choose what I put in my mouth
• I control what comes out of my mouth
• What can I permit inside of me?

Additionally, in terms of the biologically female body, there is a known causal relationship between restrictive eating, purging, and the cessation of a regular menstrual cycle. To “control” what goes in and out of one’s mouth, then, is also to manage the processes supporting fertility. In each case—analogous phrases and managing fertility—the mouth reveals itself as the site of the oral drive, which is to say the pleasure of the mouth. The mouth is an orifice marking passage between inside and outside of the body. Whether through speech, eating, or oral sex, we can seek what we desire. We can seek, but we do not attain. This is because, for Lacan, the drive is that which cycles endlessly around the void of desire. There is no comfort in the satisfaction of the oral drive; rather, there is a compulsive missed encounter with desire. Even to “eat nothing” is to engage the oral drive, albeit negatively. Eating (the) nothing over and over again conserves the distance between drive and desire, thereby accentuating the anxiety produced by the desire itself. Abstaining from sex thus rhymes with eating nothing in that two orifices are engaged negatively in a compulsive prohibition. Alternatively, a mandate to abstain from sex coupled with anticipatory anxiety about the eventuality of a sexual encounter may transfer the erotic drive from typical erogenous zones (e.g., vagina) to the mouth. As a result of the transfer, binge eating followed by purging resembles the sexual act insofar as it brings food into the oral orifice and then expels it through the same orifice, thereby satisfying the oral drive.   

The Being | Having conflict returns at this point. If I am yet to have sex but also understand that to have sex is part of my passage into adulthood, and if I fear the vulnerable ritual that supposedly occurs with my body during sex, then “I” run into a problem. I have a body that will be engaged in sex, yet I do not want to be that body. To have a body is to retain some critical distance from this body I have but that I am not. Binging, purging, and restricting food intake all become ways to rehearse the collapse between the body I have and the body I am that will take place during sex. 

Recall that each person has been stuck in a rehearsal of the collapse between the body they have and the body they are since the mirror stage. Which one is “me”? “I” am the difference between the two, the irremediable distance ( | ) between the speculative “me” that others see and the corporeal “me” that I feel I am. If we add in the social process of objectification through which a person loses idiosyncratic subjectivity and becomes, say, an object to satisfy others’ desires, then I wrestle with the question of which “me” shows up during sex. Am I the object another wishes to have, or am I going to be me corporeally? Anxiety or phobia or even certainty about the sexual encounter may lead me to control, through my eating, not what I am but what I have, the object body distinct from my subjectivity. Of course, in doing so I will overlook that by treating my body in this way, I end up negatively controlling what I am insofar as the corporeal body withers and weakens. This overlooking is where the distress comes in. The problem of the eating disorder is the overlooking of the confused distinction between being and having a body.

Why suffer the consequences of gaining control in this way? To answer that, I would need to look at what I am actually controlling. “Disordered” eating is actually a highly ordered maintenance program that monitors and manages entrance to and exit from my body, which is to say oversees the boundary between the speculative body I have and the corporeal body I am. To order and oversee in this way produces pleasure, but pleasure with a Lacanian valence. Think of this pleasure through the frame of a typically “old-fashioned” form of punishment. A father catches a son smoking a cigarette. To punish the son, the father doesn’t forbid cigarettes; instead, he mandates an excess of smoking. “You like smoking, huh? Well then smoke this entire carton of cigarettes in front of me.” The son sits down and smokes until he becomes nauseous. Our superego, the part of the Freudian intrapersonal psychic apparatus regulated by moral principles, acts much like this fabled father. “You like controlling what goes in and out of your body, huh? Very well, do it over and over again until your body starts to fail.” “You’re fascinated with sex, huh? Very well, shove all sorts of things into you.” “You enjoy eating ‘nothing’ do you? Very well, eat ‘nothing’ forever.” Pleasure, in this sense, is the quasi-sadistic fulfillment of the injunction to enjoy. 

Through this perverse enjoyment, a fascinating reversal reveals itself at the literal gate of the teeth. Mastication—the physical chewing of food and the psychic "chewing over" of thought—is twinned with its opposite: a deliberate, defensive ignorance. Binging becomes a form of hypnosis through which critical thought is severed from the somatic control process, a temporary anesthetic against the split of Being and Having. Purging, then, acts as a literal purgation—an attempt to clear the subject of the crime of consumption, to wipe the canvas clean. But here the trap snaps shut: this clearing does not liberate the subject. By expelling the crime to regain the ability to think, the subject merely restores the sterile order required by the superego. The canvas is emptied only so that the sadistic injunction to "eat nothing forever" can begin its cycle anew. 

In a recent piece on Psychiatry at the Margins, Awais Aftab invoked Lacan to remind us that “Desire is the Desire of the Other.” For the modern mental health clinician, this “Other” is often not a person, but an apparatus—a complex web of diagnostic codes, insurance metrics, and a neoliberal “Regime of Sustainability” that demands we return the patient to “normalcy” at any cost. In my forthcoming work, The Psychic Apparatus and the Regime of Sustainability, I argue that we have reached a crisis point that Aftab’s “Twilight of the Psychopharmacologists” only begins to touch. If the era of biological reductionism is waning, what is replacing it? Too often, it is a “Behavior Factory” where therapy is sold as a commodity of repair, designed to conserve social antagonisms rather than resolve them.

The Tautology of “Normalcy”

Therapists are currently caught in a trap. The clinic—in all the ways this topos manifests today—functions as a site where we “repair” individual pathologies while silently conserving the very social conditions that produced them. We tell the client that x = x—that their identity is a self-same unit to be stabilized. But as Lacan (and Aftab’s recent explorations) suggests, the truth of identity is that x ≠ x. The subject is inherently “lacking,” and by trying to sustain or conserve a fictional wholeness, therapy becomes a state ideological apparatus.

From Clinical Repair to Performance Philosophy

If Aftab is right that we need a pluralistic and transdisciplinary future for psychiatry and all domains of mental health counseling, then we must move far away from “Behavioral Health” and even “Mental Health” to a Performance Philosophy, a mode of extemporaneous being that thrives on a diversity of ways of relating. As an ongoing thought experiment, I often return to a fictional persona that I’ve named “Marina,” a 28-year-old struggling with what the DSM-5-TR labels “Borderline Personality Disorder.” In the current regime, Marina is a broken machine to be fixed. But what if we viewed Marina’s symptoms not as pathologies, but as artworks? What if her “anxious attachment” is actually a performance of a dashed hope—an encomium for a loss that the language of clinical medicine cannot name? In this thought experiment, I don’t function as a technician of the soul; rather, I become a second in battle, a companion for Marina and her forays into the fraught landscape of the social. We need a social antidote to the DSM, where diagnoses like ADHD or Bipolar are reimagined as forms of social strife—modes of conflict embedded in society itself.

The Art of the “No”

The future of therapy calls for an “Art of the No,” a rejection of the administrative control of the living. Any cure produced within an exploitative wellness industry is no cure at all; it is merely a successful recalibration of the psychic apparatus to better endure exploitation. If we are to move therapy from “asociality” to a radical “A-Sociality,” a place-making practice capable of locating anideological subject positions, we must stop trying to make people “sustainable.” We must instead embrace the “ruthless criticism of all that exists.” Only then can therapy stop being an obstacle to social transformation and start being a site of genuine liberation.

Why We Need a Performance Philosophy of Therapy

It is often said that therapy is a "helping profession," a self-evident pursuit of relief and betterment. But what if therapy’s apparent self-evidence is exactly what prevents it from working?



In my own clinical work, I’ve often been struck by two related questions: What actually produces change, and why does therapy so frequently seem to fail to produce sustainable well-being? The uncomfortable truth may be that we are working within an apparatus that demands a return to "normal"—a conservation of the very status quo that produced the suffering in the first place. Without critical interrogation, therapy risks becoming a mere "behavior factory," an ideological adjunct that helps us cope with exploitation and structural exclusion rather than challenging them.

The Generative Problem

To rethink therapy, we must first rethink what we mean by a "problem." Usually, we see a problem as something to be eliminated by a singular answer. Instead, I propose viewing problems as "generative tilth"—the matrix from which thinking sprouts. Consider the acorn: it is the "problem" of the oak tree. The seed doesn't disappear; it actualizes into the growth it was meant to become.

Each client who enters therapy is a unique "acorn". The "problem" isn't a pathology to be cured, but a site of emergence for a new kind of thinking.

Performance Philosophy as Practice

This is why I advocate for Performance Philosophy Therapy. Unlike traditional models that rely on manualized treatments or purely mind-centered idealism, this approach views therapy as an "artful practice" and a "performance thinking" event. It understands that meaning is not readymade; it reveals itself only through our social and embodied language usage.

By bringing philosophers like Adorno and Horkheimer into the room alongside science fiction and the arts, we can begin to see symptoms not just as distress, but as "artworks" or "encomia for loss". Performance philosophy allows us to transgress the boundaries of the clinic and ask better questions:

• What does this way of thinking do?
• How can we free therapy from its "already-knowing-what-it-is-ness"?

Therapies Yet to Come

We are currently living under a "Regime of Sustainability," where "repairing" the individual often serves to silently conserve social antagonisms. To break this cycle, therapists must become theorists and speculators. We need to imagine "therapies yet to come"—future time-spaces where therapy is not a tool for maintaining the status quo, but an anideological practice that frees us to relate to ourselves and others differently.

Change will not occur by merely teaching "coping skills". It occurs when we allow the therapeutic encounter to become a radically open field, a dazzling collection of "wildflowers" unique to every contact between therapist and client. It is time to unsettle the givens and build the therapy we actually need.

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