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    Beyond the Repair Shop

    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.

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    The Problem of the Oak Tree

    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.

    ck here to start customizing

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    The Seeable and the Sayable

    The word “insight” reigns supreme in therapeutic environments. It connotes an “ah ha” moment and deep, perhaps new, understanding. “Knowledge,” however, receives less attention. The word may actually carry an unfair burden because therapists tend to subordinate “knowing” to “feeling.” Interestingly, “feeling” often connotes a strange kind of knowledge, one present in the idiomatic expression, “I know it, but I don’t know it, you know?” Here, knowing means feeling, internalizing, acting upon. Thus, while I might know (cognitively) that I am a good person, I don’t yet know (feel, believe) it, as is evident through sheepish and/or self-defeating behaviors. The work of the therapist seems to be to attend to the client as he/she/they forms insight, such that the client, fully supported by the therapist, comes first to understand the difference between knowing and knowing, and then acts effortlessly in life such that the knowing bodies forth through behavior. But what does this therapeutic attendance look like? Once supported, how exactly does the client reframe knowledge such that it ceases to be remanded to the field of useless cognition and transmutes itself into the realm of useful belief and behavior? The answers to those questions pass through the terrain of insight, but they require understanding “knowledge” in a more precise way.
    ​
    The two 20th-Century French philosophers whose work helped me refine my understanding of knowledge are Michel Foucault and Gilles Deleuze. The latter, writing about the former, explains that knowledge occurs by bridging two realms, the visible (i.e., the seeable) and the articulable (i.e., the sayable). For Foucault, knowledge does not exist until that which is visible unites with that which is sayable. And this union is no easy feat because each domain is governed by its own rhythms. Artworks provide clear examples of these different rhythms at work.
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    René Magritte, Les monde des images (1950)
    ​I hung a print of this Magritte painting in my office for a while and I used it as a diagnostic tool. I was curious about which clients noticed it, commented on it, questioned it, and attempted to analyze it. Fewer than half of my clients acknowledged it at all. Those who looked at it for more than a few seconds said nothing about it. The small number of people who spoke about it were divided into two unequal categories. The first group, larger in number, made superficial comments, such as “That’s a cool picture.” The second group, including maybe 2 or 3 clients total, produced questions like, “What’s going on with that?” If people said anything about the painting at all, I would ask a series of questions. “Tell me, what do you see?” “What do you make of the broken glass?” “The title is ‘World of Images,’ why do you think it’s called that?” Exactly 0 clients ventured in-depth answers to those questions, and the same number arrived at anything resembling an analysis of the picture. As such, there was no knowledge produced during their engagement with the image. That is, the realms of the visible and the articulable were not bridged.

    Not bridging the two realms took a tremendous amount of restraint on my part because the painting produces knowledge that is, in 100% of cases, relevant to people engaged in therapeutic work. The gestalt of the scene conveys a familiar experience, one that some people may even describe as beautiful or calming: A sun setting or rising over/from the ocean horizon. The familiar starts to become strange when one notices that the view of the sun is framed by a broken window. A little bit of thinking leads to the realization that the presence of shards of glass inside the room suggests the window broke inward, i.e., something from outside broke the window. But this logical line of thought breaks, too, since the shards of glass reveal an uncanny detail. The shards are not transparent pieces of glass. They seem to have retained the image of the setting/rising sun. Interestingly, the journey of the eye across the canvas leads from the center of the sun down towards the shards of glass, and if the eye keeps moving in that direction it will leave the canvas and encounter the caption that holds the painting’s title: The World of Images. Magritte has provided the domain of the seeable (the painting) and the domain of the sayable (the painting’s title) but has not bridged the two. The bridging, which I’ll call thinking, is the work required to produce knowledge of the painting. Clients in therapy benefit from undertaking precisely this work—both of this painting in particular and of knowledge production generally—because the strangeness of “the world of images” is usually one of the distressing aspects of daily life that brings them into therapy in the first place.

    The work required is not that of making the normal (sunset/sunrise) strange (as seen felt in the view of the shards retaining that which was seen through the window), but, rather, of acknowledging the strangeness of the “world of images” and the work of knowledge production typically glossed over by habitual actions (such as, for example, the act of looking). The world outside the room is a world of dynamic forces. The forces seem to have broken inward through the glass. More than that, the image of the sun has burned itself upon the glass, much like light impresses itself upon the film in the production of photographic images. But when the eye returns to the plane dividing the interior and the exterior of the painted room, it returns with a worry. On what now are the forces of the world impressing themselves? My eyes? Who’s to say they won’t burn and break my eyes? Of course, that’s not possible because none of this is as it seems. This is a painting. The force of my seeing is producing each and every “fact” of the painting in front of me. I see broken glass, but there is no real broken glass. I see an impossibility in the form of a scene of the world imprinted upon glass that once framed the same scene of the world, but there is no impossibility here since there is no “real world,” only an image of it. The force of my looking is meeting the force of the The World of Images pressing in against my eyes. My awareness of this illuminates the materiality of my encounter with the painting, which is to say the materiality of thought. Or, as Magritte said in a letter to Foucault, “thought is what sees and can be described visibly” (cited in Deleuze, Foucault, 49). In a beautiful touch, Magritte frames his window with curtains that are reminiscent of those we might see framing a proscenium stage in a theatre. We have here a pictorial dramatization of the theatrical performance of seeing and being seen. 

    The theatre event replays itself on a daily basis in a profoundly mundane fashion. I believe that some external force is producing distress in my life. The distress is akin to the burning force of the sun that shatters the glass, throws shards inwards toward my intrapsychic fortress of solitude, and produces a disturbing, nightmarish wrinkle in the fabric of my daily life. As Epictetus pointed out millennia ago, however, it's not things that upset us, but our judgments about things. The supposedly external circumstances that bother me are known entirely through how I see and interpret them. The change one seeks will rarely take place in the world “outside;” rather, it will take place through a process of seeing differently. To return to Deleuze and Foucault, how I say and thus define what a problem is will change once I see the so-called “problem” in a new way. The knowledge of a “problem” is always multifaceted, and yet we typically hold ourselves in one position and continue to appraise the problem from a single degree of perspective instead of circling the problem to encounter the other 359-degrees.
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    Therapy as 3-Body Problem

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    Liu Cixin’s 2006 novel Three-Body Problem (三体) leapt into the imagination of Americans last year when Netflix transformed it into a series of the same name. As with most compelling sci-fi stories, the plot produces an uncanny eeriness by blending an outrageous scenario with themes that are hyperrelevant to people in the present moment. In this case, the themes of perpetual surveillance, the irredeemability of the human race, techno-authoritarianism, and the failed ideals of intellectual progress all hit pretty hard. So even though Liu is confronting his readers with a story of alien invasion, he’s really commenting on something we know too well; namely, humanity is suffering a slow death. What will save us? Math? Science? Extraterrestrials? 
    ​
    Even though readers can easily side-step the nuances of the physics and mathematical problems named in the book’s title, I’d like to argue that therapists could benefit from slowing down and grappling with the complexity of the 3-body problem. Why? If you have clients suffering from “co-occurring disorders,” then you effectively have clients suffering from a biopsychosocial three-body problem. 
    Consider that term, which therapists use all the time but rarely deconstruct: Bio-psycho-social. Three “bodies” acting upon and within one individual client. We assess our clients’ biological, psychological, and social circumstances as if each of those “dimensions” was exerting its own physical power over the person whose problems we’re helping to navigate. If we add the spiritual dimension, then a fourth “body” enters the picture and the scenario gets even more complex. 

    As it turns out, the n-body problem of the Bio-psycho-social-spiritual dimensions of our client is a perfect analogue to the mathematical three-body problem highlighted in Liu’s novel. Mastery of Newton’s laws governing gravity and motion help us map the complexities of one planet orbiting another body, such as the sun. But when another body exerting its own gravitational effect enters the picture, Newton’s laws start to become less helpful. In fact, once a third-body enters the celestial picture, it becomes impossible to accurately predict the precise motions of bodies. As such, it becomes impossible to develop certainty about the effects of each body upon the other. This mathematical problem becomes a “real” problem if you live on one of the “bodies” tangled in the 3-body celestial orbit. And if you’re thinking that such phenomena are relegated to the world of sci-fi, I will politely redirect your attention to the chaos of the biopsychosocial-spiritual reality in which you’re ensconced and point out that, hey, you’re gonna need to brush up on your “math.”
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    To get better, we need better questions.

    The answer is lebensform, but to understand it we'll need to know the question.

    Clients in the worlds of substance abuse and mental health therapy tend to share a dislike for slogans. I've played around with this in the group therapy setting by asking clients to only speak in AA slogans, using no other words. "It's all about people, places, and things for me. Just doing the next right thing, taking it one day at a time." Everyone laughs because they think of that one person at the AA or NA meetings who sincerely talks like this. When we pick the phenomenon apart, we get to the conclusion that the general dislike of the slogan and the sloganeer comes from a feeling of insincerity, as if the "bumper sticker" language misses something unique about each client's circumstance. 

    And there's the rub. Each person is unique, and yet each person also shares a surprising number of similarities with other people. We are bound together through our cultural affiliations, and we develop our sense of belonging through shared language that helps to identify us as part of the group. Slogans in fact come from this very fact. Why do AA slogans exist? People repeat them as proof of the organization's effectiveness. If you know the slogan, then, theoretically, you know the process that leads to a full understanding of the slogan, and if you have that full understanding then you are likely on the road to recovery. Sadly, however, the slogans can produce the opposite effect. They can be wielded as reprimands that suggest a failure has occurred. If only you understood the difference between progress and perfection, then you wouldn't have relapsed. Or, it sounds like somebody forgot to let go and let God. When words like these are transmitted and received in a careless way, then they can produce the opposite effect for which they were intended. The same is true for mental health problems. Tell a person with anger issues to slow down or count to 10 and you might get punched in the face. Or tell someone with a personality disorder that they aren't working from a Wise Mind and you could get your tires slashed. How do we make sure that we're using language to validate individual difference and promote group belonging instead of accidentally invalidating the unique person in front of us and spurring feelings of alienation?

    To read more, subscribe to my Substack page. 

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    How laughing heals

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    You have heard that laughter is the best medicine, but have you dwelt on how laughter heals?

    Let's start with the admission that pain and suffering exists, which his why we need healing at all. Medical doctors have determined that there is truth in the expression that laughter functions like medicine. But I'm not talking about acute medical problems. I'm interested in relief from existential dread. We live in a world where the Ignorant are in charge and fully committed to setting the conditions for maximal, pervasive distress. Given the severity of the wound, we're going to need a lot of laughter. As I argue in my new book, we need a certain kind of laughter, one that fully embraces the pain as it simultaneously points the way to a new mode of being.

    Consider the headline from The Onion above. Again, let's start with suffering. The joke hurts because it presses on a few sore points. First, schools aren't really helping young people learn how to learn. Kids are great at doing school, but, as Mark Twain pointed out long ago, that skill is actually getting in the way of education. So, on one level, the headline hurts because it reminds us that the institution of education in the U.S. has largely failed to cultivate new generations of critical thinkers. Second, of all the subjects of study to lose their grip within the halls of primary and secondary education, history is perhaps the one we ought to grieve the most. True, the joke appears to be about literacy and grammar. But by cutting the "past tense," that means that not only will students need to learn how to read in a new way but they will also lose access to the past. Level two of the joke appears here: we've already lost access to that. Texas textbook revisionism coupled with too strong of a reliance on logical positivist approaches to the past has created a shallow presentism. If history seems to repeat itself, that's because we, as a nation, can't seem to recall the history of mistakes we keep making and the poor decisions we keep making on purpose. Third, and finally, the joke hurts because funding cuts are now chipping away at our vocabulary. If we cut the past tense out of our language, that'll let us function on only 2/3 of our budget, right?

    Wrong. And yet we laugh. What kind of laugh does The Onion produce here? I call the kind of humor at work here a humor of congruence. Dialectically related to the dominant incongruity theory humor, which states that comedy often arises from the incommensurability of two or more side-by-side people, ideas, or situations, my congruent theory of humor suggests we laugh when something reveals precisely how something is. The formula shifts from "this does not equal that" to "this is this." In the headline, even though the scenario is exaggerated, the exaggeration reveals precisely what is the case; namely, the headline reveals how bad off we are in the present due to the failings of the educational institution. The laugh produced astride the recognition of what is the case is a laugh of recognition, and recognition is the first step toward healing. We can't get get better if we don't know we're sick.
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    As a mental health counselor, I often bring this theory of humor into the group therapy environment. I distribute humorous images and wait for the laughter to erupt. Once people laugh, I ask the question: what's so funny? Take this Alice In Wonderland image, for example. The theory of incongruity suggests that the humor arises from the divergent meanings of "mad." The Cheshire Cat means "we're all crazy here," but Alice thinks she's done something wrong: Are you "mad" (Angry) at me? But this incongruity (mad ≠ mad) is not the only reason, or even the main reason that healing laughter arises after encountering this meme. 

    Whether we're in a therapeutic setting or not, insecurities abound. Insecurities come from beliefs about ourselves that we safeguard and try to keep from view. Despite our best efforts, however, the beliefs do in fact show themselves, often through our speech and our behavior. When Alice interprets the cat's "mad" to mean that she's already done something wrong, she is showing us one of her insecure beliefs. She must have done something wrong because that's her thing. She's the one who has always already done something wrong. And the cat et al. know it. In my group therapy sessions, people laugh as they identify themselves with the same core belief. If people don't have that core belief, they tend not to "get" the joke right away. People who suffer from this kind of insecurity access the healing laughter first, maybe because they're the ones who need it. Presumably, the person who made this meme is one of these insecure people. It was made for the purpose of naming this common problem. What is the case? Many people enter spaces with the presumption that they are in the wrong and that everyone either knows it already or will soon find out. 

    Invisible and privately held beliefs become visible, and the healing begins. I feel like Alice. Oh, you, too? Oh wait, whoever made this meme really gets it. There's a whole community of us! Uh oh, that's not good. This feeling is a thing. A common thing? Is that what this group is about? Of course it is. I'm laughing in multiple ways now. I "get" the joke + the joke's on me + the joke's not funny + I'd rather not be the person who gets the joke. Do I drink alcohol because I feel this way? No. That's can't be it. Is it? 

    Step two of the healing process of this particular kind of laughter reveals itself at this point. Step 1: laughter makes what it is the case visible. Step 2: once visible, laughter unites people who typically suffer in silence and alone. 
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    Step 3: Healing doesn't just happen. You make it happen.

    Once something typically hidden becomes visible and we verify that, yes, this is the case, and once we unite with others who suffer in similar ways with us, then we can turn to the work of producing healing. One of the many drawbacks of Western medicine's reliance on pharmacology is that the pervasiveness of pills and prescriptions fabricate a false belief that something outside of us will fix us. But the pill doesn't do the healing. The recognition that help is required and the behaviors of seeking out and asking for help are the actions that led to the acquisition of the medication that will play a part in the treatment of whatever ails you. Similarly, when it comes to existential dread, the remedy will come about through concerted action. It is not enough, in other words, to sit in a room with people and agree that we "get" a joke about a cycle of thinking that ultimately defeats us, makes us depressed, produced anxiety, or whatever. "I'm amazing. I hate myself. I'm not real. That's exactly how it goes." Good. We have words to name a feeling and a process, but more steps are required. For starters, we need to intervene in the cycle.

    One way to do this, after introducing the meme to a group, is to challenge people to ask each other a question throughout the day, "Where are you in the cycle right now?" I hear the question, I laugh, and I respond: "Ha. I'm amazing right now." "Give it time," you'll say. "Let me know when you don't exist." We laugh together. And at what are we laughing? We are laughing now at three things: 1. It is true that I think in this self-defeating and perplexing way. 2. I know others see me thinking in this way, and I know they can see me because they, too, think in this way. 3. We're working together to do something about it. One laugh moves through many states, from the surprise of recognition to the joy of connection with others to the hope of producing a different mode of being. 
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    Want to carry the work of healing from a group therapy room or a small cohort of friends to the world at large? Don't worry. There's a meme for that.

    If I walk through the mechanics of the healing laugh with a group of people in Asheville, NC, and then show them the Tattoo Artist/People Who Need Therapy meme, lots of healing laughter erupts. Working in a substance use treatment center was hands-down the greatest place to produce such laughter because everyone in there, me include, is covered in tattoos. Everyone has some knowledge of the intriguing, medicinal pain that comes through tattooing, and everyone knows that money will sooner go toward the next tattoo than it will toward the deductible on your insurance that enables you to keep going to therapy. 

    This meme does quite a lot of work. It draws attention to a visible mark that will show itself out on the streets, and once it makes itself visible there it will have the power to continue the healing work started in the therapy room. I'm walking on the sidewalk and I pass in front of a tattoo parlor. I remember, "Ha, I wonder if anyone in there should be getting therapy instead?!" I look at my own tattoos. I need therapy. This is how it is. The work is continuous, and so many people would benefit from doing it. The knowledge produced through this train of thought is almost totally overwhelming. In certain cases, I would be crying as I thought about how many people are suffering, how many institutions perpetuate suffering, how many individuals seek out remedies, often through non-sustainable means. But right now I'm laughing as I face the same kind of overwhelm. 

    Laughter has the power to heal provided that the laugher rides the wave of the laugh into action for sustaining change in a world that prefers repetition of the same to revolution-like interventions. For something to change, a full-on political revolution is not always needed. The change can start from a tiny laugh in a small room with others who are suffering. As long as you know that that the laugh is awaiting you in the world, that you can and should seek it out, and that, once you find it, you will gain a short-lived boost of energy to intervene, then you are prepared to produce the work of healing in the world.