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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