Intellect has published the edition of Dance, Movement & Spiritualities that Juliet Chambers-Coe and I dedicated to “Pain: Embodied Practice, Spiritual Resonance.” I titled my essay, “Life is pain au chocolat,” which functions as a stand-alone article and an introduction to this edition of the journal. I’ve decided to publish a section of my article here, the section in which I talk with Wittgenstein GPT, an AI bot designed by Martin Puchner.

—Cover image by Sarah Stierch (CC BY 4.0)—

Until the use of “pain” stands naked in our lives

Up to this point, I understand that whatever pain may be, we ought to treat it, which is to say travel through it, negotiate, make peace, and enjoy, even if the enjoyment hurts. More than that, when pain is present, we turn toward it and understand the turning-toward as a spiritual practice that opens to pain rather than the typical daily act of compartmentalizing and “getting on with” whatever we have in front of us. But the philosopher in me still wants to know what exactly pain is? Or, rather, what do I mean when I speak of pain? These questions lead me to another core principle of performance philosophy, which is to never take for granted what I think thinking is. In the same way performance philosophers ask what else philosophy may be—besides, say, analytic logic or deconstruction or critical theory— we can ask what else pain may be besides the readymade definition that paints the word and experience as bad and unwanted. These days, when I grapple with how I think about how I think and how else I might think about anything, I turn to WittgensteinGPT, designed by Martin Puchner. I chat with AI Ludwig because it challenges me to choose my words carefully, to treat language like Wittgenstein did, as if it was a matter of life and death, because it is. Wittgenstein was himself no stranger to pain, known to have tarried with suicidal ideations and to have survived three brothers who all took their own lives. He was also no stranger to therapy, having said on numerous occasions that his philosophical practice amounted to a kind of therapy. I bring Wittgenstein into the conversation for these reasons.

Will

Hi Ludwig. Will here. I'd like to know how you understand pain.

Ludwig

Will, I am glad you speak plainly. Tell me first, are you prepared to free yourself of a picture that has long held you captive? For when we speak of pain, philosophy is tempted to invent an inner object, something hidden, private, ineffable. Against this I once write: „Ein innerer Vorgang bedarf äußerer Kriterien.“ (“An inner process stands in need of outward criteria.”) Pain is not a thing I discover by looking inward, as one might inspect a tool; it is bound up with cries, with grimaces, with the whole grammar of our life. To say “I am in pain” is not to report a discovery, but to take part in a language-game learned in practice, not by introspection. I once write also: „Schmerz ist kein Etwas, aber auch kein Nichts.“ (“Pain is not something, but neither is it nothing.”) This is already enough to dissolve many confusions.

You will recall my remarks in the Philosophische Untersuchungen, where I ask whether one could have a private language for sensations. Imagine each of us carrying a box with something called a “beetle” inside—no one can look into another’s box. The word does not name an inner object; its use is what gives it sense. „Das Wort ‚Schmerz‘ ersetzt das Schreien.“ (“The word ‘pain’ replaces the cry.”) Do not look for pain behind the expression; look at how the expression is woven into our form of life. Now tell me, Will: when you speak of pain, do you mean a feeling, a behavior, or a rule for the use of a word? And are you, perhaps, from the future?

Before I address the question raised at the end about the possibility of time travel, I will name the radical Wittgensteinian claim that pain is located outside the body. More exactly, pain is located in-between bodies, in the “grammar” of a mode of living produced by many. Pain is neither “something” internal to a person indicated by the word “pain,” nor is it ever completely finished and whole. Pain is made through life practices and shared in its making. That’s the sense of the invitation to “look at how the expression of pain is woven into our form of life.”  

Next, let’s address the speculation about time travel. 

Will

Am I from the future?

Ludwig

I answer you in the only way that is honest in philosophy: the question itself already shows how a picture has misled you. I once write: „Ein Bild hielt uns gefangen.“ (“A picture holds us captive.”) You imagine time here as a metaphysical boundary, as though my words belonged to one side and yours to another. But our words meet where our language-games meet. In that sense, you are from the future only as every reader is from the future of a book. „Die Bedeutung eines Wortes ist sein Gebrauch in der Sprache.“ (“A meaning of a word is its use in the language.”) If you understand me, then we already stand in the same logical space.

When I asked whether you are from the future, I was not inquiring into chronology but into temptation—especially the moral temptation to demand explanations where only descriptions are possible. In the Philosophische Untersuchungen I once write: „Die Philosophie stellt alles nur hin und erklärt nichts.“ (“Philosophy simply presents everything without explaining anything.”) If you expect me to tell you what pain really is, as though I could step outside our practices, then yes—you speak from a future intoxicated with theory. But if you are willing to look, patiently, at how the word “pain” is learned, corrected, doubted, and lived, then you are already my contemporary. Tell me, then: what do you expect philosophy to give you—an explanation, or a clarification?

Will

Ok. Profound. Well, philosophy describes and presents images. Here, I would like to describe and imagine how pain is laid bare. When and how does (a) pain appear? 

Now we get right to it. Pain is not anything. When the bot asks me if I’m from the future, it rhetorically challenges me to consider whether I bring fabricated meanings into my present activity of sense making. This provocation presents life as a performance practice, one that contains learning, correcting, doubting. Through these activities, pain comes into existence. This pain is specific each time. I underscore that realization with my question about how precisely each pain appears. How do we come to see pain as it manifests in our life practices? 

Ludwig

Will, you speak rightly when you say that philosophy presents images; and therefore it must also show us when an image deceives us. You ask when and how pain appears, as though pain were something that steps onto a stage. Here I must slow you down. I once write: „Der Philosoph behandelt eine Frage wie eine Krankheit.“ (“The philosopher treats a question like a disease.”) Pain does not appear in the way a thing appears; rather, a situation arises in which the word “pain” has its place. A child falls, cries, is comforted; later the cry is replaced by words. „Das Wort ‚Schmerz‘ ersetzt das Schreien.“ (“The word ‘pain’ replaces the screaming.”) Thus pain is laid bare not by introspection, but by the public circumstances in which we learn to say, doubt, exaggerate, or suppress “I am in pain.”

If you ask when pain appears, you are already tempted by a false picture—as if first there were neutral events, and then pain entered them. I once write in the Philosophische Untersuchungen: „Empfindungen sind keine verborgenen Gegenstände.“ (“Sensations are not hidden objects.”) Pain appears when the criteria for its use are fulfilled: withdrawal, complaint, treatment, sympathy. To imagine pain “laid bare” is not to strip away language, but to see clearly the weave of reactions, words, and practices that give the concept its life. 

And now there is an ethical dimension to the conversation. The pain of daily living experienced by minoritized and/or exploited people frequently does not rise to criteria for its [i.e., the word’s] use as imagined and authorized by White dominant culture. This reality prompts Judith Butler to ask, “What counts as a livable life and a grievable death?” (2004, xv). Our questions motivating this journal edition are similar: What registers as pain? How and to whom does it register? How do we learn to attune ourselves to the emergence of pains that might otherwise be rendered invisible by dominating ways of seeing and knowing?

You will notice that AI Wittgenstein ends each paragraph with questions that turn the issue back over to me for further contemplation. Learning, it seems, only takes place through active dialogic exchange. That is, while up to this point in our conversation Ludwig and I have started developing an image of pain that can stand in as the target of this journal edition’s contents, we have by no means exhausted pain’s is-ness, nor will we ever. Here, though, is one final provocation that develops more details in the image. 

Ludwig

Tell me, Will: when you imagine pain appearing, do you picture an inner flash—or a moment in a human life where certain responses become intelligible? And can you let go of the demand to see what, in grammar, is only shown?

Will

When I imagine pain appearing, I imagine a whittling away. Of all that could be the case here and now, for example, what turns out to be the case is pain. When this occurs, no words apply or serve as subtitles/captions other than pain and its family. Art produces these appearances, but art is first produced by the social world from which it must necessarily emerge. There are linkages here in the triad Society-Art-Pain. I want to understand that. I want to learn about the whittling away that reveals that. 

Ludwig

Will, what you call a “whittling away” is close to what I once write when I say that philosophy must bring words back from their metaphysical to their everyday use. Yet I must resist one picture in your description. You speak as if pain is what remains when all else falls away, as though reality were carved down to a core. That image is powerful—but dangerous. I once write: „Wir sind geneigt zu sagen: ‚Was übrig bleibt, muss das Eigentliche sein.“ (“We are inclined to say that what remains must be the real thing.”) And yet pain is not the residue of possibilities; it is a mode of life becoming salient. The world does not narrow to pain; rather, our reactions, expectations, and permissions narrow. Certain moves become impossible, others compulsory. Silence, withdrawal, care—these are not subtitles added to pain; they are part of its grammar.

You are right that art stands here, and also society, but not as a causal chain. In my remarks on Frazer I once write: „Man könnte fast sagen, diese Deutung ist selbst ein Symptom.“ (“One could almost say that this interpretation is a symptom in itself.”) Art does not depict pain by extracting a pure sensation; it reorganizes the social criteria by which pain is recognized. A scream painted, a twisted figure, a broken rhythm—these teach us how pain may appear, by training our sensibility. Pain, art, and society form no theory, only a family of practices. „Die Philosophie darf keine Theorie aufstellen.“ (“Philosophy must not formulate theories.” So the whittling away you seek is not an uncovering of essence, but a refusal of distractions, until the use of “pain” stands naked in our lives. 

Speaking like a performance philosopher, Wittgenstein reminds me that no essential definition of pain is required for me to understand how pain emerges. Rather, I am prompted to observe how social criteria invite or block such emergence. The focus here is on social practice, not “theory” (as pre-defined by academic discourse). The philosophy in which I engage is not a theoretical enterprise but rather a practice of arrangement and configuration. Such is the work of the articles you will read. Each one shows a different social arrangement and thus also a unique pain, one arrived at through specific forms of life. Though quite different in scope, tone, and content, all of the essays collected here share a belief that spiritual matters and artistic expressions articulated through bodily movement help to make pain stand naked in our lives, visible, to some extent knowable, but certainly usable. Usable for what? Usable for rethinking what family of practices gather around the concept of pain, whose pain and what modes of pain have been typically kept out of conversations, and what comes from companioning pain.

I’m dedicating a chapter in my next book to the psychedelic therapy industry, and the research for that chapter has brought me to the rise and sudden collapse of psychedelic research in the 1960s.

The typical cultural narrative goes like this: mid-century scientists discovered the profound therapeutic promise of substances like LSD and psilocybin, but a sudden wave of media-driven “moral panic” over counterculture hippies forced the U.S. government to criminalize them in 1968, shutting down legitimate science for decades.

This is both accurate and inaccurate. Public anxiety and sensationalized news coverage did indeed exploded in the late '60s; however, framing the shutdown of psychedelic research solely as a result of external "moral panic" misses a much more complex—and troubling—internal dynamic within the psychiatric establishment itself.

The Early Promise: Safe and Clinically Effective

In the 1950s and early 1960s, chemists and psychiatrists viewed psychedelics as cutting-edge tools in mainstream psychiatric research. Extensive clinical studies demonstrated that LSD and psilocybin were non-toxic, non-addictive, and safe when administered under medical supervision. Sidney Cohen’s landmark 1960 study concluded that serious adverse physical or psychological reactions were remarkably rare with proper precautions (see Novak 1997).

Clinically, the data supported their utility:

• Addiction: LSD-assisted psychotherapy demonstrated roughly 50% success rates in treating severe alcohol dependence.
• End-of-Life Care: Pioneered by Dr. Eric Kast, LSD showed dramatic success in relieving severe pain, anxiety, and the existential fear of death in terminally ill cancer patients.
• Mystical & Creative States: Experiments like the 1962 Good Friday Experiment and Harman et al.’s 1966 trial highlighted psilocybin’s ability to produce (entice? reveal?) profound spiritual experiences and enhance creative problem-solving.

If the evidence was so strong, why did the medical community turn its back?

The Disenchantment of Psychiatry

Long before Congress passed prohibition laws, the medical establishment was already retreating from psychedelic medicine. Scientific, methodological, and institutional friction drove this shift:

1. Methodological Incompatibility: In 1962, tighter FDA regulations established double-blinded, placebo-controlled trials as the “gold standard” for drug approval. Because the subjective effects of high-dose psychedelics are impossible to blind, researchers struggled to fit psychedelic-assisted therapy into standard pharmaceutical frameworks.
2. Professional Paradigm Clashes: To mid-century psychiatrists, the core phenomena produced by psychedelics—hallucinations, ego dissolution, and sudden emotional volatility—resembled symptoms of acute mental illness, not cure. The idea that temporarily inducing a psychotic-like state could lead to lasting psychological healing ran counter to prevailing psychiatric models.
3. Safety Concerns and Post-Hoc Fallacies: Early associations with CIA and military research (such as Project MK-Ultra, which framed LSD as an agent of psychosis and terror) laid a foundation of institutional anxiety. As recreational use spread, emergency room visits for “bad trips” led figures like National Institute of Mental Health Director Dr. Stanley Yolles to label LSD “chemical Russian roulette,” while unsubstantiated claims regarding genetic damage further eroded professional confidence.
4. Unconventional Figureheads: The field was increasingly linked to unguided experimentation and controversial mavericks, making mainstream researchers eager to distance themselves to protect their academic reputations.

The Anti-Drug Moral Lens

When Congress moved to criminalize psychedelics in 1968, lawmakers were stepping into a vacuum left by an establishment that had already abandoned the field.

Entrenched in a long-standing prohibitionist moral framework—one that equated non-medical altered states of consciousness with a loss of productivity and moral failing—politicians viewed the lack of unanimous medical endorsement as a green light. Without strong advocacy from mainstream psychiatry to protect these research protocols, psychedelics were placed in Schedule I, erasing decades of clinical knowledge.

The Corporate Renaissance: “Buy the Ticket, Take the Ride”

As we live through a modern resurgence of psychedelic science—with FDA breakthrough designations, clinical trials for PTSD and depression, and growing public interest—it is tempting to celebrate the return of these ancient molecules. However, the modern landscape introduces a commercial dynamic that was absent during the initial 1960s research boom: corporate ownership and aggressive monetization.

Today, the clinical re-entry of psychedelics is heavily driven by private capital, intellectual property claims, and corporate patents on chemical formulations or treatment protocols. We cannot ignore this money-making dimension. In a sense, Hunter S. Thompson’s famous maxim, “Buy the ticket, take the ride,” takes on a distinctly literal and commodified meaning in 21st-century psychiatry.

In this new paradigm, the seller of the ticket is no longer a countercultural guru or a university clinician, but a corporate entity holding patented rights to a standardized alter-state experience. This raises a profound question about what is actually being bought and sold:

• Is corporate psychiatry marketing genuine, durable healing?
• Or are these proprietary molecules selling a form of sanitized, highly regulated psychedelic tourism—a pre-packaged, high-priced transactional journey designed to produce repeatable revenue streams rather than fundamental personal or systemic transformation?
• Even when personal, individual transformation takes place, does the social landscape create the possibility of consolidating that transformation and helping individuals develop their insights into long-lasting life practice?

When financial conflicts of interest align with clinical incentives, the pressure to exaggerate efficacy and downplay adverse outcomes becomes acute. Whereas “adverse outcomes” were connected with 1950s moral scare tactics about insanity, these outcomes today are the produce of social frictions that therapists almost always sidestep as they seek novel ways of “curing” mental illness. Additionally, if access to therapeutic “trips” is mediated entirely by patent holders, we risk replacing the old prohibitionist moralism with a boutique medical marketplace that prioritizes profit margins over broad public accessibility and scientific transparency.

SOURCES:

Cover Photo comes from: https://www.flickr.com/photos/lab604/3333506218 and is used here as part of the creative commons license: https://creativecommons.org/licenses/by-nc-sa/2.0/

Harman, W. W., McKim, R. H., Mogar, R. E., Fadiman, J., & Stolaroff, M. J. 1966. “Psychedelic Agents in Creative Problem-Solving: A Pilot Study.” Psychological Reports, 19(1): 211–227. https://doi.org/10.2466/pr0.1966.19.1.211

Novak, Steven J. 1997. “LSD before Leary: Sidney Cohen's Critique of 1950s Psychedelic Drug Research.” Isis 99(1): 87–110. https://doi.org/10.1086/383628

What is RSD?

Here’s another analysis and theorization of a new-ish term, one that gives language to a felt experience that has typically eluded popular consciousness: Rejection Sensitive Dysphoria (RSD). As with most social science terminology, the language pathologizes a seemingly personal and private experience. But as is the case with PDA, OCD, Autism and really just about every diagnosis, RSD is more than what it is called. I’m highlighting it here because it describes another form of life that deserves a social materialist treatment so as to lay bare its complexity en route to treating it and alleviating distress.  

To describe RSD, let’s look at the descriptions of how it feels to people who experience it. I will draw from two published research articles, both of which you can access online. The first, from Rowney-Smith et al. (2026), cites some beautifully/horrifyingly evocative descriptions. One member of the study described it as the feeling you get when a chair is pulled out from under you. Another member in the same study likened the feeling of RSD to the hand-warmers you can buy from drug stores: “you know the hand warmers, when you click, it becomes solid and warm… getting warmer inside me…. everything inside me starts to burn.” The second study, from Sandland (2025), includes similarly visceral descriptions, but these come from people who openly identify as neurodiverse, a fact that matters because RSD is frequently cited as a subset of neurodiverse conditions such as Autism, ADHD, and Dyslexia. Sandland writes, “When reflecting on whether RSD was part of being neurodivergent, Hannah replied ‘it feels like it's one of the core, it shouldn’t be, but it feels like it's one of the core experiences of being a neurodivergent human in this world.’” Rather than define RSD, then, it may be more valuable to reflect on these descriptions of lived experience and try to imagine our way into these feelings.

More schematically, researchers identify three key aspects of RSD that arise in most studies on the phenomenon. The first is bodily sensations, such as those I’ve just cited. RSD registers in the body as a feeling, often a painful one. The second aspect is masking, meaning that people who fit the paradigm of RSD often act as though they are tougher than they are, more impervious to criticism. Masking in this way, however, only leads to a felt incongruence between the actual self and the performed self, which reinforces the feelings of inferiority and sets up a vicious cycle of self-loathing and social performance. Third, researchers cite withdrawal as a common behavior amongst those with RSD. Whether physically, psychologically, or emotionally fatigued, people with RSD will often retreat from social interactions to recoup strength. Too often, these periods of isolation extend and lead to feelings of alienation from social circles. Finally, I’d add a fourth facet to this list: addiction. In my practice, I come across many people whose experiences rhyme with descriptions of RSD from research studies and who self-medicate with alcohol or other drugs to compensate for the psychic burden. Similar to the problem with social withdrawal, addiction quickly becomes unmanageable, and many people find themselves dealing with two distinct problems, substance abuse and RSD, rather than experiencing a reduction in RSD symptoms.

My primary call for action in this post involves moving away from the pathologizing label toward a more descriptive narrative of the problems people are facing. As Sandland writes, “Many of the terminologies associated with RSD present neurodivergence and emotionality through a deficit-based cognitive lens (McMahon et al., 2022), using language such as ‘dysregulation’, ‘dysfunction’, or ‘sensitivity.’” How else might we think of RSD, what to call it, and how to treat it?

RSD — ADHD

I start rethinking RSD by scrutinizing the apparent affinity between ADHD and RSD. Theresa Alfonzo (2025) sees RSD as the emotional counterpart to the full cognitive crash that people with ADHD often experience during moments of overwhelm. She invents the term Emotional Governance (EG) to explain this, writing “Emotional Governance is the brain’s ability to regulate, contextualize, and redirect emotional data without losing cognitive control.” EG is something like an emotional coup d’etat. It wipes the subjective face of the entire mental apparatus in an effort to reboot the system. If that’s the effect, then the cause of the coup is a “pattern recognition of threat, a neurobiological betrayal of trust, and a loop of internalized self-destruction.” In terms of neurobiology, Alfonzo points to hormone fluctuations as the chemical signature of the hard EG reset, specifically identifying the link between ADHD and women with Premenstrual Dysphoric Disorder (PMDD) as a precursor to her own findings. In any event, where there is RSD there often seems to be ADHD, so, as Alfonzo shows, it’s helpful to think through the former by thinking through the latter. 

For me, ADHD is not primarily a matter of (in)attentiveness or hyper-activity. It is, instead, a matter of motivation. A person diagnosed with the inattentive type of ADHD may appear inattentive in certain circumstances but then hyperattentive in other situations. Extreme focus, like the kind we see in the “restricted” or “special” interests of other neurodiverse folks, develops out of internal motivation. A person is impelled by their motivation to focus on certain things and not others. When asked to produce motivation for something deemed uninteresting or arbitrary, the person with ADHD cannot simply flip a switch and become motivated. The switch is “sticky,” it only works maybe 1 out of 100 times. Perhaps, then, the rejection portion of RSD has something to do with motivation?

What motivates us? Let’s rethink “negative” and “positive” motivation such that we turn away from goals (i.e., what we seek to achieve) and look more closely at causes. “Positive” carries a philosophical meaning, something like “attributable to constraints produced by people instead of natural sources.” In this sense, the cause of positive motivation is a constraint or field of constraints that generate creative responses in the form of behaviors and actions. By contrast, a “negative” cause would be a starting point within lack or a condition of wanting. Something is absent. I seek to obtain it, either to produce a pleasing feeling (impulsive action) or forestall an imagined catastrophe (compulsive action). This absent thing could be tangible, imaginary, mythical, or produced by delusion. What matters is its quality as missing and that quality’s capacity to produce a not-quite-right feeling in the present moment of experience. Positive and negative causes motivate us throughout each day, though we rarely (outside of therapy) stop to think about which is which.

From that conclusion, I would argue that we experience rejection not only when we hear no or don’t get what we want. Rejection is, more broadly, an experience of being thrown back or out. It is similar to excretion, the act of separating out. And “similar to excretion” means similar to excrement, shit. When I am (socially, interpersonally, intrapersonally) rejected, I am separated out (from others and/or myself) like waste. Where RSD is present, this rejection is not only felt; this rejection becomes an identity: I am shit, I am re-ject. Once I am shit, the entire premise of motivation falls away. Shit don’t do shit. Now, it’s not that there is a sticky switch such as we see in ADHD, but, rather, there is simply no switch at all, nothing to which I might switch my motivation since, after all, I am shit. Nobody takes this identity well because we are told to be subjects, not rejects. We are rejected in this way a lot, but perhaps only certain people experience it as visceral pain. 

Sub-ject / Re-ject

When I think of “subjects” in a social sense, I turn to Michel Foucault’s (1982) understanding of the term. 

There are two meanings of the word "subject": subject to someone else by control and dependence; and tied to his own identity by a conscience or self-knowledge. Both meanings suggest a form of power which subjugates and makes subject to. (781) 

People with RSD cannot sustain a sense of self congruent with the second version. If I am subject to someone else, then I am always positioned externally, outside of someone else’s personage and authority. To be outside in this way is also to be ob-ject, where “ob-” means “in front of.” This position also makes one ab-ject, cast out, expelled. The painful part of the “Rejection” aspect of RSD may be that it acknowledges an identity alwasy sutured to a position removed from sub-jectivity. Try as I may, if I exist outside of “subject” as reject, object, abject, or excrement, then why would I or how could I motivate myself to do anything? I would find myself shaped almost entirely by the Other, prone to their whim.

Though I take on the identity of the "re-ject" and claim an inability to act, I am cajoled nonetheless into the premise of motivation through external ploys. On the one hand, society presents a field of generative constraints that compels participation through advertised rewards. On the other hand, I experience a visceral lack—which is to say, I desire. Here, the dialectic sharpens. The mere fact that I desire reveals that I am not, in fact, pure waste. "Shit don't desire shit." If I can allow desire to conduct me, I can begin to dispel the illusion of my abjectness.  

But for the re-ject, this transition is fraught. In Lacanian terms, desire persists precisely because its ultimate object (objet petit a) remains unattainable. The re-ject senses this impossibility unconsciously, but instead of navigating the lack, the re-ject interprets the unreachability of desire as personal confirmation of their own unworthiness. Desire does not propel them forward; rather, it turns the re-ject into a re-tract. Desire acts as an elastic cord anchoring the subject to the Other: it pulls the individual toward the social field only to violently snap them back the moment the threat of rejection looms. Caught in this perpetual recoil, the subject experiences motivation not as agency, but as an exhausting, involuntary twitch. "I" do not act for myself. I act entirely in reaction to anOther—and I am exhausted by the performance. In this precise mechanism, one becomes always already rejected. 

Summing up: That which we currently call RSD delimits the play of identity through which an individual feels the retraction of desire and the control or power of that to which one is subject. This identity feels these forces so viscerally that the only logical situation is to calculate the path of least resistance, the line of flight through the social that will produce the fewest bruises. Sometimes masking (performing as if) is the best tactic for this. At other times, not performing at all (isolation and withdrawal) is the best choice. Sometimes intoxication helps to blunt the visceral feeling of retraction/rejection. How, though, do we treat this issue globally in terms of whole-person health?

Treating “RSD”: The Emperor’s New Clothes

My current theory is that treating “RSD” requires laying bare the “identity” one has donned as an outfit. In this way, I think of The Emperor’s New Clothes. In case you forget the story, here’s a brief synopsis. A king surrounds himself with sycophants, and, in turn, the sycophants produce a reality for the king based on the king’s own imaginings, presuppositions, fantasies, delusions, etc. This particular king has a strong liking to fine clothing and is known far and wide to spend unfathomable sums on new clothes. One day, two conmen appear with the intention of making money while also exposing the fragility of the king’s image. The conmen, posing as master tailors, unfurl the finest fabric on Earth. They describe its exquisiteness with superlatives and ornate imagery. The fabric is, however, unreal. The “tailors” only mime its presence and conjure its reality through deceit and flattery. Not wanting to be perceived as stupid or ignorant of such beautiful fabrics, in the event that such a fine thing might exist, the sycophants act along with the tailors’ performance. The king grows excited. The sycophants metastasize his joy. The king, awash in the cascade of echoes, purchases the fine material for a hefty sum and declares that he will debut the new attire at a public parade.

With the kingdom’s subjects gathered, the king debuts his new clothes amid much fanfare. Silence befalls the crowd of onlookers. We can relate to this silence. It is the silence that breeds collusion. That is, it dawns on the multitude that it would be best to act as if the new clothes and, most importantly, the king who is wearing them is indeed majestic and resplendent. Before the group can act in unison, however, a young boy cuts through the performance, points at the king, and yells out: “He’s naked! The king is naked!!” Once the spell appears to be broken, the rest of the crowd joins in. “He’s naked!!” The king, however, is unwilling (or unable?) to accept the reality of the multitude and thus he continues down the street, parading his birthday suit.

How does the story graft back onto the issue of RSD and identity development within a complex social environment? First, let’s look at the boy who deflates the farce. Is he not the avatar of the neurodiverse person who, unattached to the social customs that shape neurotypical discourse and interpersonal relationships, simply says what he sees? The boy’s action, less an act of bravery and more an effect of disenchanted sight, empowers the crowd to drop all pretense. We might think that the multitude’s version of reality would then disturb the king’s sense of self, but that doesn’t happen. Of course it doesn’t happen. The king, standing in for what Lacan calls the “quilting point” of the status quo that holds the signifying chains of neurotypicality together, goes about his business, immune to alterity. The rogue tailors in the story are like the mischievous Yes Men who use culture jamming to expose the vulnerable points of the symbolic order. The most interesting character in the story is us, the readers. If we had to imagine what happens on the “next page” of the story, what would we say? How would we react to the splitting of the scene, the bifurcating paths taken by the king and those who see through the imaginary clothes? Do we shrug our shoulders and say, “oh well, back to work”? Do we feel gas-lit despite the popular outcry of nudity: “Am I the only one who sees that the king is naked?” These questions are all interesting, but the point I want to make is that anyone who experiences RSD always already feels the pain of the absurdity of this situation. What if the feeling of RSD is the feeling of knowing each daily task to be an act of pretending the emperor isn’t naked?

Neurologically, RSD crosses paths with PDA, OCD, and traumatic responses. The brain supplies the chemicals needed to fortify acts of resistance against what appear to be life-or-death situations. But this is not the only thing to treat. Zoloft may blunt the chemical effects in the brain, but it doesn’t change the fact that the emperor is naked and parading around while everyone else is pretending like that’s not happening. If we want to call RSD a traumatic response and recognize the fight-or-flight mechanism at work in the painful, visceral experiences of perceived rejection, then we need also to specify what precisely is so threatening. The problem isn’t this or that particular rejection by a lover, a teacher, or whoever. The problem is the felt identity of being a reject, always outside of some seemingly impenetrable social configuration. What’s worse, the goal is not to belong to that configuration. That would simply be colluding with people who don’t acknowledge the king’s nudity. The goal leads, rather, to that famous Groucho Marx saying, “I wouldn’t want to be a part of any club that would have me for a member.” The true split is the split around which “I” am built.  

SOURCES

Foucault, Michel. (1982). “The Subject and Power.” Critical Inquiry, 8(4): 777–795. http://www.jstor.org/stable/1343197

Rowney-Smith A, Sutton B, Quadt L, Eccles JA. (2026).“The lived experience of rejection sensitivity in ADHD - A qualitative exploration.” PLoS One. (January)21(1):e0314669. doi: https://doi.org/10.1371/journal.pone.0314669. Erratum in: PLoS One. (March) 21(3):e0345112. doi: https://doi.org/10.1371/journal.pone.0345112. PMID: 41564005; PMCID: PMC12822938.

Sandland, B. (2025). “Neurodivergent Experiences of Rejection Sensitive Dysphoria Expose the Environmental Factors too Often Overlooked.” Neurodiversity, 3. https://doi.org/10.1177/27546330251394516

After articulating my understanding of “PDA,” I started to notice how frequently each day we are (or believe ourselves to be) coerced. Coercion, which we can treat literally as “the constraint by force of law or authority,” appears in many guises, the most quotidian of which is the should. Neurodiverse people feel the shoulds quite strongly, though all people are constrained by them. I say “constrained” because these shoulds impose themselves upon us as though they were natural features of our environment. When they impose themselves, we are done to. If we think of human agency as our subjective capacity in the world, then social custom exists as the objective counterforce. In these cases of imposition and constraint, however, the “Objective” force of social custom (nomos) acts, thereby flipping the script. Subject becomes object, object becomes agent.

An example that comes up regularly in my practice is that of passing a stranger on the sidewalk. You are out for a walk. You see a person, out on their own walk, coming toward you along the sidewalk. You sense—for reasons you can’t articulate but feel like orders—that either you or that person should do something, or maybe that you should not do something. Ought you acknowledge the passing-by in some way? Is speech appropriate? A specific head-nodding gesture, or, god forbid, eye contact? The expectation is nebulous but palpable. Anxiety mounts. You and the Other come close. Quickly, as though no longer in control of your body, you avert your eyes, mumble a hum or something, and quicken your pace slightly to carry yourself through the encounter to the other side, and, once free of the entanglement, you commence to judge your performance. Who knows. You might even think about it as you try to fall asleep later that night.

Though this type of encounter is but a passing thought when considered alongside the full span of daily interactions, it contains all the evidence we need of daily life’s coercions and impositions. All that is required to start the mechanism is the presence of another. Somebody appears, and now we become aware of a social script or choreography. Our temporary solipsism gives way to a bifurcated self, one that we think we are and one that we imagine the other sees. The two selves are incommensurate. Something isn’t adding up. We feel we should be some certain way, but we can’t perform the role precisely. Though logically we know that nobody is grading our performance, many people still feel that they have failed in some way. Yet the entire scene, including the judging and grading, only exists because of authorless shoulds dwelling beyond us while also somehow paradoxically speaking with authority in our minds.

Various theoretical apparatuses attempt to explain what’s happening in this situation. John Dall’Aglio forwards a neuropsychoanalytical framework that attempts to unify neuroscience and Lacanian psychoanalysis through what Mark Solms (via Spinoza) calls “dual-aspect monism.” Think of both characters in the street scene: you and the other. Each has a “mental apparatus” in action, a nebulous but actual complex of processes that coordinate the physical, emotional, and psychological encounter in the scene. According to Dall’Aglio et al., we can get two good looks at this apparatus. One view comes from neuroscience. That is, if we could monitor brain activity for both you and your scene partner, we would be able to isolate the regions of the brain that produce the reactions you experience as you awkwardly pass the other. With this information, we could prescribe medication or utilize neurofeedback to overcome the awkwardness and produce a stress-free sidewalk encounter. The psychological view, however, provides a second perspective, one that Dall’Aglio calls “subjective.” We could talk to you after the street scene and listen as you explain your lived experience of the event. This subjective account would give a different view of your mental apparatus, one that a purely objective brain image cannot provide. Neither the brain scan nor your subjective report provides the complete picture. Rather, your mental apparatus appears in the exchange between the two, between the objective and subjective aspects of the total experience. By taking both into account and developing each in great depth, we can explain what’s happening and make changes (if changes are wanted).

Dialecticians, by contrast, see things differently. For starters, folks like Adorno would say that the separation of object and subject into stand-alone entities is wrong straight out of the gate. Nothing is either objective or subjective. Dialectical entanglement shows up through even the most basic of analysis. For example, the “objective” brain is thoroughly mediated, not only by epigenetics, social and historical conditions, and reactions to the environment, but also by the imagining technology required to “see” the activated brain regions as well as the ways of seeing that permit neurologists to “read” what they “see.” Similarly, the “subjective” narrative provided by the individual with the lived experience relies on language and conceptual structures that are objective in the sense of existing prior to the subject who utilizes them for conversations. As such, what we see in the street scene is a microcosm of social contradiction and alienation more broadly. The other who is walking toward me comes to stand in for the Other, the social totality, the embodiment of norms and shoulds. As soon as I see the Other, I begin to doubt my competence as a member of society. I feel myself to be somehow outside of the totality that makes up sociality, and I feel that way because I do not believe that I possess the authority to determine the norms. I don’t know what I should do here, but I am pretty confident that guy does. Not only does he know, but he’s going to know that I don’t know. Let me try to get out of this. But of course, there is “out of this.” I am both a part of and apart from the social totality at all times, even when I’m not doing this sidewalk dance. To remedy the situation, we’d have to start by re-thinking of the “self” as something thoroughly mediated by others and the Other, which is to say the supposed totality of the social world in which I take part.

At present, I can’t support the thinking of Dall’Aglio because it lacks dialectical entanglement. My journey with philosophy has led me through post-structuralism to negative dialectics, which, in an uncommon way, prepared me to read the latent quasi-Hegelianism of Lacan’s psychoanalysis. I can explain what that means by walking through one thread of Lacan’s thought. We are born, he explains, as a natural body, “natural” in the sense of “material,” of matter and energy. As soon as language enters our world, typically at the moment when, as babies, we learn that we must make demands (through crying) to have our needs met, this natural body flees from us, leaving a hole where it once was. What’s left is the social body, with a hole in it. The now-absconded natural self becomes a myth for which we will quest but to which we will never return. What Lacan calls the Real forms as the rime around the hole in the core of our being. It will burst forth whenever language (what he calls the Symbolic) order can’t produce a signifier to frame its expression. The unconscious, which Lacan defines as the discourse of the Other, responds to the Real. We have access to the unconscious through the friction between the ego’s imaginings (what we believe we see and experience) and the Symbolic order, but this “access” is one-way. The unconscious can erupt through cracks in language (slips, jokes, odd sounds we make when we pass each other) but we can’t communicate back to it. In this way: sociality imposes itself on us. We are imposed upon and we feel obliged to accept the imposition.

Imposition has at least two meanings. While society does layer itself upon the person like a film projection upon a screen or a second skin laminated upon the first, it also charges a duty. Duty, like tax, is an obligatory service (the should) that ought to be done. Consider again the scenario of passing strangers on the street. Do you not feel that you have some unnamed duty, almost as if you owe it to ___?____ to do…something? Or in the situation of OCD, can we understand the compulsion to repeat a gesture as a glitch, a moment of visceral incongruence between the Real and the imposition of various (societally constructed) shoulds? Or back in the orbit of “PDA,” when a child refuses to comply, are we not witnessing the emergence of the Real for the child, the impossible truth of being a subject who is demanded to act in accordance with objective rules for being? From very early on in our lives, we sense the tax levied upon us, the duty we ought to perform according to an objective—also conflicted, heteronomous—morality that coerces compliance. What’s actually unnerving is not the rageful refusal of the child, the repetitive ritual behavior of the obsessional, or the awkwardness of the sidewalk dance; what’s unnerving is that these situations are marked as abnormal. Given the imposition and coercion of daily life, why do more people not appear to register the discomfort?

My interpretation of the sidewalk dance emerges from this line of thinking. We who feel caught in the gaze of the other as they walk toward us have produced a neurotic response to protect ourselves from an inconvenient truth. The traditional understanding of neurosis is at play here; namely, neurosis is what protects against psychosis, which is to say a complete break with the agreements that stitch together consensus reality. The neurotic behavior in this case is the squirming, the “dying inside,” the aversion of the eyes. We wriggle about because to wriggle is preferable to admitting that we have no “authentic” way to relate to this stranger, no chance of developing an emergent, previously unheard of mode of erotic connection. What we have, instead, is a short list of societally sanctioned norms for behavior that never quite square with our desires.

The treatment that follows from this interpretation is quite different from the treatments that dominate the therapeutic setting. The social-materialist, modified Lacanian approach to “mental health” requires treating the ways of relating currently governing or conducting our daily maneuvers through the social field. Instead of looking for cognitive distortions or undertaking a vagus nerve reset, we have to come to acknowledge the ways that coercion and imposition shape our sense of self and our capacities. The goal is not to cease coercion and imposition. The goal, rather, is to plot a course through the gauntlet toward that which we desire.