During the first months of the Covid-19 pandemic, prescriptions for antidepressant, anti-anxiety and anti-insomnia drugs were reported to have risen by 21% in the United States.Footnote 1 In the United Kingdom, early reports also suggested demand increased between 10 and 15% for antidepressant drugs in pharmacies in the first months of the crisis (Sharma, 2020). The Office of National Statistics (ONS) reported that half of the British population experienced ‘high anxiety’ during the weeks of Spring 2020 lockdown (ONS, 2020).

Whilst uncertainty, vulnerability and stress, coupled with precarity, lace the impoverishment of overall wellbeing in critical times, what would be the line dividing a pathological disorder and a healthy, if anything, reaction to torment in light of troubling circumstances? In order to gauge the status and politics of the contemporary pathologising (and individualising and de-politicising) of anxious distress and the possibilities of our relation with it, we must begin by asking other elementary questions. If anxiety is negative, then how much anxiety is too much? And how could we measure it? The classification of psychological suffering stumbles upon the challenge of quantifying the ‘un-quantifiable’ through the systematic categorising and description of affective and mental states and their transformation into illnesses and disorders.

In this chapter, we will think about anxiety through a critical recent history of its diagnosis and treatment in the context of psychological care. This will help us to gauge the dimension of our anxious troubles a little better. By unpacking the strategies employed by mainstream psychiatry in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association (APA) since the mid-twentieth century, it is possible to unveil the dynamics of a reduction of the subject to a productive-biomedicalised body in the last decades. Such a process echoes a mode of governance that finds its realisation not only in the clinic but also in contemporary modes of consumption and discourses and policies of wellbeing. What becomes apparent is a process of quantification, qualification and management of affects; or, as I propose here, an affective-politics that assembles body and psyche in a particular mode of alienation—an ‘estrangement’.

This diagnostic culture, inaugurated in the late-1970s, is framed by a logic of categorisation and control of the body, which becomes a particularly complex locus of ‘dividualisation’ (Deleuze, 1992)—a concept Gilles Deleuze utilised to address the mode of subjective production of the contemporary society of control, entailing a loss of the possibility of experience of subjective truth in symptoms that anchor the psychoanalytic conception of anxiety. Deleuze’s mapping allows us to grapple with the current efforts of management of anxiety and management of the body that culminates in what pharmaceutical lobbying calls ‘a silent epidemic’, with circa 20% of the US population, for example, experiencing ‘pathological’ or ‘not-normal’ levels of anxiety (Cooke, 2013; ADAA, 2021; NIHM, 2021). Such mechanisms and fantasies of taming and controlling the body through consumption, public policy or medication, relate to Michel Foucault’s archaeology of ‘biopower’, once the study of power and the body in his work entails the investigation of the “modes of objectification which transform human beings into subjects” (Foucault, 1982, p. 777). Foucault (1982) summarises the three ‘types’ of objectifications in this process of subjectivation explored throughout his life’s work. They are: “the modes of inquiry which try to give themselves the status of sciences” (Foucault, 1982, p. 777); ‘dividing practices’ in which the “subject is either divided inside himself or divided from others” (Foucault, 1982, p. 778); and “the way a human being turns himself into a subject” (Foucault, 1982, p. 778). Language, scientific knowledge, discourse, governmentality and subjectivation are features of our analysis of the status of anxiety, revealing a dividualising biopolitical modulation of affect—or, a systematic estrangement that anchors care, further alienating suffering from its singular and contextual roots. The landscape is grim.

Unwanted Anxiety

The British Office for National Statistics (ONS) has been putting into practice a governmental policy-planning programme entitled ‘Measuring National Well-being’ (MNW) since November 2010. By asking a set of four questions, their aim is to “develop and publish an accepted and trusted set of National Statistics which help people understand and monitor well-being” (ONS, 2018) and by ‘wellbeing’ they understand: “‘how we are doing’ as individuals, as communities and as a nation, and how sustainable this is for the future” (ONS, 2018). The project follows the contemporary tendency that Christian Dunker, a Brazilian psychoanalyst, describes as a move guiding public policy through a ‘diagnosis’-based modus operandi (Dunker, 2015). “To diagnose,” he writes, “has become one of the activities most specifically valued in our current form of life” (Dunker, 2015, p. 20). If we look into the four questions being asked by the ‘Quality of Life Team’ to thousands of citizens in the UK in the past decade, the connection between that and a ‘diagnostic culture’ becomes clearer. They are:

  • “Overall, how satisfied are you with your life nowadays?”

  • “Overall, to what extent do you feel the things you do in your life are worthwhile?”

  • “Overall, how happy did you feel yesterday?”

  • “Overall, how anxious did you feel yesterday?” (ONS, 2018).

Whilst ‘positivity’ is measured in terms of happiness, satisfaction and purpose, the sole question qualifying ‘negativity’ of the wellbeing experience is measured by the appearance of anxiety. Feeling anxious, it seems, connotes a status of ‘ill-being’.

Such a qualification of anxiety as negative and undesirable reveals crossings between the universes of inside and outside the clinic that have merged discourses, governmentality, treatment and consumption into the same ‘diagnostic’-logic in which wellbeing, or feeling well, feeling good, means not feeling anxious. Dunker calls this logical/ideological expansion a ‘diagnóstica’ [in Portuguese], a term he summarises as the ‘diagnosis-like’ frame offering the “condition of possibilities of diagnostic systems” (Dunker, 2015, p. 20) to a context that is outside the initial scope of such diagnostic logic. A ‘diagnóstica’, therefore, is characterised by a system of framing, recognising and cataloguing other aspects of life that exceed clinical diagnosis and treatment but still remaining in a format informed by the same dynamics that frame the clinic, or the contemporary medico-scientific and therapeutic field of psy (Rose, 1996). In this sense, anxiety is inserted within the public cultural discourse following a process of pathologising and symptomatic isolation that is present in the psychiatric diagnostic context. As such, this logic seeps into the public sphere as a measure and indicator of an ‘unwanted’ status of being, as seen in the ONS wellbeing questionnaire. Anxiety is being produced by the diagnóstica that frames it at the same time. Under such lenses, the grammar of the Diagnostic and Statistical Manual of Mental Disorders (DSM) allows us to grapple the mechanisms of production of our relation with the affect of anxiety.

In the early to mid-twentieth century, owing to the psychoanalytic influence in psychiatry, the widespread nonspecific naming of the modern sense of discontent, or Unbehagen, was ‘neurotic anxiety’. In this period “anxiety and its sibling condition, ‘neuroses’, became the central themes of what came to be called the stress tradition” (Horwitz, 2010, p. 113), thus revealing a certain trend of ‘pathologising’ anxiety, despite anxiety being considered a common affliction of the post-World War II world. However ubiquitous or familiar to the post-war subject, anxiety was also the main category for discriminating in the clinic what was ‘normal’ and what was ‘pathological’ in that same period. Depression, at that point, as Horwitz (2010, 2013) defends, was ‘in practice’—and by that he means, in the practice of psychiatrists in the United States—more commonly associated with the psychotic sphere and was a characteristic diagnosis reserved for severe melancholic cases of hospitalised patients. This trend will come to a halt towards the later decades of the twentieth century precisely, as we will see in what follows, due to a disappearance of the influence of psychoanalytic theory in the field of mainstream psychiatry. Before the 1980s, psychiatric diagnoses “reflected the centrality of the ‘psychoneuroses’, which were grounded in anxiety” (Horwitz, 2010, p. 115) and the first two editions of the DSM, from 1952 and 1968 respectively, are considered to be the most flavoured by psychodynamics—the type of psychotherapeutic knowledge that takes into account the dynamic unconscious of psychoanalysis. From the third edition onwards, however, there is an increased trend in further categorising mental illness in search of a ‘reliable’ efficiency in diagnosis that culminates in the fifth and most recent edition of the manual, the DSM-V, from 2013, with its bulk of over nine hundred pages of ‘disorders’ and their respective diagnostic checklists (Vanheule, 2014; Ehrenberg, 2009; Herzberg, 2009). This change in approach will reshape the status of anxiety and, consequently, promote a biological narrative of depression in the turn of the twenty-first century. It also presents us with a paradigm shift in regards to the quantification of the body, psyche and affect, maintaining the status of ‘ruptures’ and suffering as ever more individualised and alienated from the one suffering and their context.

The process of mapping and categorising mental states and affects and transforming them into recognisable symptoms is at the heart of the birth of the DSM, making it into a quantifying dispositif par excellence, informing what Felicity Callard (2014) calls a ‘mediated’ relation to diagnosis. The DSM emerges as a ‘promise’, at least, of a more ‘pragmatic’ and ‘detailed’ approach to substitute the then existing diagnostic forms, which were mostly based on prototypical descriptions and hypothetical case-studies rather than ‘checklists’. The prototypical approach was already seen in earlier key texts of psychiatry such as Philippe Pinel’s A Treatise on Insanity, from (1806), where distinctions of ‘treatable’ and ‘untreatable’ patients and principles of moral and medical treatments of what he called insanity were laid out systematically. This was despite the fact that Pinel had “a single view of madness, characterised by many symptoms” (Ehrenberg, 2009, p. 36), rather than ‘different types of madness’, as we can see in a psychoanalytic and psychodynamic approach that divided, at a basic level, psychoses and neuroses as different structures. In the early twentieth century, Pinel’s approach was still dominant in psychiatry, making use of clinical vignettes of patients’ cases that guided doctors by some type of comparison. Psychoanalysis relied on clinical analysis and conjectural ‘judgement’, rather than on a clear-cut dividing line between what caused or classified a symptom as pathological or even as a symptom in the first place (Vanheule, 2014). A similar reliance on the doctor in question was present in the traditions that favoured a prototypical approach. It was in part as a promise to facilitate these individual judgements on the side of the doctor that the first major manual of mental illness was published in the United States by the APA in 1918. The ‘Statistical Manual for the Use of Institutions for the Insane’ was published ten different times before being substituted by the first edition of the DSM, in 1952.

At the time, however, different authors would already have diverging opinions on mental illness, and founding heavy-names of the psy-disciplines such as Emil Kraepelin and Eugen Bleuler, for example, presented contrasting views over the focus either on biological components or, rather, more ‘holistic’ aetiological approaches. Psychiatry was a mixed field and “in the 1950s and 1960s, while psychoanalysis occupied the commanding heights of American psychiatry” (Scull, 2019, p. 133), the first edition of the DSM was published. This first edition “reflected the movement of psychiatric practice from state mental hospitals to outpatient treatment and thus paid more attention to the psychoneuroses” (Horwitz & Wakefield, 2012, p. 93) instead of psychosis, the latter being more frequently ‘reserved’ to hospital wards. The paradigm of the asylum and of a medicalised culture that excluded the insane from society, as explored in depth in Foucault’s (2008a) work on psychiatric power and biopolitics, starts cracking from this point onwards. Anxiety, therefore, was a common handle in clinical practice in the mid-twentieth century due to the influence of psychoanalysis and what we may call ‘everyday’ madness and suffering (Crocq, 2015, 2017). Anxiety, importantly, was seen not a disorder in itself, but as a signal of something else that had to be treated on a contextual and individual basis.

The influence of North American psychiatry is politically relevant because such paradigmatic frameworks have reflected on systems of classification and of quantification across the globe. In the 1950s and 1960s, the then dominant group at the American Psychiatric Association (APA), under the auspices of Adolf Meyer, conferred their psychodynamic preference on the manual, and such psychoanalytic ‘flavour’ was not lost even with the changes imposed by the following second version of the DSM, published in the late 1960s (Scull, 2019). The second edition was published after the release of the 6th edition of the International Classification of Diseases (ICD), published by the World Health Organization (WHO) that had been formed in 1948; this sixth edition inaugurated the ICD model existent to date. For those of you unfamiliar with all such acronyms, ICD codes are used every day across the globe in health appointments when making a diagnosis, charging health insurances, creating epidemiological maps and informing public health policy. In the 1960s, therefore, envisaging a pairing of the DSM with the ICD-6, as this was the first of its kind to list mental health disorders, the APA launched the DSM II. The 1968 edition “did not make any major changes in the account of the anxiety disorders or in the pivotal role of anxiety in psychopathology. It maintained anxiety as the key aspect of the psychoneuroses” (Horwitz & Wakefield, 2012, p. 95). Anxiety was still a central component of the frame that conferred a diagnostic platform to the then dominant diagnoses at the period, but that was about to change in the next decade.

A contrasting view to the usually widely accepted understanding of the influence of the DSM-III in the boom of psychopharmaceutic treatment, as we will see next, is offered by Metzl (2003). In his book Prozac on the Couch, he argues that it was the Freudian psychoanalytic culture of ‘blaming’ anxious suffering on poor or disturbed mothering that contributed a vocabulary to the popularisation of tranquilising pills through women’s magazines in the United States in the 1950s. Arguing that “anxiety was the pressure of keeping intact the structure in which the doctor prescribes and the patient ingests” (Metzl, 2003, p. 124), Metzl localises in psychoanalysis the roots of later biological psychiatry in which the doctor prescribes the pill that cures. Whilst Metzl offers a compelling critique of the gendered language of both mass media and of psychoanalytic texts, rightly identifying the misogyny and biologism of Freudian and post-Freudian writing, little context of the psycho-politics of diagnosis is provided. Therefore, whilst carving a rather convincing argument about who gets excluded and on what grounds from ideals of normality, sanity or wellbeing, Metzl too quickly diagnoses psychoanalysis without looking, for example, to other countries where the psychoanalytic discourse might have been equally or more widespread in the early twentieth century. The author also fails to critically address the contributions of Freudian ideas about psychotherapeutic ‘talking cures’, where psychic life is implicated in discourse rather than reduced to a purely medicalised solution. Consequently, neither his understanding of ‘Freudian biology’ nor of the specificities of anxiety versus depression as paradigms of suffering is particularly clear. For as much as the hegemonic power of psychoanalytic discourses within psychiatry in the USA until the 1950s is noticeable, it can hardly account for the rise of depression in the following decades, as we will see next.

The DSM-III and the Disappearance of Anxiety

The third edition of the DSM, published in 1980, inaugurated a decisive distancing from the psychoanalytic approach and, with that, managed to re-signify the status of anxiety. This proved to be critical in inaugurating a novel kind of quantification of affect, favouring biological explanations of psychic distress and giving birth to depression as the illness of the century (Verhaeghe, 2008). To comprehend the motor of this change from the ubiquity of anxiety towards mass-depression diagnoses there are some elements to consider of the politics of psychiatry at the time and also the influence of products being marketed by the pharmaceutical industry (Scull, 2019). Such factors had an important role in producing the ‘grammar’ of anxiety in the last half of the twentieth century. What we see as a drastic change implemented in the DSM-III is a moving away from the prototype-based model and an introduction of the checklist-logic of diagnosis. A group of biological psychiatrists based at Washington University in St. Louis, United States, led by Robert Spitzer and known as neo-Kraepelinian—for their biological inclination—was tasked with the formulation of the third edition of the manual; their core interest was to define psychiatry as a medical discipline (Shorter, 2005). This alignment with the medical discourse was achieved by the introduction of a new system based on a list of criteria, “Spitzer’s task force was a political animal, and its aim was to simplify the diagnostic process by reducing it to a tick-the-boxes approach” (Scull, 2019, p. 172). This system inaugurated in the third edition of the manual is still guiding its current version, the fifth, since such a checklist approach that classifies, qualifies and quantifies is seen as more ‘scientific’ than narrative models of treatment that preceded it. Checklists, in fact, seem to be far from going anywhere in mental health care.

In this new model, anxiety no longer features as an aspect of psychic experience and neurotic distress, rather, each ‘type’ of suffering is allocated into an individual category. Anxiety now is divided into subcategories of phobias, separation anxiety, panic disorder and so on (Shorter, 2005; Harrington, 2019), leaving the category of General Anxiety Disorder, or GAD, as the only nonspecific category of diagnosis. GAD could only be ‘ticked’ however, when no other type of anxiety was present. This move alone demarcates a significant effort in qualifying the affect of anxiety. Conversely, the broad category of Major Depressive Disorder, or MDD, appears as the go-to general diagnosis of distress (Mojtabai & Olfson, 2008). The results of this ‘grammatical’ shift are critical. Whilst the numbers of diagnoses of depression in the USA during the 1960s accounted for roughly one third of the diagnoses related to anxiety, in the 1980s depression overtook anxiety. This trend only intensified in the following years and according to the USA National Centre for Health Statistics, by the early-2000s the proportion of anxiety versus depression diagnoses shifted completely: from about fifty million overall yearly diagnoses of mental health a year, over twenty million were of depression whilst only six million were diagnosed as anxiety (Herzberg, 2009).

Depression travels, then, as we are able to trace historically, from belonging mostly to the melancholic and hospitalised world all the way into ordinary experience. It moves from being a peripheral category into being a dominant diagnosis of the ‘stress tradition’ (Crocq, 2015). Alongside the moving away from the anxiety-paradigm of the psychoneuroses that marked so heavily the psychodynamic approach of the earlier versions of the DSM, by the late 1970s ‘depression’ as an overarching category itself also appears to “fit the professionally desirable conception of a severe and specific disease that could be associated with biological causes” (Horwitz, 2010, p. 123). Therefore, it served well the then dominant group within the hegemonic forces of the psy-field, whilst it also brought the roots of ‘discontent’ close to the body, to the organism. In simple terms, the ‘new malaise’ favoured biologism, in contrast with a hard to measure psychoanalytic neurotic anxiety, and it also served, by consequence, the thriving pharmaceutical industry (Herzberg, 2009; Harrington, 2019).

The Social Life of Depression

Beyond the United States and beyond the close-circuit of psychiatry comparable currents were being established. The sociologist Alain Ehrenberg writes of a similar flow across the Atlantic, in France, demonstrating analogous shifts between anxiety and depression from the mid to the end of the twentieth century. He points out that “according to the credes (Centre d’études et de documentation sur la santé), between the beginning of the 1980s and the beginning of the 1990s, the rate of depression increased 50 percent in France” (Ehrenberg, 2009, p. 181). What Ehrenberg offers as an interesting contextual analysis of the soaring numbers of depression diagnoses and, consequently, the changes in the meaning of anxiety as a symptom or a disorder, is the accompanying ideological shift marked by the definition of the subject of depression and its supposed ideal counterpart, the ‘autonomous’ and ‘emancipated’ subject. The rise of the autonomous individual from the late 1970s that was being slowly announced through the cultural shifts that followed the Second World War is, according to Ehrenberg, an important factor in the emergence of depression as a representation of a depleted individual that finds itself powerless, facing a demand of ‘autonomy’ and ‘emancipation’ that was accompanied by a contrasting sense of ‘freedom’—however illusory and constricted this ‘freedom’ to be oneself was and still is. In this context, anxiety appears only as a consequence of this overall sense of ‘unfitness’. It appears as an anxiety signalling the possibility of failure to truly correspond to such demands (Ehrenberg, 2009), yet, peripheral if compared to depression.

The changes in (some parts of Western) society that followed the 1960s—e.g. countercultural movements, civil rights movements, recognition movements, etc.—in various forms in different territories and contexts are, for Ehrenberg, a driving power behind a new, as he puts it, “strange obsession with being entirely oneself” (Ehrenberg, 2009, p. 135). Depression, as a polar opposite of such aspirational emancipation, appeared as a convenient representation “to describe the problems raised by this new normality” (Ehrenberg, 2009, p. 135), the ‘normality’ being therefore ‘emancipation’. For, as he points out, “individual sovereignty was not only a relaxation of external constraints; everyone could also take the concrete measure of the inner burden it brought into being” (Ehrenberg, 2009, p. 135). If Freudian psychoanalysis marked the late nineteenth century and early twentieth century neurotic subject, characterised by repression and guilt in its Victorian and bourgeois Viennese universe, the late twentieth century saw a different problem emerging, and that was, for Ehrenberg, the omnipotence that shadowed emancipation.

After the Second World War, depression separates itself from melancholia. Depression travels between two versions of the difficult task of being well: (1) anxiety, which indicated that I am crossing into forbidden territory and am becoming divided, a pathology of guilt, an illness of conflict; and (2) exhaustion, which tired me out, empties me, and makes me incapable of action—a pathology of responsibility, an illness of inadequacy.

These two versions of wellness accompany the emergence of a new era of the self, who is no longer either the complete individual of the eighteenth century; or the split individual of the end of the nineteenth century; rather, she is the emancipated individual. Becoming ourselves made us nervous, being ourselves makes us depressed. The anxiety of being oneself hides behind the weariness of the self. (Ehrenberg, 2009, pp. 43–44)

Brazilian psychoanalyst Maria Rita Kehl has a complementary insight into the matter of the rise of depression in the twentieth century and in her book O Tempo e o Cão (or ‘Time and the Dog’, in English), she depicts the depressed subject as occupying the place of the melancholic in previous centuries. Depression is, according to Kehl, a ‘positioning’—or an ‘unconscious choice’, in the psychoanalytic sense—of the subject in face of an ‘impossible’ Other, representing a ‘social symptom’. She argues that “the potential of analysis of the social bond represented since antiquity by melancholies has nowadays been relocated to the field of depressions” (Kehl, 2015, p. 49). The contrast between melancholia and depression taken up by Kehl follows a Lacanian reading of Freud’s work on melancholia, that situates it, as she explains in the book, ‘more to the side’ of psychosis (Kehl, 2015) than neurosis, as Freud had initially marked melancholia—and psychosis—as ‘narcissistic neuroses’. In this manner, to Kehl, in simple terms, the melancholic ‘in its time’ was subjected to a fundamental loss marked in the relation with a ‘mOther’ that was not desiring, not castrated, thus, not offering a ‘place’ for this subject. Subjectivity and the Other in a period that we could perhaps succinctly call ‘modern’ were crossed by the discontent of melancholia, of the loss of this possibility of having a place in the world, according to Kehl—a view shared in a way by other feminists, nonetheless (Sprengnether, 1995). The depressed, in her view, is claiming a ‘place’ in light of a different Other in our times. Furthering such acknowledgement of a sort of ‘social life of depression’, Kehl observes that “the rise in the incidence of the so-called ‘depressive disorders’, since the last three decades of the twentieth century, indicates that we should try to question what do the depressions have to say to us, from the place that was previously occupied by the old manifestations of melancholy, as symptoms of the contemporary forms of ‘mal-estar’ [the Portuguese translation of Freud’s Unbehagen]” (Kehl, 2015, p. 49). Indeed, statistical patterns of diagnosis are revealing of shifts in society; however, the production of the diagnostic categories must be considered carefully as actively productive of such shifts. This means that studies considering the rise in certain patterns of diagnosis need to also acknowledge the fact that the politics of generating the manuals, categories and checklists utilised in diagnoses will be reflected in the collective experience such studies are analysing. For instance: peaks in diagnoses of depression can offer clues to the interpretation that society is ‘more depressed’; however, this straightforward analysis is superficial if it does not take into account the factors informing these mass diagnoses. In this sense, Kehl’s book bypasses the equally statistical and data-rich analysis observed by Horwitz (2010), for instance, that the rise in ‘depression’ followed from a previous mass pathologising of anxiety and pointing out that all that anxiety, therefore, cannot have suddenly just ‘vanished’.

Kehl brings in anxiety only as a part of depression, openly limiting her attempts at elaborating on the impact of psychiatric diagnosis or even the pharmaceutic industry over the rise in the numbers of ‘depressed people’ across the globe. Diverging slightly from Ehrenberg, whilst quoting similar patterns of diagnosis in BrazilFootnote 2 to those of France and the USA, Kehl’s ‘negative’ of the depressive subject is the capitalist ‘productive subject’. Depression, depletion and under—or no—productivity are the markers of what is unacceptable or at least undesirable to the maintaining of the capitalist system in its neoliberal turn (Sadowsky, 2021). In this light, a state of ‘excess’, the opposite of ‘depletion’, could be interpreted as more favourable to this neoliberal project. However, by looking through anxiety carefully in the psychoanalytic writings of Freud and Lacan, a paradoxical state of excess [of tension], that may prompt one to act at the same time as generating a total lack of action, in stillness, is found as pertaining to the sphere of anxiety. An anxious subject is not necessarily productive, nor necessarily unproductive. We may perhaps say that the anxious subject is a subject that does not ‘fit’ into a particular capitalist project perfectly, yet, it does not ‘not fit’ either. To explore these paradoxical remarks, it is useful to comprehend not only what it ‘means’ to be categorised or diagnosed as depressed or anxious, rather, we must not separate this questioning from enquiring into ‘how’ these categories are formulated and what revolves around such ‘grammar’.

Kehl’s approach via the ‘undesirable’ subject for neoliberal capitalism has important theoretical resonances and interesting clinical value. As she explains in this piece, in the clinic, encountering depressed subjects has become increasingly more frequent and it is by offering them a different set up to negotiate their relation to this initially ‘impossible’ Other, as well as to re-inscribe their jouissance in this relation of desire and demand that analysis can offer something potent in the face of depression. However, this focus on the ‘depressed’ subject, as if this category has some ‘objective bearings’ on reality, leaves the debate around anxiety aside or at least in a peripheral space as if it ‘suddenly’ vanished from collective experience upon the rise of the diagnosis of depression. It is crucial, thus, when still engaging with the reverberations of capitalism and social arrangements in the clinic, to understand the project of privatisation of suffering and its naming, framing, categorisation and qualification up close, mapping its relation to profit and private and public institutions, as well as the ideological echoes of such diagnóstica. In other words, it is crucial to consider the grammar for such inscriptions and recognition of suffering.

Quantifying Affect: From Discontent to Medication

As early as the 1950s and 1960s, experimentations with psychopharmacological drugs and the modulation of anxiety can be observed. Felicity Callard (2016) offers a comprehensive study of the relation between agoraphobia and the still popular category ‘panic disorder’ in the collaboration between the North-American psychiatrists Donald Klein and Max Fink. Klein was part of the DSM-III taskforce, where anxiety is, for the first time, dissolved into different categories. His particular contribution was that his work on medicalising and defining what ‘panic’ looked like, in contrast with agoraphobia and a more ‘general’ anxiety, informed the alliance between segmentation of symptoms, drug effects and a new status for anxiety. Callard (2016) recounts Klein and Fink’s treatment of patients between the years of 1958–1959 with Imipramine—‘the first tricyclic antidepressant’ (Callard, 2016, p. 214); such experiments led Klein to argue “that drug action allowed the observation of two ontologically distinct kinds of anxiety (anticipatory anxiety and panic) that had been conflated in earlier models and theorisations of anxiety” (Callard, 2016, p. 204). Psychopharmaceutic thinking, or this artificial pharmacological paradigm, was thus introduced as an anchor to a biological psychiatric definition of symptoms, disorders and, overall, affect and anxiety.

The ‘fall’ of anxiety thus hardly represents the diminishing of anxious states in the experience of individuals, rather, it is a ‘fall’ reliant not solely on diluted socio-political changes and their production of subjectivity, but also on the politics of the systems of diagnosis and treatments and their representation of contemporary capitalist interests. The publication of the DSM-III and the shift towards a biological cause of distress facilitate a ‘chemical imbalance’ narrative that was accompanied by mass marketing campaigns aimed at both the general public and clinicians as well as profitable drug patents (Shorter, 2009; Whitaker, 2010). The most famous case study of the sort is the 1987 pill launched by Eli Lilly: Prozac. Within ten years of its launch, 10% of the North American population was already taking it (Segal, 2017). In the USA, in 1988, the National Institute of Mental Health (NIMH) launched the ‘Depression Awareness, Recognition, and Treatment Program’ (DART), and Prozac (fluoxetine) featured in 8 million brochures and 200,000 posters sponsored by its manufacturer (Segal, 2017). The serotogenic rebalance becomes the pharmacological promise of the following decades, giving Prozac many successful companion drugs known as Selective Serotonin Reuptake Inhibitors (SSRIs), such as citalopram, escitalopram, sertraline or paroxetine. Highly promoted through marketing, these drugs are still dominant in prescription not only for MDD as well as ‘anxieties’ and even GAD. Well known for not causing side-effects and addiction as harsh as those caused by earlier tranquilisers and anxiolytics such as Miltown (meprobamate), Valium and Librium (benzodiazepines), popular during the 1950s and 1960s, SSRIs benefit from a marketed reputation of being ‘effective’ and even ‘harmless’. It is only more recently and slowly, that the dangers of withdrawal and of severe side-effects of SSRI and SNRI antidepressants have been researched, impacting public health recommendations of disclosure of withdrawal harm upon prescription in general medical practice. In 2019 the British Royal College of Psychiatrists (2019) officially took a critical position in relation to withdrawal of antidepressants in their recommendations to NICE—the National Institute for Health and Care Excellence.

What is curious is that anxiety returns ‘blurred’ within depression through psycho-pharmaceutical treatments named ‘anti-depressant’ (Herzberg, 2009). Such is the terminology factor in the fall and rise of certain diagnosis that in an article in The Guardian, from June 2017, the then dean of The Royal College of Psychiatrists, Dr Kate Lovett, is quoted affirming that: “Antidepressants are used in the treatment of both depression and anxiety disorders. They are an evidence-based treatment for moderate to severe depression and their prescription should be reviewed regularly in line with clear national guidance” (Campbell, 2017). Under such discourse, as stressed in the ‘scientific’ tone of an adjective such as ‘evidence based’, contemporary antidepressants work in a ‘versatile’ fashion, both when you are ‘up’ or ‘down’, anxious or depressed. The first patented drug to benefit from this shift back to a ‘new age of anxiety diagnosis’, in which anxiety returns in a biologised form, was Paxil (paroxetine), approved in the United States in 1999 for the treatment of Social Anxiety Disorder, known as SAD, and in 2001 for General Anxiety Disorder (Rose, 2006). The product, only a decade later, generated three billion dollars in sales a year (Horwitz, 2010) and a good part of such ‘success’, especially in the USA, is due to the heavy television advertising of the drug promoted by GlaxoSmithKline (and its pre-merger name SmithKline Beecham) “suggesting to individuals that their worry and anxiety at home and at work might not be because they are just worriers but because they are suffering from a treatable condition. ‘Paxil … Your life is waiting’” (Rose, 2007, p. 213) read the adverts.

When the then SmithKline Beecham pharmaceutic company was seeking FDA (USA Food and Drug Administration) licensing for Paxil, social anxiety disorder was still not as widely known by the general public and to tackle this ‘problem’, the company “launched a public advertising campaign called ‘Imagine Being Allergic to People.’ The campaign included the ‘cobbling together’ of a patient advocacy group called the Social Anxiety Disorder Coalition” (Harrington, 2019, p. 568). A similar PR strategy to promote the ‘chemical imbalance’ narrative of mental distress was employed by Pfizer in 1999, when marketing the SSRI Zoloft for PTSD, Post-Traumatic Stress Disorder, for which they hired the public relations firm Chandler Chicco Agency to form the advocacy group ‘PTSD Alliance’ (Harrington, 2019). Other drugs have been approved for the treatment of anxiety in its many categories as stated in the most recent editions of the DSM since the late 1990s. Zoloft (sertraline) and Effexor (venlafaxine, officially a serotonin and norepinephrine reuptake inhibitor, or SNRI) have also been marketed for PTSD and GAD respectively. The DSM-III and following IV and V breakdown of anxiety into different disorders amplified the market scope for Big Pharma, accordingly, “the strategy of repurposing old drugs for new disorders (that, in many cases, people had not known they had) was highly successful. U.S. sales of SSRIs picked up again dramatically, peaking in 2008 with revenues of $12 billion” (Harrington, 2019, p. 571).

The profitability behind the shift towards a checklist-approach of diagnosis also reveals a tragic unethical mingling of Big Pharma and governing bodies. For the latest edition of the DSM, for example, the DSM-V, “it was reported that the pharmaceutical industry was responsible for half of the APA’s $50 million budget, and that eight of the eleven-strong committee which advised on diagnostic criteria had links to pharmaceutical firms” (Davies, 2015, p. 124). The ethically problematic conflict of interests present in the structure that creates diagnostic criteria, funds research and, in general terms, produces the ‘grammar of suffering’, reveals “the entanglement of psychic maximization and profit maximization” (Davies, 2015, p. 124), crossing through the vocabulary available for identifying and recognising mental suffering.

There are other links between this model of diagnosis and the operative global financial capitalist system, once a manual such as the DSM comes to operate as a neo-colonising discourse through the imposition of its frameworks of categorisation of psychic experience (Sadowsky, 2021). This relation is clearer if we look into the DSM’s presence around the world. Despite being a North American psychiatric manual, the DSM has its scope and influence more ‘globally’. If at the start of the DSM project and with the DSM-II in particular, there was a preoccupation in matching the ‘international’ standards of the ICD, after the third edition of the DSM, the ‘power’ shifts hands. With the publication of the DSM-III, in 1980 things move to the opposite direction and the ICD goes on to follow the trends in diagnosis already present in the DSM. Until the ICD-9, from 1975, the umbrella-terms of ‘psychosis’ and ‘neurosis’ were present. During this period, in the United States, an extraordinary issue of the international manual called ICD-9-CM (with CM standing for ‘clinical modifications’) was launched, opening path for the upcoming hybridity in codes. In the following version of the international manual, the first post-DSM-III, the ICD-10, from 1992, a longer list of very specific and detailed types of ‘disorders’ appears, reflecting the categories’ checklist system (Shorter, 2009). Despite the gaps in publishing time, both manuals present a similar development of the trends in diagnosis, especially in terms of moving away from a psychodynamic-influenced language and a shift towards further divisions and categories. Ingrid Palmary and Brendon Barnes (2015) comment on the ‘hegemonic’ power of the North American psychiatric manual in their study of critical psychology and diagnoses in African countries. Reproducing colonial dynamics, as seen in Nigeria for example, the DSM “was consistently used in such a way that the clinician could devalue the meanings given by the client and focus only on those parts of the narrative that were congruent with the way mental health was understood in the DSM” (Palmary & Barnes, 2015, p. 398). They add: “In this way, Western psychological knowledge is reproduced as the true focus whilst local knowledge is rendered irrelevant or at most a cultural variation” (Palmary & Barnes, 2015, p. 398).

This ‘imported’ and ‘exported’ grammar of suffering that is at the core of the project of the ICD for public health, whilst crossed by the logic of the DSM, also represents a colonising ‘globalisation’ of the manners of suffering that accompanied the globalisation of financial capital within the neoliberal ideology. It is worth mentioning that along the terminology of ‘global health’ and several private-public and philanthropic capitalist efforts, the USA is still the largest donor to the WHO yearly budgets. The subject ‘of’ neoliberal capitalism becomes, through such diagnostic systems and multinational pharmaceutical corporations, a ‘global’ paradigm, and the potentiality of affects such as anxiety or the possibilities involved in experiencing psychic distress are erased systematically by the hegemonic practices in the field of psy, serving the ‘powers’ of ‘globalised’ financialisation of human capital. Affect is divided and conquered in a neo-colonising effort.

The connection of this diagnostic culture to neoliberalism goes further and deeper, as we are taken to an affective-politics that produces a biologised negativity in anxiety and profits from it (Guéry & Deleule, 2014). In this manner, when we accept that the DSM provides categories for recognition of distress, “it must be recognised that this language is not neutral and value-free but rather reflects a dominant ideological rhetoric of the specific epoch, in this case the crisis in welfarism and the emergence of neoliberalism” (Cohen, 2016, p. 79). Neoliberalism and a broader culture organised by the criteria of performance/production see a reverberation in the field of psy through the relationship established with medication. What are these pills for? “Cure, palliative treatment or doping?” (Dunker, 2015, p. 23). To put it simply: where do we draw the line between the use of a substance to ease a painful difficulty/suffering and eliminate ‘all’ suffering and discomfort? Or even, when does medication become what doping is to an athlete, an aid to up one’s performances and increase benefits? Therefore, a ‘diagnostic grammar’—informed and formed by the ‘alliances’ between hegemonic powers in the field of psy and neoliberal productivity and consumption standards—provides not only a possible manner of experiencing a discontent-turned-disease, as well as it delineates the ‘exclusion’ of modes of suffering from its grammar. Anxiety, in the shift in diagnosis observed since the 1980s, turns into a ‘stranger’. The initial mass-pathologising of anxiety, followed by its breaking down into specific categories and diagnostic ‘submission’ to depression, as well as its ‘management’ through medication, accompany a cultural arrangement that is also observable outside of the clinic.

Wellness or Hellness

An individualist concept of ‘wellbeing’ has permeated neoliberal times as our attitudes towards ‘being not well’ reflect the logic of quantification, categorisation and, ultimately, financialisation of late-capitalist ideology. Such an arrangement of ‘wellbeing’ extrapolates Foucault’s account of modern governmentality as developed since the late eighteenth century under the paradigm of interiority and self-reference that permitted biopolitical subjectivation and towards which psychoanalysis is also allegedly a contributor (Foucault, 2004). The effort to ‘feel good’ in one’s body is, in the contemporary context, also framed by the disciplinary and controlling assumption of the totality of conscious speech as promoter of attitude and behavioural changes—an assumption heavily questioned by psychoanalysis, which relies, on the contrary, precisely on the potential of representational lacunae, or gaps in language, which constitute the unconscious (Lacan, [1960] 2006). Freud taught us to take symbolisation and narrative with a ‘pinch of salt’, being more concerned with what lies underneath a clinical complaint. In current wellbeing discourse, ‘mind and body’ are articulated in such a manner that digital apps, checklists, as well as medication and even some ‘yoga pants’ have become the vocabulary to address bodies that are not ‘balanced enough’ and in need of management. All the while Big Pharma and the trillions of dollars-worth ‘wellness industry’ revel in profits (Cederström & Spicer, 2016; Reaney, 2014).

Alongside the solutions offered by Big Pharma, therapeutic practices based on self-monitoring, thinking ‘positive’ and setting clear ‘goals’ such as Cognitive Behavioural Therapy (CBT) and Positive Psychology have thrived under the logic of isolating symptoms and de-politicising suffering (Scull, 2019; Binkley, 2011). Currently, in the United Kingdom, guidelines for treating General Anxiety Disorder (GAD) promote the use of SSRI drugs as well as self-monitoring and individual or group self-help based on the principles of CBT (NICE, 2011). For Pilgrim (2008), “these socially mute technologies risk individualising distress and disconnecting it from its biographical and social origins” (Pilgrim, 2008, p. 258), promising, however, a ‘quicker fix’. Argued as being a more ‘effective’ or simply put, ‘cheaper’ and easy to measure approach to therapy than long-term psychotherapy, CBT has been part of the NHS since the New Labour government of Tony Blair, promoted by his advisor from the London School of Economics, Richard Layard (Layard & Clark, 2014). The notions of ‘efficiency’ and ‘productivity’ unfold both in terms of governmental spending and of a mode of management of the self that delineates a problem based on the patient’s complaint and works towards a clear goal that involves ‘thinking and behaving’ differently in order to rid oneself of an unwanted symptom (Pilgrim, 2008). In other words, “Cognitive-Behaviour Therapy (CBT) is based on the claim that the cause of distress lies in the individual’s maladaptive thinking, or cognitive processes” (Proctor, 2008, p. 233).

In October 2007, the BBC (2007) reported on the announcement of increased funds for CBT which would widen the access to ‘talking therapies’ across the UK. It reads: “Health Secretary Alan Johnson said by 2010, £170 m a year would be spent—allowing 900,000 more people to be treated using psychological therapies. These are just as effective as drugs, says the National Institute of Health and Clinical Excellence. The plan will pay for itself as people return to work and stop needing benefits, an expert said”. The discourse is remarkably centred around an economic argument for such investment in Mental Health treatment via CBT. Not surprisingly, its wide implementation in public mental health in the UK is a ‘win-win’ situation, except that it reinforces the isolation of symptoms and of the individual and one’s competence in just ‘acting’ and ‘changing’ one’s own patterns that are causing suffering. Such suffering is often costly to the state and, under this logic, should be ‘easily’ and strategically dealt with.

Beck and Ellis, the founders of CBT in the United States, were concerned with efficiency, avoiding the time consuming psychodynamic treatment, accordingly, their “primary interest was not about researching ordinary cognitive functioning (the norm in academic departments of psychology during the 1980s) but was about altering dysfunctional conduct” (Pilgrim, 2008, p. 251). Beck’s Depression and Anxiety Inventories (BDI and BAI, respectively), specifically, are clinical tools that comprise 21-point checklist of surface symptoms that can be tackled in about ten minutes, not including any social, political, environmental or contextual factor for diagnosis of depression or anxiety. BDI and BAI, in their current formats, are widely used in primary care. It is not surprising that in the UK, unemployed people were offered CBT therapy “to help put Britain back to work” (Stratton, 2009).

As a paradox, yet reflecting the logic of such a therapeutic approach, governments, corporations and independent institutions have been investing in measuring ‘happiness’ exponentially in recent years, despite data on soaring inequality, precarity and mental health issues under austerity that circulate in the press (Segal, 2017). Economic problems and economic solutions to increase ‘happiness’ naturalise the paradigm of human capital even further, departing from a privatisation of suffering towards self-productivity management. Layard himself publishes his own Happiness book in 2005. ‘Happiness’ or ‘well-being’ seems secondary in such measuring policies once questions such as “what are these ‘sufferings’ telling us” are, if not ignored, bypassed by productivity metaphors. Cederström and Spicer comment on the rise of ‘happiness officer’ jobs and ‘wellness contracts’ in corporate institutions and universities, which are turning ‘being happy’ compulsory (Cederström & Spicer, 2016). ‘Happiness pulses’ and ‘happy city’ projects also echo such ‘happiness is the new black’ trend that leaves precisely the ‘meaning’ of what is considered as ‘happy’ out of the debate, as seen in a number of academic and theoretical critiques of the neoliberal ‘culture of happiness’ (Ahmed, 2010; Binkley, 2014; Davies, 2015; Cederström & Spicer, 2016; Segal, 2017). Overall the ‘push to happiness’ is grounded in Positive Psychology, a strand in the field of psy that aims at providing a ‘management’-based system of achieving ‘happiness’ and that has been increasingly popularised in the twenty-first century. Utilising what is promoted as ‘the most current techniques of psychological treatment’ (Binkley, 2011, p. 373) this approach takes psychology away from the constant focus on ‘negative’ affects and preaches the regime for achieving a desired state of happiness. The founders of Positive Psychology are Martin Seligman and Mihaly Csikszentmihalyi, whose works had been focusing on adaptive behaviour and depression and the popular concept of ‘flow’ (present in many guides to Mindfulness, and meaning a total immersion and focus in one activity such as exercises, crafts, etc.), respectively (Binkley, 2014). The pair met in 1997 and, as Seligman was elected to the prestigious post of president of the American Psychological Association, they secured significant research funding across the USA, the UK and beyond for their work on popularising literature, tools, courses and guides (Binkley, 2014). Their work on Positive Psychology is presented on the back of their identification of ‘Positive Personal Traits’ such as ‘optimism’, ‘courage’, ‘faith’, ‘work ethic’ and so on as factors that lead to ‘great’ mental health. Their project envisaged that ‘fostering excellence’ should be the job of psychology as a whole in order to ‘prevent’ mental illness, in their words, as even ‘normal’ people need examples of positivity, as ‘building optimism’ can ‘prevent depression’ (Seligman & Csikszentmihalyi, 2000, p. 12).

In psychoanalytic terms, wellness culture presupposes an ideal-self, an Imaginary body, in the Lacanian sense of the term, towards which all such fantasies of an ideal state of plenitude and control are projected. In this conceptualisation, if we consider the promises of an ideal, purified and efficient self present in such discourses of consumption, there is a type of ‘collective’ fantasy being composed, and fantasies can only but leave something hanging out of them, something that will not fit into the frame of this projected ideal of selfhood. In a Lacanian view of this relation to fantasy, the cyclical attempt at fulfilling a fantasy and embodying an ideal that is impossible to ever be attained will open space for a failure, and this very failure will make way for anxiety. This opens up to a paradoxical cycle. On one hand there is the ubiquitous invocations for an individual ‘work’ on one’s wellbeing, which passes through for example mass medicalisation, to Positive Psychology all the way into wellness trends. On the other hand, we can see these discourses promoting an ‘easily-reachable’ type of ideal wellbeing or ideal ‘tuning’ of the body and mind. However, by understanding this ‘ideal’ as a fantasy—one that leaves the subject to face the impossibility of ever feeling so ‘good’—we can see this ‘fantasy of control’ opening the way to anxiety and then more anxiety. Therefore, it might be possible to trace a seemingly paradoxical cycle in which the subject is caught: from discontent to wellness; from such recourse to failing to feel as good as promised; from there to more anxiety and then back over to another wellness tool, maybe another medication or a different diet this time. Metaphorically, wellness can easily become hellness.

The discourses of ‘management of the self’ present in all these spheres—from diagnosis, to treatment and consumption—also reveal a typical characteristic of neoliberal capitalism: a constant praise and calculation of the ‘individual’ that at the same time leaves no space for the ‘singular’. That is, the very promotion of a ‘fit-efficient-pure-controlled’ model for consumption or as goal and standard in mental health care presupposes that this ideal operates as a model that would work for ‘everyone’, cancelling or at least limiting the possibilities of singular potentialities, unique to each subject. The diagnostic-culture of our times, considering diagnosis and the promotion of wellbeing under such logic, reinforces, paradoxically, a state of constant anxiety that echoes a somewhat subjective precarity that anchors the mode of governance of contemporary capitalism. It comes to no surprise that by the end of 2020, according to The Guardian, the anxiety toll of Covid-19 saw 6 million new prescriptions of antidepressants in the UK only from July to September, 2020; and an overall spending of £139 million in antidepressants in 2020; £113 millions of which were in the SSRI Sertraline alone (Rabeea et al., 2021). Meanwhile, the NHS reported a drop in 235,000 referrals for talking therapy in the first semester of 2020 (Duncan & Marsh, 2021). One of or the biggest health crisis of a generation is, as we can see, tackled at the individual level by pills promoted through the serotogenic imbalance discourse (or, the premise that one’s ‘brain’ does not produce correct amount of serotonin), rather than by exploring the nuanced distress of this crisis (which is also ecological and political) singularly and in context.

Estranged from Anxiety: Modulation and Wellbeing

What the assemblage of wellness, psychiatric diagnosis, medicalisation of psychic experience and ultimately quantification of affect reveal is an affective-politics that accounts for body and psyche in a particular mode of alienation. Under the current affective-politics we can identify pharmacological corporations and governmentality replicating a modern scientific view of the body: described, divided, quantified and qualified. However, the demands for taming affective experiences are coupled with mechanisms of consumption and identification that result in post-modern technologies of subjectivity. This double-alienation that entails a colonisation of affect seen through the trail of anxiety is interestingly elucidated in Deleuze’s mapping of the birth of the dividual (1992). Whilst Foucault delineates the modern individual as a locus of reproduction of a disciplinary society based in exclusions and division that took shape during the eighteenth and nineteenth centuries, Deleuze proposes that this modern individual has been further reduced into a dividual, the locus of reproduction of the society of control—one not based on exclusion, but based on identification, participation and endless quantification (Dosse, 2016). The shift into what he calls a society of control encompasses a transformation of ‘molds’ into ‘modulations’ of subjective production (Deleuze, 1992), as I will move into elaborating next. When thinking the trail of anxiety through this prism we can find concomitant ‘mold’ and ‘modulation’-like qualities of the current psy-discourse. This particular encounter of dispositifs is precisely what qualifies the current affective-politics.

Wellbeing and governance have not become connected only in the last decades. On the contrary, it is an old modern alliance as it was particularly elaborated by Foucault in ‘The Birth of Biopolitics’ lecture series from 1978 to 1979. In these lectures, he points to the fact that, ‘wellbeing’ is a term that emerged in the eighteenth century as a ‘symbol’ of state power in its full effectiveness, thus, having been crucial in ideological control and the mechanisms of biopower since the dawn of modernity (Foucault, 2008a, 2008b). Social regulation through the care of the body is, under this prism, bound to capitalism as the refinement of ‘life-sciences’ is historically linked to what Foucault calls the ‘liberal art of governing’ (Lazzarato, 2013). Deleuze calls such dispositifs ‘molds’ (1992) and defines their logic as follows:

The disciplinary societies have two poles: the signature that designates the individual, and the number or administrative numeration that indicates his or her position within a mass. This is because the disciplines never saw any incompatibility between these two, and because at the same time power individualises and masses together, that is, constitutes those over whom it exercises power into a body and molds the individuality of each member of that body. (Deleuze, 1992, p. 5)

In this sense, the project of the DSM as a whole could be compared to a ‘mold’ as it offers a homogenisation of whatever heterogeneity is present in the forms of discontent and suffering experienced in society. The DSM and the raison d’être of efforts in categorising and identifying aetiological frames for mental illness marked across the field of psy provide a ‘name’, a ‘number’ and a ‘diagnosis’ through which an individual can be ‘positioned within a mass’. Such reduction of the multiplicity in manners of suffering to the same common ‘grammar’ and particularly ‘normative’ gramma. It generates an imposition of uniformity on symptoms based on a contemporary Western paradigm of pathology, resulting in a “neutralization of the critical potential that psychological symptoms bring to the understanding of a determined social context, as the role that symptoms have always played” (Dunker, 2015, p. 35). In other words, psychiatry emerges as a discourse of ‘morality’, distinguishing what ‘normal’ and desirable look like (Birman, 1978). Furthermore, there is also a neutralisation of the potential to produce new modalities of the social bond carried by ‘discontents’ in their singularity and multiplicity. Another ‘mold’-like characteristic of the diagnostic-culture inaugurated in the 1980s can be observed in its biological, or organicist, traits that reduce discontent to sensorial pain and suffering, thereby reducing the subject to the ‘fleshy’ body.

In the ‘modulation’ of ‘societies of control’ that unfold in the twentieth century, the picture is slightly more complex yet not too dissimilar. Deleuze describes the shift as follows:

In the societies of control, on the other hand, what is important is no longer either a signature or a number, but a code: the code is a password, while on the other hand the disciplinary societies are regulated by watchwords (as much from the point of view of integration as from that of resistance). The numerical language of control is made of codes that mark access to information, or reject it. We no longer find ourselves dealing with the mass/individual pair. Individuals have become ‘dividuals’, and masses, samples, data, markets, or ‘banks’. (Deleuze, 1992, p. 5)

One manner of illustrating what Deleuze means by ‘modulated dividuals’ is the ‘quantified self’ phenomenon in relation to wellbeing. Noting that people usually refuse or at least do not collaborate with reporting on their mental health for research, Davies (2015) cites the digital platforms and devices operated by companies such as Google or Nike through which users are ‘happily’ willing to offer details, “and report on various aspects of their private lives—from their diets, to their moods, to their sex lives” (Davies, 2015, p. 221). Such ‘enthusiasm for self-surveillance’ is welcomed by corporations that are now investing in novel health and fitness products (e.g. Fitbit, Strava or Apple Watch) that “can be sold alongside quantified self apps, which will allow individuals to make constant reports of their behaviour (such as jogging), generating new data sets for the company in the process” (Davies, 2015, p. 221). Data thus becomes a ‘password’ and offers recognition in the digitally informed social sphere. At the same time, each tap, each word, each interaction is translated into chunks of big-data that, in its turn, bounces back in the form of targeted advertising operated through algorithms on the web.

In this sense, the alliance between the DSM-model and the pharmaceutical industry, which relies heavily on marketing, echoes the ‘modulation’ of experience. Consumption of medication becomes the ‘password’ and the body, the fleshy body, is modulated as ‘medication adjustments’ operate by isolating parts and functions of the body, creating “artificial zones of contention, excitation, anaesthesia and separation that work as protective walls against discontent and zones of exception against suffering” (Dunker, 2015, p. 28). ‘Dividuality’ and the modus operandi of the society of control are evidenced in the new function of psychopathological diagnosis under the current diagnostic-culture. Instead of representing a force of exclusion from social life, as the asylum did for example, the consumption of medication(s) justified by a systematic categorisation of affects, symptoms and manners of suffering and being provide, as a modulating mapping of the fleshy body, a type of ‘fantasy’ of recognition in the model of a ‘password’. As Dunker summarises, “if previously the psychopathological diagnosis could mean a terrifying and at times irreversible inclusion in the juridical-hospital frame or moral-educational exclusion, now it seems to have become a powerful and disseminated means of determination and recognition, if not even a means of destitution of the responsibility of a subject” (Dunker, 2015, p. 33). A diagnosis can, under the paradigm of productivity, offer a form of relief from such a burden.

Deleuze, however, leaves an impression that in the present time, Foucault’s ‘disciplinary societies’ were being substituted by this new order of control, as if one followed the other. This ‘misunderstanding’ is, as defended by Gerald Raunig, in part due to the nature of Deleuze’s text itself (Raunig, 2009). ‘Postscript on Societies of Control’, the text, is extremely short, barely reaching five pages of length, and written in a very poetic—and apocalyptic, if one may add—style. What Raunig stresses is that ‘modulation’ “is the name of this merging of discipline society and control society: as the aspects of discipline and control are always to be seen as intertwined” (Raunig, 2009). Thus, the seeming linearity of temporal sequence open for interpretation in the original text is one of its ‘weaknesses’. Deleuze’s text reads as follows:

But everyone knows that these institutions are finished, whatever the length of their expiration periods. It’s only a matter of administering their last rites and of keeping people employed until the last installation of the new forces knocking at the door. These are the societies of control, which are in the process of replacing the disciplinary societies. (Deleuze, 1992, p. 4)

Indeed, this passage evokes a temporal linearity that does not translate in the shifts from enclosed confinement of institutions towards an open and multiple form of ever-changing casts. Rather, as Raunig points out, what we experience in the twenty-first century and what characterises modulation is “an accumulation of both aspects” (Raunig, 2009), a simultaneous presence of both models, intertwined and intercalating. Social subjugation and ‘forced adaptation’—the hetero into homogeneous, from mass to individual—accompany the “modes of self-government in a totally transparent, open milieu, and discipline through personal surveillance and punishment couples with the liberal visage of control as voluntary self-control” (Raunig, 2009) that ‘modulates’ a ‘dividual’.

The encounter of modulating-molds and of dispositifs of subjective production and reproduction found in tracing the trail of anxiety in mainstream psychiatric discourses allows us to elucidate, even if a little, the current arrangements of colonisation of psychic experience and affective life. Given this cartography of anxiety and the place of an anxious dividual in it, we can ask whether the dividual can speak. If anxiety is the compass that can lead us to a world beyond the veils of fantasies, if it can push novel arrangements of the social bond, it seems that an anxious dividual is left at the cliff-edge of an existential abyss that only grows deeper at the hands of hegemonic psy-discourses.

The antagonism present in this ideological organisation of a ‘society of control’ is interestingly situated in the body of the ‘anxious dividual’ of the contemporary and revealed in the relation of a ‘modulating estrangement’ to one’s anxiety. The system of diagnosis and management of the body and its affects, whilst crossed by ideological power, produce an ‘impossibility’ towards living with one’s anxiety. Anxiety travels from a mass-pathologised status to an ideology-informed disappearance within the diagnostic system and makes a return in the form of a highly medicalised and isolated symptom. The ever-expanding DSM editions and the ‘checklist’ approach in use operate as ‘molding watchwords’. At the same time, the consumption discourse of care of the body and mind, present in wellness culture, elevates the treatment framework of elimination and management of anxiety via the care of the body to the function of what Deleuze calls a ‘modulating password’. Such discourses, in and outside of the clinic, are dividualising, as within their modus operandi there is no space left for the possibility of singularity. Whilst they offer a series of ‘fixing tools’ centred on the body, these discourses presuppose, at the same time, a ‘same’ form of suffering that should be common to all dividuals they are addressing with their modulating ‘grammar’. In such a quantifying culture, the subject is locked out of the possibility of seeing what is beyond the lifting of curtains of fantasy, as Freud and Lacan proposed (Verhaeghe, 2014). The management of anxiety ‘away’ from one’s body is, therefore, the logic of the relation of ‘estrangement’ we will move into questioning, within a psychoanalytic approach.

The drive, the unconscious and the ‘transindividual’ aspects of psychic life and the self are what set psychoanalytic theory and practice aside from other discourses of mental health and wellbeing that are ideologically divergent within the field of the broad psychological discourses of the contemporary context. Such dividing differences are evidenced in the understanding of the symptom and, by consequence, of suffering and the mind-body riddle. A key difference between, for example, Cognitive-Behavioural Therapy and psychoanalysis would be the more simplistic cause and effect relation in the former, which is based on clinical techniques proposed by Ellis and Beck and successors in the United States from the 1960s onwards, where a thought becomes a recurrent ‘automatic’ cognitive route leading to specific behaviours and patterns of feeling (Rose, 2018). Beyond this direct causality, what becomes definitive in the divide between these approaches is the reliance on a ‘knowing’ and conscious awareness in the process of offering a narrative of oneself, that meaning, a clinical reliance on the patient bringing a problem and that being accepted or assumed as the actual ‘problem’, or all there is to it, usually leading to a change in behaviour in order to ease, deal or in a more unfortunate case scenario simply aim at getting rid of such a ‘problem’. With the transindividual unconscious at work and the drive as cornerstones of psychic life, psychoanalysis complicates such views of re-educating consciously one’s thoughts and behaviours—as Positive Psychology assumes—simply because a psychoanalytic narrative of oneself implies a very powerful not-knowing and its reverberations, being thus a challenge or impossibility to the project of measuring and categorising of evidence-based experimental psychological traditions.

Anxiety is understood in psychoanalytic literature, from the Freudian and Lacanian orientation, as the affect of excess. Instead of isolating anxiety by turning it into a symptom or disorder and systematically attempting to ‘eliminate’ one’s anxiety, psychoanalysis listens to anxiety and to what it may be possibly telling of the positioning of the subject in question in relation to their experience. However, the tools of interpretation, the social and subjective models of psychoanalysis and, further, psychoanalysis’ very onto-epistemic foundations enclose anxiety to an ‘abyss within’, as I will move into arguing next. A modern humanist, patriarchal and colonial inheritance still permeates both theory and praxis. In our cartography, our goal is to think beyond such hauntings in the clinic of anxiety.