Existential Health in an Age of Medical Totalitarianism

If mental health has become a reactionary concept, much like the notion of public health in the age of the Covid‐19 pandemic, then how can critical theory best elaborate a concern for well‐being which includes both a psychic and social dimension? This article proposes the concept of existential health to grasp the salubrious zest for life that has been extinguished from social life since March 2020, due to rolling lockdowns and the rise of totalitarian impulses within the medical‐industrial complex. It draws on the relational art practice of Lygia Clark along with developments in the psychedelic treatment of addiction to articulate a vision of existential health in an age of mental illness that is irreducible to the specialised domain of psychologists signified by the 'mental' in mental health.

Keywords: Autonomia; existentialism; Félix Guattari; iboga; Lygia Clark; medical power

When I first began pondering this question in 2019, in what has turned out to be an epoch ago, I had originally thought to expound the value of existential health by placing it in contradistinction to the widespread concept of mental health. After all, I had recently finished writing my book Cinemas of Therapeutic Activism: Depression and the Politics of Existence , wherein I framed clinical depression as a global pandemic that film‐makers from diverse regions of the world all sought to make sense of through the artistic resources of cinema, particularly its tradition of melancholy aesthetics. I was convinced that these auteurs' styles of visualising depression would offer up images capable of complicating mainstream narratives couched in medical perception. Writing now in 2022, I think this avenue of exploration holds up, and that future developments in cinema will continue to enact serious arts‐based research into the nature of mental illness, in a pandemic of mental illness.[1] What I couldn't fathom in 2019, in what I now acknowledge was a mix of naivety and short‐sightedness, is the extent to which the default signification of the word 'pandemic' would be upended, perhaps for the rest of my lifetime.

It is now hard to imagine writing about a pandemic of mental illness without qualification, something I did with conviction just a few short years ago; the 'Covid‐19' coronavirus pandemic that originated in Wuhan, China, has usurped all other pandemics in the cultural imagination, and certainly in common parlance. Instead of contrasting the concept of existential health with the well‐established notion of mental health, this new pandemic of infectious disease has pushed a more urgent, and likely an even more fruitful foil to the fore—that being public health. To answer the question, 'What is existential health?', we need look no further than what is negated from the social field by state‐imposed lockdowns.

Beginning in March of 2020, existential health has been systematically extinguished in the name of public health. The ability to take risks, to encounter alterity, to express embodied desire, to live collectively, to incarnate a spirit of adventure and to constitute a subjective singularity have all been uniformly suppressed. Existential health depends on all of these vocations. In its search for maximum security from the novel coronavirus, society has failed to confront the stark political and philosophical repercussions for sacrificing the conditions that make existential health possible, many of which may take decades to fully unfold. As the heavily mediatised saying goes, the current impoverishment of social life could very well persist as 'the new normal'.[2] From the vantage point offered by the present historical moment, the situation is as dire as ever: the mass media and its Big Tech social media corollaries have primed the populace for the acceptance of total biopolitical governance, best represented by vaccine passports that grant tenuous freedoms based on compliance with malleable public health protocols. The implementation of this strategy is being enabled by the calculated rise of a severe secular moralism that exalts safety as the most supreme of all values, to the extent that public health compliance passes as a type of sacrificial heroism to be universally celebrated, and that divergences from the norm established by this reterritorialisation onto the space of the home and the contact points of the immediate family are deemed legitimate targets of shame. The sacrificial ethos is nothing new. As Herbert Marcuse (1974) writes: 'Western civilization has always glorified the hero, the sacrifice of life for the city, the state, the nation. It has rarely asked the question of whether the established city, state, nation were worth the sacrifice' (p. xix).

In the current postmodern cultural nexus, opposition to the administration of the lockdown lifestyle is silenced, shadow‐banned and de‐platformed, leading to an inertia of thought in the public sphere and gross standardisation across the entire spectrum of political parties. Consequently, the natural, insuppressible desire for human relations operating at the nucleus of subjectivity production has fallen under the purview of policies that condemn the old to die alone, unaccompanied in their final moments of life, incinerated without a funeral, and the young to live alone, as mutilated orphans of the new scapegoat: Eros.

Public health is the statist command of uniform docility. Existential health is an anarchic adventure for singular potency. What left‐wing politics have reneged on, in their panicked acquiescence to the caste of public health 'experts' and their totalising managerial logic, is precisely the freedom and autonomy that processes of singularisation lay claim to. The modern history of critical theory is haunted by the living spectre of authoritarianism. One need only think of Bertolt Brecht making his final pact with the German Democratic Republic, György Lukács' recurrent Stalinism, or the espoused Maoism of Jean‐Luc Godard's filmmaking, which was representative of broader currents within France's May 1968 movement. It was with these totalitarian impasses in mind that Félix Guattari and Antonio Negri wrote their 1985 tract, Communists Like Us, which sought to reimagine a communism of singularities, that is, a non‐totalitarian communism of 'liberated possibilities'.[3] This 'Autonomist' vein of communism proposes the freedom and the autonomy for singular processes of subjectivity production to develop according to the desires immanent to them, rather than in line with duties to the state, party or other transcendent apparatus. After announcing their project to 'rescue "communism" from its own disrepute', Guattari and Negri write:

Make no mistake about it: communism is not a blind, reductionist collectivism dependent on repression. It is the singular expression for the combined productivity of individuals and groups (collectivities) emphatically not reducible to each other. If it is not a continuous reaffirmation of singularity, then it is nothing—and so it is not paradoxical to define communism as the process of singularization. (Guattari & Negri, 1990, p. 17)

Singularity is such an indispensable part of Guattari and Negri's political project precisely because it is what totalitarianism cannot tolerate. To participate in valourising pluralistic processes of singularisation is to enter a becoming anti‐authoritarian.

We have seen time and time again throughout the coronavirus pandemic that the medical authorities have used the media apparatus to discursively construct singularity as a criminal, anti‐social tendency. What matters most to these powers, more than advancing any particular strategy to mitigate the spread of the virus, is total adherence to whatever strategy they espouse at any given moment. And when they decide to change the strategy, or even provide updated guidelines that contradict their previous stance, they again tolerate no dissent, no singular break from their imposition of a uniform social protocol.

The 'necessary difficulties' of repressing the singularity of desire and the desire for singularity in the name of achieving public health has given rise to nothing short of medical totalitarianism.[4] The pandemic has proven to be an exercise in subjectification, and the docility of the body politic has been shown. This alarmist regime of total biopolitical domination could very well endure even after the last wave of the pandemic dies down, much in the same way as terror alert systems continued to manufacture consent through fear, years after the attacks of September 11, 2001.[5]

In 'The Proliferation of Margins', one of Guattari's two written contributions to Autonomia: Post‐Political Politics, a collection of primary texts from the Autonomia Operaia movement in 1970s Italy, he theorises the administered social order of post‐Fordism as being based on the repression of desire. Guattari writes: 'Social production, under the control of capitalist and technocratic "elites," is more and more cut off from the interests and desires of individuals and leads ... to the flattening out and repression of desires in their singularity, that is, to the loss of the meaning of life' (Guattari, 2007, p. 110). In response to what he and the Italian Autonomists saw in 1970s Integrated World Capitalism as the standardisation of worker subjectivity (in both capitalist and socialist countries), Guattari privileges singularity as the principle of dissent from the real economy's surplus repression, and as a struggle for the freedom to recompose subjectivity according to a collectivity's immanent machinations of desire, machinations that—if the collective has not come to desire its own repression—unavoidably break from the requirements of the labour market. Peter Pál Pelbart carries Guattari's thinking into more contemporaneous times and points to how the free marketeering of subjectivity erodes existential health. He succinctly states: 'Our era revolves around this pathology: market‐ready modes of existence' (Pelbart, 2017, p. 137). After the recent public health crisis, Pelbart's statement could be expanded to include a new range of pandemic‐ready subjectivities: the shut‐in, the hoarder, the mask‐enforcer, the social distancer, the vaccine card checker, and so on.

The praxis of recomposing subjectivity to produce novel singularities is a specifically existential praxis because it articulates difference as a lived mode of existence. It is a creative act of differentiation from the mediatised mould of standardised subjectivities, an act that gives meaning to a singular constellation of desire. If, as Sartre has proposed, 'Everything has been figured out, except how to live', existential philosophies appear at the juncture where experimentations in collective life break from the subjective coordinates already given by the established norms of the social field, perpetually asking, 'What are we?' and 'What shall we do?' (Gordon, 2013, p. 7). If there is one thing that existential philosophies demand, it is to be lived out, in the creative recomposition of a subjectivity that is never given in advance.[6]

At La Borde, an alternative psychiatric clinic in France, where Guattari worked in the 1970s, one of the therapeutic aims was to recompose the standard group subjectivity of the psychiatric institution, with its clearly defined social roles, entrenched hierarchies and stifling regimentation. The directors of the institute theorised that a permissive, non‐directive atmosphere could allow qualitative changes in group relations to take place. Pelbart describes the approach: 'As La Borde director Jean Oury highlights, along with Guattari, that is the condition for something to happen—nothing "must" happen—since it's precisely when something must happen that the most impalpable happenings run the risk of being aborted' (Pelbart, 2017, p. 141). La Borde's working formulation for prompting recompositions of subjectivity holds much pertinence for an analysis of the erosion of existential health in an age of medical totalitarianism. When Guattari and Oury say, 'nothing "must" happen', the meaning of that allowance is very different from the commands of the public health officials when they utter, 'nothing must happen'. The former is a way of saying that nothing is obliged to happen, but that something may emerge spontaneously. The latter indicates that there is an obligation to ensure that nothing ever happens. One is a relational technique for fostering existential health, the other a strategy for eradicating it in the name of public health.

The creative capacity to make something happen, without forcing something to happen, all the while resisting institutional or market demands that would either prevent something from happening or oblige something predetermined to happen, is a potency. In Franco 'Bifo' Berardi's recent essay on the coronavirus pandemic, he activates the Autonomist tradition to reaffirm the importance of the struggle for autonomy in today's political climate where the traditional orientations between left‐ and right‐wing politics have been confused, particularly as they relate to the upholding or transgression of the law. Berardi writes:

Since the first days of the pandemic, and since the beginning of the ensuing lockdowns, public opinion has been split between those who reject any limit to their personal freedom, and those who support a more or less strict regulation of social interaction. The very borders between the political fronts—the classical distinctions between right‐wing and left‐wing ideology—have been blurred on this point: opposition to state‐enforced lockdowns and health regulations has been taken over by right‐wing libertarians. How can we explain the fact that some anarchists and many other leftists are respecting health rules dictated by a 'state of exception,' while fascists are the ones reclaiming their freedom to do whatever they like? There is a comedic exchange of roles, whereby fascists proclaim themselves as the 'defenders of freedom' and progressives emerge as the defenders of the law. This, too, signals the dissolution of the twentieth‐century political landscape. (Berardi, 2021)[7]

In this disorienting political climate, where the Establishment Left and its intellectuals have absconded, the basic liberties that they have historically fought to enshrine in the constitutions of democratic nations, and when they have not only accepted, but actively demanded extravagant state intervention over a widening purview of everyday life, the need for autonomy is increasingly apparent.

Autonomy encompasses the refusal of work, freedom from toil, dissent from party politics and, ultimately, an affirmation of the unconscious and desire's creative potency for singular auto‐poesis. In other words, Autonomist politics seek to recreate on the societal scale the atmosphere of indeterminacy and non‐compulsory activity that Oury and Guattari cultivated at La Borde: a society in which 'nothing "must" happen'. When unceasingly confronted with the threat of subjugation to the motivations of state capitalism, autonomy is only realisable through potency.

Since action happens in the physical world, where physical forces are at play, freedom depends on our potency to overcome these forces. We are free to do what we have the potency to do. Only to the extent of our potency are we 'free' to choose and act. ... In the end, freedom is the dimension that we can access by strenuously pursuing autonomy, and depends only on our potency. In fact, autonomy can be defined as the potency of imagination and of action. (Berardi, 2021)[8]

Berardi's definition of political autonomy as the potency of imagination and action returns us to the question of health, and specifically to the distinctions that can be drawn between its 'existential', 'public' and even 'mental' varieties. After all, potency is consistently one of health's most reliable indexes.

One of the most enduring cultural scenes for the proliferation of existential health is the participatory art event, especially when it overturns the social norms of the art gallery, or leaves it entirely, as the Brazilian artist Lygia Clark is known for having done. Over the first half of her career from around 1944 to 1966, Clark was associated with the Neo‐Concrete Movement and her frame‐breaking paintings. Her output of this period culminated in the abstract, mutable sculptures Bichos (Beasts), made out of foldable aluminium sheets that could be reconfigured by audiences and displayed in a variety of ways. As time went on, Clark transitioned away from her practice of producing art objects, and ultimately from the commercial gallery system altogether. By the late 1970s, Clark was in a phase of her career known as Estruturação do self (Structuring the Self) where she designed Objetos relacionais (Relational Objects) to explore what could ostensibly be described as art's therapeutic value, if only the habitual meanings of art and therapy are liable to revision (see Figure 1).[8]

In her article, 'Molding a Contemporary Soul: The Empty‐Full of Lygia Clark', Suely Rolnik offers a compelling vision of how art can push therapy past its limits in the stimulation of an existential health, which in turn overruns the limits of art. Rolnik writes:

Clark's proposition surmounts in the work itself the separation between the artistic domain and psychotherapy. She creates a territory, situated neither in the sphere of art as a department of social life specialising in semiotic activities, where access to the creative power of life is confined; nor in the sphere of therapy, specialised in treating a subjectivity separated from this power; nor in the border between the two–an entirely new territory. (Rolnik, 1999, p. 99)

This entirely new existential territory, irreducible to the teleologies of both institutionalised art and therapy, where the 'creative power of life' is liberated from 'specialised semiotic activities' and the 'treating of subjectivity', is a vitality, a health. Rolnik asks, why was Clark's relational healing practice not simply 'a matter of replacing art with therapy, or using therapy as a form of opposition to art?' Because 'therapy as practiced', posits Rolnik,

was merely the corollary of art as a separate sphere: it created the conditions for listening to the vibrating body which had become necessary since the end of the nineteenth century, but so as to integrate them into the experience of the psyche, through the interpretation of fantasies/ghosts, looking toward constructing an individual history in order to reconstitute an identity, with this reconstitution as the goal of treatment. ... Why was it also not a matter of a boundary or fusion between art and therapy in a kind of conciliatory 'holistic' totality? Because the existence of each of these spheres cannot be dissociated from the division of functions that have as their basis the deeroticising of human life in its creative force. (Rolnik, 1999, p. 100)

Here, Rolnik offers a vision of health as existentially significant aesthetic production attuned to the quivering of Eros, which may supply the material basis for fine art or clinical therapy, but which is irreducible to their specific teleologies. This line of flight from the logic of the clinical is entirely consistent with Rolnik's intellectual orientation. Along with Peter Pál Pelbart and others, she is a torchbearer of the schizoanalytic tendency within psychoanalysis that has made an enormous contribution to Brazil's anti‐authoritarian political culture. After the fall of the military dictatorship in Brazil in the 1980s, Rolnik guided Guattari on a tour of the country to meet with activist groups associated with the Partido dos Trabalhadores (the then‐burgeoning Worker's Party, which would eventually win the elections of 2002 when its leader Lula da Silva became president), an adventure chronicled in the astounding book Molecular Revolution in Brazil (Guattari & Rolnik, 2008).

If the relational art experiments of Lygia Clark and others can be attributed a non‐clinical therapeutic potency, capable of fostering existential health via the potential for recomposing subjectivity, it is because they gift their interlocutors the chance to leave the experience different than they arrived. When this happens, even though it never 'must' happen, and certainly cannot be mandated beforehand, existential coordinates that give rise to a sense of self shift through embodied negotiations with values, risks, affective intensities and signs.

It is not a coincidence that the aesthetic events that give most fertile expression to the collective vibrating body have been shuttered since March 2020 due to their having been deemed non‐essential by the public health authorities. The pandemic's ensuing lockdowns have acutely raised the question as to what constitutes an essential activity, and which professional caste is endowed with the credentials to make such a judgement. The trials of this new era have shown that the arts that give existential health its rightful chance have proven expungeable, subsumed to public health's unyielding command for sacrificial compliance at all costs.

The blatant antagonism of the present historical moment between the suppressed struggle for existential health and the statist impositions of public health leverages critical distance to think about how the mental health system has historically functioned mostly as a set of institutions and techniques for adapting worker subjectivity to the false necessity of toil under capital. In this regard, psychoanalysis itself appears as a pharmakon. It has at times functioned as a grand apology for the societal superego, and yet it has also proven to be the most fertile ground for intellectual inquiry into the production of subjectivity. That is why the survival of psychoanalysis is probably the most urgent battle in mental health being fought today. Without it, mental health professionals will be left with an antiseptic range of treatment options coalescing around the 'evidence‐based' altar of cognitive behavour therapy (CBT), which expunges Freud's prodigious discovery of the dynamic unconscious. Guattari (2011) legitimately critiqued psychoanalysts for being 'specialists of the unconscious' at a time when psychoanalysis was a dominant cultural force in France, and it far too often took the side of the law in order to maintain its hegemonic position (p. 10). Today, with psychoanalysis having been returned to its origins as a therapeutic practice marginal to the medical establishment, the unconscious is in jeopardy of becoming an artefact of a bygone imagination, like the Egyptian art that adorned Freud's study.

There are many cogent arguments that could be given to demonstrate the deleterious effects of cleansing therapeutic modalities of contact with the unconscious, and yet since a plethora of excellent critiques have already been made of CBT, dialectical behaviour therapy (DBT), positive psychology and other manualised treatments, this essay will end by bringing in one of the newest clinical developments in mental health treatment to show how it too, like public health in the age of Covid‐19, has difficulties accepting the high risks—but also the marvelous rewards—of commitment to a praxis of existential health that is sensitive to the dynamism of the unconscious.

A favourable regulatory landscape in Canada has turned Toronto into a hub for psychedelic medicine companies. The most high‐profile brand with the widest range of clinical trials underway is a publicly traded company named MindMed. One of its missions is to address the opioid crisis in North America, which has claimed over half a million lives since the turn of the millennium, and still ravages today, with no end in sight.[9] The company is currently undergoing late‐stage clinical trials to determine whether 18‐methoxycoronaridine (18‐MC), a 'novel iboga alkaloid congener', can act as an addiction inhibitor in people suffering from severe opioid addiction (Glick et al., 2000). If successful and approved by the regulators, 18‐MC's therapeutic application could mark an extraordinary clinical breakthrough that dramatically improves the mental health of countless people, to the point of even saving them from premature death. However, once the psychedelic origins of 18‐MC are brought under consideration, this medical accomplishment starts to seem much less noteworthy.

18‐MC is a derivative of the highly psychoactive substance ibogaine, which is found in the roots and bark of the sacred Tabernanthe iboga (iboga) plant that grows primarily in Gabon. Indigenous medicinal knowledge from the region has already proven the therapeutic benefits of iboga according to its own radically empirical methods. The Bwiti religion reveres iboga as the fruit of knowledge described in the Book of Genesis, and initiation into Bwiti takes place through the plant's ritual ingestion.[10] Iboga is possibly the most powerful psychedelic medicine on the face of the Earth, and a full 'flood' dose can produce an intense altered state of consciousness complete with visions lasting up to eight hours, with heavy residual effects continuing for longer than 72 hours afterwards.[11] Anthropologist of the Bwiti Stanislaw Świderski describes the significance of the visions prompted by the iboga experience: 'For the initiate, the visions are indeed a process of revelation of the beyond by audio‐visual means, paired with an immediate, intuitive understanding. ... As the initiates say, it is through vision that everything is understood' (Świderski, 1981, pp. 404, 413).

The reason why MindMed has opted to invest in the commercialising of 18‐MC as a possible consumer pharmaceutical, rather than simply promoting the cultivation and supervised use of iboga, even though the latter already has a history of medical uses both amongst the Bwiti and in alternative clinics and retreat centres, is that iboga, to invoke the standard medical terminology, is highly 'hallucinogenic'. A full dose of iboga is almost certain to render someone incapable of walking or sleeping for days, and during the first six to eight hours after ingestion, that person is very likely to experience vivid, overpowering visual images inside of their mind's eye. With 18‐MC, MindMed strips the hallucinogenic properties out of the iboga while attempting to retain its anti‐addictive properties, thus producing what the company markets as an 'antibiotic of addiction' and a 'safer', 'next‐gen version of Ibogaine'. [12] MindMed's website takes pride in this intention, and it boasts very straightforwardly: 'We are pioneering medicines that have the potential to maintain the therapeutic benefits of psychedelics, without the hallucinogenic effects.' In sum, MindMed wants to make psychedelically derived medicine, without the psychedelics. If this company is successful in bringing its opioid treatment to market, 18‐MC will be available for microdosing in pill form, and would be consumed daily without any alteration of one's routine. Yet again, this time in the realm of psychedelically derived mental healthcare, 'nothing must happen'.

The purpose of MindMed is to eliminate the unconscious images of existential significance that iboga brings to vision. The company believes that mental health outcomes can be improved without grappling with the presence of the unconscious, and taking on the risks of pursuing existential health. The strategy of this psychedelic medicine company is thus entirely consistent with the general trend over the last forty years since the publication of the DSM‐III evacuated the unconscious from the clinical scene. It remains to be seen what kind of impact 18‐MC may play in quelling North America's opioid crisis. There is strong evidence to show that it could very well change the landscape of treatment options and provide patients with better results than current medicines such as methadone.[13] Nevertheless, no matter how much of an evidence base the scientists may build up around it, I remain sceptical that it will ever prove as powerfully transformative as iboga in its natural state (or in its total alkaloid format), precisely because the authentic reception of iboga is capable of bringing the initiatory subject into an encounter with an unconscious image of existential significance. People who have ingested a full dose of iboga report seeing the very reason why they have an addiction in the first place.[14] Unlike 18‐MC, iboga does not cure a brain disease named addiction. It produces a sequence of moving images that indexes the unaddressed root trauma that led to addiction and allows the patient to heal that trauma right then and there, in the psychedelic realm, by responding to the unconscious images revealed to them and then incorporating these images into a new composition of subjectivity that dramatically transforms how life can be relationally lived.

To be certain, there is a real risk involved in embarking on the iboga adventure. The Bwiti make no attempt to hide the fact that on rare occasions, some initiates do not survive the ritual, and yet this has never deterred them from exalting iboga. On the contrary, it has deepened their conviction because the Bwiti see the value in every death. Before every Bwiti initiation, the candidates are required to make a full and complete confession, and they are warned that intentionally leaving out any wrongdoings could lead to the most severe of repercussions during the ritual. For some, their initiation is merely aborted due to having failed to receive iboga with a clean conscience. Others die. According to Bwiti beliefs, every death from iboga corresponds to an insincere confession.[15]

If and when MindMed is successful in the distribution of 18‐MC, the company will have managed to poach the iboga plant's therapeutic efficacy, but without the experimental semiotics that comes along with it, and certainly without the risks of a disingenuous confession leading to death. 18‐MC could very well have a positive impact on global mental health and play a major role in mitigating the current opioid crisis. However, it also attests to a broader tendency within both the mental health–industrial complex and the recently emboldened public health institutions to govern moments of crisis through risk‐management strategies which foreclose an adventure of existential health where the production of subjectivity is at stake. MindMed's approach to psychedelic medicine and the majority of governmental responses to the Covid‐19 pandemic are but iterations of wider trends whereby the institutions responsible for both mental and public health attempt to extinguish any last yearning for existential health.

After all, this should come as no surprise. As Tobie Nathan suggests, 'Healing is always an act of pure violence against the order of the universe.' A praxis of creating the conditions for existential health to bloom, and of anarchically pursuing the potency of singularity, is bound to throw the reactive forces of society's reigning superego into question and attract the most severe of retaliations. Whether it be unconscious exploration through iboga, the relational art of Lygia Clark or other types of collective experience such as cinema or raving, these arts of playful signification solicit a spirit of adventure to recompose subjectivity and its relationship to the law. The play of aesthetic production provides common transferential material for the creation of lay analytic relationships that offer a bridge out of the alienation of being a sovereign individual responsible for one's own mental health, and the isolation of being legally obligated to bear the burden for the entire population's physical health. In this sensuous aesthetic zone of transversal experimentation relegated to the far margins of social life and outlawed by an infinitely dilating state of exception, the unconscious pulses and vibrates, machining clandestine existential territories, open to be inhabited and given new meaning in the living out of their tenuous significance by lay analytic adventurers who are not afraid of being irreversibly changed by a singular relational process of mutual discovery.

This article draws on research supported by the Social Sciences and Humanities Research Council of Canada.