It's Time to Talk About Mark Fisher I.
What one of our heroes gets wrong about mental illness and what to do about it.
Hay golpes en la vida, tan fuertes... ¡Yo no sé!
Golpes como del odio de Dios; como si ante ellos,
la resaca de todo lo sufrido
se empozara en el alma... ¡Yo no sé!César Vallejo, Los Heraldos Negros
It’s time to talk about Mark Fisher. Darling of the new generation of the literate disenchanted. I can think of no other writer who has so convincingly conveyed a ubiquitous experience of feeling broken and anxious while also giving it a clear sense of meaning. Without having known him personally, I have met many who've been tremendously influenced by his signature blend of comfort and inspiration - a simultaneous assurance that you're not alone and a call to arms because things can't go on like this. This is why I feel like I have to express some concerns that have been getting louder in my head every time I reread Capitalist Realism. Forgive me, Mark 🙏
Now, to assuage anyone already tensing up in the tired anticipation of internet-anger - either with me for trying to cancel the late lovable soft-boy or with him for being guilty of having hung out with then not-yet-fascist Nick Land or some other offense, I'll let you know from the beginning that there’s no argument here about why he’s bad, wrong, terrible, needs to be brought to justice, or whatever. While writing this, I have spent more time with Fisher’s writing than ever before, and this week alone I have been brought to tears at the sense of forlorn displacement in his descriptions of depression. These tragic feelings are only heightened further by the knowledge of his suicide not too long after their publication, as well as by my own ongoing struggles with similar feelings of paralysis and hopelessness.
Mark’s is a voice that can easily follow us in daily life, whose sentiment subtly haunts our encounters with subway advertisements, political news tickers, blockbuster cinema, and our most personal depths of heart. In fact, I hope that Mark would gladly have heard the following comments, as I would gladly have addressed them to him or anyone else for whom the relation of capitalist culture and psychology holds such personal importance; I think we’re all working on the same problems here.
To state it outright, my concern with some of Fisher’s more popular arguments is that when it comes to the topic of mental illness in the current world of market-driven relations, many readers will agree too readily. I fear that this effect, a combination of his clear voice, sympathetic analysis, and particular theoretical background, can end up as a sort of sedative, preventing the development of a serious political project that has hope for impacting the way psychopathology - depression, personality disorders, schizophrenia, etc. - is seen and addressed.
Before having read Capitalist Realism or anything else by him, I spent the four years of my undergrad grappling with a particular form of psychoanalysis - the forms will matter as we’ll see. This approach to psychoanalysis is the one dominated by the figure of the infamous French psychoanalyst Jacques Lacan which has in the last few decades become widely known through cultural and aesthetic disciplines such as film theory, gender & sexuality studies, etc.. I myself came to it through reading the frantic writings of contemporary Slovene malcontent Slavoj Žižek, whose style resembles a sort of irreverent cultural philosophy equivalent to Pollock’s action painting - always moving, never time to stay with one idea or reference long enough to describe it to completion. So I too took on Lacan as my area of interest, as many Cool Kids in cultural studies tend to do at some point, and finished my undergraduate thesis with remarks from the Lacanian reading professor that my work was, to paraphrase, ambitious but theoretically flawed (aka bullshit), while the rest of the sociologist profs all openly admitted they didn’t know what to make of the Lacan bits and gladly moved on.
I also had to move on from a world where these arguments carried concrete importance, and so, lost and confused after graduation, residing on the couch of a generous friend in a small dull German city, I read CR for the first time, and of course, loved it. I was, at the time, an unimpressive Moses leading no one but myself - and that pretty poorly - through a desolate world that made me feel worthless, hopeless. Mark pointed at what was then just a glimmer of a promise of a way out of that desert. That the desert was primarily comprised of my own almost laudably insistent unemployability was, as were many other truths about my life at the time, somehow painfully clear yet also seemingly unassailable.
Mark captures this state perfectly, one likely horridly familiar to either you yourself, dear reader, or that self-pitying humanities-studying cousin of yours (who you imagine should have at some indistinct point decided instead on trade school), on his K-punk blog:
Like many people I know, I spent my twenties drifting between postgraduate courses and unemployment, encountering many pointless and demoralising “helping you back to work” initiatives along the way. There wasn’t much difference between what I did on an average day when I was a student and what I did when I was unemployed, and there isn’t a great deal of difference between what I was doing then and what I do now. But now I’m fairly confident that I “make a contribution”; then I wasn’t. For a number of reasons, during my twenties I believed then that I was unemployable — too feckless to do either manual work or retail, and nowhere near confident enough to do a graduate job of any kind.
Fisher, Mar. (2018). ‘contributing to society.’ k-punk: The Collected and Unpublished Writings of Mark Fisher (2004-2016). ed. Darren Ambrose with Simon Reynolds. Repeater Books.
I think it’s worth repeating that there’s something about the relatability of Mark Fisher’s work which has elevated him to the status of an almost benign martyrdom among today’s literate disillusioned. It’s easy for people like us to see ourselves in his words - and I should warn against believing this makes them inherently useful. Nonetheless, at the time, Fisher was barely short of messianic for me in his Marxian brand of absolution and so I continued with my existence.
The next time I read him coincided with the beginning of my studies in clinical psychology. A reading group had formed in Berlin, and it was the perfect way to find some people who talked a bit more like me, as almost everyone else in my academic program hadn’t strayed far from their clinical psych track. In this sense, Fisher has provided comfort in company in more ways than one, the theoretical and the social; it would be unwise to consider these as unrelated. In these meetings, I was excited to connect the material of my studies with the bits of CR where psychopathology came up. Similarly, I was touched by seeing many people relate on a very personal register with the analyses that Mark put forward, and I felt that my studies would help me develop a better understanding of what Mark is saying; someday it could help me help people like, well, like us.
The thing is, there is a history of conflict between the camps of those who want to fix people and those who want to fix society. There’s a reason why psychoanalysis, not to mention American style psychiatry, has gained the reputation over the decades of being conservative. Despite claims to revolutionary potential, whether in the advances of neuropsychological science and accompanying promises of modern medical solutions or in the mysterious radicality of the psychoanalytic unconscious in which the meanings of everyday life are questioned, these doctrines of psychological intervention have for the most part proven to be unable to even tolerate anything remotely radical. This is something Mark knew well:
The radical therapist David Smail argues that Margaret Thatcher’s view that there’s no such thing as society, only individuals and their families, finds “an unacknowledged echo in almost all approaches to therapy”. Therapies such as cognitive behavioural therapy combine a focus on early life with the self-help doctrine that individuals can become masters of their own destiny. The idea is “with the expert help of your therapist or counsellor, you can change the world you are in the last analysis responsible for, so that it no longer causesyou distress” — Smail calls this view “magical voluntarism”. […] Depression is the shadow side of entrepreneurial culture, what happens when magical voluntarism confronts limited opportunities.
Fisher, Mar. (2018). why mental health is a political issue, in k-punk: The Collected and Unpublished Writings of Mark Fisher (2004-2016). ed. Darren Ambrose with Simon Reynolds. Repeater Books.
Therapeutic disciplines have had, as their target, the shoring up of the strength and boundaries of a vague cluster of labels hovering over an even looser notion of modern selfhood which includes the self, ego, identity, health, autonomy, and innumerably more.
Of these, the term identity is particularly useful for understanding the situation faced by a potential revolutionary psychology. Used today most often as in its substantive form, identity’s philosophical roots are in its relational form (the subject of an upcoming essay of mine on Hume, Locke, and Freud & the question of identity in politics). Here it will suffice to say that identity is best understood as an equivalence to something. Something is identical to another thing. Hence, when we talk about our identities, we are bringing up the personal and cultural objects in which we see ourselves, that is, to which we are identical. Consider this exhilarating passage from Karen Barad’s Meeting the Universe Halfway:
Existence is not an individual affair. Individuals do not preexist their interactions; rather, individuals emerge through and as part of their entangled intra-relating. Which is not to say that emergence happens once and for all, as an event or as a process that takes place according to some external measure of space and of time, but rather that time and space, like matter and meaning, come into existence, are iteratively reconfigured through each intra-action, thereby making it impossible to differentiate in any absolute sense between creation and renewal, beginning and returning, continuity and discontinuity, here and there, past and future.
Barad, K. (2007). Meeting the Universe Halfway: Quantum Physics and the Entanglement of Matter and Meaning. Duke University Press.
It then makes a lot of sense to say that, at their core, therapies are structures for handling conflicts intrinsic to our identities - understandings of ourselves through our friends, family, work, nation, race, gender, and the many other ways of formulating those who are what I am. These are the stakes of the conflict, whether viewed as a dogmatic opposition or as a challenge to be overcome, between the work of therapy and the work of radicality.
Fisher is aware of how difficult it is to include any serious idea of radicality into a therapeutic framework by emphasizing the precarious position of identity. In the introduction to Ghosts of my Life, he points out that
Michael Hardt and Antonio Negri [Commonwealth, 2011] are right when they say that the revolutionary take on race, gender and sexuality struggles goes far beyond the demand that different identities be recognised. Ultimately, it is about the dismantling of identity. The “revolutionary process of the abolition of identity, we should keep in mind, is monstrous, violent, and traumatic. Don’t try to save yourself—in fact, your self has to be sacrificed! This does not mean that liberation casts us into an indifferent sea with no objects of identification, but rather the existing identities will no longer serve as anchors.”
Fisher, M. (2014). Ghosts of My Life: Writings on Depression, Hauntology and Lost Futures. John Hunt Publishing.
However idealistic you, dear reader, might be, it shouldn’t be difficult to acknowledge that a project whose core demand goes so far would likely be a bit of a tall order for any school of therapeutic work coming of age in the world of medical standardization and increasing private/corporate subsidization of both research and practice.
The reconciliation of the difference between internal and external, normative and revolutionary is something that Fisher can work with as easily as he does because his work stays mostly in the realm of cultural commentary, something he directly acknowledges:
my take on the old phrase ‘the personal is political’ has been to look for the (cultural, structural, political) conditions of subjectivity. The most productive way of reading the ‘personal is political’ is to interpret it as saying: the personal is impersonal. It’s miserable for anyone at all to be themselves (still more, to be forced to sell themselves). Culture, and the analysis of culture, is valuable insofar as it allows an escape from ourselves.
Fisher, M. (2014). Ghosts of My Life: Writings on Depression, Hauntology and Lost Futures. John Hunt Publishing.
I want to make clear that Fisher's notion of the personal, from which he draws his language, is a fundamentally cultural one. This is exemplified in his definition of depression which follows the text quoted above: "Depression is the most malign specter that has dogged my life - and I use the term depression to distinguish the dreary solipsism of the condition from the more lyrical (and collective) desolations of haunto-logical melancholia." In a retrospectively tragic moment, Fisher then attributes the force behind his work to the social world, saying "it's no accident that my (so far successful) escape from depression coincided with a certain externalization of negativity: the problem wasn't (just) me but the culture around me."
As for this relation between the internal and external one, it's an admittedly appealing maneuver. No wonder that a generation of the agitated, culturally literate, and professionally doomed have been so inspired precisely by authors like Fisher alongside Žižek, Jameson, and others who take the public space of expression as their point of departure for radical projects. The details of this relation, which are worth looking at more closely, are the guiding question in the forthcoming second half of this investigation.
For now, it suffices to say that when it comes to building something equivalent in the world of mental health practices, relating the personal and the political becomes a much more pernicious trick to pull off than in theory alone. Not that there haven’t been any who’ve tried. For those who have championed precisely this issue with the clinical sciences (also the subject of an upcoming essay on Anti-psychiatry here at Mental Health @ the Apocalypse) it has often been the social and political pressure on the relevant institutions which were identified as the cause of therapies failing to soothe various social ills.
Ultimately, a problem lies in the fact that neither the nature of either the cause or the substance of mental disorders (note that now I’m avoiding the term illness…) can be said to be located entirely in its external factors. Fisher comes extremely close to this problematic conflation in a passage in ‘why mental health is a political issue’:
It would be facile to argue that every single case of depression can be attributed to economic or political causes; but it is equally facile to maintain — as the dominant approaches to depression do — that the roots of all depression must always lie either in individual brain chemistry or in early childhood experiences. Most psychiatrists assume that mental illnesses such as depression are caused by chemical imbalances in the brain, which can be treated by drugs. But most psychotherapy doesn’t address the social causation of mental illness either.
It’s good that Fisher takes the first step of denying the annoying scientism which for centuries has thought that the human mind is just a few more years away from being fully laid bare by our guys and gals working around the clock in the bio-pharma laboratory. And before any psychoanalytic readers get too smug and think themselves safe for their lack of white coats, it should be remarked that this ideology was also considerably influential on a certain Sigmund Freud who was, after all, coming out of Vienna, where he “supplemented his physiology courses with an intense series of lectures delivered by Franz Brentano, whose commitments to empiricism, logic and natural scientific ideals influenced Freud’s later approach to psychology” (Tauber 2009). I have a feeling that these days psychoanalysis only seems radical to those who don’t encounter it precisely as a branch of psychological practice.
But the glaring problem with Fisher’s analysis is that he, despite trying to avoid doing so, often cuts a binary distinction between the factors recognized by various psychological sciences - in this case biological or developmental experiences - and the political. The dissection of the latter is one of Mark’s virtues, but as we’ll see, his account of the former entails some serious shortcomings. All it takes is a serious look at the current state of affairs over at the people handling psychotherapy to see that things are a little different than what Fisher usually describes.
While Fisher’s claim that “current ruling ontology rules out any possibility of a social causation of mental illness” is in some senses true, it's far from an accurate representation of the state of affairs in the widely varying world of clinical sciences. So while we can and should point at the systemic issues which deny practitioners the ability to consider or even care about the broader realities of their patients, this would be more productive if we acknowledge the state of things. These days doctors and therapists of all stripes are getting an education which at some point inevitably includes a discussion of the biopsychosocial model, a conceptual development in medicine which took place already in the 1970s. Its developer, George Engel, who had a particular interest in psychosomatic medicine:
recognized that mental and social phenomena depended upon but could not necessarily be reduced to (ie, explained in terms of) more basic physical phenomena given our current state of knowledge. He endorsed what would now be considered a complexity view, in which different levels of the biopsychosocial hierarchy could interact, but the rules of interaction might not be directly derived from the rules of the higher and lower rungs of the biopsychosocial ladder. Rather, they would be considered emergent properties that would be highly dependent on the persons involved and the initial conditions with which they were presented, much as large weather patterns can depend on initial conditions and small influences. This perspective has guided decades of research seeking to elucidate the nature of these interactions.
Borrell-Carrió, Francesc & Suchman, Anthony & Epstein, Ronald. (2004). The Biopsychosocial Model 25 Years Later: Principles, Practice, And Scientific Inquiry. Annals of family medicine. 2. 576-82.
Of course, of course, of course, a single glance at any handful of clinical practices anywhere in the anglophone world suffices to raise the red flag of doubt that such a wonderfully holistic philosophy is making its way anywhere near the medical world. Unfortunately, the reasons for this aren’t as simple as what can be discerned in Fisher’s writing. He often alludes to his ‘third-way’ approach to psychology as we saw it above, in which he tries to move beyond either the idea that psychic disorders are purely biological or that they are solely the outgrowth of early childhood development issues. So perhaps you’d be surprised to hear that the current dominant model of mental illness actually ignores both of these roads as well.
Instead, the practicing guidelines for psychiatrists for the last few decades, the DSM-III/IV and ICD-10, “were deliberately atheoretical with chapters and disorder definitions that focused on symptom pictures.” This means that the discrete categories of so-called mental disorders are made up by grouping together symptoms which are commonly seen together, eschewing any underlying or overarching principle - biology, development, social cause - which exceeds this empirical category. While your therapist or psychiatrist might touch on things like brain chemistry or memories of your mother, the ‘official medical’ definition of things like depression or antisocial personality disorder is limited entirely to which symptoms the doctor doing the diagnosis can verify.
Amusingly enough, despite the fact that Fisher often refers to a sort of dismal under modern capitalism of mental suffering as an imbalance in the brain, the newest American iteration of the guide to psychological diagnosis, the DSM-V, was famously charged with saying “nothing about the biological underpinnings of mental disorders” - an accusation published in Scientific American. As we’ll see shortly, one of the most relevant debates in contemporary psychology research is actually over how to best frame disorders to include both biological and psycho-social factors.
From another perspective, it’s commonly argued that the current models of diagnosis ignore precisely the cultural and political dimensions of their own creation. The British Psychological Society itself, the governing body which most likely was in many ways responsible for the treatments that Fisher experienced in his life, strongly condemned the newly rolled out DSM-V diagnostic perspective in a remarkable statement:
The putative diagnoses presented in DSM-V are clearly based largely on social norms, with 'symptoms' that all rely on subjective judgements, with little confirmatory physical 'signs' or evidence of biological causation. The criteria are not value-free, but rather reflect current normative social expectations. Many researchers have pointed out that psychiatric diagnoses are plagued by problems of reliability, validity, prognostic value, and co-morbidity.
Going even further, the BPS includes a list of the main disorder categories with a statement attached to each one, highlighting their critical stance on the use of the disorder in question as a diagnostic tool. Next to the category of depressive disorders, the following is included:
We believe that classifying these problems as ‘illnesses’ misses the relational context of problems and the undeniable social causation of many such problems. For psychologists, our well-being and mental health stem from our frameworks of
understanding of the world, frameworks which are themselves the product of the experiences and learning through our lives.
These general concerns about the scientific validity and utility of diagnoses articulated above apply equally to the area of depressive disorders. We note that, in this context, sadness and unhappiness which are deserving of help and intervention – are not best considered illnesses. We also note that, by regarding them as such, there is a danger of misunderstanding their nature and cause and applying inappropriate medical remedies.
British Psychological Society. (2011, June). Response to the American Psychiatric Association: DSM-5 development. Leicester: British Psychological Society.
Keep in mind, this is a declaration by the organization chartered to register practicing psychologists in Britain up until 2009 - incidentally when this power was removed in another of the waves of bureaucratic oversight which Fisher describes in his work. The BPS is no radical agency and I include it to highlight that it would be a severe mischaracterization to portray the existing state of affairs in clinical knowledge as one-dimensionally as often occurs in Fisher’s work.
Our course of action should be crafted in light of the fact that these issues are already acknowledged by voices much less politically radical than Fisher and his CCRU compatriots. For instance, the weighty and almost guaranteedly un-marxist compendium Contemporary directions in psychopathology: scientific foundations of the DSM-V and ICD-11 includes multiple chapters on critical issues of culture and social power as they relate to the establishment of diagnostic categories. While this may be surprising to those who imagine such books written by lab-coat wearing pharmaceutical jockeys, the inevitability of these issues is laid out in an illuminating passage which is worth including in its entirety:
as helping professions rooted in an understanding of the human condition, psychiatry and psychology aim for theories of psychopathology that can be used across social and cultural contexts. An international diagnostic nosology should provide a common language allowing psychiatrists everywhere to exchange knowledge about specific patients, have ready access to current technical approaches, and contribute to the advance of psychiatric science. Unfortunately, this project of a global scientific psychiatry tends to view culture as a distraction from the project of developing a body of universal knowledge. That is, cultural diversity becomes an obstacle to scientific research and delivery of care, or else a matter of trivial differences—of “window dressing” on the essential core of universal human experience that might ground a universal nosology.
This more dismissive view of the relevance of culture for world psychiatry is part of the legacy of European empire, in that it assumes that the pertinent categories, concepts, principles, and practices—constructs that emerged almost exclusively from certain subpopulations or social strata within a handful of European and North American societies—constitute a universal, transcendent, ahistorical, and “culture-free” basis for recognizing “natural kinds” (i.e., the categories that are immediately given to perception or that can be readily discerned by “carving nature at its joints”) within the domain of psychopathology.
Gone, J. P., & Kirmayer, L. J. (2011). On the wisdom of considering culture and context in psychopathology. Contemporary Directions in Psychopathology: Scientific Foundations of the DSM-V and ICD-11. Millon, T., Krueger, R. F., & Simonsen, E. (Eds.). Guilford press.
This looks pretty familiar, and the fact that this critique exists already within the institutions which Fisher usually implicitly takes issue with suggests a new range of questions. To be clear, my goal isn’t to suggest we throw out his position on the topic entirely. Instead, a renewed attempt at understanding the real-existing state of psychological treatment and its theoretical structures should allow us to take the cultural and political foundations of Fisher’s writings and engage with the present state.
One potential battleground has been provided to us by the advocates for a more biological model of psychological diagnosis themselves. A 2010 article in Science takes aim using the same example of anhedonia which Fisher famously uses in his Capitalist Realism:
constructs such as anhedonia (inability to experience pleasure) and executive function cut across many current diagnostic categories. RDoC asks researchers to shift from designing research projects narrowly built around current diagnostic categories to dimensions or systems, such as social processes or negative valence (responding to aversive objects or situations), which are supported by a deep cognitive and neural science and can be the basis for objective measures of psychopathology.
Insel, T. R., & Cuthbert, B. N. (2015). Brain disorders? Precisely. Science, 348(6234)
In light of this information, the need to re-examine Fisher’s critical statements on the state of psychology and psychiatry should be clear, not because they are ultimately disagreeable but because they fail to allow us a truthful and thereby effective critique of the reality of modern psychology. One cause of the problems with modern psychology can be discovered in its very nature as a scientific attempt at grappling with the human.
In this case, the extant attacks on the DSM-5 model of psychological care are opening up a space in which the new ontology of psychopathology will be determined. The authors quoted above are arguing for a position that emphasizes the neurological whilst paying social systems mostly lip-service; acknowledging and including real clinical sciences and thereby formulating a convincing response to this debate is needed to allow mental health practices to constructively change and support other movements of human liberation. It’s likely unreasonable to hope for an official successor to the DSM-V that Fisher would have approved of, but shifting our attention to these questions can lead to new and very real forms of practice in clinics, organizations, and people.
Continued at Part II on Lacan and Deleuze.
This concludes the first half of my discussion on Mark Fisher. Subscribe to the newsletter and receive the soon-to-be released final segment on what project moving forward with Fisher’s work in light of these engagements can look like.
I really enjoyed this piece. I recently discovered MF and have read all his stuff. I'm a huge fan. I too struggle with mental health issues, recently starting a Substack page. You're correct about Fisher. I also have some critiques as well. But, damn. He's such a great writer/thinker, and so relatable.