The Substantial Thing
Tanya stumbles into the park; punch-drunk in her swaying. There’s something substantial wrapped around her forearm. The arm dangles as if dislocated, not moving with the rest of her body—like it doesn’t belong to her. It gives her an asymmetric feel, the substantial thing, as though she’s caught between two different gravities. She sits down on the bench and pulls a cider from her pocket. Her eyes are glassy and blood-shot. She looks exhausted. The substantial thing is a bandage, the once-white fabric roseate with the stanched diffusion of claret. She’s been cutting.—Extract from field-notes.
Abstract
The DSM-5 proposes that self-harm be recognized as a diagnostic category of mental disease, compared to its previous definition as a behavioral symptom. Based on fieldwork in London, I challenge this proposal by exploring the life-history of a homeless sex-worker and substance-user who practices self-cutting. By bringing phenomenological anthropology into conversation with psychoanalytic theory, this article provisionally re-conceptualizes self-harm as an ethics of self-reparation and existential affirmation in the face of extreme precarity. Approached as an agentive practice through which human beings reclaim “somethingness” by altering their bodily conditions, we can conceive self-harm in a way that is attentive to the situational conditions that shape existential pain, instead of reaching straight for the diagnostic toolkit. In taking self-harm as simultaneously a reaction to and a reflection on existential crisis—rather than a sui generis disorder—this paper situates such practices as a pluralized condition-of-world rather than a bounded pathology-of-mind.
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Notes
This theoretical framework, it is worth noting, bears a deep resemblance to Holbraad and Pedersen’s (2017) vision of ontologically inclined anthropology—what is often dubbed as the discipline’s “ontological turn.” What makes anthropology an ontological enterprise, they claim, is that—because of its immersive ethnographic component—it holds the immanent potential to operate as a way-of-being (i.e., an ontology) rather than simply a way-of-knowing (i.e., an epistemology); dynamically open to the alterity that the ethnographer finds themselves swept up in. Here, then, the word ontological has been adopted by the authors to radicalize the Malinowskian imperative, to not just grasp the native’s point-of-view but use such perspectives to creatively remodel our own viewpoints: to think (and thus potentially be) otherwise. Whilst there have been attempts—notably Pedersen’s (2020) recent article—to parse out the key differentiators between the ontological turn and critical phenomenology 2.0, it is difficult to escape the sense that, enlivening though such debates are, one is bearing witness to the kind of “small differences” feuding between neighbouring communities that Freud wrote about. In short, whilst both camps clearly draw on their own intellectual genealogies, their similarities far outweigh their differences. Rather than seeing them as oppositional, it seems far more productive to consider these two modes of theorising as isomers of one another—the same analytic formula, just with a different intellectual arrangement.
It is for this reason that Hacking (1999) has challenged the idea that there is a binary split between that which is socially constructed and that which exists empirically. Dismissing the notion that there is some hierarchy of reality in which the physical/biological sits above the metaphysical/sociocultural, Hacking instead advances that both aspects exist in a constant state of dynamic recombination. This position has been consistently supported by ethnographic accounts of illness (Freidson 1970; Joyce 2008; Timmermans 2007). Across this body of literature, the analytic focus moves away from questions of adjudicating what counts as real, shifting instead towards questions of how something—be it depression, anxiety, alcoholism, etc.—comes to be conceptualised and experienced as a “disease” or “illness” in the first place.
Exploring the ways that notions of bodily substance have been taken up in the anthropology of kinship, Carsten draws on her time amongst Langkawi Malays to demonstrate how bodily fluids—such as blood and breast milk—constitute kin relations through their ongoing transmission across corporeal boundaries. Like these shared substances, then, kinship is a mutable and fluid process that is continually maintained through eating and living together in houses.
In a recent article (Burraway 2018), I have provided an extensive account of the way that grief, crisis, existential presence, and the subjective experience of time coalesce in experiences of dissociative intoxication amongst the homeless.
This model is the foundation on which the chronic relapsing brain disease model hinges. In short, the basic idea explaining how addiction develops and why it is a chronically recurring condition is that certain drugs “hijack” the reward pathways in the brain—especially those responsible for producing dopamine, the neurotransmitter associated with, among many other things, feelings of pleasure and euphoria. At one point dubbed the “master molecule” of addiction, the dopamine = pleasure formula has since been refuted as a gross oversimplification, the interaction between neurotransmitter production and subjectivity proving to be far more nuanced and complex. Nevertheless, the broader brain disease paradigm within which the dopamine hypothesis is grounded has shown itself to be pervasive, underpinning the prevailing idea that drug addiction is rooted in individual biology. In such a view, the addictive substance is seen as mounting a kind of hostile takeover in which the neurological mechanisms of reward, desire and pleasure are systemically compromised.
See Desjarlais (1997).
Tanya’s lived experience of bipolar disorder echoes observations made by anthropologists who have emphasised the uneasy tension between external chemical intervention and the pressures of self-management for those who suffer from this condition (Weiner 2012). For example, on several occasions I was invited to attend Tanya’s doctor’s appointments with her in an advocacy capacity. These visits tended to follow a similar pattern: Tanya would talk about how her various medications—for bipolar but also for insomnia and anxiety—were making her feel sluggish, drowsy and “monged out,” hinting that she wanted to experiment with a lower dosage. Then, the doctor would interrogate how Tanya was feeling in and of herself, specifically in relation to previous instances where—after going off her medication—she had suffered psychotic episodes that had resulted in self-harm or hospitalisation. On each occasion, Tanya was encouraged by the doctor to conceptualise herself at a crossroads, with her medication emerging both as a psychiatric necessity and as a tool to pursue a more healthy and reliable self. As the doctor memorably put it at the end of one appointment: ‘Obviously I can’t make you do anything, but here’s how you could think of it. You have two choices—two roads in front of you. One leads to chaos. The other calm. The choice is yours. I think it’s really important to make the right one.’
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Acknowledgements
I would like to thank China Scherz, Aidan Seale-Feldman, George Mentore, Anne Alison, Louise Meintjes, and Jarrett Zigon for their helpful comments throughout the many drafts of this article. Most importantly, I would like to thank Tanya. Without her friendship, hospitality and candor, none of this would have been possible.
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This study was funded by the Economic and Social Research Council (ESRC).
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All procedures performed in this human participant research study were in accordance with and approved by the University College London Research Ethics Committee. All research conducted was in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Burraway, J. Attending to Aliveness: Self-Harm, Body and World in Contexts of Urban Homelessness. Cult Med Psychiatry 45, 282–311 (2021). https://doi.org/10.1007/s11013-020-09687-1
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DOI: https://doi.org/10.1007/s11013-020-09687-1