For a while now, and in many fields, discontent has been growing in the Anglo-Saxon world concerning the weight of evaluation procedures and the management-oriented quantification of all our activities, a protest that is not always clearly targeted but is often felt. The market seems to dictate its law to all human activity, its technique to all modes of thinking, and the supposed necessity for transparency becomes a tyranny that leads to the conformity of all modes of jouissance, even within the accepted frontiers of communities. The power of quantification and the search for objectivation is such that many in the Anglo-Saxon world wonder today whether this does not indicate the death of subjectivity.
While the movement of the Forums launched by Jacques-Alain Miller in France has been able to mobilize “enlightened opinion,” signs have come from the United States or from England that we can interpret as disparate testimonies of a revolt against the totalitarianism of the “audit culture” and the erroneous application of statistical tools to the most intimate aspects of our lives and of our civilization. The time seems right for banking anew on the subject, on his/her responsibility towards what is irreducible in his/her specificity.
Many signs in that quest for renewal stand out and make what has gone before – and sometimes quite recently – seem almost caricatural. For example, a serious article published in the science section of The New York Times (March 22, 2005) recounts the attempts made by some doctors – professors from prestigious universities – to lobby for the recognition by the DSM of a new category: the “body-integrity identity- disorder” or B.I.I.D. This disorder, rare for the moment, consists in attempting to have surgically removed a healthy member that has become unbearable for the subject. It is about really removing from the body an excess jouissance that cannot be resorbed in any other way. This disorder, constructed on the basis of a few cases, raises – for the journalist and the doctors – the ethical question: should one operate or not? The answers vary: some say we should, based on the example of transsexuals requesting a sex change, whereas others consider that the demand should be deferred with medication and/or a form of behavioral therapy called “response prevention and thought-stopping therapy,” intended to block the patient’s worrisome thoughts.
This outrageous example shows not only the disastrous extent to which the DSM can go: no one thinks of analyzing this type of demand in the context of psychosis and even less of hysteria (a category which has been taken out of the Manual). The subject’s demand is taken literally and his/her desire may go unquestioned. Beyond the ridiculousness of such a classification, we can see how the “ethical” questions and responses are biased because they are solidly linked to the way mental illness is conceived. In this example, the patients’ subjectivity is annulled either because the explicit demand of the individual is answered immediately, or it is ignored and combated with a treatment that reforms and forbids by attempting to block thoughts. Besides the fact that we may doubt that these thoughts can be blocked (most especially if they are psychotic certitudes), we see here to what extent the person in question is, as Marcuse said, a One-Dimensional Man.
This New York Times article is never critical, which implies that the vast majority of its readers is in agreement with this very widespread mode of thinking, and tends to make one imagine it is worthy of appearing in the science section of a respectable newspaper.
There is, however, a different current of thought being expressed, most especially about psychiatry and the DSM (Alix Spiegel, “The Book of Disorders,” The New Yorker, January 2005). This long and informed article talks about Robert Spitzer, the “one man who revolutionized psychiatry.” It shows the marketing methods with which his Manual was launched. It describes the standardization and the transformation of qualitative categories into quantitative scales. It describes the unavoidable manipulations in this type of procedure and the considerable loss involved, leaving a space for discretionary opinions given by the experts (among them Spitzer himself). These decisions or personal influences always appear in the Manual anonymously. Finally, the interest of this long article is to show that the DSM, created to eliminate the psychiatrist’s subjectivity in his/her diagnoses, does not manage to satisfy the Manual’s own scientific criteria – the same criteria as those of psycho-technical tests: reliability, the ability to produce a consistent, replicable result, and validity – which includes the temporal dimension.
Despite the success of the DSM, which is supposed to render the greatest service to insurance companies, courts, social services, schools, etc. (it has already been adopted as a reference by these institutions for calculating profitability), Spiegel shows that the central problem – that is, reliability – has not been solved. We are therefore equipped with a dictionary of disorders that manages to destroy past clinical practices but whose value is questionable.
Equally, from British universities, we can hear very strong criticism of the devastation wreaked by the audit culture. A professor of social anthropology at Cambridge, Marilyn Strathern, denounces “the tyranny of transparency”. The British university system, whose reputation is excellent, has had to undergo the forced evaluation of the culture it has promoted, leaning on a secular tradition in order to respond to management and pedagogical criteria of immediate profitability. Two authors in particular, themselves scholars and anthropologists, Chris Shore and Susan Wright, report the deleterious effects of the quality assessment approach: “The new audit technologies are typically framed in terms of quality, accountability, and empowerment, as though they were emancipatory and self-actualizing […] while […] these processes beckon a new form of coercive and authoritarian governmentality.” The authors show, based on a case study, how these practices break down the traditional social link with the university; how they lead to the separation of research from teaching and an increase in administrative tasks; and how they overlook the fact that teaching on a university level is not equivalent to force-feeding information for immediate use. We would say, in psychoanalytical terms, that these technological tools demolish all transference – the cement of the social link as well as support for the desire to know. In the place of transference there appears a vile calculation of what will please the Master, even if this farce is only there to mask the ritualized moment of evaluation.
By Pierre-Gilles Guéguen