Serotonin and the Sovereign

Allan V. Horwitz’s (b. 1948) argument, developed in Creating Mental Illness and later in All We Have to Fear with Jerome Wakefield, is that American psychiatry systematically misclassifies normal emotional responses to difficult circumstances as pathological conditions requiring treatment. Grief becomes major depression. Situational anxiety becomes generalized anxiety disorder. The DSM strips context from symptoms, so a person responding reasonably to loss, failure, or threat looks clinically identical to someone whose distress has no external cause. The result is massive diagnostic inflation and a pharmaceutical industry built on treating ordinary human suffering as brain malfunction.
Randall Collins’s (b. 1941) interaction ritual chains framework says that emotional energy is not just a political variable but a feature of everyday social life. When interaction rituals succeed, people feel alive, purposeful, and connected. When they fail chronically, people feel flat, depleted, and unmotivated. Liberal proceduralism institutionalizes ritual failure at the political level. Horwitz suggests something parallel at the personal level: that modern therapeutic culture pathologizes the emotional consequences of that same ritual poverty rather than naming it for what it is.
The person who feels chronically empty, disengaged, and without a sense of collective purpose is not obviously suffering from a chemical imbalance. He might be suffering from a social environment that has systematically stripped away the interaction conditions that generate emotional energy. No bodily copresence, no shared focus, no clear group boundaries, no rhythmic entrainment. Just dispersed attention, atomized consumption, and the thin sociality of digital platforms. Horwitz’s critique of psychiatry and Collins’s sociology of ritual point to the same underlying condition from different angles.
We may have privatized and then medicalized political failure. When liberal order’s ritual impoverishment produces widespread motivational deficit, the response is not only political. Individuals get diagnosed and medicated. The social problem gets reframed as a personal one. The person who hungers for intensity, solidarity, and charged collective experience does not get told that his political environment fails him. He gets told his serotonin is low. This is a structural feature of how liberal societies manage the costs of their own design. The exception, when it comes, draws on exactly this reservoir of privately managed but socially produced despair. The sovereign who names the enemy and recharges the political symbols is not manufacturing appetite from nothing. He harvests what the therapeutic apparatus has been quietly containing.
If ordinary sadness gets diagnosed as illness, ordinary anger gets a parallel treatment: management, de-escalation, conflict resolution, sensitivity training. The emotional repertoire that high-intensity ritual requires, righteous anger at the enemy, exhilarating solidarity with the in-group, is precisely what therapeutic culture treats as symptomatic. Carl Schmitt’s sovereign does not offer therapy. He offers permission to feel what the surrounding culture has been telling people they should not feel. That permission is part of the emotional goods the exception delivers. Randall Collins explains how the ritual works. Allan Horwitz explains why the population is primed to receive it.