This chapter offers some preliminary thoughts about the general concept of social pathology and its usefulness for social philosophy. The first section distinguishes five conceptions of social illness that differ from the one I endorse in this book. Following that, I discuss various advantages and disadvantages of the concept of social pathology. Finally, analyzing a little-known example of Rousseau’s, I illustrate various possible features of a sick society that help to illustrate how that concept aids us in understanding and evaluating social reality.

Rival Conceptions of Social Pathology

It is necessary to say something first about the sense in which I speak of social pathology in this book since the term has various meanings – I note here five – that I want to distinguish from my own usage. There is, for example, a very simple conception of social pathology, according to which (i) a society is “ill” whenever a significant number of its members is ill.Footnote ¹ (I will often place “ill” and its synonyms in quotation marks to remind us that those terms are used metaphorically.) One might claim to find this conception of social pathology in Richard G. Wilkinson’s Unhealthy Societies: The Afflictions of Inequality, which marshals empirical evidence for the claim that developed societies with extensive economic inequality tend to have higher rates of illness among their members – including among the better off – than more egalitarian societies (Wilkinson Reference Wilkinson1996: 3). In this case the unhealthy societies mentioned in the book’s title are simply those with large numbers of physiologically unhealthy members.

Two features of this simple conception of social pathology distinguish it from the one I employ here. First, it makes illness in the social realm derivative of nonsocial illness. In Wilkinson’s case the illnesses in question are physiological, but one could devise a similar conception of social pathology that referred to mental illness instead.Footnote ² Such a conception does not countenance a distinct way in which societies can be ill that is not traceable back to the physiological or mental illnesses of its members. Second, this conception of social pathology requires no understanding of human society as anything more than a collection of individuals. It offers an aggregative picture of social pathology, in which a society’s being ill consists simply in the logically prior fact that many of its members are ill. Such a view does not depend on any specifically social understanding of human society, of how it is structured, or of what its distinctive functions consist in.

In fact, however, Wilkinson’s unhealthy societies come closer to exemplifying social pathology in the sense I defend here than the previous paragraph suggests. For his thesis is not only that unhealthy societies are those that contain many physiologically ill individuals but also that such societies foster those illnesses. According to this second, more complex conception of social pathology, (ii) societies are ill just in case they play a substantial causal role in making a large number of their members physiologically or mentally ill; that is, the illnesses of social members indicate social pathology only if those illnesses have social causes. In Wilkinson’s case the relevant cause of the illnesses found in the individuals of an unhealthy society is a social phenomenon – economic inequality – which both consists in social relations (not in properties individuals possess on their own) and is explained by supraindividual features of society, such as its economic structure or its laws and practices.

I have no objection to regarding Wilkinson’s unhealthy societies as pathological since the illnesses of their members result from distinctly social factors. A society that makes many of its members ill qualifies as pathological, but its specifically social pathology resides in the social dynamics that produce the illnesses of its members. As I argue throughout this book, the socially pathological character of such a society lies in its dysfunctional dynamics, not in its members’ physiological or mental illnesses. To see why Wilkinson’s examples count as social pathologies, compare them with a society with inordinately high rates of physiological or mental illness where this is due to (nonsocially caused) environmental changes. As this case suggests, the mere fact many persons in a society are ill does make that society ill.

Wilkinson’s unhealthy societies are not, however, paradigm cases of sick societies, for they suggest too narrow a picture of social pathology. This is because, like the first conception of social pathology, his account presupposes a picture of what health in individuals consists in and then speaks of social pathology whenever social conditions negatively affect the health of social members so conceived. As I treat the concept here, social pathology does not require that individual social members themselves be ill, either mentally or physically. To see this point, consider Marx’s account of alienation. Workers are alienated in capitalism, but this does not imply that they are ill. What makes capitalist alienation a social pathology is that it is a systematic result of capitalism’s class structure and its mode of organizing production and accumulation. As noted above, social pathology consists in a dysfunction at the level of social structure or in a society’s constitutive dynamics. Whereas anything that counts as a social pathology must be bad for (at least some) social members, the way in which individuals are negatively affected generally does not take the form of illness. To take another example from Marx: the inherent tendency of capitalism to produce recurring crises qualifies as a social pathology but not because those crises make individuals sick (even if illness might be one effect of the unemployment produced by crises). Such crises produce alienation and poverty for many – and would not constitute a social pathology if they did not have some such negative effects – but they are relevant to a theory of social pathology because they are signs of dysfunction in social processes, not because they make individuals ill.

My claim that social pathologies must be bad for at least some social members does not, however, imply that socially caused suffering is either a necessary or a sufficient feature of social pathology. Some philosophers of medicine place suffering at the center of their accounts of illness, and certain social theorists likewise regard (iii) “social suffering” as the hallmark of social illness.Footnote ³ My objection to this conception is not that suffering is a rare feature of social pathologies – it is not – but that it blinds us to the fact that felt suffering need not be present in them. (And, as Durkheim notes in making the same point, plenty of organic illnesses do not involve suffering either [RSM: 87/50].) Here, again, think of Marx’s claim that although the bourgeoisie is alienated in capitalism, it “feels confirmed and at ease in its alienation, experiencing it as its own power” (MER: 133/MEGA: II.37). Conversely, taking social suffering as a sufficient indicator of social pathology yields false positives: when I walk in my neighborhood in Berlin and see passersby’s expressions of pained outrage at seeing so many black faces or hijab-wearing women in “their” streets, I am reminded that not all social suffering is a response to genuine social ills. (Moreover, as Nietzsche reminds us, some suffering, as in pregnancy, signifies growth and new possibilities rather than degeneration or dysfunction.)

None of this implies that theorists of social pathology should avoid taking the expressed suffering of social members seriously but only that one cannot assume that experienced suffering in the social domain by itself indicates social pathology. Rather, social theorists (some of whom themselves belong to suffering groups) must interpret suffering and judge it in light of normative criteria – those implicit in some inclusive version of the idea of a good human life – that go beyond experienced physical or psychic pain. This may sound harsh or paternalistic, but it is nevertheless true that social suffering must be articulated and made comprehensible to those who do not suffer from it if social transformation is to occur. In the twentieth century this was seen, by the “sufferers” themselves, as a principal task of the Civil Rights movement in the United States, of women’s liberation, of unionization drives, and of lesbian and gay politics. In all these cases those suffering from the relevant injustices and pathologies succeeded in translating their suffering into terms that those not directly afflicted came to understand as ethically compelling. The mere expression of social suffering that was previously invisible to others played a major role in the progress achieved by these social movements, but even more important was their ability to articulate the meaning of their suffering to others, showing it to be an injustice or, more broadly, a grievous impediment to living a good human life.

A fourth conception of social pathology conceives of society on the model of an individual human being and of its illnesses as (iv) large-scale versions of physiological or mental illnesses that afflict individual humans.Footnote ⁴ Plato’s positing of an isomorphism between polis and soul moves in this direction, as does the famous frontispiece of Hobbes’s Leviathan depicting the commonwealth as a super-sized human individual. Although strange, it is not unheard of to depict social pathologies as near-literal analogues to the physiological illnesses suffered by human bodies, as does the Leviathan’s notorious (and entertaining) Chapter XXIX. It is more common and more plausible, however, to think of social pathologies conceived of on this model as collective forms of mental illness, as in popular invocations of collective psychosis, when describing contemporary political discourse in the United States or in Carl Jung’s conception of collective neurosis (Jung Reference Jung1964: 85). On this model of social pathology, human society is conceived of as an organism (or collective subject) and is taken to be ill when it falls short of the standards of health applicable to individual organisms (or subjects). Although I do not take a stand on the plausibility of accounts of collective mental illness, I distance myself from the general model of social illness that informs them. None of the classical instances of social pathology rely on that model, and, more important, thinking of the relevant functions of social life as close analogues to those of human bodies or minds diverts our attention from real social phenomena and from the specifically social dysfunctions in which, according to my account, social pathologies consist.

Finally, there is a loosely defined conception of social pathology that once enjoyed wide currency in academic circles, especially in the United States. Developed by sociologists in the first half of the twentieth century, it achieved popularity in the 1960s and 1970s outside academia, when it became common in the press and among social workers to refer to (v) a haphazardly collected group of “social problems” – including poverty, crime, drug abuse, “promiscuity,” and racism – as social pathologies (Mills Reference Mills1943: 165–80).Footnote ⁵ Pathology in this conception is defined primarily as a deviation from prevailing social norms and is often understood as a failure on the part of individuals to “adapt” or “adjust” to those norms. The norms in question include such “virtues” as thrift, sobriety, heterosexual monogamy, discipline in work, and commitment to family, all of which are regarded as essential to social order and as conditions to be reproduced rather than called into question.

Even if such pathologies are condemned primarily because of the threat they pose to the smooth functioning of society, they are also taken to be bad for the afflicted individuals, and the social work inspired by this conception of social pathology was surely motivated more by the desire to improve the lives of individuals than by the larger aim of putting society in order. For this reason, this conception of social pathology goes beyond the alternatives discussed above in expanding the idea of social illness beyond a narrowly physiological or psychiatric definition to include social phenomena that appear as pathological only in the light of broader normative criteria for a good or flourishing human life. Poverty, for example, counts as pathological for this view not because it makes the poor sick, physically or mentally, but because (as Hegel pointed out) it prevents them from achieving basic goods – satisfying work, self-esteem, forms of relaxation and enjoyment – available to the better off in their society. In relying, however implicitly, on some idea of the human good and of how social conditions can promote or hinder it, this conception of social pathology takes us a step away from the original idea of illness. This, however, is not its defect. (The fact that homosexuality, for example, was long taken to be one of these pathologies should remind us, however, of the dangers inherent in judging social conditions to be pathological according to prevailing criteria for a good human life, as well as of the fallibility of our present judgments as to what fails to meet those criteria.) For, as noted above, a central claim of this book is that an adequate conception of pathology in the social domain must be normative in respects that go beyond the narrower ideas of physiological and mental illness.

I do not deny that some of the problems picked out by this conception of social pathology are indicative of pathologies, but I reject the loose conception of social illness it employs. One respect in which that conception is insufficiently social shows itself in the fact that it was often interpreted as attributing responsibility, even moral blame, for social pathologies to the “maladjusted” and undisciplined individuals whose (for example) “weak ego structures” (Rigdon Reference Rigdon1988: 113) prevented them from complying with social norms. The tendency of this conception of social pathology to moralize social problems is surely connected to its deeper theoretical deficiency, namely, the implicit assumption that a list of “social problems” constitutes an account of social illness. My chief objection to this once-popular way of regarding crime, poverty, and drug abuse, then, is not that it is excessively normative but that it lacks a sufficiently complex conception of human social life to grasp the problems it concerns itself with as social pathologies in the more robust sense in which I employ the concept here. For on this conception, diagnoses of social pathology are made independently of any specific understanding of a society’s structure or basic functions. The problem with this approach is not that it regards alcoholism or crime or high rates of suicide as social ills but that, in the absence of an account of a society’s structure and basic functions, its diagnostic procedures amount to little more than compiling a list of diverse problems, the causes of which it then locates in a variety of social conditions. As C. Wright Mills pointed out, this way of conceiving of social pathology is capable only of “collecting and dealing in a fragmentary way with scattered problems” (Mills Reference Mills1943: 166). Mills can be taken to imply that an enlightening conception of social pathology must do more than uncover a diversity of ways in which individuals are afflicted by social conditions; it should also be able to say how a society in its basic structure is deformed or unbalanced, or how its essential functions are disrupted, impaired, or misaligned. One way of expressing this point is to say that a high rate of alcoholism might indeed be a symptom of social pathology (rather than, say, the effect of cold, dark winters) but that the pathology resides in a deeper functional deficiency of society that explains the high incidence of alcoholism and reveals its connections to other social ills bound up with the same pathology.

Disadvantages of the Concept of Social Pathology

It is important to acknowledge that there are good reasons – conceptual, rhetorical, and ideological – for approaching the idea of social pathology with skepticism. There can be no doubt, for example, that the concept has been used, by philosophers and politicians alike, in the service of projects that are intellectually and morally objectionable. To cite the most egregious instance: Nazi ideology made extensive use of the idea of a diseased society to impress on its adherents the need to attack with violence those parts of the body politic – those groups of human beings – in which society’s malady, imagined varyingly as syphilis, cancer, or tuberculosis, was thought to reside (Sontag Reference Sontag1978: 82–3).Footnote ⁶ Along with the notion that sickness must be treated by violent means, the baffling idea that agents of disease are morally culpable, and therefore deserving of punishment, appears to be a persistent element of our (mostly unconscious) attitude to the basic fact of our vulnerability to illness, and this creates a standing potential for corrupting our responses to whatever phenomena we diagnose as social pathologies. Some of the oddness of our moralistic attitude to illness is evident in the fact that it often coexists with its precise opposite: sometimes a condition’s being regarded as an illness functions to shelter the ill from moral condemnation, as in the thought, regarded not long ago as progressive, that homosexuals are not morally depraved but sick, implying that medical treatment rather than persecution is the appropriate response to “abnormal” sexual orientation. In any case, the line between regarding persons as ill and perceiving them as depraved is easily traversed, as can be seen in the fact that academic sociologists in the United States today are most likely to associate the discourse of social pathology with “social deviance,” a term whose problematic connotations hardly need to be pointed out. The fact that perceiving some condition as an illness has the potential to engender hostility, disgust, and condemnation is an important reason for theorists of social pathology to be scrupulous in insisting that societies or institutions, not individuals, are the bearers of the illnesses their theories diagnose.

Beyond this, the popularity of social Darwinism in the latter decades of the nineteenth century surely accounts for some of the disfavor into which the concept of social pathology and the society-as-organism analogy has fallen today. Social Darwinists gave a distinctive ideological twist to the idea that society is akin to a living organism. For them, this analogy implied that the key to establishing a science of society lay in appropriating the methods and outlook of the newest advance in biological science: Darwin’s theory of evolution. Although the founder of this school, Herbert Spencer, developed his main ideas before the publication of The Origin of Species, much of the influence social Darwinism enjoyed in subsequent decades depended on the mistaken perception that he and his followers were applying the principles of Darwinian science to social life.

Spencer’s social theory is based on the idea that, despite superficial differences, biological and social “organisms” are subject to the same laws of evolutionary development. The details of this theory need not concern us, apart from the most significant respect in which Spencer’s conception of the evolutionary process diverges from Darwin’s: in the case of the social organism, Spencer posits an end-point – a state of “equilibration” (Spencer Reference Spencer1969: 141) – at which perfect adaptation has been achieved and no impetus for further development is present. Although this end-state is supposed to be one of social integration in which peaceful, industrial activity becomes society’s chief occupation, it must be preceded by an ongoing “struggle for existence” among antagonistic social units. Unfortunately, it was this idea that most captured the imagination of Spencer’s followers, who elevated it into a full-blooded ideology in support of laissez-faire social policies they took to serve the “survival of the fittest” (a term coined by Spencer, not Darwin). Government aid to the poor, state-financed education, public health measures, even the regulation of commerce – all were regarded as misguided attempts to interfere with the natural workings of society,Footnote ⁷ which, if left to its own devices, would eliminate the least “fit” of society’s members (Spencer Reference Spencer1969: 379). (The pseudoscientific character of social Darwinism is especially visible in its interpretation of the “fittest.” Spencer’s most prominent American follower, William Graham Sumner, took the fittest to be, as one commentator puts it, the frugal, tax-paying, middle-class man who “went quietly about his business, providing for himself and his family without making demands upon the state” [Hofstadter Reference Hofstadter1959: 64].Footnote ⁸)

There are also philosophical reasons for avoiding the concept of social pathology, and they, too, must be acknowledged upfront. The most obvious of these reasons is ontological: the concept of illness belongs to the study of animal organisms, and societies – so the objection – are not animal organisms nor sufficiently like such organisms that the concept of illness could be meaningfully applied to them. Of course, that societies are not animal organisms is plain enough – and recognized by all serious theorists of social pathology – but this alone does not settle the issue of whether the two are so dissimilar that categories applicable to the latter have no value for understanding the former.Footnote ⁹ Here, too, it is worth noting that the figures I rely on here reflect extensively on the differences between organisms and societies and go to great lengths, if not always successfully, to do justice to them. The widespread assumption that the entire tradition of theories of social pathology can be dismissed by the observation that human societies are not animal organisms betrays either a penchant for easy philosophizing or an ignorance of how and why such theories have employed the concept of social illness.

It is instructive that some of the figures mentioned in the Preface – Machiavelli, Marx, and Habermas, for example – appear unable to dispense with the idea of social illness even when they generally avoid conceiving of human society on the model of an organism. Of course, the more one distances oneself from the organism analogy, the more difficult it becomes to see why one should employ the idea of social illness at all, especially if one wants to avoid emptying it of all content by referring to whatever one disapproves of as “sick” (Sontag Reference Sontag1978: 74). In line with this thought, I will argue that there are good reasons to employ the concept of social pathology and that doing so commits one to thinking of human societies, not exactly as animal organisms, but as “alive” – as “living” beings – in some nonliteral but still meaningful sense. Or, formulated differently, an important part of my task is to articulate in which respects societies are like living organisms (and in which respects they are not), since in the absence of any such similarities, speaking of sick societies would indeed be empty talk (Honneth Reference Honneth2014a: 701). Before addressing this issue further (in Chapter 2), it is important to consider why, despite its disadvantages, the concept of social pathology has an important role to play in social philosophy.

Advantages of the Concept of Social Pathology

Diagnosing a society as ill involves claiming sometimes more than, sometimes something other than, that it is unjust. This gives theories of social pathology two advantages: First, they can draw our attention to social phenomena worthy of critique to which theories focused exclusively on justice are blind; and, second, they have at their disposal critical resources beyond those employed by most liberal political and social philosophy. It is not that the category of injustice is always irrelevant to diagnoses of social pathology but rather that, even when it is relevant, conceiving of the social deficiencies in question only as injustices underdescribes them. Consider the example of global warming. It is certainly appropriate to regard human-caused global warming as an injustice (to future generations, or to contemporaries who only suffer its effects while others profit from it). It would be odd, however, to take this as an exhaustive description of the problem. It is hard to avoid the impression that there is something sick – or perverse, or gravely awry, but in any case something more than unjust – about social practices for which we are responsible that systematically thwart fundamental human ends, in this case ends as simple as those deriving from our biological nature. The appearance of illness becomes only stronger when one considers that, after becoming aware of global warming, we continue, and even intensify, the very practices that threaten our species’ survival.

One way of bringing this issue into focus is to abstract from those to whom injustice is done – future generations and the global poor – thereby removing injustice from our picture of why global warming is worthy of critique. What is left then could be described as a systematic thwarting of the – in this case, self-preservative – ends of the very agents whose activities produce global warming or, alternatively, as a systematic undermining of the conditions of those agents’ good and, ultimately, of their very agency and lives. What makes human-caused global warming a pathology and not only an injustice is that it is the result of a social dynamic – a self-reproducing nexus of collective practices – that, apart from its connection to injustice, diminishes the good (or impedes the ends) of those who participate in those practices.Footnote ¹⁰

The first of these points implies that theories of social pathology take as their object not isolated human actions but ongoing social processes that constitute a dynamic with a coherent logic and point. This is the idea behind Max Weber’s distinction between isolated, sporadic acts of profit-seeking and “capitalistic enterprise,” the distinguishing feature of which is that it is a continually repeated series of actions unified by a specific aim (the maximization of profit) and exhibiting a certain structure (economic efficiency, as determined by market-oriented calculations of profitability) (Weber Reference Weber1992 [1905]: xxxi–xxxii). Social processes such as these have not only ends; they also exhibit a characteristic logic or dynamic that may or may not be consciously apprehended by those whose activities sustain it. For this reason, diagnoses of social pathology rely on a dynamic understanding of how social processes work (or function) and how they reproduce or transform themselves over time; in other words, social critique on this model requires social theory, and the primary objects of such critique are not individual actions but social practices and institutions. The social forces behind contemporary global warming, for example, cannot be understood as the aggregative result of independently undertaken actions on the part of thoughtless or greedy individuals. Rather, global warming is the outcome of a system of production and consumption that follows a logic of its own – bound up with the aim of capitalist accumulation – that cannot be countered without substantially reforming institutions.

The second point (that, apart from considerations of justice, social pathologies diminish the good or impede social members’ ends) suggests that in most cases such disorders are – to employ a familiar but not fully transparent distinction – failures in realizing the good, broadly construed, rather than in achieving the right. Examples of such failures include but are not exhausted by the following phenomena: felt estrangement from social institutions; having a purely instrumental attitude to one’s social activity; failing to realize the distinctive goods available through participation in collective enterprises; missing out on satisfying forms of work and self-esteem; and embracing values and ends the pursuit of which is self-undermining or inimical to one’s own good. In general, then, diagnosing a society, practice, or institution as ill involves ascribing to it specific ends bound up with conceptions of human flourishing that are somewhat “thicker” than those typically admitted by liberal theories of justice.Footnote ¹¹ A social theory that makes pathology a part of its critical arsenal relies on a vision of the social, according to which human societies cannot be adequately grasped or evaluated without attributing ends to their practices and institutions that – because connected with ideals of human flourishing – are broadly ethical in nature. For this reason the concept of social pathology is less restricted to “ends set by nature” than is the concept of illness in the case of merely animal beings;Footnote ¹² a diagnosis of social pathology is always in part an ethical critique.

To show that the concept of social pathology can illuminate deficiencies in social life not capturable by discourses confined to the categories of legitimacy, justice, or moral rightness, it will be helpful to return to Marx’s critique of capitalism (which is inseparable from an ambitious theoretical account of how capitalism works as a system, reproducing and transforming itself in accordance with its own logic.) Of the types of critique attributable to Marx – that capitalism is alienating, exploitative, self-undermining, and that it ultimately fails to develop human productive forces as well as other practically available forms of society would – only one has a natural home in contemporary Anglo-American social or political philosophy: only the claim that capitalism requires the systematic exploitation of workers lends itself to reformulation in the language of justice that contemporary liberalism takes as the central category of social critique. One of the strengths of Marxist theory is that it sheds light on broadly ethical problems of modern society typically ignored, even today, by justice-oriented political philosophies, where topics such as alienation, reification, self-defeating social dynamics, and justice in nonpolitical social spheres go largely unmentioned. To take only the first example, the problem with alienated labor is not primarily that it is unjust.Footnote ¹³ The problem, rather, is that the conditions under which such labor is carried out make it impossible for laborers to realize spiritual goods – recognition, self-esteem, successful execution of complex tasks, the satisfaction of producing for others, and so on – that can be had from labor in societies with highly developed productive forces.

Merely to decry such conditions as unjust not only says too little about what is problematic about them; it also fails to grasp how they are grounded in the structure and logic of existing institutions rather than being sporadic or contingent. This points to a further respect in which theories of social pathology go beyond mainstream social and political philosophy: in addition to employing a broader set of normative standards, such theories aspire to uncover the social dynamics that explain why the pathologies they diagnose are more than accidental. One might say that theories of social pathology aspire to distinguish symptoms from underlying pathologies and that their diagnoses go beyond mere classification to include an account of the social forces or underlying structural conditions responsible for producing the symptoms at issue. This explanatory aspiration means that a diagnosis of pathology typically carries implications about the treatment likely to eradicate or ameliorate the diagnosed condition; for the social pathologist, as for the physician, diagnosis goes hand in hand with practical orientation.

Finally, theories of social pathology differ from much (but not allFootnote ¹⁴) contemporary political philosophy in eschewing a priori justification of the critical norms they employ, seeking them instead within the social practices they investigate. This point raises the tricky question of how the diagnosis of social pathologies relates to what has come to be called immanent critique, as well as – since some notion of contradiction is central to such critique – to what extent social pathologies involve contradictions in the sense in which Hegel and Marx employ that concept. These questions would be easier to answer if immanent critique and contradiction were univocal concepts.

The locus classicus of the method of immanent critique is Hegel’s Phenomenology of Spirit, but, in a different form, it plays a role in his Philosophy of Right as well: his critique of widespread poverty there, for example, rests on the idea that basic features of civil society impede its ability fully to realize the ideals – such as self-reliance and finding meaning in one’s work – that animate its own workings. In Marx the closest analogue to this form of immanent critique is Capital ’s account of how the ideals that justify the wage–labor relation and the appropriation of surplus value – “freedom, equality, property, and Bentham” (Cap. 280/MEGA: XXIII.189) – are necessarily realized only one-sidedly in capitalism. In both cases, one could speak of contradictions – between normative aspirations that inform institutional life and the internal impossibility of fully achieving them – but for Hegel and Marx “contradiction” tends to imply something more as well, namely, an internal potential for transformation, or the presence of real forces that have the capacity to resolve the contradiction at issue and, in doing so, produce a new, “higher” social configuration in place of the old. (This dimension of “contradiction” has an analogue in the method of immanent critique employed in the Phenomenology, but it is not part of the Philosophy of Right’s account of poverty.) This conception of contradiction in the social domain finds its clearest expression in Marx’s account of the “contradictions of material life” – the conflicts between the forces of production and the relations of production – that explain epochal change in his vision of historical materialism:

Diagnoses of social pathology, as I conceive of them here, depend on a form of immanent critique but do not necessarily regard pathologies as contradictions in this sense: uncovering a pathology in social life does not imply the presence of forces that will or could resolve the relevant dysfunction and lead to radical transformation “at a higher level.” In other words, the metaphysical commitments of theories of social pathology are more modest (and realistic) than views of history that emphasize contradiction-based progress, and this in two ways: in rejecting the idea that dysfunctions carry within themselves the resources for overcoming them, and in denying that only radical transformation – revolution rather than reform – is genuine progress. In both respects theories of social pathology are closer to the diagnosis of medical illness than to “dialectical” social critique, for they presume nothing about the likelihood or potential for overcoming the illnesses they diagnose. Thus, illness in its social form, like physiological pathology, is sometimes cured; it sometimes leads to change or death; and sometimes it merely persists indefinitely. On this point, the view of social pathology I defend here is closer to the positions of Rousseau and Durkheim than to Marx’s or Hegel’s. The metaphysical modesty of such a view may be disappointing, but it also avoids the embarrassment of predicting social transformations that never come about.Footnote ¹⁵ (At the same time, forward-looking critical social theories ought to attempt the kind of analysis Marx provides in Capital of real social and material developments that might have the potential to remedy contemporary dysfunctions and to transform the social world in ways that make their recurrence less likely; although such analyses are important for guiding political action, they cannot be regarded as predictive or determinable with the precision of natural science.)

There is another aspect of the uncovering of social contradictions that, at least for Marx, has implications for the form social progress must take: Capital ’s method of uncovering the “contradictory movement of capitalist society” – primarily in its account of the periodic cycles of capitalism that culminate in “universal crisis” – is said to be “revolutionary in its essence” (Cap.: 103/MEGA: XXIII.27–28). In other words, social contradictions in the sense at issue here are taken to apply not to superficial features of societies but to their deep structure,Footnote ¹⁶ which means that resolving those contradictions is closer to killing off the extant social “organism” than to curing it.Footnote ¹⁷ In this respect – in insisting on the revolutionary character of social critique and of the political actions implied by it – Marx fits less comfortably into the social pathology tradition than other figures covered in this book. Nevertheless, as I argue in Chapters 3 and 4, both the language and concepts of social pathology critique figure prominently in Capital ’s accounts of the nature of capitalist production and its inherent defects.

In any case, drawing too close an analogy between physiological and social illness can make diagnosis of the latter appear more conservative than it need be. Normally we take cures of physiological illness to aim at restoring the sick organism to its previous healthy state without transforming it or giving it new powers. If the same were always true of diagnoses of social pathologies, they would indeed be inherently conservative in an objectionable sense. Yet no major theorist of social pathology takes the concept to be restricted in this way – certainly not Durkheim, who, because of being associated (unfairly) with sociological functionalism,Footnote ¹⁸ has seemed to many the social pathologist most vulnerable to this charge. No doubt this difference between biological and social “organisms” can also be traced back to ontological differences between what Hegel calls spirit and mere life, especially to the intrinsically historical character of spiritual beings due to their self-conscious nature.Footnote ¹⁹

While restoring society to a previous state of health is in principle a possible aim of theories of social pathology, it in fact plays little, if any, role in the theories I take most seriously here. Instead, there is a general presumption in these theories that remedying social pathologies requires real change that typically falls short of “revolution” but does not for that reason amount to “mere reform” that leaves the underlying causes of dysfunctions unaddressed. Like medical approaches to disease, which distinguish symptoms from underlying causes, theories of social pathology are not opposed to grasping social problems “at their root,” but they do not assume that an adequate response to such problems requires complete extraction of the roots in question. A satisfactory response to poverty or economic inequality might involve abolishing the market economy and replacing it with production organized on a different basis, but it might also be remedied by substantial changes to the market economy, including revised conceptions of property and of the rights belonging to its owners,Footnote ²⁰ that should not be dismissed as “mere reform.” In truth, we do not (yet) know whether in this case revolution or reform is required. For his part, Durkheim calls his vision of the social order that has overcome the pathologies of modernity “socialism,” and the fact that Marx does not use the term in this way should not prevent us from entertaining the possibility that Durkheim’s socialism might represent real growth and substantial change – something beyond “mere reform.”

Finally, it is important to forestall a further possible misunderstanding regarding the sort of immanent critique theories of social pathology rely on that may have its source in the circumstance that the locus classicus of this method is Hegel’s Phenomenology rather than his social philosophy.Footnote ²¹ The source of this potential confusion is that the object of inquiry in that text is not real social formations but configurations of consciousness (or modes of knowing), the contradictions of which consist in mismatches between the norms for knowledge espoused in those configurations and what subjects who subscribe to those norms actually do when they attempt to know the world in accordance with them. This aspect of the Phenomenology might suggest that immanent social critique always involves revealing how consciously held norms of social members fail to be realized in the society they inhabit. On this issue, the form of critique employed by theories of social pathology is more like the immanent critique one might ascribe to medical diagnoses of illness, where “immanent” means not “internal to a form of consciousness” but immanent to the form of life of the relevant species (Thompson Reference Thompson2008: 81). In the case of physiological illnesses the defect picked out by “immanent critique” involves (but is not exhausted by) dysfunctions defined relative to the species’ normal functioning.Footnote ²² Obviously, such diagnoses do not appeal to consciously held norms but to standards of the well-functioning of the species. As we shall see in later chapters, in the social domain consciously held norms play an important role in constituting social reality, and a systematic failure to realize such norms is relevant to, but not exhaustive of, diagnoses of social pathology. The more fundamental thought underlying immanent social critique is that social life is made up of goal-directed practices informed by internal criteria for their own success. In this respect social life bears a resemblance to the processes of animal life – the circulation of blood, the digestion of food, the production of sweat – with the difference that in the former, practice-immanent norms are in part (but not always) consciously known and followed by the humans whose activities constitute the practices in question. In other words, the standards enabling the social pathologist to diagnose dysfunctionality in social life are already present – and therefore already partially realized – in the institutions under investigation, even if many questions remain concerning how the specific functions carried out in social life are to be determined. On this conception, even Marx’s account of the recurrent crises of capitalism counts as a form of immanent critique, insofar as they impede the function (or work against the “point”) of economic cooperation.

An implication of this feature of social life is that the projects of understanding and critique are more interdependent for the social pathologist than they are normally taken to be in contemporary moral and political philosophy. In some form the interdependence, and therefore inseparability, of the two projects is a dominant theme in much of post-Kantian European philosophy – in Hegel, Marx, Nietzsche, Freud, and Durkheim, for example – but it is not found only there. It is also present in the best social theories outside this tradition – in Adam Smith, who predated the tradition, and in Max Weber, who, although a member of it, did his best in his methodological reflections (but, to his credit, not always in his empirical studies) to embrace as his “official” normative position a rigorous, neo-Kantian version of the separation of fact and value.

Let us consider how these issues play out in Smith’s social theory. Nothing distinguishes The Wealth of Nations more from the social and political philosophy of Smith’s contemporary Rousseau than this methodological point. The normative logic of the Social Contract begins with an abstract, relatively a priori account of the basic interests all humans share and proceeds from there to deduce the fundamental principles of legitimate political association that allegedly apply at all times and places (SC: I.6.v). The contrast to Smith is even more apparent in Rousseau’s Discourse on Political Economy, which, like The Wealth of Nations, discusses trade, the division of labor, and the proper balance between commerce and agriculture but does so from the same a priori normative perspective that guides the Social Contract. This is evident in the Discourse’s opening paragraph, where political economy is defined as the science dealing with the wise administration of a state (PE: 3/OC: 241), after which it proceeds as though the rudiments of sound economic policy could be derived directly from the principles of the Social Contract, assuming that both follow from a single normative principle, that of the general will.

Smith’s treatment of commercial society could hardly be more different. In fact, it is an example of social theory that engages in what Hegel calls “comprehending what is.” In this context comprehending involves understanding both how an existing economic system, “commercial society,” works and how its functioning nonaccidentally realizes certain ends that for this reason can be thought of as inscribed in that system itself, even if some of them may not be immediately apparent to its participants. Smith’s first aim, in other words, is to understand how a part of the existing social world actually functions rather than to evaluate it from an a priori normative perspective or to construct superior institutions from scratch. That is, Smith takes as his object an already existing economic system and asks not how it ought to function but how it (or an appropriately idealized version of it) in fact does: Which factors determine the prices of commodities and the wages of labor? How do increases in the rate of profit affect the various classes of society and the economy as a whole? What is the source of a nation’s wealth? Finding systematic answers to these questions enables Smith to see the good realized by commercial society, which turns out to consist, as it does for Hegel, in some combination of well-being and freedom. The latter value is not imposed on commercial society by Smith’s own normative commitments. Rather, freedom, conceived in a certain way, is intrinsic to the functioning of commercial society, insofar as the latter relies on the normative status of laborers as free beings who, independently of others’ wills, enter into wage-labor contracts with their employers, without which production in commercial society would not take place. Smith’s defense of the free-market economy derives not from a priori arguments about which institutions are ideally suited to human beings given their essential nature or interestsFootnote ²³ but from a comprehensive account of how actual institutions function and of what they can accomplish under favorable but realistic conditions. Similarly, his prescriptions for commercial society are limited to measures that would fine-tune an already functioning system rather than replace what exists with a more perfect, wholly invented ideal.

Examples of Social Pathology: Rousseau

An illustration of some of the claims made above about the concept of social pathology can be found in a passage from Rousseau’s Discourse on Political Economy, which, along with his Discourse on Inequality, is a founding text of the modern tradition of social pathology critique:

This tale contains several elements relevant to social pathology in imperial Rome. One is that citizens fail to “see themselves as having an interest in the common cause,” implying a lack of the civic unity characteristic of a well-functioning society. This deficiency – the absence of solidarity among citizens – manifests itself in their failure to recognize a convergence among their interests and those of fellow citizens. As described here, this failure is said to reside in how citizens perceive themselves and their relation to society. This itself might be taken as an indication of social pathology, but in this case the problem is deeper, for the absence of civic unity is not merely a matter of false consciousness. Rather, the perceptions of citizens track something real, namely, that their society is divided into factions – citizens, magistrates, paid henchmen – whose members, because of these divisions, pursue interests so opposed that consensus on what is best for all becomes impossible: The magistrates are interested in subjugating the citizens; the latter are interested in having enough to eat and in avoiding subjugation; and the mercenaries are interested only in the money they receive for defending Rome.

It is important that this problem is not merely one of injustice, for example, the citizens being subjugated by their rulers. Rather, it is that something like a tear in the social fabric makes healthy social life impossible. Civic unity is important for Rousseau because it is necessary if individuals are to be “morally free” qua citizens (SC: I.8.iii). There is an important difference between being subjugated by others and being unfree in the sense of being obligated to obey laws that one does not endorse or see as expressing one’s will. Although both forms of unfreedom are problematic, it is the latter – a forerunner of what Hegel calls alienation – that is at issue here. In Rousseau’s tale the inability of citizens to regard laws as proceeding from their own wills might well be bound up with the fact that those laws produce their own subjugation, but there could also be instances where the absence of civic unity is not due to injustice – for example, when a society is basically just but individuals do not identify with it because their institutions fail to foster in them the values or self-conceptions necessary for doing so, or where divergences among interests pose insurmountable obstacles to the formation of a general will without those divergences depending on injustice.Footnote ²⁴ In such cases, too, the absence of civic unity would constitute an ethical deficiency that has its source in nonaccidental social conditions; it would be, in other words, a social pathology.

A second element of Rousseau’s tale pointing to social pathology is the magistrates’ hiring of mercenaries or, more broadly, the inappropriate introduction of money into social relations. We should not saddle Rousseau with the view that it is bad for social relations of any kind to be mediated by money; a more plausible claim is that certain types of social relations are ruined once money comes to serve as their organizing principle. One of Rousseau’s complaints is that individuals who carry out the duties of citizens only because they are paid to do so are easily manipulated by those in power in ways that undermine the proper ends of political life. (Mercenaries let themselves be used to subjugate citizens rather than to secure their freedom and promote their good.) A further point is that “citizens for hire” tend to assume an instrumental attitude to their associates and to their own social activity. Adopting a purely instrumental attitude to what we do, and to those with whom we do it, may be consistent with acting freely (voluntarily), but when this attitude extends to much of what we do, the result is estrangement from others and from our own activities. Again, the idea is not that it is always inappropriate to relate to others as a self-interested calculator of gain but rather that there are types of social activity in which cooperation mediated by money is incompatible with the kinds of bonds and cooperation that constitute the very point of those activities. Here, again, the problem is not injustice but the failure of individuals to realize certain goods in principle available to them as social members.

Rousseau’s characterization of the hiring of mercenaries as dishonoring the legions suggests a further respect in which his description of Rome is relevant to an account of social pathology, namely, in its depiction of what has come to be called, by interpreters of Axel Honneth’s work, pathologies of misrecognition.Footnote ²⁵ This aspect of Rousseau’s tale points to a specific good, social recognition, that plays an important role in many accounts of social pathology and serves to illustrate one of the ethical deficiencies such accounts are concerned with. At the same time, Rousseau’s description of the consequences of the hiring of mercenaries brings out a more formal point about what can make a social problem, loosely conceived, a pathology. For his treatment of misrecognition does more than establish that large numbers of Romans failed to find recognition from their fellow citizens; it also diagnoses a pathology of misrecognition, insofar as it reveals the dynamic underlying those recognitive failures, enabling us to understand the social forces that perpetuate them.

The import of Rousseau’s remark that the legions were dishonored when money replaced civic allegiance as the reason to serve the fatherland is that this event, itself a form of misrecognition (of those who had served in the legions out of conviction and attachment), undermined other relations of recognition in society, generating a self-perpetuating system of recognition gone awry. One aspect of Rousseau’s account concerns the effect the hiring of mercenaries had on their self-conceptions and their sense of their own worth: the mercenaries judged their own value only “by the price at which they sold themselves.” This point is familiar to members of societies in which the market plays a dominant role: when money becomes the main principle around which social relations are organized, individuals are subject to a nearly irresistible tendency to judge their own worth in terms of the monetary value the market places on them and their services. One problem with this is that prices determined by supply and demand are ethically arbitrary. In the same way that a market responds not to need but to effective demand – production is organized not by what humans need in order to live a good life but according to what those with the greatest resources desire – it is accidental whether the measure of worth employed by the market tracks the characteristics that make for good societies and individuals.

Closely related is the fact that markets measure value according to a quantitative, one-dimensional metric: price expressed in terms of money. This encourages social members to value themselves quantitatively rather than qualitatively, less for the intrinsic merits of their qualities and achievements than for the (numerically measured) extent to which they happen to be in demand by those with the resources to purchase their services. This, too, could be described as alienation from who one is and what one does. In such circumstances we tend to value our socially beneficial qualities not because they contribute to a human good but because they serve to increase our value as determined by the price we command on the market. Moreover, measuring one’s worth by a quantitative metric makes it harder to satisfy the desire to have value in one’s own eyes and others’. In contrast to qualitatively defined ideals – being a good nurse or parent or citizen – measuring one’s worth quantitatively admits of no natural stopping point in the quest for confirmation of one’s value. Money prices can in principle always be improved on, and once this way of measuring one’s worth has been internalized, satisfaction tends to become thin and unstable – there is no reason not to seek ever larger sums of what one seeks and hence no reason to place bounds on what Hegel calls a dynamic of “bad infinity.”

Rousseau’s tale also suggests that a distorted sense of where one’s own value lies translates into a distorted picture of the value of others; a faulty evaluation of self goes hand in hand with the misrecognition of others. As Rousseau puts the point, once the hired security forces began to judge their own worth by the price at which they sold themselves – once they “believed it brought them more honor to be Caesar’s henchmen than the defenders of Rome” – they also lost respect for the state, its laws, and their fellow citizens. The most vivid sign of this is that losing respect for others allowed them to hold “the dagger over their fellow citizens, ready to slaughter at the first signal.” Yet this misrecognition is but a consequence of a more fundamental one: the fact that the magistrates no longer cared about the happiness of their subjects and, in “preferring to command mercenaries rather than free men,” ceased to recognize their subjects as citizens, whose fundamental right is to remain free from the arbitrary wills of others.

This account of pathologies of misrecognition in imperial Rome points to an idea that frequently underlies diagnoses of social pathology, that of a self-perpetuating dynamic that makes a bad situation worse and, once initiated, is extremely difficult to break. This idea cannot be illustrated more clearly than Rousseau himself does in describing another pathological dynamic in which Rome found itself caught up:

The idea of a self-perpetuating dynamic represents another way in which a diagnosis of social pathology goes beyond merely uncovering social problems and how grasping certain phenomena as pathologies can provide a better understanding of social reality than theoretically less ambitious alternatives, in this case because doing so reveals the social forces at work that explain the persistence of the social ill in question. In Rousseau’s example, the cycle of increasing poverty, taxation, inflation, and militarization makes it hard to avoid the impression that the society described, beyond the respects in which it is unjust, is internally dysfunctional in a way reminiscent of certain physiological illnesses. Apart from the diagnosis of impaired functioning, the idea of a self-perpetuating social dynamic points to another respect in which the analogy of illness seems not to be out of place in social theory: to locate the source of dysfunction in a social dynamic is to regard society as something like an autonomous, “living” system of forces, where one function affects and is affected by others and where their interaction acquires a life of its own not directly dependent on the will or consciousness of those whose activity constitutes those forces.

A similar point about dynamics can be seen in Marx’s treatment of what is now called structural unemployment. Merely establishing that capitalist societies exhibit high rates of unemployment, and that they have done so for a long time, falls short of locating a social pathology. Marx’s analysis of the industrial reserve army, in contrast, diagnoses a pathology of unemployment because it shows how the phenomenon is required by the capitalist system itself, which is to say, it shows how capitalist accumulation necessarily produces (and reproduces) unemployment and, moreover, how doing so serves the interest of the dominant, surplus value-appropriating class. Understood in this way, unemployment is more than merely a social problem; it points to a pathology because it is the nonaccidental result of an ongoing dynamic, a remedy for which requires a realignment of social structure and a transformation of institutions, rather than piecemeal attempts to stimulate a lagging economy or to provide welfare aid to those who cannot find work.

Before concluding this chapter, I want to point out two significant disanalogies between animal and social illness. The first is relevant to social ontology because it marks a fundamental distinction between the kinds of being characteristic of animal and social “organisms.” I first develop this point in Chapter 6 in conjunction with Rousseau’s claim that human societies, in contrast to products of nature, are artificial, or humanmade. The point underlying this claim is that human societies are normatively constituted entities whose workings depend on the agency, including some sort of “acceptance” of social norms, of their human members. Moreover, because the functioning of social institutions depends on the (free) agency of their participants, there is an important sense in which the continued existence of institutions, as well as potential transformations of them, is “up to them,” that is, up to those whose activities and attitudes sustain them. In contrast to the life-sustaining components of animal organisms, it is in principle within the capacity of human social members to transform at least parts of the social world they inherit from previous generations.

This means that the diagnosis of social pathologies contains a moment of critique lacking in the diagnosis of animal illness. Although even the latter involves revealing defects of a certain sort – the sick organism falls short of the standards of well-functioning appropriate to its species – in the former case diagnosis implies criticism of a more robust sort. It is appropriate to speak here of critique, and not merely diagnosis, first, because the diagnosis at issue is reflexive, carried out both on and by the very same being, much like in Kant’s critiques reason is both the subject and object of critical inquiry; and, second, because diagnoses of social pathology ascribe to their objects a kind of responsibility (to be explained in Chapter 6) and imply a practical imperative addressed to the human wills on which the illness of those objects depends.

It is important, however, to distinguish the critique involved in diagnoses of social pathology from moral critique,Footnote ²⁶ if the latter is taken to involve ascriptions of moral blame or praise for individually imputable actions. Although diagnoses of social pathology typically invoke ethical standards beyond that of efficient functioning narrowly understood, appealing to some understanding of the human good, this does not mean that the critiques delivered by such diagnoses imply moral culpability. (This point is exemplified by Rousseau’s Discourse on Inequality, which offers an ethical critique of modern society and yet, while regarding society and its ills as humanmade, does not ascribe moral culpability to those whose free actions, unintentionally and without foresight, produced the ills in question.) The main reason that diagnoses of social pathology do not imply moral culpability is that although the dysfunctions characteristic of them involve failures to realize the good, such failures result from social dynamics the persistence of which is independent of the intentions of specific individuals; ascribing blame for them to individuals is therefore highly problematic.

Even if it were possible to apportion moral responsibility for social pathologies, it is unclear what relevance moral critique would have to the main aims of critical social theories, namely, to understand, evaluate, and, when appropriate, indicate directions for transforming social life. One might put this point by saying that, whereas the attribution of moral blame is largely backward looking – concerned to establish whose actions are causally responsible for a certain state of affairs and, when to appropriate, to attach moral blame to those responsible – theories of social pathology are forward looking in attributing responsibility to social actors (in the sense of: “It is up to us to transform the world our actions maintain”). Such theories ask not: “Whose actions created our condition, and what good or evil intentions do they express?” but instead: “How are existing institutions bad for us, what social forces maintain them, and how can we collectively transform them?” Theories of social pathology can criticize institutions for being unjust and for being less good than they can be, giving us reasons to seek alternatives, but figuring out whom to blame for those institutions is not a principal concern.

To take the classic Marxist example: the “moral capitalist” who comes to regard the wage–labor relation as unjust and therefore refuses to participate further in the system – perhaps even giving away his accumulated capital for relief of the unemployed – may be in some way morally laudable, but his actions, because they do nothing to alter the systematic injustice that motivated his withdrawal from the system, remain irrelevant from the perspective of social theory. Or consider cruel or environmentally harmful agricultural practices (which, the social theorist will remind us, became pervasive only after family farms were ruined by entities ruled by the logic of “agribusiness”). While there might be room somewhere for finding individuals morally guilty of inhumanely enclosing livestock or of overusing chemical fertilizers, doing so is of little concern to social theory. Apart from the fact that the agents of such practices are largely corporate entities rather than individuals, whatever moral badness those practices contain does not explain why they exist (and persist). Again, understanding, evaluating, and transforming social practices depends not on assigning moral responsibility but on understanding the social forces and conditions – the logic of capitalist accumulation but also the absurd, manipulated “preferences” and habits of consumers – crucial to explaining why the agents involved act as they do.

The other disanalogy between animal and social illness poses a more significant challenge to my project since it can appear to cast doubt on the wisdom of attempting to rehabilitate the concept of social pathology. This issue came to my attention in discussions of that concept with nonacademics, when the question frequently arose, “Have there ever been human societies that were not sick?” This initially startling question, to which the answer is immediately obvious, reminded me of the greatest of all diagnosticians of cultural pathologies, Nietzsche, and of his haunting remark – a fitting epigram for Rousseau’s Discourse on Inequality – that “the human being is more sick, more uncertain, more changeable, and more unsettled than any other animal; of this there is no doubt – the human being is the sick animal” (GM: III.13). The import of Nietzsche’s remark is twofold. First, it raises the possibility that no human reality – and hence no human society – can be completely void of illness, so that to wish illness out of the social world is to wish away its humanness. Second, the context of Nietzsche’s remark suggests that it is precisely this tendency to fall ill that not only makes human existence “interesting” (GM: I.6) but also creates the conditions that make possible great spiritual health (GM: II.20). Taking these points seriously appears to render the social pathologist’s aspirations doomed to failure, naïve about the conditions of the human good, and, worst of all, inimical to the optimal development of the human species.

What, if Nietzsche is correct, are we to make of a social theory whose chief aim is the diagnosis and cure of social pathologies? An answer to this question can be found in Nietzsche’s thought itself. For, as he recognizes, the fact (if it is one) that human societies are always somehow ill implies neither that all are equally ill nor that all illnesses are equally dangerous. Nietzsche makes this point in characterizing the cultural world bequeathed by Christianity to nineteenth-century Europe as plagued by “the most terrible sickness yet to have raged in the human being” (GM: II.22), an illness that risks exhausting the very source of human vitality and bringing about “the great nausea, the will to nothingness, nihilism” (GM: II.24). Or, to put the point differently, there are healthier and less healthy ways of dealing with a condition in which illness is unavoidable. (The ancient Greeks’ conceptions of their gods and what is owed them is an example of the former.) In the first place, the value Nietzsche attaches to human self-transparency, if not unconditional or overriding, is sufficient to convince him that, apart from all prospects for a cure, there is a point to diagnosing human illnesses – revealing them for what they are – rather than “suffering” them, unspiritually, in self-ignorance. Beyond this, however, he recognizes that the impossibility of eradicating illness is not a reason to let it simply run its course without seeking to meliorate it – including the needless or unproductive forms of suffering it causes – or to mitigate the dangers it poses to human well-being. Indeed, no one (with the possible exception of Freud [Whitebook Reference Whitebook, Leuzinger-Bohleber and Haubl2011: 120–42]) deserves the title “diagnostician and treater of spiritual pathologies” – or “philosophical physician” – more than Nietzsche. All this confirms, it seems to me, that diagnosing and combating social pathologies remains a legitimate aim of social theory, even if there has never been, and never will be, human social life free from all illness.