Mrs Thatcher the Prime Minister of the UK Government PLC in the 1980s, and one of the architects (with Reagan of the USA) of neoliberalism, referred to the miners’ Union under Scargill’s leadership as ‘The Enemy Within’. Perhaps the sadistic destruction of the mining industry by a masochistic corporation, British Coal (under the American McGregor) is a metaphor, and a forerunner,  for the autoerotic self destruction of the individual today within the discourse of the market. British Coal had to destroy itself by consuming that which enabled it to exist. Perhaps Capitalism itself will one day also self destruct by the consumption of humanity as we know it, the humanity that enables capitalism to exist.

Below I am going to link relationships between structures of discourse consisting of a ‘truth’, that supports the activities of an ‘agent’, that puts to work a tool to produce a commodity.

And now the jump to medicine. The expert physician has the means of production, this is ‘all knowledge’ (S2)- arcane, mathematical and beyond the ken of mere mortals – this is the discourse of the University. ‘All knowing’ expert (S2), puts to work a gadget, the ‘medical-test-dia-gnosis’ (tool of the hetero-genesis that is dia-gnosis), known as ‘a’ in Lacan’s typology; the test heterogeneticises and produces the subject, like Foucault’s madman, always already ‘marked’ by the process of hetero-genesis (that is dia-gnosis) as the ‘patient’, $ in the typology. The truth that warrants the experts knowledge is S1 – the logic of mathematics, and the mechanistic autonomous rationality of probabilistic reasoning and the Cartesian Mind.

Evidence Based Medicine is stuck on this Cogito of Descartes and this discourse of the University, and remains alienated from its product the patient; and reinforces the loss of the Master experienced by the subject of the discourse of the Market, of capitalism.

The dynamism between the structure of the University for both the medical expert and the ‘patient’ and the structure of the discourse of the market is the transition between states of neurotic and perverse psychic structures from anxiety about the indeterminism of the desire of the other (little ‘o’ refers to a concrete other in front of me) awareness of the lack of the Other (capital ‘O’ refers to an imaginary fantasised Big Other, witness that sees me as I am) being personified by the lack of the concrete other.  The patient’s desire to be desired by the expert, seeing the expert as lacking and a void that the patient seeks to fill by being desired – the relationship, like the neurotic sexual relationship that must always reach an impasse and fail. The market of capitalism entails the disavowal of the Other, though the Other is still functioning as a disavowed witness in the unconscious.  The autoerotic paradox is that the sadist refuses to be the incarnate flesh object, for the patient now has to be his own subject-agent, sadistically forcing himself to desire  and attempt to achieve satisfaction by forcing himself to be flesh, the object of his (as subject’s) desire. And then, when flesh is offered up by his masochistic objectivity satisfaction must be refused to torture the masochist objectivity within.

As the flesh is sacrificed in hope of satisfaction it is simultaneously refused as inadequate for satisfaction. The masochists hoped for total humiliation as the object of the sadist-within’s satisfaction is dashed, and the sadist’s hope to see the masochist humiliated and objectified is also dashed and the whole process must be repeated ad infinitum  to attempt to achieve satisfaction, again and again. This is the impossible libidinal circle the patient and the medical expert both play independently of each other within the structure of the discourse of the market, roles they can play using the tools and structures set up by the discourse of the university. What is the role of the discourse of the university here? Presumably it does continue to counter to some extent the discourse of the market as it does continue to be evident, evidence of neurotic anxiety. So can structure of neurosis and perversion exist within the discourse of the market? The market induces an ontological solipsism and is the end result of a process ontology theorised by Marx’s historical materialism. The neo-human necessitates the death of man, is defined by tools that enable permanent regeneration of a neo-humanity – perhaps through no longer a Heideggerian becoming?