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Wednesday, 17 October 2012

A SUITABLE CASE FOR TREATMENT?


This piece is a commentary on the impact of austerity and capitalism on mental health, and was first posted on the the HullRePublic website, which can be found on Twitter @HullRePublic…



“Depression,” says Mark Fisher,”is the shadow side of entrepreneurial culture, what happens when magic voluntarism confronts limited opportunities.” In the rest of his Guardian article, in response to the news that suicides among older men are rising, http://www.guardian.co.uk/commentisfree/2012/jul/16/mental-health-political-issue, he argues for a deeper understanding of the political dimensions of mental health.  He cites the Calum’s List website, which lists suicides in which welfare cuts have played a part http://calumslist.org/ and which has been savagely attacked by right-wingers as ‘politicising’ mental health on the grounds that “welfare suicides don’t exist. Suicide is a mental health issue.” However, what has been clearly illustrated in places where the economic crisis is particularly acute is that economic insecurity impacts powerfully on mental health. Greece used to have the lowest suicide rate in Europe at 2.8 out of 100,000 when the crisis began 3 years ago. Now it has double that figure: figures show a 40% rise over a 12-month period, an appallingly steep increase.

However, I would argue that capitalism itself, even when it is not in crisis, has profoundly negative effects upon mental health, in particular, although not exclusively, upon that of the working class. This is related to lack of control and the distortion of creativity in the process of what Marx called ‘alienated labour.’ Even before the economic crisis began, the treatment of mental illness was often based on incorrect assumptions and incomplete analysis. But with the rise of neoliberal capitalism, its marginalisation of alternative models of society and of cultural and political dissent, the increased manipulation of popular consciousness and the rise politically of what Tariq Ali refers to as the ‘extreme centre,’ radical social critiques, including those of psychiatry, have diminished. The ‘anti-psychiatry’ of such practitioners as David Cooper and R.D.Laing , which related many kinds of mental distress to the way society operated, in particular through the institution of the family, have disappeared. In particular, the Marxist theory of alienation has ceased to inform models of psychological thinking.

A general sense of how human beings experience their life activity as something external, alien and hostile to them has evolved over several centuries, developing out of the writings of Rousseau, and later Hegel and Feuerbach. The special understanding of it developed by Marx, however, saw it not as an inevitable part of the human condition but as connected to particular ways of organising human activity. Dan Swain, in his excellent book on the subject, http://resolutereader.blogspot.co.uk/2012/03/dan-swain-alienation-introduction-to.html, quotes Bertell Ollman: ”Alienation is the intellectual construct in which Marx displays the devastating effect of capitalist production on human beings, on their physical and mental states and on the social processes of which they are a part.” The absence of workers’ control over their own creativity in a system where they simply create commodities, and are themselves commodified, has a huge impact. Any theory of psychology which does not contain some sense of this, and of the ways in which the politics of production adversely affect mental health, is not addressing reality. 

Rather than locating psychological suffering in a society which placed impossible and contradictory demands upon people, healthcare in the 1990s increasingly located it deep within the neurochemical transactions and DNA of the individual. This model, of course, hugely benefitted the big pharmaceutical companies, whose PR people heavily promoted the drugs to GPs. The philosophical model used was related less and less to the dialectic of social and economic relations and focussed more and more, in a modern version of ‘balancing the four humours’ of ancient Hippocratic medicine, on chemical deficiencies, excesses, imbalances: things that could be cured, or at least treated, with chemicals. Psychiatric treatment for psychological and emotional disturbances of all kinds became essentially extended drug therapy, with short bursts of cognitive behaviour therapy (CBT). Patch ‘em up and send ‘em back to work, which was in many cases the very thing which was driving them crazy in the first place, although, paradoxically, unemployment and lack of money does the same thing, often more quickly.

But the profit motive, especially in conditions of free market capitalism, distorts our attempts to understand, and cure, ourselves. For example, Darian Leader in the Guardian points out how the huge increase in the diagnosis of bipolar disorder over the last 15 years coincided with the patents running out on the big-selling tricyclic antidepressants in the mid-1990s. This meant that bipolar products became the recipient of the big pharmaceutical companies’ marketing budgets, and the drugs involved began to be aggressively promoted.  The World Health Organisation now regards bipolar disorder as the 6th main cause of disability for people aged 15-44. In children, the diagnosis has increased by over 400%. A similar process occurred in the early 1990s with the increase in diagnosis of attention deficit hyperactivity disorder (ADHD) especially among troublesome or disruptive schoolchildren. This apparent shift in diagnosis, which was actually a shift in patterns of capital accumulation in the pharmaceutical industry, exposes how capitalism commodifies everything, even human suffering. The most subjective dimensions of life become part of the cash nexus. This ‘medicalisation’ of human experience can similarly be seen in the treatment of depression and anxiety, and in the widepread use of antidepressant drugs like fluoxetine (Prozac, Sarafem, Fontex) http://en.wikipedia.org/wiki/Fluoxetine. Millions of people are now routinely treated with a range of these selective serotonin reuptake inhibitors (SSRIs). In 2010, over 24.4 million prescriptions for fluoxetine were filled in the USA alone. Under conditions of deregulation and rudimentary public scrutiny it is hardly surprising that, like the banks, the pharmaceutical companies often indulge in behaviour which is unprofessional or downright illegal. At the time of writing the British pharmaceutical giant GlakoSmithKline has pleaded guilty to criminal charges and agreed to pay £3 billion to settle the largest case of healthcare fraud in US history, relating to the mis-selling and mis-marketing of antidepressants. This involved distributing a misleading medical journal article, and inducements to GPs included free meals, spa treatments, European hunting trips and even tickets to a Madonna concert!

This is not to say that all these drugs have no use value. For millions they alleviate psychological suffering and enable people to cope when otherwise they could not. But while it would be facile to argue that the roots of all mental illness and distress are economic and political, it is equally the case that the economic restructuring of society, over the decades of free-market ‘reforms,’ treats people more and more either as consumers, or as workers with few rights, and less and less as human beings. The economic changes in society that governments are attempting to enforce in the wake of the banking crisis are producing widespread and profound human suffering, which is duly creating social unrest but also an increase in mental distress which will not be solved by the development of some new SSRI.

Mark Fisher believes that most psychiatrists today assume that mental illnesses like depression are caused by chemical imbalances that can be treated with drugs. But it’s also the case that, even when it’s available, psychotherapy today does not address the social causation of mental illness. The radical therapist David Smail argues that Thatcher’s infamous utterance that ‘there’s no such thing as society’ finds an ‘unacknowledged echo’ in almost all approaches to therapy. Today, as societies go through the economic shock therapy which the banks and the International Monetary Fund prescribe, we need to reclaim our own lives and, in the process, the very notion of therapy. The struggles which are coming will be political, but they will also be about exactly what it means to be human. True empowerment, not the managerial travesty of that word, occurs when, in the process of effecting social change, we change ourselves.

There is a lovely story, set, I think, in Poland during the period of the Solidarnosc independent trade union, a time of immense social upheaval and popular resistance. It describes a psychiatric hospital where, during this period of ‘people power’, patients suddenly began to discharge themselves, saying they no longer felt ill. There was a time when the wards were deserted. Then they slowly began to fill again. But this time it was with a different social layer: this time it was not workers, but managers.        



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