Well worth reading are two articles by Mat Little that is well worth quoting extensively and adapting into one. The originals can be read here and here
While we are quite able to look back with clarity on the deficiencies of past epochs, says the Belgian psychoanalyst Paul Verhaeghe,“we are blind to what goes on in our own day and age.”
The UK charity, Mind, which has as its tagline “for better mental health”. The charity aims to ensure everyone experiencing a mental health problem gets help and support and is a member of Time for Change, a coalition of charities that campaigns against mental health discrimination and stigma. There is nothing wrong with any of this and Mind does important work trying to make sure people with mental health problems are not unfairly affected by the Work Capability Assessment and other benefit atrocities. But if you really want to achieve “better mental health” you have to extend your gaze immeasurably. You have to examine how the current organisation of work generates mental distress rather than mental health, how the claustrophobic inescapability of work coupled with ever-present disposability is a cause of both mental and physical illness, how inequality generates distress, and how the erratic quality of early childhood relationships incubates mental problems that emerge later in life. And, in these times, you have to confront how the onslaughts of austerity are exacerbating or creating mental distress.
In other words, you would have to delve - as the twentieth century German psychoanalyst Erich Fromm did – into what brings about a ‘sane society’ and what causes its opposite. This would inevitably take you into controversial and difficult issues, such as how success in contemporary society is dependent upon the fostering of certain characteristics, such as (in Verhaehge’s words) “flexibility, speed, efficiency, result-orientedness and articulateness in the sense of being able to sell yourself.” And how the lack of these skills leads to self-blame.
But Mind and other mental health charities wouldn’t dare approach any of these issues. To do so would take you away from symptoms, which can always be ameliorated or looked upon in a different way, into the dangerously “political” waters of root causes.
The pervasiveness of mental distress in developed capitalist countries inspires two contrasting explanations. One is to assert that the pharmaceutical industry, having comprehensively infiltrated the medical and psychiatric professions, is now manufacturing diseases to match the drugs available. What used to be ordinary sadness has been rebranded as depression, an illness that can conveniently be combated by the dispensing of billions of pills to correct a chemical imbalance in the brain; a ceaseless process that coincidentally makes fantastic profits for Big Pharma.
The other reaction is to contend that capitalism is generating a “mental health plague”, causing an acute intensification of emotional distress, depression, anxiety and personality disorder. Inequality, consumerism and an inescapable obsession with work are combining to produce an epidemic of mental ill-health. Pharma companies are merely cashing in on the ensuing wreckage.
The number of anti-depressants dispensed by doctors in Britain nearly doubled since 2001 and accelerated since the financial crisis? (and, no, you can’t pin all the blame on pharma companies pathologising sadness.) ‘Cognitive behavioural therapy’ (CBT) is now the UK National Health Service’s mental health treatment of choice (apart that is from prescribing those anti-depressants).
But perhaps these two perspectives are not as far apart as they first appear. According to Paul Verhaeghe, what has happened to the understanding of mental distress in recent years is that symptoms have started being reclassified as diseases. One example is attention deficit and hyperactivity disorder. Because a child is hyperactive and has difficulty concentrating, they obviously have ADHD. The inference is always that because a disease has been diagnosed, the source of the problem must be neurological or genetic, and can be treated by drugs. Verhaeghe says we are trapped inside circular arguments and pseudo-explanations: a person has ADHD because they have difficulty concentrating and are hyperactive and they have difficulty concentrating and are hyperactive because they suffer from ADHD. Breaking out involves accepting, in common with the British Psychological Society and the World Health Organization, that mental disorders are primarily caused by social factors.
This would lead into subversive areas. Can autism or schizophrenia really be seen as social disorders? There would be enormous resistance to this, not only from the psychiatric profession, but also from mental health patients themselves. In the UK, as in many countries, people with mental health problems have to fight to prove there is something medically wrong with them in order to receive welfare benefits. It would be a short step from emphasising the underlying social cause of many mental problems to affixing responsibility for the problem to the person suffering from it, or even denying there is anything fundamentally wrong with them.
Yet, because a disorder is classified a symptom, rather than a disease, a social rather than a genetic problem, does not make it any less real, or any easier to cure. Nor does it mean some people are not more genetically prone to suffer from it than others. A changed social environment will ameliorate mental health problems for some people. For others it will make no difference. But that is not the point. What this acknowledgement what do is allow the integral role of society in generating mental health or illness to be accepted. Then, the onus would firmly be placed on changing society, not altering brain chemistry or patterns of behaviour.
We know that gross inequality feeds mental distress, and that a consumer society that constantly presents images of others enjoying the blessings of a materially superior life, are lethal to feeling good about yourself, yet vital to a capitalist economy that lives on the profits of selling more and more products. Turning away from ourselves and instead concentrating on changing the external world may be the route to better mental health. The Second World War in Britain was a time when the country definitively turned away from private concerns to face an external enemy. Yet, contrary to the predictions of psychiatrists, mental distress declined during the war. Physical health also improved and perhaps even more counter-intuitively, life expectancy in Britain during World War 2, rose. If, as clinical psychology suggests, powerlessness and helplessness are the most toxic of emotions, then a sense of being able to influence how the world is constituted, turning our gaze from inside to outside, can be a way out of the fog.*
CBT tries to get the patient to change their attitude to the world around them, and in the process, come to understand that the complexities and frustrations it generates are, in fact, produced by themselves, not by other people or the world outside. It tries to get the patient to view their problems in a new light by talking them through. CBT, this society’s response to the epidemic of mental distress, is actually a microcosmic version of its belief about how a healthy person should live their life. Happiness, or its lack, is the personal responsibility of the individual, and can be attained with the right attitude. The outside world is taken as an unchangeable given. If the conventional route of career advancement doesn’t work, or doesn’t supply enough meaning, there are legions of self-help or positive thinking regimens to fill the void. If that doesn’t satisfy, versions of Eastern religion and Buddhism are on hand to provide ancient wisdom. But what all these different disciplines have in common is an unshakeable focus on a person’s internal life, not the world ‘out there’. And when the world doesn’t respond as it should, there is no-one to point the finger at but ourselves. The sociologist Richard Sennett has made the disconcerting discovery that in recent years, people who are made unemployed for structural reasons, nevertheless blame themselves for their joblessness. The UK government seeks to change attitudes among unemployed benefit claimants as if that is all that is holding them back. But a go-getting attitude will not make falling real wages rise, turn last-ditch self-employment into an entrepreneurial road to riches, or transform workers into anything other than “labour costs” for those eager to exploit them. Social problems will not be solved by individual solutions.
We are, says the writer Dan Hind, offered various regimes of “self-administered mind control”. Dan Hind, in his book writes “The Return of the Public, “There are few of us who wouldn’t benefit from some time spent talking in confidence with a qualified professional,” he says. “But all of us would benefit from talking with one another about matters of common concern.” He advocates the formation of assemblies in each Parliamentary constituency to debate issues of public concern. Freedom, he says, “requires the opposite of solitude”, and a place to meet other people in conditions of equality, not seeing them as economic rivals or clients, may be the opportunity to turn away from ourselves that we most need.
Mat Little, himself, suggests:
“ A serious endeavour to “de-marketise” our society, to provide a basic and secure income for all, to return public services to a concern with the experience of the user, not the profit of the investor, to supply the basic necessity of decent housing, and above all to reduce the sense of being ripped off and exploited at every turn, would, I am sure, result in a quantifiably mentally healthier society. Certainly, a less anxious one.”
We would go a bit further than he since he still seems to believe that our society requires a basic income and welfare state. Our answer is one that has as a principle, free access to the collective resources of society, a universal entitlement more encompassing than the so-called basic-income, “from each according to ability, to each according to need”
*This blogger has previously touched upon the topic of indigenous suicide and quotes Professor Colin Tatz of the Australian National University suggests that when you are engaged in a struggle, a struggle to survive, suicide rates are very low. In apartheid South Africa there were few suicides among blacks. When people are involved in a struggle there is a reason to exist. Psychiatrist Professor Martin Graham from the University of Queensland, believes ‘ There is a deep sadness among Aboriginal peoples and that that translates to a sense of anomie perhaps. A kind of deep sense of sadness and boredom and dispiritedness relating to loss of land, loss of culture, loss of languages in some cases and a sense that none of it can be changed. So despite all of the government money going in, despite all of assistance that has been offered, despite a whole range of programs like the Life Promotion Program, for instance, this sense of deep despair remains and Norm [Sheehan] would track it back and say it’s probably related to a sense of distress at the genocide that was perpetuated by white Australians from 1788. That kind of makes sense to me but it kind of doesn’t make sense to me because if you believe another group is trying to kill you off surely what you do is fight that and try to stay alive and live longer than the bastards?’
But, the ‘refusal to die’ solution is something many governments will become wary of. In ‘Dying to Please You: Indigenous Suicide in Contemporary Canada’ by Roland Chrisjohn and co-authored with Shaunessy McKay and Andrea Smith we read:
‘We have no doubt that the most positive ANTI-SUICIDE program for Indigenous peoples that has been seen in Canada in the last few years is the Idle No More Movement, Indians behaving like Indians, which at the same time was perhaps the scariest thing seen by the government.’ The authors explain, ‘Suicidology has chosen to reformulate the question: ‘Why are Indians killing themselves at such high rates?’ as ‘What’s wrong with Indians that makes them want to kill themselves at such high rates?’… Models of Indian suicide are individualistic, relying on supposed internal characteristics instead of looking at…social, economic, and political forces impinging on Aboriginal Peoples…. We invite suicidologists to stop peering inwardly, start looking at the world around us, and see what’s happening to us all.’