By David Hugh Hartery
Taken from http://www.communistpartyofireland.ie/sv/07-health.html
Going hand in hand with a reduction in the stigma attached to mental illness is a growth in diagnoses. Some of this can be attributed to better health education, leading to fewer sick people going untreated; but with unprecedented numbers now receiving treatment, we have to ask, What part of modern society is making us ill?
This article does not aim to critique the practice of mental health treatment under capitalism—though Peadar O’Grady’s excellent “Stop making sense: Alienation and mental health” in Irish Marxist Review (no. 11, 2014) provides that analysis (and some of it is relied on here); instead it tries to explain why the capitalist system necessarily causes stresses—leading to mental illnesses—and how the very response to that phenomenon has been weaponised by capital.
Firstly, part of the reason for an increase in diagnoses is a definitional one. Increasingly, normal aspects of life under late capitalism are medicalised. Stress, anxiety and uncertainty are often foundational (even laudatory) aspects of the capitalist system, with the precariousness of workers’ contracts seen as a boon to bosses and working yourself to your stress limits seen as dedication, which will be rewarded.
In this way, it could be argued that the anxious, medicated, CBT-practising precarious worker is in fact the ideal citizen of late capitalism.
Marx’s assumption is that humanity is defined by how it labours: there is a drive to create new surpluses, new needs, new value. Alienation from labour, however, is obviously a precondition of capitalism, necessary for the extraction of surplus value.
However, such alienation has takes a psychic toll, with a survey by the British government showing that workers at lower rungs of professions exhibit higher levels of stress than their bosses. Similarly, the report of the Anxiety and Depression Association of America for 2006 shows that workers who were given more autonomy showed less signs of mental illness. Alienation, then, is a scale, and when the degree of alienation increases we see more mental illness or distress, and when it wanes, workers should see mental and physical benefits.
However, such forces have existed since the advent of capitalism. What has led to the surge in mental illnesses in late capitalism? The tendency of the rate of profit to fall—and its effect on the balance between work and life—has a lot to do with this. In the modern neo-liberal order, work is increasingly precarious and highly specific: this is necessary to get the maximum productive value from each worker, as capitalists try to arrest this fall in profit. The advent of zero-hour contracts and an app-based service economy has provided a new way to circumvent hard-won employment protections and introduce a culture of scientific management through the back door.
Even the liberal paragon of employment, the tech start-up, inculcates a culture of absolute devotion through the provision of sleeping areas, free food, and on-site leisure facilities. Tech companies exploit the passion of computer enthusiasts to create a culture of competition—and long working hours. The increasing use of productivity micro-targets in all work-places also adds another stress factor to employment.
When combined with long commuting times, poor nutrition from convenience food and a highly sedentary life-style, this mix of stress and poor self-care is toxic to mental health. Sleep, long established as one of the primary factors in preserving our mental resilience, is also affected by these long, stressful days—with Silicon Valley investigating pills that would defer the need for rest, allowing capital to further colonise sleep. Coffee, however, is our current substitute.
In the face of these factors, these stressors, there is an understandable outbreak of mental illness.
The culture of individuality, so prominent in the economic sphere since the 1980s, is also the predominant mode of combating mental illness. It’s impossible for health to be conceptualised within the wider socio-economic framework when the “blame” for mental illness is individualised. We are told to “Please talk” or to watch the “little things” that will foster better mental health, but there is no talk of the systemic factors that lead to illness. The closest that practice will come to understanding how capital divorces us from our human nature is to talk of the importance of “occupation,” a term that practitioners strive to keep “apolitical” and often a synonym for busywork.
Cognitive behavioural therapy (CBT) is perhaps the most egregious example of this. It works through teaching patients to think about their life differently, positing that through thinking more “factually” about events and behaviour we can learn to stop “negative automatic thoughts” and improve the quality of life.
CBT is cheap, short, and scalable, so it has become the poster-child for the neo-liberal health model. It does work for a lot of people—though, as the excellent article “Therapy wars: the revenge of Freud” by Oliver Burkeman in the Guardian (7 January 2016) explains, the success rates are dropping continuously; but it is a sticking-plaster for a social ill. The increasing use of programmed CBT artificial intelligences in many health services, or drop-in centres dispensing CBT worksheets without access to a practitioner, shows how the CBT practice is becoming increasingly cold and inhuman.
We cannot “fix” mental illness by socialising more, arbitrarily choosing to think differently, or making token life-style changes. This amounts to mere commodity consumption, something that can superficially fill the gaps in our human needs, but does not fix the underlying problems of alienation. Our position within the socio-economic system dictates whether we can meet our needs through satisfying work or whether we are left to seek fleeting relief through rituals of consumption.
When we look at the incidence of mental health among homeless people, the incarceration of vast swathes of “undesirables” in mental health asylums throughout Irish history, the tragedy of addiction and the prevalence of mental health issues among the working class, we can see that mental health is undeniably a class issue, and one that is getting worse.
Instead of celebrities enriching themselves through bourgeois calls for “awareness” we need to form a comprehensive, politically aware response to this crisis.