Jane Stratton and Lauren Wroe argue that mental health is an anti-capitalist issue. Originally published in May 2010.
Neither of us are experts in mental health, nor do we have a long history of involvement in radical or democratic health activism. We don’t claim to know everything about these issues. We weren’t around in the 60’s/70’s when movements around democratic mental health really took off in the UK, the States and other areas of Europe, particularly Italy. One of us bought Deleuze and Guattari’s ‘Anti-Oedipus’ four years ago- it’s been a good door stop so far.
However, what we have seen through our initial encounters with mental health activism and mental health organisations and services is a lack of analysis and critique that we have come to expect where our friends and colleagues have engaged in other political, social and environmental issues. Our gut instinct is that mental health, and in fact most kinds of health care, are seen as personal issues that are either best dealt with by professionals or through personal choices such as alternative healthcare, healing or therapeutic communities or alternative self-help groups. In this article we are not pushing for another single issue campaign, or for the exploration of alternatives to mainstream psychology (although we recognise the importance of these). What we are asking is why isn’t health, and especially mental health an issue that we more regularly see as part of our anti-capitalist politics?
Here we want to talk about our own experiences and why we think mental health, when looked at with the same level of analysis as many of the other issues we engage in, should be an ongoing point of conversation for anti-capitalists. We hope to feed into a conversation that we rarely hear in our networks and to find those people who are already talking about these issues politically.
The ‘anti-capitalist movement’ we have been a part of in the UK (we offer this definition very broadly and with caution!) constantly strives to create its own infrastructure, whether this is motivated by apocalyptic visions of the future or autonomy from capitalist social relations (or both) everyone’s at it. Squats, housing co-ops and social centres. We build our networks to consist of people who can do accounting, plumbing, squat defending and cooking. We like doing things together and creating our own spaces, and we know how to do it. But for the past too many years we’ve arrived in fields around the UK and Europe, put up some tents, made the running water happen, fought the cops and then… invited a group of ‘action medics’ to set up a tent where we’ll later go to them with our splinters. On the one hand we strive for autonomy and on the other we treat some of our individual and social needs as services to be provided by others. The effect of this is not only that we hand over responsibility and control of our physical and mental health to others, but that we fail to engage with health as a political issue.
For example, in another time and place, some people are starting a transition town group in their local area. In transition town collectives working groups for all the vital aspects of life are set up. This time we remember that health needs addressing. At our first transition town meeting, we attended the health brainstorm. We listened to people discuss the morally deplorable manner with which the NHS disposes of its waste, and casually (probably under-)estimate the amount of plastic that the NHS uses so irresponsibly, “How can we go about persuading them to return to sterilising metal equipment?” Beside providing another example of our obsession with carbon emissions at the expense of social issues, we again failed to identify health as political.
We always seem to forget about health. We talk about authoritarian immigration laws, ID cards infringing on our civil liberties, incarceration of political prisoners (etc. etc.) but a quick look at the health section of Indymedia shows a fine example of the lack of debate there is in our movements around healthcare. There are hardly any posts under the health section of the web page and the ones that are there are mostly concerned with animal rights and incinerators. Why don’t we talk about how capitalism creates mental and physical health problems on both a global and individual level? Or health inequality? Or arbitrary diagnostic criteria that attempt to pathologise the personal burdens we carry from living in such a demanding society?
Mental health and anti-capitalism
When attempts are made to tackle issues surrounding mental health we seem more than happy to tolerate a conspiratorial understanding of society and power that we deplore elsewhere (psychiatrists controlling the masses etc. etc.). The authors believe it makes more sense to understand mental health discourses and practices as largely economically contingent, rather than as the result of some reactionary ideology peddled by a brain washing elite. Mental health practitioners are bound by the same economic limitations and requirements as everyone else, drugs are always the first port of call because they’re cheap, and, as we all know, medical science and research is dominated by pharmaceutical companies because the research just couldn’t happen without their money (significantly the majority of randomised clinical trials undertaken to evaluate the efficacy of drugs versus other forms of therapy are sponsored by the very same companies who manufacture the drugs). But the problem runs deeper than this, historically the industrial revolution facilitated new attitude to ‘madness’ and health, the transformation of nature through manufacture opened the way for ideas about the transformation of people, through transformative therapies and rehabilitation. We saw a move away from the view that madness was an incurable affliction and a move toward therapies intended to ‘cure’ what were now understood as mental illnesses with the view of rehabilitating people back into cooperative and productive members of society. Capitalism requires us to be productive and thus mental health practices and discourses are oriented towards this necessity.
Attempts at reforming mental health services without addressing capitalism inevitably fail. Moves to community care were seen as a great success for the democratic mental health movement in Italy where psychiatric institutions were abolished and all psychiatric and mental health services were outsourced into the community. The eighties and nineties saw a similar move in the UK. Victorian asylums were closed and psychiatric and psychological services were moved into the community. Whereas there is no doubt that psychiatric services are now ‘better’ than they were in the sixties, the failure to challenge the entirety of the system within which mental health services are situated led to what has been described as the mere outsourcing of psychiatric services into peoples homes. The asylums may have gone but the institution hadn’t and couldn’t change.
On a more grass roots level we also limit our potential for change when we revert to DIY life-stylism rather than radically critiquing the health service and the economic system and social processes that produce it. Anarcha-feminists are generally better at politicising health, it was feminists who focused the idea of autonomous health by starting to check their own breasts for lumps. But they also fall into a trap of lifestylism often talking about how to deal with ’so called’ PMT or how to make your own sanitary towels (we hope never to sit through one of these again) rather than how political and economic forces negatively affect people’s everyday experience of healthcare. Why do we never have a radical position on why most health resources are used treating the results of excessive food, alcohol and drug consumption? It’s not enough to encourage healthy, green, organic and active lifestyles or tell people to stop watching telly and get an allotment. In practice this is what doctors try to do everyday in order to lower peoples’ cholesterol and blood pressure, but after years of experience, they know they will always revert to drugs. Similarly it’s one thing to tell someone with high blood pressure to do a bit more exercise and quite another to tell someone suicidal who probably has inadequate housing and may be unemployed to radically change their lifestyle. That just doesn’t cut it for the majority of people. Instead let’s talk about society and what makes it that way.
Consumer and individual choices alone do not carry the antagonistic element that would have the potential to realise change in our society. Whilst this reduction of social problems to the individual diverts attention it also places undue pressure on people who already live in a highly pressurised and externally managed environment. Many attempts at linking Marxist theory and mental health have identified alienation as having psychological or individual origins, but alienation originates from social organisation. Capitalism and the State require us to be active and productive citizens, to embrace our ‘rights’ and responsibilities and to participate equally in liberal democracy. We are dispossessed by society and labelled mad or unfit not then, because we are seen as being ‘possessed’ (as was once the case), but because we are no longer useful. Our focus therefore has to be on this form of social organisation that requires us to participate in limited and pre-determined ways.
This leads us to one other concern, and that is the anti-medical, anti-corporate or anti-progressive streak that dominates some areas of mental health activism. A progressive socially critical position recognises that capitalism manifests in the ways we relate to each other in our everyday activities and not just in the big corporate monster or your local super-market. Rather than throwing the baby out with the bath water we feel that certain technological and social advances, whether that’s drug treatments, medical science or professionalised health services, should be embraced as the product of human creativity and innovation with a valuable and necessary role in society rather than purely as the product of an exploitative capitalist economy. For example rather than shouting down anti-depressants, we should talk about why capitalist economics make antidepressants the best and most ‘effective’ treatment for every person experiencing depression? Instead of criticising health and social care workers, we should recognise the time pressures on their work, the necessary corporate funding that keeps training courses, institutions and research centres afloat and the knock on effect this has on how health services are delivered.
Finally, we feel it’s worth saying here that we are not denying the truly debilitating impact of some emotional and psychological experiences on people’s lives. By saying that mental health has a social and economic dimension we do not intend to belittle the experience of the individual, rather we are asking that our understanding of and activism on health issues has an antagonistic element and a social orientation.
Continuing the conversation
Like we said earlier we’re not pushing for another single issue campaign, rather we’re asking that when we are confronted with issues regarding mental and physical health we see them as political and as part of our struggle as anti-capitalists. Alternative approaches to a range of psychological ‘illnesses’ and experiences exist all over the country, the Hearing Voices Network works with people on an individual and collective level toward finding new ways of understanding and living with experiences of voice hearing. Mad pride and ‘bed pushes’ through city centres are examples of attempts to highlight the injustices experienced in the mental health system and to offer a voice for the ‘dispossessed’ to shout back. But rather than focusing too much on solutions and protest we want to continue exploring how ‘madness’ and health are embedded in social and political processes. We believe that the movement towards a truly democratic ‘mental health’ must be an anti-capitalist movement.
Jane Stratton is involved in the No Borders network, an action medics collective, and studies Medicine.
Lauren Wroe is co-editor of Shift magazine, researches in critical social psychology and is involved in the No Borders network.