Mental illness has become incredibly widespread because capitalism is a fundamentally alienating and sick system, argues Chris Breen
Over the next two years the Turnbull government will cut over $140 million from mental health services for young people.
Labor Senator Katy Gallagher says, “Headspace’s six early psychosis centres… have been told their budgets will be cut by 25 per cent on 1 July and by 70 per cent the year after that.”
The cuts are not a result of any improvement in mental health. In Australia there are around 3000 suicides a year, roughly double the road toll. According to the Australian Bureau of Statistics around one in every five Australians will experience a mental disorder in any given year and 45 per cent will experience a mental disorder in their lifetimes.
Those are staggering figures. The figures are similar in the US and only slightly lower in other developed nations.
How do we explain this? Mental illness is a symptom of a society that breeds unhappiness and anxiety. Another answer is that the definition of mental illness has expanded, as drug companies promote the idea it is an illness that drugs can cure.
As Susan Rosenthal, Professor of Medical Psychology at Columbia University, writes in her pamphlet Marxism and Psychology:
“Capitalism is a sick social arrangement that damages physical and mental health. And, by expanding the definition of mental illness, more people can be labelled sick and more profits can be made from selling them treatments”.
If there was ever a question about the social roots of mental illness the Australian government has unquestionably answered it with the horrific experiment of offshore processing of asylum seekers.
A 2014 report by International Health and Medical Services (IHMS), who run detention health services, found that around half the asylum seekers and refugees on Manus Island and Nauru suffer from significant depression, stress or anxiety.
Australian of the Year and psychiatrist Patrick McGorry rightly called them “factories for producing mental illness”.
We have known for a long time that mental illness has social causes; links with poverty, unemployment and homelessness are well established.
This is one reason the Turnbull government’s proposed cuts to Newstart Allowance are particularly cruel.
A study in 2015 by professors of epidemiology in Greece found that in 2011 and 2012 after harsh austerity measures were imposed from 2010, suicides increased by 36 per cent compared with the previous decade.
Any severe trauma from war, to child abuse, to cancer, can contribute to mental distress, but the scale of mental health problems goes beyond those who have experienced trauma and requires explanation.
Most people internalise the values of the society they live in from an early age. This includes the idea of being a “success”, the importance of competition, or their role in a family.
Even people who come to reject particular aspects of this are not unaffected by the values of those around them. The contradiction between daily reality and what the system tells us to expect can cause mental distress.
Life under capitalism can be a stressful and dehumanising experience. Many people perform routine jobs where they have no control over how the job gets done, or the pace and hours of work. They are often unable to speak openly about what is wrong through fear of unemployment.
We’re told that if you can’t find a job that pays enough, or can’t find a job at all, it is your fault. The competition structured into capitalism means difficulties people face are usually explained away as personal failings. We are not taught to blame the system for its inability to provide decent jobs, social support, housing, or health care. It is surprising that anyone is mentally healthy under capitalism.
Given the stresses and insanity of capitalism, mental revolt against the way things are is quite a natural response. The psychiatric industry, however, is not designed to tell people that their mental illness has social causes.
Instead, as Susan Rosenthal writes, it should be understood as one of the “institutions of social control” that is designed to justify existing society.
It does this through a focus on blaming mental illness on factors within the individual. “Prioritising individual factors,” she writes, “whether wrong thinking, wonky brain chemistry, or defective genes absolves the system of responsibility.”
She continues, “Science has yet to detect biological markers in the brains of people with different forms of mental distress that are not present in people without those forms of mental distress”
Psychiatrists categorise rather than diagnose causes. Physical diseases do not change throughout history, but what is considered “normal”, and how suffering has been able to be expressed, has always been a political question.
What psychiatry considers illness is shaped by the ideology and needs of those who run society. This can be seen in the some of the changes in what has been considered a mental illness.
The condition drapetomania was coined by physician Samuel A. Cartwright in the 1850s. He claimed its main symptom was slaves “absconding from service”, and it was caused by masters who “made themselves too familiar with [slaves], treating them as equals”.
Because he believed in the necessity of slavery, the idea that trying to escape might be a logical response apparently eluded him.
Black people in US today are more than three times likely to be diagnosed with schizophrenia than whites. In the 1960s at the height of the civil rights movement, the definition of schizophrenia in the DSM was broadened to include the words, “aggression”, “hostility”, and “delusions of persecution”. At the same time left wing psychiatrists campaigned to have racism defined as a mental disorder, but this was rejected by the American Psychological Association on the basis that racism was normative.
Even today, as Rosenthal writes, “Psychiatry serves capitalism by diagnosing defiance as a mental disorder. Psychiatrists and psychologists have pathologised the protests of slaves and political dissidents. They have lobotomised rebellious women and tried to convert homosexuals. They have campaigned for the euthanasia and sterilisation of ‘social defectives’. They assist at interrogations and torture.
“They drug soldiers to keep them killing. They drug old people and prisoners to keep them quiet. And they drug rebellious children… Those who suffer, who protest or whose needs undermine productivity are more likely to be labelled mentally unwell.”
Conversely there is commonly regarded as nothing wrong with people who imprison refugees, wage war or order drone strikes. The people who carry out drone strikes however have reported high levels of mental health problems.
Defining mental illness
Official definitions of what constitutes mental illness have also been expanding, particularly in the US where conditions listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM) determine insurance payments for treatment .
Doctors Shorter and Tyrer argued in the British Medical Journal in 2003 that, “Industry has been busy behind the scenes in this handy convergence of eccentric new diagnoses and the market niching of compounds”.
Well they might, as sales of anti-psychotic drugs top sales of all other drugs. Eli Lily rebranded Prozac as a pink pill called Sarafem in 2001 after the DSM listed Pre-Menstrual Dysphoric Disorder.
This also allowed it to extend its patent by seven years.
GlaxoSmithKline took a broader approach with the drug Paxil, marketing it with slogans like, “The Paxil treatment, treat one. Treat them all,” and, “look for the Paxil spectrum in every patient”.
GlaxoSmithKline hid data that showed Paxil as ineffective with risky side effects.
They ended up paying out $1.3 billion in compensation for suicides and birth defects associated with Paxil. However that was a tiny portion of the $15 billion they made from Paxil sales between 1997 and 2006.
The psychologist R.D. Laing noted than mental illness is diagnosed by conduct, but treated biologically. The drugs given to people are not treating known biological mechanisms.
As Rosenthal explains: “Parkinson’s Disease, Huntington’s Disease, and Alzheimer’s Disease are all diseases of the brain, they have characteristic biological markers that make it possible to diagnose them reliably. However, the mind is not the same as the brain. The mind is not a physical organ, but develops out of a complex inter-relationship between the brain, the body and the social environment. Mental distress can occur when any of these components or their relationship is disturbed or damaged.”
This means the causes of mental illness are usually more complex than can be dealt with through simple drug-based remedies.
In an article in New Scientist in June this year, Clare Wilson questioned the effectiveness of Selective Serotonin Reuptake Inhibitor (SSRI) drugs (such as Prozac), which are designed to work by increasing levels of the chemical serotonin in the brain.
“While the drugs do boost serotonin,” she said, “there is no proof that low levels cause depression. Anti-depressants do change how we feel, in a way that some find helpful and others don’t, but that doesn’t mean they are correcting a chemical imbalance. Many people find alcohol helps them relax, but that’s not because it’s correcting an alcohol deficiency in the brain.”
Irving Kirsch, a lecturer in medicine at Harvard, went further. He used Freedom of Information requests to get unpublished drug company trial results.
Kirsch argues in The Emperor’s New Drugs that when considered together with published studies the results show that most SSRI drugs are no better than placebos.
Others argue that the drugs are slightly better than placebo. Studies in the field are difficult because there is no objective definition of which patients to include, and any improvements are generally self-reported. However when it comes to objective measures such as suicide reduction across a population, the drugs have no effect.
Drug companies are pulling their money from new research. Since 2000 they have reduced spending on new mental health drugs, and in 2011 four big companies pulled out altogether saying that it was too expensive and had produced no results.
What about genes?
The focus on individual as opposed to social causes of mental illness has led to attempts to explain it as a result of genetics.
It may be that there are interactions between genes and the environment that predispose some people to dealing better or worse with particular situations. But it would be a mistake to think that individual genes for schizophrenia or depression will be found, any more than genes for “intelligence” will be found.
One factor is simply the complexity of interactions between genes, the social and physical environment, and early development.
Some studies have claimed to show a small statistical association with particular gene regions and schizophrenia.
Leaving aside the difficulty of defining schizophrenia, these studies are not predictive. That is, the majority of people who have the genetic variations do not have schizophrenia or any signs of mental illness. There is a greater link between schizophrenia and living in a city than having a family member with schizophrenia.
Working class people are more likely to be diagnosed with schizophrenia, and as mentioned earlier, so are black people in the US.
People diagnosed with schizophrenia can be unable to differentiate between what is real and what are fantasies.
Rosenthal writes of Schizophrenia: “Human perception is socially constructed. The ideas that dominate society shape what people think, what they want, who they trust, who they fear, who they blame, and what is and is not acceptable.
“Misperception is also socially constructed. Psychologists, advertising consultants and management experts are employed to sell a system based on deception (“It’s a free country”), contradiction (war as humanitarian intervention), denial of lived experience (hard work is always rewarded), and threat (work or starve). While most people accept the unacceptable, they do not like it. Some rebel openly. Others protest through physical and mental symptoms, addiction and suicide. Some escape to a different reality.”
Schizophrenia usually develops during adolescence, when the effort to make sense of the world and one’s place in it is at its most acute.
Mental illness is a disease of society. This means that the best treatment within our existing society is based on increased social support and attention.
As Rosenthal writes “A Canadian study of more than 2000 severely mentally ill homeless people found that providing stable housing was more effective than any other treatment.”
Just as austerity can cause mental health problems, raising living standards can have the opposite effect. Another study in the US found that after a new casino began paying out bonuses that lifted some poor families out of poverty, psychiatric problems among children in those families fell to the same level as in better off families. Their parents could afford to properly look after them and satisfy their needs for the first time.
Other forms of social support are also important.
In the context of the victims of Ireland’s “troubles” Patricia Campbell writes: “The tradition of testamonio—sharing stories in a supportive environment—can help participants view their problems not as personal failings, but as the collective wounds of war. The recognition of shared experiences can alleviate symptoms and promote a sense of belonging acceptance and validation.”
In the 1960s as protest and strikes spread across the globe the psychiatrist R.D. Laing coined the popular slogan “Do not adjust your head, the fault is in reality”.
The best way to deal with the social problems that cause mental health is to fight back, and win victories that begin to challenge them.
Rosenthal gives the example of how: “In the 1980s workers in Poland organised themselves into the world’s largest union, containing one third of the working-age population. As strikes spread and demonstrations grew, hospital psychiatric beds began to empty of workers and fill with sick government officials. This happened because rising class struggle opens the door to solving individual problems collectively.”
Similarly the Arab spring and the toppling of dictator Hosni Mubarak led to his hospitalisation for severe depression.
Capitalism is a system based on deepening inequality which makes life a misery for millions of people. But the global working class has the capacity to end the oppression and poverty it produces, through uniting grassroots struggles everywhere into a fight to overturn the system.
A socialist society run in the interests of the majority is possible. But, as Susan Rosenthal comments, “don’t expect this diagnosis will ever appear in the DSM”.
Marxism and Psychology by Susan Rosenthal is available from www.remarxpub.com/marxism-and-psychology/