"It is the economic and political system under which we live—capitalism—which is responsible for the enormously high levels of mental-health problems which we see in the world today." Compelling article from David Matthews:
"A mental-health crisis is sweeping the globe. Recent estimates by the World Health Organization suggest that more than three hundred million people suffer from depression worldwide.
Within the monopoly-capitalist nations, mental-health disorders are the leading cause of life expectancy decline behind cardiovascular disease and cancer. In the European Union, 27% of the adult population between the ages of eighteen and sixty-five are said to have experienced mental-health complications. Moreover, in England alone, the predominance of poor mental health has gradually increased over the last two decades. The most recent National Health Service Adult Psychiatric Morbidity Survey illustrates that in 2014, 17.5% of the population over the age of sixteen suffered from varying forms of depression or anxiety.
In capitalist society, biological explanations dominate understandings of mental health, infusing professional practice and public awareness. Emblematic of this is the theory of chemical imbalances in the brain—focusing on the operation of neurotransmitters such as serotonin and dopamine—which has gripped popular and academic consciousness despite remaining largely unsupported.
What is abundantly clear is the existence of significant social patterns that elucidate the impossibility of reducing poor mental health to biological determinism. The intimate relationship between mental health and social conditions has largely been obscured, with societal causes interpreted within a bio-medical framework and shrouded with scientific terminology. Diagnoses frequently begin and end with the individual, identifying bioessentialist causes at the expense of examining social factors.
However, the social, political, and economic organization of society must be recognized as a significant contributor to people’s mental health, with certain social structures being more advantageous to the emergence of mental well-being than others. As the basis on which society’s superstructural formation is erected, capitalism is a major determinant of poor mental health. As the Marxist professor of social work and social policy Iain Ferguson has argued, 'it is the economic and political system under which we live—capitalism—which is responsible for the enormously high levels of mental-health problems which we see in the world today.' The alleviation of mental distress is only possible 'in a society without exploitation and oppression.'
Supporting Ferguson’s assertion, I argue that capitalism is crucial to determining the experience and prevalence of mental well-being, as its operations are incompatible with true human need. This sketch will include a depiction of the politically conscious movement of users of mental-health services that has emerged in Britain in recent years to challenge biological explanations of poor mental health and to call for locating inequality and capitalism at the heart of the problem.
Mental Health and Monopoly Capitalism
In the final chapters of 'Monopoly Capital', Paul Baran and Paul Sweezy made explicit the consequences of monopoly capitalism for psychological well-being, arguing that the system fails 'to provide the foundations of a society capable of promoting the healthy and happy development of its members.' Exemplifying the widespread irrationality of monopoly capitalism, they illustrated its degrading nature. It is only for a fortunate minority that work can be considered pleasurable, while for the majority it is a thoroughly unsatisfactory experience.
Attempting to avoid work at all costs, leisure frequently fails to offer any consolation, as it is also rendered meaningless. Rather than being an opportunity to fulfill passions, Baran and Sweezy argued that leisure has become largely synonymous with idleness. The desire to do nothing is reflected in popular culture, with books, television, and films inducing a state of passive enjoyment rather than demanding intellectual energies. The purpose of both work and leisure, they claimed, largely coalesces around increasing consumption.
Modern monopoly-capitalist society continues to be characterized by an incompatibility between, on the one hand, capitalism’s ruthless pursuit of profit and, on the other, the essential needs of people. As a result, the conditions required for optimum mental health are violently undermined, with monopoly-capitalist society plagued by neuroses and more severe mental-health problems.
It was Fromm, most notably, who was to develop a unique Marxist psychoanalytical position that remains relevant to understanding mental health in the current era of monopoly capitalism. While making explicit the importance of Sigmund Freud, Fromm acknowledged his greater debt to Karl Marx, considering him the preeminent intellectual.
Accepting the Freudian premise of the unconscious and the repression and modification of unconscious drives, Fromm nonetheless recognized the failure of orthodox Freudianism to integrate a deeper sociological understanding of the individual into its analysis. Turning to Marxism, he constructed a theory of the individual whose consciousness is shaped by the organization of capitalism, with unconscious drives repressed or directed toward acceptable social behavior.
While Marx never produced a formal psychology, Fromm considered that the foundations of one resided in the concept of alienation. For Marx, alienation was an illustration of capitalism’s mortifying physical and mental impact on humans. At its heart, it demonstrates the estrangement people feel from both themselves and the world around them, including fellow humans.
Alienation’s specific value for understanding mental health lies in illustrating the distinction that emerges under capitalism between human existence and essence. For Marx, capitalism separates individuals from their essence as a consequence of their existence. This principle permeated Fromm’s psychoanalytic framework, which maintained that, under capitalism, humans become divorced from their own nature.
Meaningful Association and Loneliness
For Fromm, there existed an inherent relationship between positive mental health, meaningful personal relationships in the form of both love and friendship, and expressions of solidarity. Acutely aware of their 'aloneness' in the world, individuals attempt to escape the psychological prison of isolation. Nonetheless, the operation of capitalism is such that it frequently prevents the satisfactory fulfillment of this need.
While difficulties in measuring its existence and nature abound, arguably one the most widespread neuroses to plague present-day capitalism is loneliness. It is increasingly considered a major public-health concern, perhaps most symbolically evident with the establishment of a Minister for Loneliness in 2018 by the British government.
As a neurosis, loneliness has debilitating consequences. Individuals may resort to alcohol and drug abuse to numb their misery, while persistent experience increases blood pressure and stress, as well as negatively impacts cardiovascular and immune-system functioning. A mental-health condition in its own right, loneliness exacerbates additional mental-health problems and is often the root cause of depression.
In 2017, it was estimated that 13% of individuals in Britain had no close friends, with a further 17% having average- to poor-quality friendships. Moreover, 45% claimed to have felt lonely at least once in the previous two weeks, with 18% frequently feeling lonely.
Fromm contended that the promotion and celebration of the virtues of the individual means that members of society feel more alone under capitalism than under previous modes of production. Capitalism’s exaltation of the individual is made further apparent by its potent opposition to the ideals of collectivism and solidarity, and preference and incentive for competition. Individuals, it is said, must compete with each other on a general basis to enhance their personal development.
Not only is loneliness integral to capitalist ideology, it is also exacerbated by the very functioning of capitalism as a system. Significantly, loneliness is not just a feature of life outside of work, but a common experience during work. In 2014, it was estimated that 42% of British employees did not consider any coworker to be a close friend, and many felt isolated in the workplace.
Alongside the acceptance of work, Fromm identified the desire to consume as an integral characteristic of life under capitalism, arguing it was a significant example of the uses to which human energies are directed to support the economy. With consumer goods valued for their conspicuity rather than their intended function, people have gone from consuming use values to symbolic values. The decision to engage in popular culture and purchase a type of automobile, brand of clothing, or technological equipment, among other goods, is frequently based on what the product is supposed to convey about the consumer. Frequently, consumerism constitutes the principal method through which individuals can construct a personal identity.
Under monopoly capitalism, consumerism is more about consuming ideas and less about satisfying inherent biological and psychological needs. Consuming is essentially the satisfaction of artificially stimulated phantasies. The need for identity and creative fulfillment encourages an insatiable appetite to consume. Each purchase, however, regularly fails to live up to its promise. Rarely is satisfaction truly achieved through consumption, because what is being consumed is an artificial idea rather than a product that imbues our existence with meaning. In this process, consumerism as a form of alienation becomes evident.
While consumerism as a value exists in all capitalist societies, in those of greater inequality—with Britain displaying wider wealth disparities than most—the desire to consume and acquire greatly contributes to the emergence of neuroses, as the effort to maintain social status and emulate those at the top of society becomes an immense strain. The impact of this has been demonstrated within British families in recent years. In 2007, UNICEF identified Britain as having the lowest level of child well-being out of twenty-one of the most affluent Organisation for Economic Co-operation and Development nations.
Resistance as Class Struggle
While not denying the existence of biological causes, the structural organization of society must be recognized as having serious repercussions on people’s mental health. Monopoly capitalism functions to prevent many from experiencing mental well-being. Yet, despite this, the medical model continues to dominate, reinforcing an individualistic conception of mental health and obscuring the detrimental effects of the present mode of production.
This oppresses users of mental-health services by subordinating them to the judgment of medical professionals. The medical model also encourages the suspension and curtailment of individuals’ civil rights if they experience mental distress, including by legitimizing the infringement of their voluntary action and excluding them from decision-making. For those who suffer mental distress, life under capitalism is frequently characterized by oppression and discrimination.
Aware of their oppressed status, users and survivors of mental-health services are now challenging the ideological dominance of the medical model and its obfuscation of capitalism’s psychological impact. Furthermore, they are increasingly coalescing around and putting forward as an alternative the need to accept the Marxist-inspired social model of mental health. The social model of disability identifies capitalism as instrumental to the construction of the category of disability, defined as impairments that exclude people from the labor market. Adopting a broadly materialist perspective, a social model of mental health addresses material disadvantage, oppression, and political exclusion as significant causes of mental illness.
In 2017 in Britain, the mental-health action group National Survivor User Network, NSUN unequivocally rejected the medical model and planted social justice at the heart of its campaign.
As part of its call for a social approach to mental health, the group explicitly denounces neoliberalism, arguing that austerity and cuts to social security have contributed to the increasing prevalence of individuals who suffer from poor mental health as well as to the exacerbation of existing mental-health issues among the population. Recognizing social inequality as a contributor to the emergence of poor mental health, National Survivor User Network proposes that the challenge posed by mental-health service users should be part of a wider indictment of the general inequality in society, arguing that 'austerity measures, damaging economic policies, social discrimination and structural inequalities are causing harm to people. We need to challenge this as part of a broader social justice agenda.'
Moreover, representing ethnic minorities, Kindred Minds vigorously campaigns on an understanding that mental distress is less a result of biological characteristics and more a consequence of social problems such as racism, sexism, and economic inequality “pathologised as mental illness.” For Kindred Minds, the catalyst for deteriorating mental health is oppression and discrimination, with ethnic minorities having to suffer greater levels of social and economic inequality and prejudice.
Capitalism can never offer the conditions most conducive to achieving mental health. Oppression, exploitation, and inequality greatly repress the true realization of what it means to be human. Opposing the brutality of capitalism’s impact on mental well-being must be central to the class struggle as the fight for socialism is never just one for increased material equality, but also for humanity and a society in which all human needs, including psychological ones, are satisfied.
All members of society are affected by the inhumane nature of capitalism, but, slowly and determinedly, the fight is being led most explicitly by the most oppressed and exploited. The challenge posed must be viewed as part of the wider class struggle, as being one front of many in the fight for social justice, economic equality, dignity, and respect."
Capitalism and Mental Health
by David Matthews
monthlyreview.org/2019/01/01/capitalism-and-mental-health/