Post by Admin on Nov 4, 2020 17:45:30 GMT
Capitalism, coronavirus and mental distress
Issue: 168
Posted on 7th October 2020
Iain Ferguson
isj.org.uk/coronavirus-mental-distress/
"This is above all a collective crisis, the roots of which lie in a system which prioritises profits over lives". Terrific article by Iain Ferguson on the intimate relationship between capitalism, coronavirus, and mental distress:
"The Covid-19 crisis has combined mental health stressors that have been studied before, in other disasters, but which have never been seen consolidated in one global crisis. So, for example, there is research on how humans cope with quarantine, mass disasters, and ongoing stressors but not on all three.
The Royal College of Psychiatrists has described the impact of the pandemic on mental health as being like a 'tsunami'. The analogy is accurate in the sense that, like a real tsunami, the virus and the consequences it brings in its wake—biological, political, economic—can overwhelm our psychological defences, our normal ways of coping.
Nevertheless, this analogy can also be misleading. As writers such as Mike Davis and Rob Wallace have shown, there is little that is natural about the origins of this pandemic, the ways in which it has spread or the degree of death and devastation that it has wrought across the globe. Rather, as has been argued previously in this journal, all of these processes have been shaped by factors such as global capitalism’s relentless drive for profit, the response (or lack of response) from national governments to the disease and the impact of existing divisions and inequalities on rates of infection and death.
This applies no less to the short-term and long-term impact of the pandemic on mental health. Its effects will not be experienced evenly across society. Rather, as with every other aspect of this crisis, they will be shaped by the divisions and inequalities of neoliberal capitalist society. A major recent study of the mental health impacts of the pandemic concluded that although 'we are all in the same storm…we are not all in the same boat'. These impacts will be discussed in the first part of this article.
Fighting for more and better mental health services for affected individuals is an important task. However, this is above all a collective crisis, the roots of which lie in a system which prioritises profits over lives. Millions of working-class people across the globe have lost their jobs. Many more are being forced to work in unsafe conditions without proper protective equipment. Moreover, we have all been forcefully reminded yet again just how little black lives matter in a society built on racism.
As I shall argue in the final part of the article, that shared collective experience allows for the possibility of a collective political response. Such a response would challenge those responsible for so many avoidable deaths, but it could also challenge the feelings of powerlessness, shame and isolation that are associated with mental distress through promoting a sense of political agency and solidarity.
Capitalism, psychiatry and mental health
The responses of ruling classes to the mental health impacts of the pandemic are shaped by the dominant understandings of mental distress. These understandings are not politically neutral: they are shaped by class interests, class ideologies and class struggle. Not surprisingly, the dominant definitions of health within capitalism focus primarily on the ability to sell one’s labour power and are therefore usually negative or functional definitions—health as the absence of illness or disease, health as the ability to work. In other words, if you are not ill, you are well and, by implication, well enough to work.
This narrow view of health has framed the Tory assault on working class people, and disabled people in particular, in Britain over the past decade. Witness, for example, the attack on so-called 'sick note culture' by then prime minister David Cameron in 2015 and the use of the hated work capability assessment, backed up by the threat of sanctions, to force workers with a range of (often severe) mental and physical health conditions back to work. Ideological support for these assaults on workers’ health has been provided by supine academics and medical leaders through, for example, the spurious argument that 'work is good for you'. There has been a neoliberal redefinition of health as personal responsibility, with the insistence that it is up to the individual to maintain good health by exercising, keeping their weight down, not overindulging in alcohol and so on. This ignores the impact of structural factors such as poverty, the availability of healthy food and the pressures of work on people’s lives and 'choices'.
In relation to mental health, these arguments find ideological support in the dominant biomedical model. This sees different forms of mental distress as discrete illnesses, similar in all major respects to physical illnesses. These illnesses are seen as originating in faulty brains or genes, with some allowance made for the influence of 'environment'. As with the approaches discussed above, biomedical psychiatry individualises mental distress and downplays the well-documented role of structural factors, such as class, poverty and racism.
Space does not allow for a full discussion and critique of this model. That critique does not, however, have to involve a denial that mental distress 'involves' brains. Indeed, it would be hard to think of any aspect of human behaviour that does not involve brains. However, as Nikolas Rose has recently argued in a powerful review of biomedical psychiatry: 'No one would doubt that mental distress and mild, moderate and severe mental disorders involve brains. But these are not “brains in vats”…brains are part of complex bodily systems, so disorders are of organisms—human beings—and human beings in particular and sometimes stressful social contexts.'
Hence, Rose argues, 'we must be rather cautious with the powerful rhetoric about "the burden of brain disorders", because…many of these conditions could equally well be called "social adversity disorders".'
It is the tendency of mainstream psychiatry to individualise mental distress, rather than its emphasis on brains, that is exemplified in leading Irish psychiatrist Brendan Kelly’s recent book, 'Coping with Coronavirus: How to Stay Calm and Protect your Mental Health'. Importantly, Kelly’s book offers no acknowledgement of the social, political and economic factors contributing to the pandemic. Rather, in Kelly’s naturalistic account, viruses simply 'spread'.
The solution to that spread 'lies in the hands of health authorities and the governments that fund them at global national and local levels'. Of course, it may be unreasonable to expect an awareness of the role played by profit-driven neoliberal agricultural methods and global trade networks from a book of this type. However, some acknowledgement of the role played by governments across the globe (including the Irish one) in failing to prevent the spread of the virus—for example, through not imposing lockdowns early enough, not providing sufficient PPE and not protecting care homes—would be welcome. Such a recognition might lead to people becoming very angry indeed and taking collective action rather than 'staying calm', but such a response is not contemplated in this book.
What is lacking from Kelly’s account is any awareness that neither these existential threats nor the material threats arising from the crisis—unemployment, poverty, being forced to work in unsafe conditions—are evenly shared or randomly distributed across society. Rather, they are shaped by the divisions and inequalities of capitalism. As noted above, the risk of dying from the virus is four times greater for black and minority ethnic people in Britain than for white people. Official figures show that men in low-skilled jobs are four times more likely to die from the virus than men in professional occupations .
Capitalism, war and trauma
In contrast to the biomedical model, trauma-informed approaches have become more influential in recent decades. These approaches locate the origins of mental health problems in people’s lived experience rather in faulty brains or genes.
The key question in treatment becomes not 'what’s wrong with you?' but 'what’s happened to you?'. PTSD is, in fact, the only diagnosis in the DSM whose name references the causes of the condition. Potentially, therefore, it opens the door to an understanding of mental distress that sees it as a response to living in a racist, sexist, class-divided society.
Like the biomedical approach, trauma-informed approaches can also lead to highly individualised and medicalising responses. For example, describing post-traumatic stress as a 'disorder' carries medical overtones, and it also implies there is something wrong about how an individual is responding to previous traumatic events. Indeed, almost every 'diagnosis' (itself a medical term) in the DSM—including those relating to anxiety, depression and personality—ends with the word 'disorder'. Despite this, the DSM says nothing whatsoever about their causes.
As John Read and Pete Sanders comment: 'It hasn’t always been so. In the very first edition of the DSM in 1952, the same problems now called disorders were all called “reactions”. This was a different era in which psychoanalytic psychiatrists were in the ascendancy in the US. Like the public…they understood that mental health problems stem largely from life events and our interpretation of these events, rather than from faulty genes or brain chemicals… The diagnostic approach to human distress medicalises all sorts of things, turning our reactions to life events into disorders.'
This is one reason why radical Latin American psychologists and psychoanalysts chose not to use these frameworks to make sense of people’s responses to the regimes of terror imposed by military juntas during the 1970s and 1980s: 'We do not think the concept of PTSD is an adequate one to describe the psychological impact of state terror. It makes a psychiatric problem out of a social phenomenon…we don’t even speak of trauma because it is usually understood to mean an intrapsychic experience. We use the concept “traumatic situation” in order to represent the social sources of the psychological suffering produced by state terror… The essence of social trauma is that it is not a private experience but a public and shared experience.'
Similarly, the authors of 'The Power Threat Meaning Framework' occasionally refer to 'trauma' in order to convey the severe impact of some life events, but prefer the term 'adversity': 'This is partly to avoid the medical overtones of “trauma”. However, it is also to avoid the potentially misleading impression of discrete, possibly very unusual, extreme or life-threatening events impinging from outside—rather than, as is often the case, of continuous or repeated very negative experiences. These experiences are often embedded in people’s lives and relationships and in the discourses, structures and practices of our social world. We would argue that these qualities of adversity can be crucial in understanding the experiences themselves, as well as children’s and adults’ responses.'
Collective trauma, collective responses
The coronavirus pandemic will have a profound impact on the mental health of many people around the globe, now and for years to come. Past experience suggests that the response of governments to that distress will be to minimise its extent and significance and to pathologise those experiencing it as 'mentally ill' or as lacking 'resilience'.
However, when trauma takes the form of a collective event or experience, it is possible to develop collective responses. These can challenge the isolation and sense of powerlessness that are both cause and effect of mental distress. At the most basic level, these responses can take the form of mutual aid, which might not always address the political roots of the problem, but nevertheless offers emotional and practical support for those affected.
The period since the economic crash of 2008 has been marked by a huge increase in the number of people experiencing mental distress along with massive cuts to mental health services. For example, the number of people in Scotland being prescribed anti-depressants increased by 48 percent from 2009-10 to 2018-19.
During the same period, mental health services across Britain have been cut and staffing levels have fallen. Since 2009, the budgets of mental health NHS Trusts in England have been cut by 30 percent, and the ratio of mental health doctors to service users has fallen from one doctor to 186 service users to one for every 253.
The theorist and activist who wrote most explicitly about the relationship between collective struggle and the overcoming of trauma was the psychiatrist and revolutionary Frantz Fanon. Yet many of the great thinkers in the Marxist tradition have been acutely aware of the transformative potential of collective action and, above all, of revolution. In fact the need to shake off what Marx described as the 'muck of ages'—not only backward racist and sexist ideas but also the feelings of shame, powerlessness and inferiority that many experience as a result of life in class society—was one of the reasons he saw revolution as necessary.
If the Covid-19 crisis has highlighted one thing above all others, it is that the 'essential' workers in this society are not the likes of Jeff Bezos, Richard Branson or Mark Zuckerberg. Rather, they are the bus drivers, retail workers, cleaners, nurses and the social care workers, without whose labour the wheels of capitalism would grind to a halt. It is with these and with millions of other essential workers across the globe that our power as a class lies."
This is only a very edited, abbreviated version of the article. I fully recommend reading the entire pice - it’s beautifully clear, well written, and compellingly argued:
isj.org.uk/coronavirus-mental-distress/
Issue: 168
Posted on 7th October 2020
Iain Ferguson
isj.org.uk/coronavirus-mental-distress/
"This is above all a collective crisis, the roots of which lie in a system which prioritises profits over lives". Terrific article by Iain Ferguson on the intimate relationship between capitalism, coronavirus, and mental distress:
"The Covid-19 crisis has combined mental health stressors that have been studied before, in other disasters, but which have never been seen consolidated in one global crisis. So, for example, there is research on how humans cope with quarantine, mass disasters, and ongoing stressors but not on all three.
The Royal College of Psychiatrists has described the impact of the pandemic on mental health as being like a 'tsunami'. The analogy is accurate in the sense that, like a real tsunami, the virus and the consequences it brings in its wake—biological, political, economic—can overwhelm our psychological defences, our normal ways of coping.
Nevertheless, this analogy can also be misleading. As writers such as Mike Davis and Rob Wallace have shown, there is little that is natural about the origins of this pandemic, the ways in which it has spread or the degree of death and devastation that it has wrought across the globe. Rather, as has been argued previously in this journal, all of these processes have been shaped by factors such as global capitalism’s relentless drive for profit, the response (or lack of response) from national governments to the disease and the impact of existing divisions and inequalities on rates of infection and death.
This applies no less to the short-term and long-term impact of the pandemic on mental health. Its effects will not be experienced evenly across society. Rather, as with every other aspect of this crisis, they will be shaped by the divisions and inequalities of neoliberal capitalist society. A major recent study of the mental health impacts of the pandemic concluded that although 'we are all in the same storm…we are not all in the same boat'. These impacts will be discussed in the first part of this article.
Fighting for more and better mental health services for affected individuals is an important task. However, this is above all a collective crisis, the roots of which lie in a system which prioritises profits over lives. Millions of working-class people across the globe have lost their jobs. Many more are being forced to work in unsafe conditions without proper protective equipment. Moreover, we have all been forcefully reminded yet again just how little black lives matter in a society built on racism.
As I shall argue in the final part of the article, that shared collective experience allows for the possibility of a collective political response. Such a response would challenge those responsible for so many avoidable deaths, but it could also challenge the feelings of powerlessness, shame and isolation that are associated with mental distress through promoting a sense of political agency and solidarity.
Capitalism, psychiatry and mental health
The responses of ruling classes to the mental health impacts of the pandemic are shaped by the dominant understandings of mental distress. These understandings are not politically neutral: they are shaped by class interests, class ideologies and class struggle. Not surprisingly, the dominant definitions of health within capitalism focus primarily on the ability to sell one’s labour power and are therefore usually negative or functional definitions—health as the absence of illness or disease, health as the ability to work. In other words, if you are not ill, you are well and, by implication, well enough to work.
This narrow view of health has framed the Tory assault on working class people, and disabled people in particular, in Britain over the past decade. Witness, for example, the attack on so-called 'sick note culture' by then prime minister David Cameron in 2015 and the use of the hated work capability assessment, backed up by the threat of sanctions, to force workers with a range of (often severe) mental and physical health conditions back to work. Ideological support for these assaults on workers’ health has been provided by supine academics and medical leaders through, for example, the spurious argument that 'work is good for you'. There has been a neoliberal redefinition of health as personal responsibility, with the insistence that it is up to the individual to maintain good health by exercising, keeping their weight down, not overindulging in alcohol and so on. This ignores the impact of structural factors such as poverty, the availability of healthy food and the pressures of work on people’s lives and 'choices'.
In relation to mental health, these arguments find ideological support in the dominant biomedical model. This sees different forms of mental distress as discrete illnesses, similar in all major respects to physical illnesses. These illnesses are seen as originating in faulty brains or genes, with some allowance made for the influence of 'environment'. As with the approaches discussed above, biomedical psychiatry individualises mental distress and downplays the well-documented role of structural factors, such as class, poverty and racism.
Space does not allow for a full discussion and critique of this model. That critique does not, however, have to involve a denial that mental distress 'involves' brains. Indeed, it would be hard to think of any aspect of human behaviour that does not involve brains. However, as Nikolas Rose has recently argued in a powerful review of biomedical psychiatry: 'No one would doubt that mental distress and mild, moderate and severe mental disorders involve brains. But these are not “brains in vats”…brains are part of complex bodily systems, so disorders are of organisms—human beings—and human beings in particular and sometimes stressful social contexts.'
Hence, Rose argues, 'we must be rather cautious with the powerful rhetoric about "the burden of brain disorders", because…many of these conditions could equally well be called "social adversity disorders".'
It is the tendency of mainstream psychiatry to individualise mental distress, rather than its emphasis on brains, that is exemplified in leading Irish psychiatrist Brendan Kelly’s recent book, 'Coping with Coronavirus: How to Stay Calm and Protect your Mental Health'. Importantly, Kelly’s book offers no acknowledgement of the social, political and economic factors contributing to the pandemic. Rather, in Kelly’s naturalistic account, viruses simply 'spread'.
The solution to that spread 'lies in the hands of health authorities and the governments that fund them at global national and local levels'. Of course, it may be unreasonable to expect an awareness of the role played by profit-driven neoliberal agricultural methods and global trade networks from a book of this type. However, some acknowledgement of the role played by governments across the globe (including the Irish one) in failing to prevent the spread of the virus—for example, through not imposing lockdowns early enough, not providing sufficient PPE and not protecting care homes—would be welcome. Such a recognition might lead to people becoming very angry indeed and taking collective action rather than 'staying calm', but such a response is not contemplated in this book.
What is lacking from Kelly’s account is any awareness that neither these existential threats nor the material threats arising from the crisis—unemployment, poverty, being forced to work in unsafe conditions—are evenly shared or randomly distributed across society. Rather, they are shaped by the divisions and inequalities of capitalism. As noted above, the risk of dying from the virus is four times greater for black and minority ethnic people in Britain than for white people. Official figures show that men in low-skilled jobs are four times more likely to die from the virus than men in professional occupations .
Capitalism, war and trauma
In contrast to the biomedical model, trauma-informed approaches have become more influential in recent decades. These approaches locate the origins of mental health problems in people’s lived experience rather in faulty brains or genes.
The key question in treatment becomes not 'what’s wrong with you?' but 'what’s happened to you?'. PTSD is, in fact, the only diagnosis in the DSM whose name references the causes of the condition. Potentially, therefore, it opens the door to an understanding of mental distress that sees it as a response to living in a racist, sexist, class-divided society.
Like the biomedical approach, trauma-informed approaches can also lead to highly individualised and medicalising responses. For example, describing post-traumatic stress as a 'disorder' carries medical overtones, and it also implies there is something wrong about how an individual is responding to previous traumatic events. Indeed, almost every 'diagnosis' (itself a medical term) in the DSM—including those relating to anxiety, depression and personality—ends with the word 'disorder'. Despite this, the DSM says nothing whatsoever about their causes.
As John Read and Pete Sanders comment: 'It hasn’t always been so. In the very first edition of the DSM in 1952, the same problems now called disorders were all called “reactions”. This was a different era in which psychoanalytic psychiatrists were in the ascendancy in the US. Like the public…they understood that mental health problems stem largely from life events and our interpretation of these events, rather than from faulty genes or brain chemicals… The diagnostic approach to human distress medicalises all sorts of things, turning our reactions to life events into disorders.'
This is one reason why radical Latin American psychologists and psychoanalysts chose not to use these frameworks to make sense of people’s responses to the regimes of terror imposed by military juntas during the 1970s and 1980s: 'We do not think the concept of PTSD is an adequate one to describe the psychological impact of state terror. It makes a psychiatric problem out of a social phenomenon…we don’t even speak of trauma because it is usually understood to mean an intrapsychic experience. We use the concept “traumatic situation” in order to represent the social sources of the psychological suffering produced by state terror… The essence of social trauma is that it is not a private experience but a public and shared experience.'
Similarly, the authors of 'The Power Threat Meaning Framework' occasionally refer to 'trauma' in order to convey the severe impact of some life events, but prefer the term 'adversity': 'This is partly to avoid the medical overtones of “trauma”. However, it is also to avoid the potentially misleading impression of discrete, possibly very unusual, extreme or life-threatening events impinging from outside—rather than, as is often the case, of continuous or repeated very negative experiences. These experiences are often embedded in people’s lives and relationships and in the discourses, structures and practices of our social world. We would argue that these qualities of adversity can be crucial in understanding the experiences themselves, as well as children’s and adults’ responses.'
Collective trauma, collective responses
The coronavirus pandemic will have a profound impact on the mental health of many people around the globe, now and for years to come. Past experience suggests that the response of governments to that distress will be to minimise its extent and significance and to pathologise those experiencing it as 'mentally ill' or as lacking 'resilience'.
However, when trauma takes the form of a collective event or experience, it is possible to develop collective responses. These can challenge the isolation and sense of powerlessness that are both cause and effect of mental distress. At the most basic level, these responses can take the form of mutual aid, which might not always address the political roots of the problem, but nevertheless offers emotional and practical support for those affected.
The period since the economic crash of 2008 has been marked by a huge increase in the number of people experiencing mental distress along with massive cuts to mental health services. For example, the number of people in Scotland being prescribed anti-depressants increased by 48 percent from 2009-10 to 2018-19.
During the same period, mental health services across Britain have been cut and staffing levels have fallen. Since 2009, the budgets of mental health NHS Trusts in England have been cut by 30 percent, and the ratio of mental health doctors to service users has fallen from one doctor to 186 service users to one for every 253.
The theorist and activist who wrote most explicitly about the relationship between collective struggle and the overcoming of trauma was the psychiatrist and revolutionary Frantz Fanon. Yet many of the great thinkers in the Marxist tradition have been acutely aware of the transformative potential of collective action and, above all, of revolution. In fact the need to shake off what Marx described as the 'muck of ages'—not only backward racist and sexist ideas but also the feelings of shame, powerlessness and inferiority that many experience as a result of life in class society—was one of the reasons he saw revolution as necessary.
If the Covid-19 crisis has highlighted one thing above all others, it is that the 'essential' workers in this society are not the likes of Jeff Bezos, Richard Branson or Mark Zuckerberg. Rather, they are the bus drivers, retail workers, cleaners, nurses and the social care workers, without whose labour the wheels of capitalism would grind to a halt. It is with these and with millions of other essential workers across the globe that our power as a class lies."
This is only a very edited, abbreviated version of the article. I fully recommend reading the entire pice - it’s beautifully clear, well written, and compellingly argued:
isj.org.uk/coronavirus-mental-distress/