Why Mental Health is A Political Issue

Here's another great piece by Mark Fisher - originally published in the Guardian in 2012

 'Mental illness has been depoliticised, so that we blithely accept a situation in which depression is now the malady most treated by the NHS'. Photograph: Darren Staples/Reuters

Why Mental Health is A Political Issue

 Welfare suicides don't exist. Suicide is a mental health issue." That line, by the former Labour official Luke Bozier, pretty much sums up the standard rightwing response to the website Calum's List. According to its founders, the aim of Calum's List is "to list the number of deaths where welfare reform has alleged to have had some culpability, and to make the best effort possible to work towards reducing this death toll." Bozier's Twitter comments were a gloss on blogposts by The Spectator's Isabel Hardman and the Telegraph's Brendan O'Neill.

There's more than a whiff of Freud's "kettle logic" (I didn't borrow your kettle; when I borrowed the kettle it was already broken; when I returned the kettle it wasn't damaged) about the cluster of incompatible arguments that these three presented against Calum's List. Their principal claims were as follows. The suicides have not been caused by the changes, and therefore to mention them is an act of opportunistic exploitation; if suicides have been caused by the reforms, this is no reason to abandon them; the problem is not the reforms themselves but how they are managed (ie those forced back to work should be given adequate support); suicide is not a rational act, which means that it can have no political significance.

I don't wish to argue here about whether or not specific cases of suicide were caused by the new legislation. But I do want to contest the bizarre idea that, in principle, suicides could not be adduced as evidence against the changes in the welfare system. If people dying as a consequence of the implementation of measures cannot count as evidence that the legislation has detrimental effects, what would?

O'Neill displays a strangely judgmental attitude towards suicide, arguing suicide "is not a rational response to economic hardship; it is not a rational response to having your benefits cut". This is a spectacular case of missing the point: for many of those suffering from mental illnesses, the capacity to act rationally is impaired, which is one reason that they need to be protected. As for the idea that those returning to work should receive proper support, the lack of such support is the issue. Atos, the agency responsible for testing whether claimants are fit to work, has seen a large number of appeals against its judgments upheld. And who can have faith the government will properly support those returning to work when it entrusts the transition to a discredited agency such as A4e?

But there's a more general problem here. Some of the rightwing commentators condemning Calum's List have deplored the "politicisation" of mental illness, but the problem is exactly the opposite. Mental illness has been depoliticised, so that we blithely accept a situation in which depression is now the malady most treated by the NHS. The neoliberal policies implemented first by the Thatcher governments in the 1980s and continued by New Labour and the current coalition have resulted in a privatisation of stress. Under neoliberal governance, workers have seen their wages stagnate and their working conditions and job security become more precarious. As the Guardian reports today, suicides amongst middle-aged men are on the increase, and Jane Powell, chief executive of Calm, the Campaign Against Living Miserably, links some of this increase with unemployment and precarious work. Given the increased reasons for anxiety, it's not surprising that a large proportion of the population diagnose themselves as chronically miserable. But the medicalisation of depression is part of the problem.

The NHS, like the education system and other public services, has been forced to try to deal with the social and psychic damage caused by the deliberate destruction of solidarity and security. Where once workers would have turned to trade unions when they were put under increasing stress, now they are encouraged to go to their GP or, if they are lucky enough to be able to be get one on the NHS, a therapist.

It would be facile to argue that every single case of depression can be attributed to economic or political causes; but it is equally facile to maintain – as the dominant approaches to depression do – that the roots of all depression must always lie either in individual brain chemistry or in early childhood experiences. Most psychiatrists assume that mental illnesses such as depression are caused by chemical imbalances in the brain, which can be treated by drugs. But most psychotherapy doesn't address the social causation of mental illness either.

The radical therapist David Smail argues that Margaret Thatcher's view that there's no such thing as society, only individuals and their families, finds "an unacknowledged echo in almost all approaches to therapy". Therapies such as cognitive behaviour therapy combine a focus on early life with the self-help doctrine that individuals can become masters of their own destiny. The idea is "with the expert help of your therapist or counsellor, you can change the world you are in the last analysis responsible for, so that it no longer cause you distress" – Smail calls this view "magical voluntarism".

Depression is the shadow side of entrepreneurial culture, what happens when magical voluntarism confronts limited opportunities. As psychologist Oliver James put it in his book The Selfish Capitalist, "in the entrepreneurial fantasy society," we are taught "that only the affluent are winners and that access to the top is open to anyone willing to work hard enough, regardless of their familial, ethnic or social background – if you do not succeed, there is only one person to blame." It's high time that the blame was placed elsewhere. We need to reverse the privatisation of stress and recognise that mental health is a political issue.

isthisnameanygood 

16 Jul 2012 12:17

4243

The ignorance that lies at the core of Tory welfare policy reform is not an ignorance of unawareness, or an absence of knowledge, but rather one of calculated disinformation. Probably the most disgusting thing about this coalition is the deliberate spreading of lies to facilitate a systematic assault upon the sick, the poor and the disabled. 

It's all ideologically driven. They have lied to and misled the public in order to promote a squalid agenda, an agenda to dismantle the welfare state. 

The fact that 32 disabled a week are committing suicide as a direct result of this governments policies is immaterial, they don't give shit.

They are indifferent to suffering, indifferent to the facts.

The nasty party writ large.

wightpaint 

16 Jul 2012 12:16

5354

Anyone who has suffered from clinical depression knows that it can simply happen, with no exacerbating factors present at all; but also knows that if one is depressed to begin with, the impact of external events - unless one's catatonic - can make the condition worse and even push one to suicide. I don't know anything about the Labour official whom you quote, but if he believes otherwise he is a dangerous fool. 

It doesn't surprise me that the number of older men killing themselves is increasing - if, for example, you lose your job at even 40-plus, your chances of finding another are slim; if 50-plus verging on impossible; at 60, non-existent. If men of this age are pressured to find work which isn't there for them, if men approaching the (present!) age of retirement are harried to get off Incapacity Benefit and into work via a "supported" group, a contradiction is established - you seek work, are told to seek work, but there is none - to which there can seem only one solution. Add to this the daily pressure of debt collectors' calls, which many of us nowadays face - people can take so much, but, particularly if their mental health is already disturbed, no more. 

Grayling et al have pretended that the link doesn't exist between poverty or the fear of impoverishment and mental ill-health - as every tiny bit of evidence available points to the opposite conclusion, it's impossible to believe these characters don't know the truth.

This is an absolutely excellent article. And it's not only mental health, more and more illnesses are being caught under the psychs web - ME/CFS probably the most famous but also Asthma, diabetes, athritis, chronic pain conditions, instertital cystitis. Get one of these and you're increasingly likely to be offered CBT and told that it's all about how you manage your illness. 

Now personally, I don't have an issue with CBT as I've found it a useful help for me personally but I doubt it works for everyone and there is a wider issue of the de-medicalisation of illness. The use of psycho-social models and what they mean for the sick person and for the wider welfare state. 

Even within cancer treatment etc you get the underlying message more and more that those who don't recover didn't have the right mental attitude! 

As for not linking economic policy to depression that is just absolutely staggering. Of course losing your jpb, fearing losing your home, losing that four hundred quid a week ESA money etc - all these things are going to cause a person great anxiety and in the end our body responds to all that increased adrenalin and cortisol etc, by either pushing the anxiety ever upwards until we enter breakdown territory, or it cuts it off and plunges us into depression. 

I doubt very few people would react to outright economic hardship with a chipper smile on their face. The fact that those in power think they can or indeed should only goes to show how very out of touch the bastards are.

ManWhoFellToEarth 

I think, really, two competing ideas about mental health inform this mindset. The first is the 'suck it up' or 'deal with it' mentality, the one that says 'well, plenty of people are unemployed/on welfare/getting their benefits cut, and they aren't killing themselves, so it's obviously not the fault of the policy and the person is just weak/prone to depression.' Said approach entirely fails to understand mental illness, and is frankly barbaric in its callousness, but it doesn't stop it from being the go-to position of pretty much everybody who's never encountered depression, lived with it, or done any reading on the subject.

The second, as the article says, is the hyper-medicalised mentality, which says that depression is entirely insulated from external factors and is just a lottery - you either are or you aren't, and your personal circumstances aren't going to affect that so there's no reason to tinker with policy. Again, it's a myopic viewpoint, because while depression certainly can and does strike anybody, regardless of their circumstances or background, it's a damn sight better to be a wealthy person with depression than a poor person with depression (private treatment, economic flexibility allowing for more time off work to recover, etc) and living a generally miserable life is a very good way to trigger an underlying tendency in somebody who is prone to depression.

One is somewhat shouting into an echo chamber, however, if one thinks that drawing attention even to suicides and death would be enough to deter the current incumbents of DWP from their welfare reforms. If they're not going to be deterred by statistics and evidence showing that the policies don't work by any measure you care to name, a few proles topping themselves is hardly likely to move them.

languageandgenes 

16 Jul 2012 12:31

910

Wasn't the mental health of the nation affected by the Thatcher regime
during the 1980's, when it climed from one million to three million?

The politics of mental health is rooted in the rightwing politics of cuts and despair.