Continuing a strand of debate, Canadian socialist Susan Rosenthal argues that we must look to social rather than individual solutions to mental ill health.
Marx and Engels described capital as a relationship and capitalism as a system of relationships. Did they mean that every aspect of our relations with ourselves, others, and society is shaped by capitalism, so that a socialist revolution would transform all of these relationships? Or were they being too general? Are some aspects of human experience unaffected by society, so that we need something other than Marxism to understand them and something more than socialism to transform them? This is the core of the conflict between Marxism and psychology.
The Marxist method considers human experience in social-historical context. Psychology, psychoanalysis, psychotherapy, medicine, genetics and most other disciplines consider the individual (or parts of the individual) separate from the social context. The assumption is that the individual (or the part) has enduring biological or psychological qualities that are governed by different rules than those that govern the larger society. Therefore, these qualities can be changed only at the level of the individual or the part.
Separating the individual from the social in order to emphasise the individual is capitalist ideology, not science. Prioritising individual factors absolves the system of responsibility. And if individuals can choose what happens, they can be blamed for choosing badly, again letting the system off the hook.
Science tells us that the social and individual shape each other in dynamic interaction. If one has more weight, it is the material and social environment out of which our species evolved and which capitalism has poisoned.
Environmental toxins cause the vast majority of cancers, yet cancer victims are blamed for making unhealthy choices and for having “cancer personalities” or “cancer genes”. Similarly, alienation makes people mentally sick, yet mental illness is blamed on wrong thinking, wonky brain chemistry, or defective genes. Blaming the victim protects the system by keeping the focus on what individuals are doing instead of what the system is doing to them.
Mental illness used to mean insanity. The 1918 American compendium of psychiatric disorders contained 22 diagnostic categories, 21 of which referred to forms of insanity. Since then the category of “mental illness” has ballooned to include a broad range of deviant and rebellious behaviours, different ways of processing information (neurodiversity), emotional responses to isolation and deprivation, and trauma-related symptoms. The label of mental illness is used to pathologise those who protest, those who suffer and those whose needs undermine productivity. Whether limitations are physical or mental, the less-productive are stigmatised as socially defective and more or less expendable.
People labelled “mentally ill” form an oppressed group. Like all forms of oppression, mental illness affects people from all classes. However, as with other forms of oppression, the burden falls most heavily upon the working class. The mentally ill suffer legal, medical, social and housing discrimination. They can be forcibly confined in institutions, drugged against their will and denied the right to make decisions regarding their lives. They are over-represented among the incarcerated and are more likely to be unemployed, poor and homeless.
Oppression is essential to capitalism. Subjugating oppressed groups enables a small ruling class to divide and rule a much larger working class. In particular, oppressing the mentally ill enforces conformity of thought, feeling and behaviour in society as a whole.
Psychiatry serves capitalism by diagnosing defiance as a mental disorder. Through the 1950s the label of schizophrenia was mainly applied to discontented housewives. The anti-racist revolts of the 1960s prompted the Diagnostic and Statistical Manual of Mental Disorders (DSM) to change its description of schizophrenia from primarily depressed moods to hostility, aggression and delusions of persecution, that is, from White suburban housewives to rebellious urban Blacks. Today, Black Americans are three times more likely than White Americans to be labelled “schizophrenic”.
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.
As families sink into crisis, parents are less able to meet children’s emotional needs. Schools contribute to children’s distress by confining them in closed rooms for long periods to memorise information that has no connection to their lives. When children protest by acting out, professionals label them as mentally disordered and their parents as inadequate.
Once children are labelled, parents can be legally compelled to drug them. In 2013 more than 8 million American children under age 17 were prescribed psychiatric drugs. One million of these children were under age five, and a quarter of a million were less than a year old.
Socialists stand up for the oppressed. We reject the argument that women should raise children because they are genetically programmed to be nurturers. We reject the argument that Black people are more likely to be poor because they are less intelligent. We understand that such biological arguments are not based on science; they are pseudoscience — propaganda disguised as science. Capitalism systematically confuses science and pseudoscience, replacing what is true with claims of what is true. An example of pseudoscience is the claim that mental illness is rooted in biology.
The biological model of mental illness reduces the mind to the brain, which becomes the object of study and treatment. (A variation of this model is Freudianism, which reduces the mind to the genitals.) Such crude materialism should not be confused with Marxist materialism, which views mental illness in social and historical context — as the individual expression of a society made sick by alienated labour.
The fact that social conditions generate mental illness is so obvious that a psychiatric industry is required to convince us otherwise. The 1952 edition of the DSM described mental illness as a reaction to some external event, situation, or biological condition. This description was removed from all subsequent editions.
The failure of the DSM to identify an external cause for mental illness implies that the cause is internal to the individual (faulty thoughts, behaviours, chemistry, or genetics), and the treatment is to change the sufferer, not the conditions that cause the suffering. The emphasis on drug treatment and gene research flows from the biological model. And the practice of directing patients to change their thoughts, feelings and behaviours implies that the central problem is the patient’s failure to function adequately.
Some concede that adverse conditions might cause child distress and emotional disorders such as anxiety and depression, but perceptual disorders like psychosis must have a biological cause. This is faulty logic.
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.
Psychosis typically develops during the transition from adolescence to adulthood, when the conflict between the way the world is and the way that it should be is most keenly experienced. Inability to resolve this contradiction causes some people to become highly anxious and deeply suspicious. The world makes no sense, so they “break with reality” and hide in fantasy realms where imaginative metaphors communicate what cannot be articulated. We all talk to ourselves, but psychosis disrupts the relationship with the self so that internal voices are misperceived as coming from outside. Visual cues are also misinterpreted to form the shapes of people and things that are not actually present.
The social basis of psychosis is dismissed by biologists and psychiatrists who treat the psychotic individual as a checklist of deficits to be corrected. The person’s experience, perspective and social needs are ignored. No attention is paid to what the person is trying to communicate through speech, emotions, body language and behaviour patterns. The emphasis is on manipulating brain chemistry, countering defective genes, and controlling behaviours.
The best treatment for mental illness is social support. A large American study found that psychotic patients who received less medication and more individual and family support fared much better than patients who got the usual drug-focused treatment. The social-support model has been used successfully in Australia, Scandinavia and elsewhere. The fact that social support can remedy disorders of perception tells us that these disorders are socially based.
Social support is also effective in treating mental illness on a societal level. A Canadian study of more than 2,000 severely mentally-ill homeless people found that providing stable housing was more effective than any other treatment.
Raising living standards can actually cure mental illness. An eight-year study in the US found that poor children were being diagnosed with more than four times as many psychiatric symptoms as children who had never been poor. Midway through the study a new gambling casino began paying financial bonuses that lifted 14 percent of the families out of poverty.
Psychiatric symptoms among children who were no longer poor fell to the same level as children who had never been poor. In contrast, psychiatric symptoms remained high among the children who remained poor. Rising incomes enable parents to meet their own needs so that they are more able to meet their children’s needs.
Capitalism is driving more people into crisis. In California the assault on services provoked a working class response.
In January 2015 more than 3,300 members of the National Union of Health Workers (NUHW) struck at Kaiser Permanente, the largest medical corporation in America. Despite record profits, Kaiser refused to employ sufficient staff to meet patients’ needs. In protest, NUHW psychologists, therapists, social workers and psychiatric nurses launched the largest-ever strike of mental health workers, with 65 picket lines in 35 cities.
The week-long strike was followed with petitions and a “No more Kaiser suicides” campaign to publicise the numbers of patients dying from lack of care. Finally, threatened with an open-ended strike, Kaiser agreed to the union’s demands: the right to advocate for patients; wage and pension protection; and a new scheduling ratio that enables patients to be seen more often and mandates new hires to fill the demand.
Linking the needs of workers and patients produced an unprecedented victory. However, we need more than access to services. We need a world that doesn’t make us sick.
Capitalism has transformed the entire world into a factory for producing capital. Every human need that stands in the way is treated as an obstacle to be removed. “Lean production” pushes workers to their physical and emotional limits. Those who succumb are discarded and replaced.
It is impossible to be mentally healthy under capitalism. Growing daily misery is compounded by the horror of perpetual war and environmental destruction. If you open your mind to the barbarism of capitalism, you are traumatised. If you close your mind to it, you lose your humanity.
The World Health Organisation reports that the global suicide rate has risen 60 percent over the past 45 years, accounting for half of all violent deaths in men and 71 percent of violent deaths in women. Suicide is the leading cause of death in adolescent girls aged 15 to 19. In the US the suicide rate for Black boys aged five to 11 years has doubled since the 1990s.
Over the past 15 years the inflation-adjusted income for American households headed by a high school graduate dropped 19 percent. This income drop has been accompanied by a 22 percent rise in the mortality rate of less educated middle aged White Americans, primarily due to alcoholism, drug addiction and suicide. If the mortality rate for this group had stayed constant, 96,000 deaths would have been avoided. If it had continued to decline at its previous rate, half a million lives would have been saved.
Removing the social sources of sickness is not an option under capitalism because nothing is allowed to interrupt the flow of profit. Instead the system strives to improve people’s ability to function under toxic conditions. That means limiting science, research and experts to the study and manipulation of individual factors. This is as true for cancer as it is for mental illness.
While some forms of mental illness (and cancer) might be caused by faulty biology, we cannot know for sure in a system that poisons every aspect of life down to the molecular level. After we eliminate capitalism and establish a health-promoting society, we can see what remains to be addressed biologically. Until then socialists must emphasise collective solutions for social problems, not indulge the delusion that they can be solved by scientists and experts at the individual level.
The conflict between Marxism and psychology is not really about psychology or mental illness. It is about understanding capitalism as an all-encompassing system of social relationships where individual experience changes in the process of changing society.
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.
Decades of working class retreat have undermined confidence in collective solutions. Socialists are not immune to this discouragement. It is extremely difficult to raise class solutions in a society dominated by individualism and the “yes-but” stance of reformists who promote individual solutions “in the meantime”. There is no meantime. Our survival depends on reconnecting the socialist tradition with the working class now.
Oppression is integral to capitalism and the fight against it must be integral to the struggle for socialism. We build mental health in the process of fighting for better working and living conditions. We build mental health in the process of building class solidarity, laying the foundation for a socialist society that will strive to engage everyone’s abilities and meet everyone’s needs.