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Mental Illness, or Social Alienation

A row has broken out between psychologists and psychiatrists, reminiscent of the anti-psychiatry movement of the 60s and 70s, over the exact cause, and less obviously the exact nature, of what we call ‘mental illness’.

Much like all human behaviours, to be ‘mentally unwell’ carries value judgements, and social judgements, that impact hugely on the social treatment that those who exhibit such behaviour can expect. Because it is such a loaded term many have pointed out that a Guardian article called ‘Does mental illness really exist?‘ is incredibly unhelpful. Mental illness certainly does exist, and to deny that it does risks suggesting those who find themselves excluded, attacked, or minimized, do so somehow as a result of their own moral failing. That explanation is the easiest route in an individualized society, because of the prejudice surrounding mental illness – but it is not the only explanation possible. We need to ask, is mental illness what we think it is?

Scarfolk

Scarfolk Council’s ‘Don’t’ Campaign

The main question in the debate for the two professions is over ‘medicalization’, and therefore the use of medication. Like any industry, the pharmaceutical industry has an interest in finding new markets, and new products to satisfy existing markets. What is less commonly understood is that it is just as important to create new markets, new desires, and thus new needs for products which are profitable to produce.1

The easiest way for the health industry to create new needs is to latch onto currently existing social behaviours which may not look like an ‘illness’ yet, and find a way to change those behaviours. Solving a problem you didn’t know you had – the solution to the problem creates the ‘problem’ in the first place. If  a new drug gives you some sort of ‘competitive edge’, the lack of that competitive edge soon comes to appear as a disorder.

The key new disorders featured in DSM-5 – the new handbook for psychiatrists – concern hyperactivity and depression. These are behaviours which have increasingly commonplace medicines used to treat them – Adderal, Dexadrine, Ritalin; Prozac, Zoloft, Wellbutrin, Xanax etc. I am certainly not suggesting that no one suffers from hyperactivity and depression – I question whether medication is the best way to solve what is increasingly a society-wide series of ‘disorders’.

There need be no debate over the issue of whether people are ill, or whether they are suffering – they are, and this suffering should be minimized. People should be able to receive the best treatment – free at, and beyond, the point of use – possible2.  Nor at question is whether these medicines are rebalancing a chemical imbalance in the brain, they certainly are. The question we should be asking is whether this imbalance is an accident of birth or genetics, or whether there is an environmental factor. In many cases it will be the former – a genetic issue. But people are not simply born, they are also made: for example, a “review of 23 studies shows that schizophrenics are at least three times more likely to have been abused than non-schizophrenics”. As a thorough-going materialist, I don’t consider emotions or ‘minds’ as separate from brains. How we feel is part of the operation of an electro-chemical brain, and how we feel links into our relationships, our food, and our social environment:  I’m with the psychologists on this one3.

Medicine relies on the ‘medical gaze’, the ability to separate having a body from being a person. There is in fact no separation.  There is something odd happening when we are told to ‘love our bodies’ (something they are grappling with at ‘Project Naked‘) – especially when it is linked to a new hair-removal cream or odd yoghurt. What we should be doing is trying to collapse the logic whereby we believe our bodies are something seperate from ourselves, something which we can take or leave. The temptation to do so is huge, especially when we are constantly being told our bodies are faulty.  It is not a fault if some-people are less social than others, less interested in studying, have body hair or are heavier than others – it is the fault of society’s value-system.

Crazy People, Crazy World

I often deliver the post to the house where R.D. Laing was born 75 years ago. It is in a working class area of Glasgow, Govanhill. Laing, as part of the anti-psychiatry movement, simply pointed out that it is not necessarily our selves that are ‘unwell’, but that it may be society which has got it wrong:

Our civilization represses not only ‘the instincts’, not only sexuality, but any form of transcendence… A man who prefers to be dead rather than red is normal. A man who says he has lost his soul is mad. A man who says that men are machines may be a great scientist. A man who says he is a machine is ‘depersonalized’ in psychiatric jargon. A man who says that Negroes are an inferior race may be widely respected. A man who says his whiteness is a form of cancer is certifiable.

A little girl of seventeen in a mental hospital told me she was terrified because the Atom Bomb was inside her. That is a delusion. The statesmen of the world who boast and threaten that they have Doomsday weapons are far more dangerous, and far more estranged from ‘reality’ than many of the people on whom the label ‘psychotic’ is affixed.’

(R. D Laing, The Divided Self, London: Pelican, 1960, p.11-12)

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R.D. Laing: he, Michel Foucault and many others, were major critics of psychiatry and medicalization as forms of social control.

Laing realised that it is not simply what is ‘inside us’ that makes us ill, but it is the difference between our understanding of the world, our abilities to cope with it and our ability to change it that produce behaviours which society finds it hard to cope with. Of course, the way societies deal with difficult behaviour is legion – exclusion, ghettoization, prison, EST, lobotomy, execution.  Looking historically, this seems like common-sense to me – remember that many things, including worker and class insubordination, homosexuality and female sexuality, were all considered ‘mental illnesses’. At work we are asked to behave like rats, and when as Jimmy Reid said, this “entails the loss of your dignity, and human spirit” and causes depression, alienation and rebellion, we are then branded unwell. The refusal of work is increasingly being classed as the biggest social obscenity.

What did prove to be in [the bourgeois’s] interest, and what it did invest, was not the fact that [the mad and the masturbaters] were excluded, but the technique and procedures of their exclusion. It was the mechanisms of exclusion, the surveillance apparatus, the medicalization of sexuality, madness, and delinquency, it was all that, or in other words the micromechanics of power that came at a certain moment to represent, to constitute the interest of the bourgeoisie…
(Michel Foucault, Society Must be Defended, Picador, 2003, p.32)

Do we want to treat depression to get ‘back to normal’, back to work at the depressing job that caused the depression in the first place, or should we make the job of living less awful?

This process is going even further in academia, where medicines like ritalin and modafinil are used by nominally healthy students to gain an intellectual advantage on their peers – but what happens when enough people are medicated in order to change the common perception of ‘normal abilities’, much like has happened in professional sports? In some high-ranking American Universities over 50% of students report using such ‘cognitive enhancers’ – entire subcultures and industries are growing around their use.

provigil

Provigil – another name for modafinil – cartoon from userfriendly.org.

Soon those considered mentally unwell – or ‘intellectually subnormal’ – will be all those who are not taking psychologically enhancing medicines.

We are changing the human body, and the very concept of humanity itself, in order to meet the needs of a social world that will endlessly find new, tougher and more grotesque demands of us. It is no surprise that it is attentiveness, and ability to stay happy, which are the major ‘illnesses’ of today – these are the result of social alienation, these are the very demands that service and education-sector economies puts on us: stay alert, and smile at the customers. There are even a series of medicines availavble to treat ‘shift work sleep disorder‘. Traditionally service-sector workers self-medicate with alcohol and weed, soon we might be required to actually be happy in an unhappy world, rather than simply zone out, or act out. Emotional labour is being made more efficient through what amounts to bio-engineering. As one review of modafinil puts it:

There is truly one nasty side effect of coming off of modafinil: You go back to normal. And normal is pretty shitty compared to mighty.

I’m fine with us getting better, with making ourselves better – but better for ourselves, not the better for our bosses. We should be changing this society, not ourselves, before we get any worse.

References

  1. It seems strange when people say that you don’t need a new product, you simply desire it. This always came up with mobile phones, televisions, or internet  - especially when blaming ‘the poor’ for their own poverty – in today’s society, to be part of that society, you need these things. []
  2. the problem is that the ‘best treatment’ is not necessarily the most profitable treatment []
  3. I also believe that feelings are material – but a thorough explanation would take more space than this article has available []
  • Neil Crabtree

    I totally agree. According to the definition of life, if we don’t evolve then when are not alive so we should seek to be who we are and we can’t be that without the markers of the society around us and a natural truthful personal expression within that society.