David Matthews, Monthly Review - January 2019
David Matthews is a lecturer in sociology and social policy at Coleg Llandrillo, Wales, and the leader of its degree program in health and social care.
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. Furthermore, twenty-three million are said to experience symptoms of schizophrenia, while approximately eight hundred thousand individuals commit suicide each year.1 Within the monopoly-capitalist nations, mental-health disorders are the leading cause of life expectancy decline behind cardiovascular disease and cancer.2 In the European Union, 27.0 percent of the adult population between the ages of eighteen and sixty-five are said to have experienced mental-health complications.3 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 percent of the population over the age of sixteen suffered from varying forms of depression or anxiety, compared to 14.1 percent in 1993. Additionally, the number of individuals whose experiences were severe enough to warrant intervention rose from 6.9 percent to 9.3 percent.4
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.5 Moreover, reflecting the popularity of genetic reductionism within the biological sciences, there has been an effort to identify genetic abnormalities as another cause of mental-health disorders.6 Nonetheless, explanations based on genomics have also failed to generate conclusive evidence.7 While potentially offering illuminating insights into poor mental well-being in specific cases, biological interpretations are far from sufficient on their own. What is abundantly clear is the existence of significant social patterns that elucidate the impossibility of reducing poor mental health to biological determinism.8
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.”9
In what follows, I briefly sketch the state of mental health in advanced capitalism, using Britain as an example and utilizing the psychoanalytical framework of Marxist Erich Fromm, which emphasizes that all humans have certain needs that must be fulfilled in order to ensure optimal mental health. 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.”10 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.11 The purpose of both work and leisure, they claimed, largely coalesces around increasing consumption. No longer consumed for their use, consumer goods have become established markers of social prestige, with consumption as a means to express an individual’s social position. Consumerism, however, ultimately breeds dissatisfaction as the desire to substitute old products for new ones turns maintaining one’s position in society into a relentless pursuit of an unobtainable standard. “While fulfilling the basic needs of survival,” Baran and Sweezy argued, both work and consumption “increasingly lose their inner content and meaning.”12 The result is a society characterized by emptiness and degradation. With little likelihood of the working class instigating revolutionary action, the potential reality is a continuation of the “present process of decay, with the contradictions between the compulsions of the system and the elementary needs of human nature becoming ever more insupportable,” resulting in “the spread of increasingly severe psychic disorders.”13 In the current era of monopoly capitalism, this contradiction remains as salient as ever. 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.
Erich Fromm: Mental Health and Human Nature
Baran and Sweezy’s understanding of the relationship between monopoly capitalism and the individual was significantly influenced by psychoanalysis. For one, they made references to the centrality of latent energies such as libidinous drives and the need for their gratification. Moreover, they accepted the Freudian notion that social order requires the repression of libidinal energies and their sublimation for socially acceptable purposes.14 Baran himself wrote on psychoanalysis. He had been associated with the Institute for Social Research in Frankfurt in the early 1930s and was directly influenced by the work of Eric Fromm and Herbert Marcuse.15 It is within this broad framework that a theory of mental health can be identified in Baran and Sweezy’s analysis, with the contradictions between capitalism and human need expressing themselves chiefly through the repression of human energies. 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. And it was from this that Baran, in particular, was to draw.16
While making explicit the importance of Sigmund Freud, Fromm acknowledged his greater debt to Karl Marx, considering him the preeminent intellectual.17 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.18 For Marx, alienation was an illustration of capitalism’s mortifying physical and mental impact on humans.19 At its heart, it demonstrates the estrangement people feel from both themselves and the world around them, including fellow humans. ...
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