[D66] Why mental health is a political issue | theguardian.com

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Why mental health is a political issue
By
Mark Fisher
theguardian.com
4 min
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'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

"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.