Our health is shaped by the world around us—and capitalism has a profound impact on mental health.
That’s the central argument of Iain Ferguson’s new book Politics of the Mind—Marxism and Mental Distress.
He explores how ideas in wider society relate to diagnosis and treatment of mental illness, and in doing so makes a compelling case for socialism.
One of his arguments is that capitalism is “responsible for the enormously high levels of mental health problems which we see in the world today”.
The World Health Organisation says depression now affects “350 million people worldwide and by 2020 will be the leading cause of disability in the word”.
Iain says that “although sadness and grief are likely to affect people in any type of civilisation,” prior to capitalism “you wouldn’t see such high rates of depression and mental distress”.
Capitalism is a form of society based on exploitation and that makes all the difference.
It is too simplistic to say that it causes all forms of mental health problems. Even in a socialist society there would still be unhappiness. And there is a biological basis to some conditions.
But capitalism plays a role in developing these into serious mental health problems and making it harder for people to cope with them.
If you are poor and if you are oppressed, you are more likely to suffer mental distress.
The effects of austerity add enormous pressure. Greece had one of the lowest suicide rates in Europe before the financial crash of 2008, Iain explains. It then went up by 60 percent.
Oppressed groups also suffer disproportionately from mental health problems. Anxiety is more prominent in women than men. Black people are more likely than whites to be diagnosed with psychosis.
This partly reflects racist and sexist bias in diagnosis. The same symptoms can sometimes be viewed differently depending on whether they occur in a man or a woman, a black person or a white person.
But racist and sexist oppression can also have real effects on people’s mental health.
Class is also a powerful factor. Iain explores how living in poverty means that children’s brains develop differently than those whose parents have a higher income bracket.
He cites researchers in arguing that “the key factor shaping children’s neurological—as well as social, emotional, and cognitive development—is class.”
The effects of capitalism aren’t reducible to the experience of living in poverty, but the wholesale impact of a society based on exploitation and capital accumulation.
Iain uses Karl Marx’s theory of alienation to explain this.
Marx saw humans as defined by labour—our ability to consciously act on and change the world around us.
But capitalism denies workers any control over the process or the result of their labour.
This lack of control stunts our creativity and imagination and has “devastating effects” on how people feel about their life, Iain writes.
Capitalism also alienates us from each other from each other. Humans are social beings who live and work together.
But capitalism means competition that pits workers against each other. Artificial competition for jobs or resources creates the material conditions for divisive ideas, such as homophobia or racism.
Iain argues that the loss of control begins in the workplace “but shapes every aspect of life under capitalism”—including mental health.
It is no wonder people feel powerless in a system where they are denied opportunities to make real decisions.
Capitalism needs workers in order to function—and the developing capitalist class of the 19th century wanted to separate those who could work, and those who were unable.
So they looked for an “institutional solution” that resulted in workhouses, prisons and asylums.
Horror at the conditions in which people have been institutionalised, often against their will, was part of what drove a shift towards “care in the community”.
But community care can be a way of reducing, not improving, mental health services.
The number of mental hospital beds “fell from 150,000 in 1955 to 22,300 in 2012.” And psychiatric beds dropped by 39 percent between 1998 and 2012.
Today in Britain, Tory austerity is causing a crisis of care. Mental health services have been cut by 8 percent in the last decade, while referrals have risen by 20 percent.
There have been many debates, including on the left, about how to understand mental health and distress. These often focus on how much is about the biology of someone’s brain and how much is about the effect of social factors.
Underlying this is a tension between the need to fight for services in the face of cuts and the need to defend people’s rights from attempts to dismiss or override them.
The way mental health treatment has changed also reflects the changing dominant ideas in society.
Iain describes the “anti-psychiatry” movement of RD Laing that challenged dominant ideas about psychiatry in the 1960s.
Laing argued that those suffering apparent mental ill health were in fact reacting to the world around them.
Laing saw mental distress partly as a reaction to how people experience their place in the family and the operations of wider capitalist society.
The anti-psychiatry movement was part of “the social struggles of the 1960s” that “also led to a questioning of the whole spectrum of dominant ideas”.
In Britain today the “medical model” is the dominant ideology about mental distress. It sees mental distress in terms of distinct and diagnosable illnesses. One of the ways people are diagnosed is through health practitioners using a book called the Diagnostics and Statistical Manual of Mental Disorder (DSM)
It lists hundreds of disorders, themselves described through lists of symptoms—not the mechanisms that cause them.
And, for example, if a person matches five out of eight symptoms of depression, they are likely diagnosed as such.
Iain argues that the DSM has contributed to the “medicalisation of human nature”.
For example, grief was included in a recent edition of the DSM. But bereavement and loss are normal parts of human experience.
This focus on medicalisation can be used to dismiss the social causes of mental distress.
And it reinforces a bias in treatments, away from talking therapies and towards prescribing drugs.
Drugs can sometimes play an important rule. But it’s obviously beneficial for the pharmaceutical industry to have tools such as DSM used widely.
And half of the DSM’s authors have had “financial relationships with the pharmaceutical industry at one time”.
Sometimes getting a diagnosis is the only way to get treatment.
But a unifying factor for a lot of mental health service users is an experience of “not being listened to and of views and experiences being discounted and invalidated”.
Iain argues passionately for treatment where people are seriously listened to, rather than simply observed enough to be put in the right box.
It is partly this experience of being ignored that has led to a mental health service user’s movement to fight their oppression—in larger numbers than ever before.
Groups like the Mental Health Resistance Network also operate with an additional challenge—mental distress of the activists themselves.
The campaigning motto “nothing about us without us” sums up the struggle for a user-centred approach. With capitalism central to the problem, the solution has to include fighting capitalism.
Iain points to a correlation “between the level of class struggle and the levels of mental health problems in society”.
So people’s mental health can be affected by the experience of fighting back—feeling less powerless, and less isolated.
If people had the opportunity to create a society organised in their interests, that would make an enormous difference.
The current levels of mental distress are not inevitable.
Socialists should be part of struggles for better services in the here and now.
But the biggest improvements to mental health can be won through fighting for a society that gives people genuine control over their lives.