Workers are being hit with increasing levels of mental distress
Mental distress is often painted as an individual’s fault or problem. How does this benefit those who push that narrative?
The dominant model is a biomedical one—that mental illness is something that happens in our brains or genes. But this has come under increasing critique.
For very distressed people, it makes sense to connect what’s happening in their lives to the world around them.
Most people have responded well to the argument in the first edition of my book that mental health problems are rooted in life experiences. That’s not always a comfort when services aren’t available.
Explanations that locate problems in individuals are very ideologically convenient. The privatisation of mental health services in England especially, as well as making money, locates a problem in individuals.
If someone is experiencing a mental health problem, it’s seen as a weakness or deficiency in them. Diagnoses are also contradictory. Getting one is seen as helpful—you can make sense of the world, and it can be a relief to know.
For some they can’t access help like Universal Credit without a diagnosis. But there’s also the stigma and misdiagnosis that comes with this and the over-medicalisation of certain things based on natural differences between people.
In Scotland one in five people are on anti-depressants, and alternative options for people are minimal. Often, a drug-based response or limited cognitive behavioural therapy (CBT) is offered.
Anti-depressants are a big earner for giant pharma companies. It takes more than just good critique to make that disappear.
Those drugs become more addictive than was previously thought. Many people see their anxiety and depression levels worsen because of dependency. Yet many people don’t have any choice and find drugs help them. There can be no room for moralism.
But as I discuss in the new introduction, tests for depression for GPs in England were drawn up by the drug company Pfizer. The whole thing is built into the system and is complicated.
The impact of a decade of austerity, even before Covid, meant our campaign slogan was for “More and better” mental health services. Better means less medicalised. Those suffering at the moment are overwhelmingly young people.
There are 250,000 children who have been denied help by the NHS because of caseloads. Average waits for first appointments can vary from ten days to three years. Without a huge fightback, we’ll see fewer and worse services and more drug-based solutions.
How does class affect mental health and our ability to access help?
Decades of research, going back to Frederick Engels in The Condition of the Working Class in England, show that poor and working class people are more likely to suffer mental distress.
Class completely shapes our mental health. It doesn’t mean that ruling class people can’t experience emotional problems—their issues are often linked to how their children are brought up and sent to boarding schools.
But almost every research going shows if you are poor, working class and experience oppression, you’ll have some form of mental distress. For example, some 41 percent of trans people have attempted suicide.
Class spares those at the top some stresses, such as “Can I feed my children or not”. There’s not been much research on the impact of the cost of living crisis, but you can see the enormous pressures of surviving.
Engels wrote about how more working class people were admitted to mental health hospitals, especially with alcoholism, because this was a way of escaping their awful lives.
The impact of class on mental health is global and hard to escape. Where there’s a big increase in anti-depressants being prescribed in Scotland or England, it’s in the poorest areas.
The way that people seen as “mentally ill” are separated from society is a product of the industrial revolution.
A person deemed mentally disabled couldn’t have their labour power exploited by bosses. What we’re seeing in places where there’s been a rise of fascist leaders, like Italy and Brazil, there is a re-emphasis on individual and biomedical psychiatry.
We also hear a lot in Britain under the Tories about a growth in people unable to work. A major reason for that is mental health problems.
We’ve already seen work assessments testing people to get them back into work. Within the next year or so, we may see new attacks on people with mental health problems.
There’s a whole coercive aspect of psychiatry, with unemployed people being sent for CBT training because the view is it’s their attitude stopping them from getting a job.
New proposals will likely force people back into the workplace because capitalism only views people as worthy if they can sell their labour power.
Why was it important to update the book Marxism and Mental Distress?
A lot has changed since 2017. First there’s the overlapping crisis we are facing. We’ve had the Covid pandemic, deepening environmental crisis, the cost of living, the war in Ukraine and more.
The second change is there’s been some very important research and publications that critique the biological-medical model of understanding mental distress.
And there’s the changed political situation. In 2017 Labour’s Jeremy Corbyn was doing extremely well, as was Bernie Sanders in the US.
But there’s also been the defeat of Corbynism, and the rise of powerful social movements, particularly Black Lives Matter in 2020.
I wanted to look at the impact of these collective movements as a way of responding to grief and trauma. And I though it important to examine the potential impact of the current strike wave. There are arguments that very low levels of struggle since the 1980s saw an increase “from picket lines to worry lines”.
There has been a huge increase in work-related stress. But there’s also the way in which workers fighting back impacts their confidence and mental health.
Research on the pandemic has been contradictory. There are the 227,000 people who died, the disabled people whose support was withdrawn and the dire situation for health and social care workers.
But that impact was uneven. The super-rich could swan off in their yachts to private islands. Many workers could work from home and not have to travel to work every day, and they could spend more time with their families.
Some 93 percent of people supported the first lockdown because it protected the NHS—it was seen as a collective crisis.
But as an uneven pandemic experience developed, it fuelled tremendous anger against the Tories.
If collective action impacts mental health positively, what do we do when struggle is low or there are losses for our movements?
In the same way as ideas do not change automatically, struggle opens up the possibility for people to see things in different ways.
And the occasional one- day strike here and there isn’t going to have much impact on people’s confidence level and mental health.
When strikes are defeated, or there are lousy deals, they have a more demoralising effect. That’s the situation in France. We saw reports that people had a sense of confidence and power during the mass mobilisations.
A movement like BLM, where the slogan was, “No justice, no peace”, means there’s a sense of something being done.
But where there is no justice, for instance, around Hillsborough, people often feel very stuck. And it’s not for lack of ideas that mental health services aren’t improving.
There have been great strengths from the service user movement to understand what helps, and there are different open dialogue models in practice in places such as Finland.
We do know what works, but investing in these things is not profitable, and those in charge are not prepared to put the money in. That’s why there’s a dominance of biomedical psychiatry.
The immediate thing we have to fight for is better services. People need, whatever the causes and roots of their distress, help and support.
But where we can collectivise, we should look at the structural roots of mental distress. The bigger argument is that none of this sea of emotional misery is inevitable.
The book’s central point is that people are clearly struggling, but it’s not about your individual failings—it’s structured into a system rooted in alienation and inequality.
Iain will be launching his book at the Marxism Festival in London at 5pm on Thursday 29 June. Go to bit.ly/marxism23 for details
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