BREAKING THE SILENCE: CAPITALISM and MENTAL HEALTH

Breaking the Silence:

Capitalism and Mental Health

David Paul Tahrir Thurston

There is stark evidence of a growing mental health crisis in the United States.  In early October 2008, a man who had recently lost his job, killed his entire family and then committed suicide.  A few weeks later, a 90-year-old woman shot herself as her house was under foreclosure.  Over the course of this year, the epidemic of murders and suicides has accelerated, generating media attention and intense public concern.  Without doubt, our deepening downward spiral economically is driving more and more people to the breaking point.  Veterans of the wars in Iraq and Afghanistan suffer disproportionately.  By early Spring 2008, the number of veterans committing suicide at home in the U.S., exceeded the numbers dying of violence in Iraq.  While these are extraordinary examples, it remains true, every year, that far more people in the United States die from suicide than from homicide—a fact the street crime obsessed mass media rarely discloses.  An estimated 30,000 people commit suicide each year.  Between 1993, and 2003, the suicide rate hovered between 11 and 12 per 100,000 people, while the homicide rate declined from just under 10 per 100,000 to roughly 7.[1]

These are among the most extreme examples of a crisis that affects millions of people.  While the acutely mentally ill are a minority of the population, millions more suffer from milder forms of depression, anxiety, and other syndromes that make life in a brutally unequal and profoundly oppressive society all the more difficult. 

The mental health crisis is intimately linked to the larger crisis of health care.  The 47 million residents of the United States, who lack health insurance have little to no access to mental health services.  Millions more live with profoundly inadequate access to medication or therapy.  Insurers typically limit visits to mental health professionals at 20 per year—a level profoundly inadequate for anyone suffering severe distress.  Medications are often not covered for chronic illnesses.  Millions of people fail to seek access to treatments for anxiety or depression because of deeply rooted guilt and shame around these issues which still pervades U.S. culture.  All of this leaves aside the question of whether the predominant approaches to mental health adequately address the roots of emotional and psychological turmoil in our society.

The issues of mental health and mental illness are complicated.  It is undoubtedly true that the viscitudes of capitalist society, from economic exploitation to oppression in all its forms, are a crucial source of the emotional and psychological issues that plague so many.  Yet there is also persuasive evidence that human biology plays an important role in determining each person’s likelihood of contending with particular mental health conditions.  What we know about how the mind works has expanded exponentially over the past hundred years.  Yet in many respects, our understanding of the mind and of human emotions remains in its infancy.  Many of the treatments which professionals know to be effective were discovered by scientific accident, and are barely understood at a theoretical level.

The concept of mental illness is useful as a means of describing the condition of those most acutely disabled by disorders of mood and cognition.  The notion of mental illness has been progressive in that it has established a basis upon which to compare afflictions of the mind to those of the body.  Yet the limitations of the concept are evident in widespread views of the mentally ill as an incomprehensible population whose troubles bear no relation to the daily ups and downs that effect the rest of us.  In contrast, the notion of mental health suggests that attention to moods, emotions, and psychological tendencies should be a basic part of what all of us deem important in attempting to live healthy and productive lives.

Debates on the Left

Mental health is not a subject frequently addressed by those on the left—but when it is, discord and confusion often reign supreme.  Debate has raged over the question of medication, with many voices arguing forcefully that the widespread use of psychotropic medication is the product of sinister collusion between the pharmaceutical industry and the Federal government.  Ignoring the fact that millions of people see some value in taking medication, critics argue that these treatments range from useless to harmful, and dismiss the potential of medication to provide relief for painful conditions.  Some have minimized the value of currently available mental health treatment, arguing that mental distress is simply a product of an oppressive and exploitive society, and is inevitable as long as those larger forces reign supreme. 

While there are grains of truth in these arguments, there is much to defend about the scientific advances made in the understanding of the mind in recent decades.  Capitalism exacts a severe toll on the human psyche, but has also given birth to a range of treatments that hold enormous potential for alleviating emotional suffering.  We have a multitude of tools at our disposal for treating mental health issues, and need to use all available methodologies to find what works.  One critical problem is access—those most in need of advanced treatments are least likely to be able to afford them.  While the goal of the left must be to fundamentally transform society, we should be passionate advocates for all those who need help in the present. The Marxist understanding of human society—of exploitation, alienation, oppression, and commodification—could do much to inform social work, psychology, and psychiatry.  The task of the left is to build the kind of social movements that can facilitate the fusion of the best scientific knowledge about our minds and emotions, with a materialist understanding of how change can be made in class society.

Among the most menacing barriers to the social progress we need around mental health are the profound levels of guilt and shame that suffuse these issues.  Capitalist society teaches us that we are each personally responsible for our own success.  A corollary of this is that emotional and psychological difficulties we encounter are our own fault.  This belief is such a firm part of ruling class ideology that millions of people who would never openly articulate this idea, nonetheless accept it in subtle and overt ways.  People are often ashamed that they need medication, seeing this as revealing some constitutional weakness.  People feel guilty about needing therapy, thinking that they should be able to solve their problems on their own.  Millions of people fail to seek any treatment, because mental health care is seen as something that only the most dramatically unstable person would turn to.

We need to break the silence around mental health.  These are issues that all of us should have some basic exposure to.  The proportion of the population that will experience an episode of acute emotional distress is extremely high.  Those of us who have never been depressed probably know and love several people who have.  With these issues, as with the AIDS crisis, silence is deadly.  People are left to face acute trauma not knowing that there are millions of people who share their struggle, not knowing that there are viable means of relief, and not knowing that if treatment is successful they can lead meaningful and joyful lives.

This is as good a moment as any to explain the origins of my personal interest in these questions.  Five years ago, I entered an acute mental health crisis, which eventually led to my being diagnosed with manic depressive illness, known more commonly as bipolar disorder.  This talk is deeply personal for me, because contending with mental health issues has been a central part of my life for years, and I have read as much as I could about them in order to be an informed consumer of mental health services.  As I have written this, I have tried not to overgeneralize from my own experience.  But I feel it is most honest to admit to my personal bias as someone who has benefited tremendously from advanced mental health treatment.

I also want  to create space that destigmatizes mental health issues.  While I believe it is important to respect each person’s right to handle their own mental health issues as privately as they feel necessary, I do think that it is valuable for us to be able to come out about mental health issues.  There should be no more shame in admitting to struggling with depression or anxiety, than in declaring that one has diabetes or is recovering from cancer.  We need to consciously open up space to talk about these questions, and to break the silence.

Mental Health and Oppression

Mental health challenges are often created and compounded by the many forms of oppression that pervade capitalist society.  Sexism is a tremendous emotional and psychological burden on women, and is a likely contributor to the fact that women’s rates of depression are roughly double those of men.  Racism makes life more difficult for blacks, Latinos, and other oppressed groups, and then affects the way people from these groups are treated when they seek mental health treatment—or are forced into it through an encounter with the criminal justice system.  As mental health institutions have been dismantled, the prisons have emerged as a de-facto mental health system.  A staggering proportion of people in prison have diagnosable mental health issues; thousands probably develop mental health problems as a result of the brutal and inhumane conditions that have come to pervade the prison system.  Homophobia is also a critical factor in mental health difficulties for members of the LGBT community.  Growing up in a homophobic society produces a toxic confluence of guilt, shame, fear, and mental isolation.  Suicide rates for LGBT teens are staggering.  The immigrant community also has its own mental health crisis.  Many immigrants experience depression, anxiety, and substance abuse because of poverty, the threat of deportation, and feelings of inadequacy because of not achieving economic success in the U.S.

What is to be Done?

Developing solutions to the mental health crisis requires developing both short and long-term goals.  In the debate about national health care and in debates over employment based health care, socialists should argue for the full coverage of mental health issues.  We should challenge the preference of insurers for funding medication, in lieu of therapy, arguing that each patient should have the right to craft appropriate treatment in consultation with professionals.  Medication can be extremely effective, but for it to work properly, one needs a strong balanced relationship with a professional in which the client can honestly report symptoms, side-effects and seek changes if necessary.  Psychiatry is unique in medicine in that the best instrument for judging the efficacy of a treatment is the client herself.

Being educated about mental health issues is also of tremendous importance.  Whether we encounter issues in our own lives or those of others, an informed perspective on mental health allows us to be active participants in treatment.  To do their jobs well, professional social workers, counselors, and psychiatrists need clients who are engaged and participatory.  We also need to consciously challenge the stigma around mental health.  Of course, we should defend each person’s right to choose whether or not to disclose the existence of a particular ailment.  But it should be no more shameful to say that one has manic depressive illness, than to announce that one is asthmatic or has breast cancer.  Talking about these issues is part of the solution.  Breaking the silence can be liberating.

Ultimately, however, the struggle for mental health must be a struggle to transform the social conditions that produce unnecessary psychological and emotional damage for millions of people.  In a world without poverty, war, racism, sexism, or homophobia, we would surely still have mental health issues, but the nature of those issues would be unimaginable in relation to the profound destruction of the human personality that is carried out daily by capitalism.  Mental health needs to part of what a socialist left talks about when it expands upon a vision for a changed society.  Mental health care should be part of what we demand when we think about solutions to the economic crisis, or the needs of Iraqis and U.S. soldiers in the wake of a senseless war of occupation.  We are fighting for a world where the best mental health care will no longer be a luxury possessed by a tiny few, but the natural right of all.  That is a world worth fighting for, and consciousness about the importance of a mental health can be a piece in the armament that helps us get there.

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